LASA Fusion Spring 2014

The voice of all aged services Spring 2014 | www.lasa.asn.au

LASA: EMPOWERING AGED CARE ENABLING CHANGE

National Congress Edition: breakthrough: Motivate Innovate Integrate

It takes a Community:

Arcare’s innovative dedicated staffing model

LASA puts industry workforce innovation on national stage Financial viability post LLLB: finding the new “Low Care” option

What makes a Healthcare Leader?

Emotional Intelligence at Work

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The voice of all aged services Spring 2014 | www.lasa.asn.au

CONTENTS

49 LASA Employment Relations Advice

5 CEO Report

54 Senior Techies

7 Chair Report

56 LASA puts industry workforce innovation on national stage

8 SA Report 10 NSW-ACT Report

59 Why defining and directing culture is critical

12 VIC Report

62 Leadership: Do we motivate?

13 QLD Report

65 Financial viability post LLLB

14 WA Report

70 What makes a Healthcare Leader?

16 Aged Care and Retirement Village disposals and acquisitions

73 RedUSing the use of sedatives in Aged care

21 Age Australia Fair?

76 Energy optimisation for continuous patient care

25 Make your mark on aged care overseas

78 The Palliative Approach Toolkit

29 Calculating the means tested fee is no mean feat!

80 Positive Outcomes for people with behavioural and psychological symptoms of dementia (BPSD)

30 An Aussie in aged care abroad 34 It takes a Community...

82 Managing Extended Non-Work Related Illness or Injury

39 Alzheimer unease

85 Book review

42 Psychological Injuries

86 Product news

EDITOR

75 A playful approach to dementia

Justine Caines National Government Relations and Communications Manager

LASA Federal Patrick Reid CEO Unit 4, 21 Torrens Street Braddon ACT 2612 E: patrickr@lasa.asn.au

LASA Victoria Gary Henry Interim CEO Level 11 600 St Kilda Rd Melbourne VIC 3004 E: garyh@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

Adbourne

Adbourne Publishing PO Box 735 Belgrave, VIC 3160

Advertising Melbourne: Adelaide:

Neil Muir (03) 9758 1433 Robert Spowart 0488 390 039

Production Emily Wallis

(03) 9758 1436

PUBLISHING

Administration Robyn Fantin (03) 9758 1431

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 organisation’s staff. No part of Fusion may be reproduced in any other form without written permission from the article’s author.

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FUSION | 5

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

I

am proud to welcome Dr Graeme Blackman OAM as LASA’s new Chair. Securing Dr Blackman is a real triumph at such a critical time for our industry. He is easily one of Australia’s leading company directors and has deep experience in balancing the unique mix of mission and commercial aspects of our industry. For those attending Congress I encourage you to welcome Dr Blackman. His presentation on Margin versus Mission is very timely and his unique industry experience and strong understanding of both private and not for profit enterprises is highly regarded and will certainly assist LASA in its goal of one industry, one voice.

As an organisation LASA is only two years old and yet we have consistently taken the leading role; be it in the development of policy, advocacy to government or in the dissemination of concise advice and information to our members. I am proud of how LASA is developing; an example of this was the aged care capability and workforce forum developed by LASA and hosted by Minister for Industry, Ian Macfarlane.

It was fantastic to bring innovative and successful projects to Canberra. This demonstrated not only the capacity of industry; also the need for government to recognise age services, a sector Deloitte Access Economics cite as a ‘Mega Trend’, as a workforce priority area in the Department of Industry’s $476 million dollar Skills Fund.

As a result of the roundtable LASA has provided an industry wide funding submission to the Department of Industry with a strong outcomes focus. This is a key strength of LASA, as the only association representing all of the age services industry with the added expertise as a Registered Training Organisation.

The political and operational landscape has not been predictable for the age services industry for some time and for a number of years we have been presented with considerable ongoing challenges, most recently with the removal of the Aged Care Payroll Tax Supplement in the Federal Budget in May and the subsequent cessation of the Dementia Supplement in June, a fiscal hit of more than $700 million dollars. For providers affected by both this represents a significant operational deficit, with some providers on the brink of viability.

LASA’s advocacy response was swift. The precept of competitive neutrality has been disregarded with the removal of the payroll tax supplement for private providers and although the effect

of the removal is yet to be felt but I predict it will have a significant impact.

The government actually goes against its own justification for the payment “that In the interests of competitive neutrality, the Commonwealth currently refunds for-profit providers for the payroll tax that they pay”; This decision perversely destroyed competition, as the supplement contributed to their own assertion that there is a ‘strong rationale for government involvement in aged care on equity grounds’. The Aged Care Sector Committee has stated that it seeks a truly ‘contestable market’ for age services, something that is impossible to achieve while fiscal uncertainty and an unbalanced playing field exists.

LASA will not allow a state/federal ‘blame game’ to threaten care and services to older Australians. Our advocacy remains focussed at the Federal level while we ramp up activity to include State Governments, and COAG to prevent political ‘buckpassing’. Our resolve is to ensure government abide by their commitment to fair funding that enables industry to provide the care deemed necessary for older Australians. With both NSW and Victoria in the lead up to elections our state offices have their advocacy programs developed to support industry as much as possible through strong representation to federal and state parliamentarians.

The removal of the Dementia Supplement for residents with severe behaviours was a demonstration of Departmental intransigence in seeking the right formula and illustrates how poor outcomes result from a lack of cooperation with industry.

LASA supports co-design of measures and programs as the pragmatic approach with a strong correlation between funding and achievable outcomes. This is why we will continue to advocate for genuine co-design, not only with the dementia supplement but across the ageing portfolio.

The LASA Congress is poised to be a fantastic success.

An exceptionally strong program offering expertise and insights across all facets of age services, a sell-out exhibition, and the promise of record numbers. This event is testimony to the talent and commitment of LASA members and recognition of the position LASA holds because of your hard work. Also, no conference of this quality comes together without the hard work and dedication of the LASA staff and Organising Committee who have designed a conference by providers for providers. On behalf of the Age Services Industry, Thank you. ■

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FUSION | 7

Message from the Chair Dr Graeme Blackman OAM Chair, LASA

I

am excited by the challenge and the opportunity that lies before me as Chair of LASA. For now, and the foreseeable future, my eyes are firmly set on enhancing LASA’s position and working towards the establishment of a unified voice across age services; considering this was the clear mandate delivered from more than 73% of all providers to the peaks before the ACSA/ACAA merger talks collapsed. This mandate has not gone away and continues to drive LASA, and should exercise ACSA members’ minds, with a view to a national unified organisation representing all regardless of heritage.

As former Chairman of Anglicare Victoria and until recently Director of Benetas I am acutely aware of the challenges both our industry and our current and future governments face in the establishment of responsive and equitable age services for a country with the fortune of older Australians living longer. Living longer unfortunately does not necessarily mean older Australians live well. I am proud to be the chair of an organisation holding the mantra “Helping older Australians to live well”.

In the next two decades our society must embrace ageing and importantly the contribution of older Australian’s in a truly intergenerational manner. To date this essential policy area has not been assessed or developed with a view to the role Australians will play, regardless of their age. Our focus needs to turn to engaging all Australians in discussing ageing with a view to sparking the requisite action leading ultimately to social change.

The vast majority of us only think about age services when it is of critical importance, too often at a time of crisis. LASA must and will assist in changing this. I am heartened to see LASA leading the way in establishing a national conversation on ageing, through the Q and A panel at National Congress; with such a great line-

up of thought leaders I believe we will set the pace for future discussions and policy agendas.

Since the Federal budget in May, our industry has been hit hard. These unexpected cuts via the removal of the Payroll Tax and Dementia Supplements do not create the environment our industry needs to grow to meet demand. I acknowledge the tight fiscal environment and respect the government’s commitment to reduce debt. When one is delivering essential human services, especially aged care, achieving the right balance via policy and funding initiatives is critical. However, starving the industry when it needs to be nourished to grow strongly, is not good social policy.

I support LASA’s position to promote those with the capacity to contribute to their accommodation and services to do so. In order for this concept to flourish the government needs to promote and support a level playing field across industry, a playing field that is based on competitive neutrality that can still cope with the high levels of regulatory burden and reliance on federal funding.

I understand in response to LASA’s advocacy in relation to the Dementia Supplement the government has committed to a codesigned response. This is promising and I look forward to leading LASA through this process to ensure our industry can provide not only critical care but also continue to move forward with innovative and person centred care. In doing this we can not only support therapies that provide comfort to our most vulnerable, but promote a quality of life and participation from older Australians enabling them to realise their fullest potential.

I look forward to meeting LASA members at National Congress. The program is a credit to LASA staff and members who have brought together a fine program that highlights the dedication of our industry to provide quality care and continue to find new innovations that enable older Australians to live well. ■

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South Australia Report Paul Carberry Chief Executive Officer | LASA SA

I

recently participated in a panel discussion facilitated by NAB Health in Adelaide, where I was asked the question: “Given the 1st July has now ticked over and Living Longer Living Better has now commenced, what do you see as the biggest opportunity for the aged care industry in Australia moving forward?”

My reply is below.

Well, the reforms which came into effect on 1st July are the beginning of a new era for the aged care sector. One which will see an increasing focus on providing services, choice and accommodation standards which will attract clients.

The big shift on 1st July was that consumers are now being asked to contribute more towards the cost of their care and accommodation where they afford to do so. Consumers will expect value for the money they pay, and aged care providers in the cities and large towns will have to compete in order to attract clients to their services.

In conjunction with these regulatory changes, the other driving force is the ageing of the Australian population. This will see a huge increase in demand for aged care services during the coming decades.

So these two factors: 1. Reforms with respect to consumer pricing and consumer choice; and 2. a rapidly expanding market for aged care services represent very significant opportunities for the sector to grab hold of.

So, to respond to the question, what’s the biggest opportunity for the aged care industry?

It’s to understand that the reforms do introduce an environment where providers can increase the margins they earn

on accommodation and can increase their revenues by offering additional services and amenities, which their clients want and are prepared to pay for.

This could encompass many options, including better choice of menu, wine with dinner, Foxtel in the client’s room, more interesting outings and social events.

To achieve these outcomes providers will need to: • Invest in upgrading their physical stock so that their accommodation meets people’s expectations; • Understand their clients’ wants and needs and offer additional services which people value and will be prepared to pay for; • Invest in marketing and sales training to ensure their service is presented effectively to prospective clients; and • Ensure they have good benchmarking and business reporting systems, so that they understand where their income is coming from, where their costs are, and can analyse what’s working and what needs to change.

Some providers will see an opportunity to expand their operations to achieve economies of scale. We’ve already seen quite a lot of activity in acquisitions this year, with Allity acquiring ECH’s facilities in SA, Estia acquiring Padman in SA and Cookcare in NSW, and Japara acquiring the four sites operated by Whelan in SA. I expect to see more of this in the coming months.

However, I also think there will be good opportunities for smaller organisations to establish strong positions in the market by being innovative, flexible and offering high levels of service.

These are interesting times for our industry and I believe that the 1st of July reforms are just the beginning of a long period of transformation. ■

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NSW-ACT Report Care and unity Charles Wurf Chief Executive Officer | LASA NSW-ACT

T

he implementation of the Living Longer, Living Better reforms from 1 July 2014 has required much effort from all providers of age services, with each having responsibility to prepare and adapt to enormous change in a way that is appropriate to their unique circumstances.

Living Longer, Living Better has demonstrated that there cannot be a generic template for an age service organisation in Australia, neither now nor in the future, and individual providers from the private to the not-for-profit, church, community, charity, and state governments will continue grow, evolve, or struggle based on a combination of individual and industry-wide factors.

Throughout 2014 Leading Age Services Australia NSW-ACT has provided members with new and up-to-date information, education, and advice to ensure the implementation of reform is as manageable as possible. While progress is being made there are still many months of work for some providers until operating under the reforms is second nature rather than a day-to-day stress.

Added to this challenging time of implementation has been the mid-2014 funding shocks with the Federal Government’s cuts to the Payroll Tax Supplement and the Dementia and Severe Behaviours Supplement.

With regard to the Payroll Tax Supplement, disruption which marginalises any section of the industry will ultimately impact on all of the others. The workforce and capital issues inherent in the delivery of care in 2014 Australia mean that in the short to medium term, a stagnation or failure in one significant section of the industry cannot be readily adjusted to by others.

For the future delivery of age services in Australia we must have industry unity and this must be now. All sections of the industry, from the private to the not-for-profit, are needed to face the surge in care needs in coming years and decades.

Competition is healthy, but disunity is detrimental to all.

In recent months, regretfully, only LASA has provided meaningful advocacy in support of all providers of age services.

It has only been LASA which has been advocating to ‘grow the pie’ for adequate funding for the industry, and to seek redress for the cuts to Government Supplements.

In this second half of 2014 LASA NSW-ACT Members can expect new materials and information, and also the opportunity to participate in a range of advocacy initiatives and forums designed

to benefit providers from across the spectrum of age services organisations. More information will be circulated in the immediate future.

We will also continue to ferociously stand-up for all providers and will act firmly against any notion which disunites providers, or enables Government to have the industry ‘fighting over the scraps’ of funding support.

Advocacy on behalf of all providers, particularly to redress Government funding decisions, will be prosecuted without tradingoff one section of the industry against another.

We are truly fortunate, in spite of the difficulties posed by the reform process, to work in an industry where care, compassion, and commitment are at the core of our daily and ongoing purpose.

At LASA NSW-ACT we look forward to working hard during the second half of 2014 to ensure that the industry’s focus in 2015 can be more about quality care, than policy implementation.

Thank you to Francis Cook In June Francis Cook announced the sale of the Cook Care Group. As a consequence, Francis has resigned his positions as Director and Vice-President of LASA NSW-ACT, and from the position of NSW Delegate to the LASA National Board. Francis has been involved in the policy deliberations of our industry since 1980, and has contributed many years of sterling service to our industry Association, both in New South Wales and nationally.

The contribution made by Francis over the years has been extraordinary, and was formally acknowledged at his last Board meeting in June. On behalf of members, we offer our best wishes to Francis and Christine Cook.

During July the Board confirmed the replacement roles with Cynthia Payne elected as Vice President and Ross Peden as Treasurer. The NSW-ACT delegates to the Federal Board of LASA were confirmed as Robert Orie and Cynthia Payne, with Campbell Meldrum confirmed as alternate.

With Cook Care now Estia Health and continuing as a member of the Association, the Board has resolved to appoint James Saunders, representing Estia Health, to the casual vacancy created on the LASA NSW-ACT Board. Congratulations to Cynthia, Ross, Campbell, and James on these positions. ■

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victoria Report Marketing and sales in aged care: Are you putting your best foot forward?

Ingrid Williams President | LASA VIC

I

t is well known that the Australian aged care environment has changed significantly over the past two years. The introduction of the aged care reforms – the beginning of the Government’s ten year plan to reshape the industry – has not only changed the ways in which providers operate their residential and community care services, it has heralded a significant shift for care recipients towards a user pays system.

As a result, it is now more important than ever to recognise that the culture of our industry has shifted; whether we like it or not. For instance, a family’s first consideration may now be price. As those researching care options are increasingly directed by all government departments to review www.myagedcare.gov.au – with its list of aged care facilities by area and the prices associated with each service – this will continue to be a major influence in our ageing population’s care decisions.

Price and competition In this new environment, pricing policy becomes vitally important.

As does your sales and marketing strategies to ensure you are delivering the right information, to the right audience, at the right time. Investing in the development of these processes will ensure your phone continues to ring; is answered in the most engaging and informed manner and overall, that you maximise your service delivery.

In addition to the increased influence of price on care decisions, our industry will only become more competitive. Many organisations are already looking at making improvements to every level of service provision, and considering innovative ways of providing these services to ensure they stand out in the crowd. Now is the time to consider whether there are opportunities for your services to rethink your marketing strategy to stay competitive.

In residential care, prospective residents and their loved ones will of course still want to visit your service to experience the lifestyle options and care you provide. Your organisation’s brand and reputation will be a key factor at this time, as will the processes and procedures in place to facilitate this experience. However, it is important to consider whether their experience reflects your strong brand, your excellent reputation and the exceptional care you provide.

Education and Training There have also been enormous challenges for services in providing education to staff about the new reforms and their associated, often complicated, terminology. However, it is absolutely vital for staff to understand the new terminology and be able discuss

this with confidence to prospective new residents and their families in order to build confidence in the services and the management.

Customer service: Seven simple rules Customer service trainers in the residential sector have identified some rules, or handy tips, in the form of seven simple rules for staff to follow when talking to new residents or their representatives; tips that translate across all industry service areas: 1. G ain knowledge: Staff responsible for showcasing your home should have a comprehensive knowledge of all aspects of your service and options available 2. K now your customer: Have some background information about a prospective resident if possible, so you can tailor the tour to their needs 3. P romote your service: You work hard at your service so now is the time to showcase all the good you do; have well prepared facts and information about the care you provide 4. K now your competition: Have an understanding of who you are competing with and what services they offer 5. M ake the client feel comfortable in discussing their requirements and take time with them so they will want to be part of your service 6. K eep all the information as simple as possible alk about your point of difference in comparison to other 7. T services; openly discuss the benefits of your service over others.

By ensuring your organisation is adhering to simple rules such as these, your organisation will be recognising the need to be prepared and to be competitive in the new aged care market.

More information Here at LASA Victoria we have developed a range of relevant professional development workshops in sales, marketing and understanding the reforms. These are available across Victoria, and may be able to be delivered as webinars on request.

Upcoming workshops in October and November include: • Residential Care fees and charges – Post reforms: The basics • Successful sales in Residential Care • Marketing and branding your residential care facility Please visit vic.lasa.asn.au/training-and-consultancy/workshops for more information. ■ Author note: Content originally supplied by Denise Mitchell, Residential Care Manager, LASA Victoria; appeared in LASA Victoria’s VOICE Magazine Spring 2014 Edition.

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Queensland Report We’re all in it together Barry Ashcroft Chief Executive Officer | LASA QLD

I

have written in the recent past about age services not being a contest. This was in relation to the Australian Government’s withdrawal of the Aged Care Payroll Tax supplement; a decision that will see $700m stripped from the industry - much of which will come from private providers.

I suggested then, that as well as the significant financial impost this kind of arbitrary decision making has on age services, there was also a very real and concerning threat to industry cohesion, unity and harmony that collectively we’ve worked so tirelessly to establish.

Indeed, it was in recognising the strength in diversity and need for equity for all age services providers; irrespective of profit or mission status, organisational structure or geographic location, which saw the establishment of the federation of individual state aged care associations under the Leading Age Services Australia (LASA) framework that we enjoy today.

I went on to say that with the Payroll Tax announcement, the government had taken the diversity of age service delivery and driven a wedge between providers based solely on tax exemptions which would almost certainly see age services jobs and new developments placed at risk.

And all this at a time when the demand for age services is increasing exponentially to meet a rapidly growing ageing population.

Whilst there has been no fundamental change to this position in the period between articles, I find myself considering the For-Profit/Not-For-Profit ‘wedge’ from a much more introspective angle, particularly in light of what seems to be a resurfacing of the ‘mission vs. margin’ debate.

As with all industries, the differences (and similarities) around mission, financial and non-financial metrics, and governance between age service providers has been well documented, with little to no variance established since the discourse began.

What I think is worth revisiting however, are the drivers that lead to the creation of LASA as the age services peak, of which I believe there are an essential three.

• Prior to the establishment of LASA, independent research identified overwhelmingly that Australian age services providers wanted a single, unified voice representing their interests (at a ratio of 3:1).

• Industry intelligence demonstrated that government and other sector stakeholders were keenly seeking a unified industry voice that encompassed all facets of service provision.

• Consumers were demanding more choice from amongst a range of diverse providers from within a robust and dynamic sector.

So what, if anything has changed?

Certainly in my interaction with providers in the years since the establishment of LASA…not much.

Most providers continue to be perplexed and disappointed by any talk of a return to an industry divided by provider ‘status’ and vaguely represented by several groups who are divided and weakened (by disunity) in representing their needs.

It is still apparent that governments and stakeholders continue to prefer engagement with one industry peak, as has recently been highlighted by LASA’s representation at key reform discussions and deliberations on issues such as the withdrawal of the Payroll Tax and Dementia Supplements.

And finally, with the advent of Consumer Directed Care and centralised consumer hubs such as MyAgedCare, diversity in choice from amongst a growing range of products and services has never been more important to older Australians.

So in harmonising both of my articles on this topic, I reiterate that age services is not a competition, we’re all in it together, and together we can be One Industry. One Voice.. ■

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WESTERN Australia Report Equity of Care Beth Cameron Chief Executive Officer | LASA WA

A

s you are no doubt aware, Western Australia punches well above its weight in most areas, and ensuring equity of care for all older Australians is no different.

I represented LASA at the National LGBTI Roundtable in Sydney, along with many colleagues from the west, to discuss ways to overcome the barriers to providing the best care to older LGBTI people.

If you’re wondering why there is so much discussion about our LGBTI elderly at the moment, there are two reasons: 1. There was a change in legislation last year, that made it unlawful to discriminate against a person on the basis of sexual orientation, gender identity and intersex status under federal law. This includes within aged care organisations and there is no religious exemption when it comes to care for people, without prejudice.

2. Believe it or not, the Government has actually spent money on the development of a LGBTI strategy for aged care, and training to support its implementation.

This is great news, and has seen the rollout of training in inclusion offered free to aged care providers across Australia. If you haven’t yet held training in your organisation, contact your local LASA team for details. The training incorporates the very latest research, so I guarantee everyone will learn something new.

But, in news from Sydney, the Roundtable presented some very interesting points for consideration: • The roundtable considered expanding the aged care project to working with groups such as mental health; disability; and financial services, to see greater understanding of inclusive practice in these industries, for the benefit of our elderly.

• They discussed difficulties in research and data collection, with significant agencies such as the Australian Institute of Health and Welfare reluctant to include LGBTI demographic questions in surveys - making evidence based research and understanding more difficult.

• While Australian society at large is very youth-centric, this is magnified for the LGBTI community and adds to the social

isolation of LGBTI elders. There are projects underway to facilitate inter-generational communication, especially around Pride Fest in WA this year, which have been successful in the past, and will hopefully take off around Australia.

• While some states have successfully introduced Community Visitor Schemes for older LGBTI people, there is a need to expand eligibility criteria to include people in residential care, and younger people in care.

• There are issues with inconsistency of law around Wills and Advanced Care Directives across states. This means if you move interstate, your wishes may be over-ridden by a next of kin as your new home state may not be recognise them.

• Older LGBTI people with dementia may be more vulnerable to discrimination as they become less inhibited and unable to remain ‘closeted’. This is particularly of concern to Dementia caused by HIV, which impacts the frontal lobe specifically and is particularly disinhibiting.

• Of concern is that research shows that older LGBTI people will avoid seeking care they need for fear of discrimination.

Sadly, this is a fear often based on past experience. For example, in recent decades mental health services were likely to administer electric shock treatment to LGBTI patients.

So research shows that understandably, older LGBTI people often remain reluctant to access needed health care services.

These issues were presented to fellow Western Australian, Senator Dean Smith, a thought leader in the consideration of care for older LGBTI people (his article in the Guardian is worth a read), and representative of the government on the day.

Addressing the above issues will not only be of benefit for our LGBTI elders, but all elderly people as issues such as legal inconsistency; limitations on the visitors scheme and improved research are addressed.

LASA will continue to lead and support improved research and policies that ensure the care of all older Australian’s and we look forward to working with you to identify future areas for improvement. ■

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16 | FUSION

Aged Care and Retirement Village disposals and acquisitions

By Julie McStay

General

S

ince the commencement on 1 July of the latest aged care reforms and as the property sector warms up (albeit varying in different locations) we are seeing increased activity in the development and sales of both aged care facilities and retirement villages. In this article we consider some of the key issues that parties are likely to face in buying or selling a residential aged care facility or a retirement village.

If you are intending to buy or sell a residential aged care facility and/or retirement village it is imperative that the sale is structured in a manner to best suit your needs from a commercial and operational perspective as well as to limit the inherent risks with any transaction of that type.

Contracts and structure of transaction The nature and content of the sale contracts are vital. A standard ‘off the shelf’ type contract is typically inadequate to cover the unique circumstances of each individual sale.

When buying or selling an aged care facility or retirement village a threshold issue is whether the transaction is structured as a share sale or an asset sale.

In a share sale you buy the actual corporate seller entity (warts and all) whereas in an asset sale you buy the property that makes up the facility and business. You need to consider the risks and benefits of each approach from both a liability and taxation/duty perspective.

Usually there will be a contract for the real property (being the land and buildings) and a separate contract for the business and other assets (can be either or both a residential aged care facility and/or retirement village). While less common, some transactions may involve the purchase of the business of operating the facility/ village only – in those cases there would need to be a lease or other arrangement in place for the use of the land and buildings for the buyer as operator after settlement. This type of transaction can be more complex and will usually involve a higher level of scrutiny from regulators.

The contracts must clearly set out the assets and liabilities that are being transferred (or not transferred) between the parties for the agreed purchase price as well as timing for various stages during the transaction.

Contract terms The contracts should be subject to various conditions being satisfied before the parties are committed to the sale and purchase, including:

• due diligence • finance/board approval • application for the transfer of aged care allocated places (bed licences and home care packages) • application to be an approved aged care provider (for new providers only) • consents of residents to the transfer (if required) Other matters to consider include the following: warranties and indemnities adjustments to purchase price employees GST tax benefits or subsidies The above is not an exhaustive list of the issues that may be relevant to a particular transaction.

A buyer should consider the warranties and indemnities provided by the seller as the buyer will usually inherit all liability of the seller entity after settlement. There is always an element of commercial risk but including the proper provisions will seek to limit that risk to a manageable level.

A prudent seller will also want to include some warranties and indemnities from the buyer, mainly in respect of anything that happens after settlement.

• • • • •

Due diligence From a buyer’s perspective a thorough due diligence is critical.

Effective due diligence should give a buyer far greater clarity on what they are buying which is of course essential to setting price as well to limit the buyer’s risk of any costly surprises post-settlement.

It will also give the buyer a chance to seek a response from the seller on any issues that arise while they still have that leverage – once the contract is unconditional the seller will generally be less motivated (and definitely less obligated) to provide any such assistance.

From a seller’s perspective it may be that the transaction is structured on the basis that the buyer’s recourse is limited once they conduct their due diligence enquiries. As an example that could mean if there were any issues reasonably discoverable by a prudent due diligence then the seller wears no liability in respect of those issues.

Ultimately the actual content of any particular due diligence will depend on the nature of the sale and each buyer’s particular circumstances and expected outcomes.

At a minimum a buyer should seek legal and accounting advice as part of their due diligence. They should also consider planning consultants, building professionals and to assist with the due

FUSION | 17

18 | FUSION diligence process depending in the nature of the assets being purchased.

While there is naturally a cost for a buyer in engaging the right professionals for due diligence, it is an investment that will both: • give that buyer piece of mind regarding the purchase to ensure any issues are dealt with before settlement where possible; and • shift the risk relating to the acquisition onto those other parties.

Aged care Some key considerations that apply specifically in the aged care context are listed below: • the resident/care recipient agreements – it is important to review (at a minimum) a sample of the agreements to check for compliance but also to consider whether any particular arrangements have been offered to any resident that the buyer will have to meet post settlement • any significant capital expenditure issues that will need to be addressed such as fire safety requirements post settlement • employee entitlements and/or short falls that you will have to address post settlement, rosters and staff mix • any significant outstanding compliance issues under the Aged Care Act • any outstanding litigation including WHS prosecutions, civil claims or coronial matters • any significant ongoing resident complaints that have been long standing and are likely to create significant operational drains post settlement • the value of the bond pool

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• the nature and type of allocated places being sold as part of the assets and any conditions attached to the places to be transferred

Retirement villages Some key considerations that apply in the retirement village context are listed below: • types of tenure – it is important to look at what type of tenure applies to the village – that may affect your profitability and also perceived attractiveness of the units to prospective residents in the market. Some residents may prefer the perceived security that a registered lease provides in contrast to a licence.

• different financial models/arrangements – there can be various models which apply in one scheme. The scheme operator may have also agreed to various one-off arrangements with residents which would affect a buyer as the new scheme operator on their departure.

• whether there are any rental arrangements in the village • financial due diligence – this is crucial especially with respect the village funds as the buyer may inherit any issues or deficiencies after settlement • checks undertaken for those persons in decision-making positions

Other issues and considerations Buyers should also consider the following as part of the process: • duty exemptions – depending on the circumstances not-for-profit organisations may be entitled to a total or partial exemption of transfer duty payable on an acquisition.

• operators and providers will also need to manage aged care document reviews, retirement village turnovers and ongoing legal and compliance issues post-settlement.

Conclusion It is vital that any transaction is structured properly and that you obtain the right advice along the way to avoid any unexpected issues and to limit risk. We are well placed to assist both sellers and buyers at each step in the transaction.

This article is only intended to highlight some of the issues you need to consider in the purchase of an aged care facility or retirement village scheme. The matters listed above are by no means an exhaustive list of issues to be considered, but they are the first things you should consider in any transaction in the aged care and retirement living industry.

Further information Webinars We recently ran a number of webinars dealing with aged care and retirement village disposals and acquisitions, these were: • Buying and selling aged care facilities – essential issues for private and not for profit providers • Buying and selling retirement villages – essential issues for private and not for profit providers If you are interested in purchasing a recording of these presentations and associated material please email marketing@hyneslegal.com.au ■ For further information on buying and selling an aged care facility please contact Julie McStay on (07) 3193 0503.

FUSION | 19

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FUSION | 21

Age Australia Fair?

Policy choices on demographic changes in Australia and abroad

By Travers McLeod1, CEO, Centre for Policy Development

I

n September 1967, then Prime Minister Harold Holt delivered a lecture in Melbourne titled “Advance Australia”.

“We are getting younger as a people. The median age of the population is being lowered,” Holt said, with “no indication in sight of any significant upward trend”.2 Fast-forward nearly half a century and how the times have changed. The second line of our national anthem may proclaim we are ‘young and free’, yet our population is not so young anymore.

When Harold Holt spoke there were about eight Australians working for every Australian over the age of 65. Now that number is five. By 2050 it is projected to be less than three.

In 2100 there may be more people aged over 100 than babies born that year.3 Professor Sarah Harper, a British gerontologist who heads up Oxford’s Institute of Ageing, has described this century as the last century of ‘youth’ as we know it.4 This is nothing to be gloomy about. Now is an incredible time to be alive. We are living longer than ever. Even so, we must ask whether existing policies and institutions are fit to handle the demographic shift fairly, productively and sustainably? On balance, it would appear not.

The good news is that Australia does not need to reinvent the wheel. The demographic shift is impacting other parts of the world, particularly Europe, much faster than us. But we need to start drawing on these international lessons, change the framing of the issues involved, foster individual agility and enable independent institutions to safeguard the long-term.

Lifting our sights on challenges that will define this century motivated Now for the Long Term, the report of the Oxford Martin Commission for Future Generations. Chaired by Pascal Lamy and including Nick Stern, Amartya Sen, Arianna Huffington and leaders from China, India and South Africa, the Commission sought to counteract short-term thinking on challenges cutting across disciplines and jurisdictions. Changing demography was one of them.

What became clear was the futility of looking at a growing and ageing population in isolation. Here lies the difficulty. So many responses to an older population rely on how well we grapple with new technology, geopolitical change, urbanisation, a growing middle class, inequality, resource scarcity, and changes in the global burden of disease. Gone are the

days when we can put issues into neat boxes. They are as interdependent as the countries responding to them.

There is little doubt ageing will transform populations over the next few decades. Around the world, the 60-80 and 80+ populations will grow considerably relative to other age groups.

Half of Europe will be over 50 by the end of this decade. Except in Africa, one in every four people will be 60+ by 2050. In Europe it will be one in three.5 The three Australian Intergenerational Reports (IGRs) foreshadow the slowing of economic growth and declining workforce participation as consequences of an ageing population. ‘Business as usual’ age-related government spending (largely on pensions, health, the pharmaceutical benefits scheme and aged care) would see spending as a proportion of GDP climb nearly 5% by 2050.6 The risk to fiscal sustainability has prompted increases to the retirement age.7 Yet our approaches to an ageing Australia risk being swept up by Abraham Maslow’s saying: “If you only have a hammer, you tend to see every problem as a nail”.8 After continuous economic growth for more two decades an understandable concern is how we can maintain wage growth and improved living standards for the long-term. This is why an older population is often viewed as a threat to productivity and economic output.

The problem with such framing is it risks generates negative connotations about old people. This is captured by a sentence in last year’s Productivity Commission’s report, An Ageing Australia: “Older Australians are characteristically neither infirm nor inept”.

This language is unfortunate. Institutions like the Productivity Commission make important, rigourous and independent contributions to many policy debates, not least continued national prosperity. Imprecise framing and an exclusive focus on the 3 Ps of “population”, “participation” and “productivity” appear to have hamstrung this particular report.

Framing can have profound effects on stakeholders, perceptions and the intergenerational exchange of ideas.

The ageing debate disappointingly verges on framing older Australians as a commodity. We are all ageing. This is an opportunity to be embraced, not a problem to be managed.

It is therefore necessary to use a more sophisticated measure, such as the comprehensive Active Ageing Index prepared by the European Commission,9 to understand the issue in a holistic way. Political participation, mental wellbeing,

22 | FUSION educational attainment, and bridging the digital divide are all indicators on the Index.

Another key factor is social cohesion and connectedness.

This is also part of the Active Ageing Index. More than that, it is fundamental to health, wellbeing and productivity. A recent University of Chicago study of more than 2,000 people over 50 found that loneliness can be twice as unhealthy as obesity.10 Maintaining links across generations, and avoiding loaded language which pits generations against one another is increasingly significant in this context.

Agility will become vital.11 Individuals will need to be nimble and receive support across multiple life transitions between education and employment, particularly as automation and technology change the nature of employment.12 Careful thought should be given to what the jobs of the future look like, which industries they will be in and which ones they will not be in.

Over time, we may also need to reconsider the institution of employment, at least how we measure it. There may be merit in considering an “activity” target instead of an “employment” target to pick up unpaid and voluntary work in the services sector.13 This will only increase with an ageing population, and as “jobs” in the form we understand them continue to change. Related to this, of course, is whether we count working, volunteering and caring as output, or only that which is paid.14 The tax burden on jobs, wealth and consumption will also require realignment. The increasing reliance on personal income tax for revenue is unhelpful and out of step with reforms elsewhere. The absence of a frank debate about tax reform is symptomatic of a political environment where, all too often, longterm, intergenerational issues are put into the too hard basket.

Institutions will need to loosen historical biases to let foresight keep a check on short-term politics.

This mismatch between skills and jobs, rising youth unemployment and the potential decoupling of economic and employment growth has forced a discussion of both means and ends in achieving economic growth. There are challenges for business too – in recruitment practices, workplace training, strategic workforce planning, and long-term value creation.

But there is little point enhancing workforce agility at one end of the age spectrum without equal attention across the spectrum.

Best practice in Europe would suggest a mix of the Swedish and German models are ideal for enhancing the agility of the workforce across the board. The German dual apprenticeship system (whereby vocational education courses are shared between employers and education providers) is well known in the context of responding to youth unemployment but seems suited for employment transitions later in life also. Sweden performs brilliantly on the Active Ageing Index and has an employment participation rate of the 50-64 cohort some 16% above the OECD average. Its pension reforms, in work tax credits and commitment to lifelong learning (including supplementary vocational education targeted at older workers) are worthy of further attention.15 Germany provides a neat segue to the importance of institutional agility. Chancellor Merkel’s negotiations for the next Grand Coalition are set to result in the retirement age being lowered.16 This has been labelled as another example of shortterm politics trumping sensible longer-term policy. If anything,

it demonstrates the value of some public institutions being agile and independent enough to steer a longer course.

Fostering institutional agility and independence presents many challenges. I do not mean agility to enable short-term fixes.

Instead, I mean an agility to stretch the planning horizons and resist a bias towards the short-term in favour of older generations as well as future generations.

Australia has nothing like the National Planning Commissions of China, India, South Africa; has not experimented with bespoke institutions to protect the interests of future generations; or contemplated a cross-party “Committee for the Future” as in Finland to provide longer-term assessments of policy and regular horizon scanning to understand the impact of new technologies and policy opportunities.17 In a 2004 report, Finland’s Committee for the Future was at the forefront of the debate drawing on expertise from economic, health, technological, education and social spheres. The report, ‘Good society for all ages’, recommended a greater research focus on supporting independent living, gerontechnology that facilitates everyday life and new forms of elderly care services, such as communal living. Issues of unemployment, housing policy, public transport and social cohesion were knitted together to address the policy question. This is what a well-rounded, considered approach can look like.18 Australia’s foresight in preparing for the long-term has been applauded abroad, whether it emanates from Treasury, the Reserve Bank, the Productivity Commission, Infrastructure Australia, the Future Fund or the Intergenerational Reports.

Yet there is a risk Australia’s capacity to safeguard the longterm is a chimera. Take, for example, our Parliamentary Budget Office. Its submission to the National Commission of Audit compared its powers to similar institutions in the US, UK, Canada and South Korea. The results revealed a toothless tiger.19 To develop strong policies for the long-term, institutional design and independence is of fundamental importance. Whatever one’s view on national planning, it seems clear the IGR needs to be safeguarded, and its release structured. It is too important to be derailed or gamed by short-term politics. The IGR must not be seen as a creature of one side of politics or the other.

Australia will exacerbate an intergenerational deficit unless we lift our sights and face up to the question of what sort of society we wish to bequeath to future generations. This cannot be done in silos. Focusing on current constructions of output, growth and revenue without contemplating qualitative and quantitative changes to their composition may comfort but ultimately mislead.

Inside the box thinking would not have helped Australia to lower its median age post World War II. It would not have assisted us in floating the dollar and opening up Australia’s economy. A locked in mentality will not help us to grow fairly, productively and sustainably in our old age. Those key vectors need not be conflict between the various generations. They will be unless we think laterally, change the framing, foster individual and institutional agility, and take heed of best practice around the world. ■ Travers McLeod is the Chief Executive Officer of the Centre for Policy Development. He is Associate of the Oxford Martin School and an Honorary Fellow of the School of Social and Political Sciences at the University of Melbourne. This is adapted from a keynote address to COTA Australia’s National Policy Forum in Canberra on 22 July 2014.

FUSION | 23

References 1. With thanks to Matthew Jensen and Josie Murray for research assistance.

2. The Hon. Harold Holt, Prime Minister, ‘Advance Australia’, Monash University Inaugural Economics Lecture, 1967, available <http://pmtranscripts.dpmc.gov.au/ transcripts/00001659.pdf>.

3. Productivity Commission, An Ageing Australia: Preparing for the Future, Productivity Commission Research Paper, November 2013.

4. Sarah Harper, “21st century – the last century of youth”, Oxford London Lecture, March 2012, <http://www.ox.ac.uk/media/news_stories/2012/120314_1.html>.

5. See Now for the Long Term, Report of the Oxford Martin Commission for Future Generations, p. 14; UN-DESA, World Population Prospects – the 2010 Revision (New York: UN Department of Economic and Social Affairs), p. 8.

6. See, further, Martin Parkinson, “Sustainable Wellbeing – An Economic Future for Australia”, The Shaan Memorial Lecture, 23 August 2011, available at: <http:// archive.treasury.gov.au/documents/2134/HTML/docshell.asp?URL=shann.htm>.

The 2002, 2007 and 2010 Intergenerational Reports are available at <http://archive. treasury.gov.au/igr/>.

7. Productivity Commission, An Ageing Australia, p. 15.

8. See Abraham Maslow, The Psychology of Science (Maurice Bassett, 1966), http:// www.abrahammaslow.com/books.html 9. See European Commission and UN Economic Commission for Europe, ‘Policy Brief: Introducing the Active Ageing Index’, March 2013, http://www1.unece.org/stat/ platform/display/AAI/Active+Ageing+Index+Home 10. Seee UChicago News, 16/2/2014, http://news.uchicago.edu/article/2014/02/16/ aaas-2014-loneliness-major-health-risk-older-adults; The Guardian, 16/02/2014, http://www.theguardian.com/science/2014/feb/16/loneliness-twice-as-unhealthy-asobesity-older-people 11. Bloom, Boersch-Supan, McGee and Seiki, “Population Ageing: Facts, Challenges, Responses”, Harvard, 2011 Working Paper Series, p. 7.

12. See Carl Frey and Michael Osbourne, “The Future of Employment: how susceptible are jobs to computerization”, Oxford Martin School, September 2013, http://www.oxfordmartin.ox.ac.uk/downloads/academic/The_Future_of_Employment. pdf; The Second Machine Age – Frey and Osbourne – The Onrushing Wave, The Economist, Jan 2014, http://www.economist.com/news/briefing/21594264-previoustechnological-innovation-has-always-delivered-more-long-run-employment-not-less; Lindsay Tanner and Martin Stewart-Weeks, Changing Shape: Institutions for a Digital Age (Melbourne: Longueville Media, 2014).

13. See Tony Atkinson, ‘Ensuring social inclusion in changing labour and capital markets’, Institute for New Economic Thinking, Oxford Martin School, 2013.

14. Consider Eva Cox, “Putting Society First: welfare for wellbeing”, in Miriam Lyons, Adrian March and Ashey Hogan (eds), Pushing Our Luck: Ideas for Australian Progress (Centre for Policy Development, 2013), pp. 80-82.

15. See, further, data from the OECD, http://www.oecd.org/employment/emp/ ageingandemploymentpolicies.htm#Country.

16. The Economist, “Reform in Germany: Going Backwards”, 26 April 2014, http:// www.economist.com/printedition/2014-04-26 17. Consider Now for the Long Term, Report of the Oxford Martin Commission for Future Generations, pp. 46-47.

18. The full text is available via the Committee for the Future’s website: http://web. eduskunta.fi/Resource.phx/parliament/committees/future.htx?lng=en 19. The submission is available here: http://www.aph.gov.au/About_Parliament/ Parliamentary_Departments/Parliamentary_Budget_Office

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Make your mark on aged care overseas

W

ith a burgeoning senior population, changing household dynamics and increasing wealth, the aged care or senior living sector in Asia has become a new growth industry.

Many countries around the world are looking to Australia’s aged care system as a benchmark of quality healthcare.

In particular, the large economies of China and India, as well as smaller economies such as Malaysia and beyond, have a need for a full range of seniors’ health products and services – and Australia is well equipped to supply.

Launching overseas in November, SeniorsHealthExports.com.au, a new online directory and flipbook offers exporters, and potential exporters in the senior living industry, the chance to showcase their business.

The project is an Australian Trade Commission (Austrade) initiative and is being jointly developed with DPS Publishing, publishers of the DPS Guide to Aged Care, and the leading website AgedCareGuide.com.au.

Austrade is the Australian Government’s trade commission with a global network of 90 offices across 50 countries.

Austrade’s role is to advance Australia’s international trade, investment, and education and tourism interests by providing information, advice and services.

Austrade has identified the seniors health and living area as a significant export opportunity for Australia.

The culmination of the Austrade/DPS Publishing project will be an online directory listing more than 250 companies that currently export or are looking to develop export markets. The website will offer a key word search facility and provide business contact details, branding, and links to websites, areas of industry expertise and a 100 word capability statement.

In addition to the website there will be a digital book and a hardcopy publication.

Australian businesses and companies are able to list their products or services being exported or that are ‘export ready’, both on the website and in the ebook.

The website directory, and digital and hardcopy publications will be promoted by Austrade via its international network and will have a presence at selected international trade events. In addition, the directory will be used by Austrade to support the delivery of qualified opportunities to capable Australian companies.

Exporting can be a profitable way of expanding your business, spreading your risks and reducing your dependence on the local market.

Austrade research shows that, on average, exporting companies are more profitable than their non exporting counterparts. It can increase productivity, create better growth prospects and produce highly skilled and productive staff.

Australia’s reputation is based on a long history of aged care experience - world leading government legislative policy

and funding, a well regulated accreditation framework, sound private sector funds management expertise, high education standards providing both preventative and clinical care to aged care qualifications, and substantial investment in research and experienced firms.

According to Dugald Anthony, Austrade Trade Adviser International Health, the concept of aged care services and support in many Asian markets did not exist until recently as the traditional Asian culture expects families to look after their ageing family members.

To assist, Austrade administers a scheme, Export Market Development Grants (EMDG), which is a key Australian Government financial assistance program for exporters and those aspiring exporters.

The EMDG scheme encourages small and medium sized Australian businesses to develop export markets; reimburses up to 50 per cent of eligible export promotion expenses above $5,000, provided that the total expenses are at least $15,000; and provides up to eight grants to each eligible applicant.

Guiding Industry and Consumers through Aged Care Maze Trying to understand the aged care ‘system’ can be overwhelming for consumers, and health professionals, including nurses and doctors who work in aged care, report feeling similar emotions when they embark on the ‘aged care journey’ for their parent or spouse.

In addition to SeniorsHealthExports.com.au and the ebook, DPS Publishing’s AgedCareGuide.com.au helps to streamline the process of investigating different care options, making it the highest ranked and most used website for aged and community care and retirement living in Australia.

In comparison to the Federal Government’s My Aged Care website, launched as part of the $198 million Aged Care Gateway, AgedCareGuide.com.au has, for more than a decade, provided a comprehensive directory of care homes, as well as home care services and retirement living accommodation options in each state and territory.

Updated daily, AgedCareGuide.com.au has a trusted reputation for being an easy to use and accurate ‘go to’ resource for industry workers.

The Federal Government’s My Aged Care has been likened to sites such as MySchool and MyUniversity, which are reportedly rarely updated and not often used by consumers who rely on up to date, immediate information.

The Power of Print While AgedCareGuide.com.au remains a trusted online resource, printed resources will likely always have their place in

26 | FUSION the aged and community care industry when it comes to informing and educating seniors.

Complementing AgedCareGuide.com.au is the DPS Guide to Aged Care, a glossy, full colour printed directory of quality aged residential, community care and retirement living options, providing indispensable information for health professionals, consumers and carers since 1998.

As a social worker in the 80s and 90s, David Baker, DPS Publishing’s chief executive, assisted older people and their families in finding residential aged care homes. It was clear to Mr Baker that the industry lacked an independent guide to assist people to navigate their way through the process.

The DPS Guide to Aged Care was created to meet this need in the industry and now helps simplify the process for thousands of Australians looking to make the move to retirement living, home care or aged care.

Published annually for each state and territory, the DPS Guide to Aged Care educates consumers on a number of considerations when choosing accommodation and care options later in life.

Similar to the website (AgedCareGuide.com.au), it also includes a comprehensive directory of nursing homes, home care packages,

retirement villages and home and community care products/ services.

Distributed by Aged Care Assessment Teams or Services (ACAT/ACAS), government agencies and public hospitals around the country, the DPS Guide to Aged Care has remained a favourite publication for industry health professionals, consumers, their family and carers.

Your Retirement Options DPS Publishing’s Your Retirement Living, which complements the website RetireRealEstate.com.au, is a directory magazine specifically for older Australians contemplating moving on from the family home to something more suitable to their current lifestyle.

Published annually, the state divided publication provides detailed information on the legal, financial and social considerations in choosing one of more than 1,000 retirement communities. ■ For more information on SeniorsHealthExports.com.au, or to advertise your organisation’s facilities, products or services in the DPS Guide to Aged Care or Your Retirement Living, contact DPS Publishing on (08) 8276 7999.

FUSION | 27

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South Australia

JULIE LOCKERIDGE CFP®, Dip FP

KATE PHILLIPS

Kimmorley Financial Management julie@kfm.net.au www.kfm.net.au Suite 1404, Level 4, 56 Scarborough St Southport QLD 4215 (07) 5591 1725

DFS, ADFS, B T. , B Ed.

SHAUN AKROYD Bravien Financial shaun@bravien.com www.bravien.com Suite 9 / 60 Macgregor Tce Bardon QLD 4065 1300 272 843

MICHAEL YOUNG Second Innings Pty Ltd michael@secondinnings.com.au 156 Commercial Street East Mount Gambier SA 5290 (08) 8723 0411

Tend Financial Planning kphillips@tendfp.com.au www.tendfp.com.au 48 Fullarton Rd Norwood SA 5067 (08) 83624555

GAVIN WILLIAMS Garden Financial Services gwilliams@gardenfs.com.au www.gardenfs.com.au 1/5 Oval Avenue Caloundra QLD 4551 (07) 5437 2744 BRAD MONK LifePath Financial Planning info@lifepathfp.com.au www.lifepathfp.com.au 643 Kessels Road Upper Mt Gravatt QLD 4122 (07) 3219 4670 0433 271 001

ALDIS PURINS CFP®

Western Pacific Financial Group P/L aldis.purins@westernpacific.com.au www.westernpacific.com.au 355 Scarborough Beach Road, Osborne Park, WA 6915 (08) 9340 9200

JASON GORDON Dip FP, B. Bus (Accounting) Brisbane Hillross

jason.gordon@hillross.com.au www.brisbanehillross.com.au Level 8, 141 Queen Street Brisbane QLD 4000 (07) 3012 8040

Want to know more about aged care? ...Ask the Gurus!

Aged Care Gurus

Email: asktheguru@agedcaregurus.net.au Web: http://www.agedcaregurus.com.au

FUSION | 29

Calculating the means tested fee is no mean feat!

By Rachel Lane

W

ith the aged care reforms starting on 1 July all new residents are now subject to the comprehensive means test to determine their ability to contribute towards the cost of their accommodation and care.

Just to reiterate, the comprehensive means test assesses a resident’s assets and income based on the following formula: 50c per dollar of Income above $24,835p.a (single) $24,367p.a (couple each) plus 17.5% of assets between $45,000 – $154,179 plus 1% of assets between $154,179 – $372,537 plus 2% of assets above $372,537

BRENDON O'SULLIVAN CFP, Dip FP, DipAll, JP

Hillrossof the test gives a liability of less than IfBrisbane the outcome brendon.osullivan@hillross.com.au $52.49p.d then the resident is eligible to be supported. If the www.brisbanehillross.com.au outcome is 141 greater than $52.49p.d then the resident will be Level 8, Queen Street Brisbane QLD 4000and the amount above $52.49p.d will a market price payer (07) 3012 8040 be their means tested care fee.

Understandably, most residents and their families find the means testing arrangements utterly confusing. Adding to the confusion – some of the assessments are coming back incorrect!

The department have estimated that around 100 people have received an assessment where the covering letter incorrectly stated the value of the assessed assets is $0.

The covering letter is attached to the asset summary table showing the value of the assessable assets, in some cases we have seen this is hundreds of thousands of dollars. For at least one person, the value of the former home was appearing in the assessable assets despite a protected person living there.

The same assessment also incorrectly stated the value of the home as being $110,000 For one of our clients the assessment was particularly obscure, the assessment clearly showed that they had assessable income of $1,401.51pfn and assets of $367,490.20 (including the capped value of the family home at $154,179.20) which was correct. However, the calculated amount of the means tested care fee was $58.35p.d – it should have been $21.90p.d – the amount had been calculated based only on the assets and without deducting the $52.49. The department have explained that some letters are currently being generated manually and that the person sending this letter had incorrectly calculated the fee. They have assured us that additional quality assurance processes have been implemented to overcome such issue arising again.

Such a significant change to the system is bound to cause teething problems, and unfortunately I don’t think we have seen the last of them – questions still remain as to what some partially supported residents will pay when the facility significantly refurbish or increase or reduce their supported resident ratios. In the meantime, residents and their families look to facility managers to help them understand what the cost of care will be and an integral part of that is the means tested care fee. Unfortunately the comprehensive means test is too complex to enable transparency of what someone should be paying. There are software programmes that can assist facility managers and the myagedcare calculator is available to both facility managers and residents and their families. Of course these are not a substitute for financial advice but they can provide a checking mechanism for what the means tested care fee should be. The Aged Care Gurus Adviser Network can provide you and your residents a free estimate of the means tested care fee over the phone. ■

30 | FUSION

An Aussie in aged care abroad

By Dr Amee Morgans

W

hat are the benefits of an international conference and what does it achieve? As a first time attendee of the International Federation of Ageing Conference, I had the opportunity to reflect on that question and obtain some insight into the importance of discussion, review and comparison of ageing advocacy goals on an international scale.

I found the most notable benefit was not any one particular discussion or debate, of which there were many, but a much greater idea that qualifies and provides perspective to our work in the aged care sector domestically. What stood out was the reality that Australia has good values and standards and that our work is a valuable source of insight for others.

Forty-seven countries were represented at this year’s conference, including speakers from across the world who discussed topics such as costs of living, housing and transport for older people, sexual health and productive ageing. For me personally, the experience was particularly insightful to see what the rest of the world is pursuing in research, policy and innovation.

It was a privilege to share what is happening in the Australian context, as well as what we do and have achieved at Benetas.

It was also helpful to better understand where Australia sits internationally, and to gain a broader understanding of our health and aged care system, as they operate as a whole and compared to our international companions.

It’s true to say that comparatively Australia is heavily regulated by government, which is something that can restrict and limit providers. What we do forget, however, is that this also provides many safeguards and benefits that become evident when compared to others. It was through my observation and participation in conference discussions that I have returned with a renewed commitment to our model of governance and finding ways to use the benefits of this framework to develop better practice, understanding and achievements.

A key insight was how Australian national standards represent the pros and cons of our system. These are a great advantage for service provision, costs and quality, and provide consumer protection in the form of safeguards in all of these areas. It’s interesting to note, that as much as accreditation impacts our daily service experience, our minimum standards are far higher than many other countries’, including some which I had previously thought of as world leaders in aged care. I say this not as an

insult, but as recognition of the success government, stakeholders and the community have achieved in Australia.

What this experience has also shown me is that Australian national standards are just that – minimum standards. We can and should always strive to achieve better. In fact, the use of these as a minimum level of service can help us develop better services into the future.

Through a focus on quality of care and client choice we can drive our industry to achieve far above current standards, and it’s something I’m proud to say Benetas is already taking action towards.

It’s true that too often, as advocates and contributors in aged care, we can become immersed in the minutiae and detail of our system without taking into context the larger picture. The conference provided me with that context and insight, and afforded me the opportunity to see how similar our work is in Australia and its worth as an international contributor.

A particular highlight was an address by Nobel Laureate, Professor Muhummad Yunus, who spoke about his work to break the cycle of poverty in Bangladesh and how ageing is significantly different in societies with a long-term crisis of poverty. Professor Yunus sought to make a difference through the provision of small loans to women living in Bangladeshi villages, in recognition of the age-old philosophy that small amounts of seed money can begin a process of financial and social elevation. He founded a not-for-profit institution to administer these loans and has grown this institution to service some 87 million customers. In addition, this entity now uses its profits from the financial sector to provide continued investment in the community through the provision of pension funds for women in environments where this would not normally occur.

It was his perspective on ageing that showed the significant difference in culture and attitude. Professor Yunus sees an adult phase of life as quite restrictive with commitments to work and family, however believes that once individuals have transitioned

FUSION | 31 past these commitments, it is important to dedicate oneself to helping others who are less fortunate.

Professor Yunus echoed the World Health Organisation statement that ‘living longer is a public health achievement, not a social or economic liability’, and affirmed his belief that there must also be a focus of care over cure.

It’s important to recognise the key differences faced in the provision of aged care in different communities and how, although models, standards and practices change, communities often share a universal idea and commitment to older people among them.

One such commonality is the shared preference for ageing in the home and a commitment to a safe, secure and responsive care environment.

The conference included presentations on health including mental health and mobility, workforce participation and finance and debt transference between generations. There were also discussions on volunteering and lifestyle support, impacts of widowhood and the quality of nursing. One quote that was thought provoking in the social inclusion and community engagement space was “should we focus on adding years to life, or life to years?”

An interesting presentation included the differences between what ‘a good ageing experience’ looks like in Russia and what ‘a good ageing experience’ looks like in Bangladesh.

This encouraged me to reflect on our own service provision and the importance of culture. The 2011 census showed that a quarter of Australians are born overseas, and a further 20% of the population were born in Australia, but have a parent born overseas. From an aged care provider perspective, the current top five countries of origin in Australia in the 65+ age group are all European, but the next wave of migration is a largely Asian population (this includes India), so there will be some changes to our client base over the next 10 years. Clearly, understanding

diversity in aged care service provision is something we should be thinking about.

Something which was great to see was the enthusiasm and zeal members of the Australian delegation displayed as part of our contribution. A young social worker from the Royal Melbourne Hospital, who had worked in secure dementia wards and aged care, presented a project on the implementation of a screening tool for elder abuse in the hospital setting. Whilst a distressing topic, she presented some strong evidence for standardised methods for assessment, detection, reporting and outcomes.

It was a great example of how we can use the strong position we find ourselves in as a nation and a community, and provide guidance and insight to the rest of the world as they come to deal with like issues in the future. The presentation highlighted the need for continued research and reform in all areas of the sector and the importance of advocacy to ensure all groups within our health and aged care system are represented and heard.

I presented on a number of topics, one of which was Benetas’ work on the federal government funded SALLY project. SALLY, the Sub Acute Linkages in Later Years project, represents a unique opportunity to better understand the relationship and intersection of our Australian health and aged care systems.

My experience provided perspective to our work at Benetas.

It re-emphasised the bigger picture in aged care and gave me key insight into our work as a national community. So often we fall into the trap of becoming immersed in our system without taking a moment to see the wider world.

I would urge anyone with the opportunity to attend a similar event to do so, and believe you would return with a greater understanding of the importance of our work and a renewed commitment to health and aged care going forward.

The next International Federation of Ageing conference will be held in Brisbane in June 2016 and I very much look forward to the discussion, debate and contributions to be made on home soil. ■

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FUSION | 33

at national aged care awards A provider delivering services through telecommunication, the team behind an innovative wellness program and a Victorian improving access to services in Aboriginal communities have received top honours in the 2014 HESTA Aged Care Awards.

The winners were recognised for excelling in service provision, innovation and advocacy in the aged care sector in the categories of Outstanding Organisation, Team Innovation and Individual Distinction.

HESTA CEO, Anne-Marie Corboy, said the 2014 winners reflected the diversity of Australia’s older population and the new and innovative ways they can access services.

“Our winners are using technology and innovation to ensure older people have access to the services they need to remain living independently for longer and engaged in their communities,” Ms Corboy said.

“We are proud to acknowledge the work of those on the frontline of aged care delivery, ensuring older Australians are treated with the dignity and respect they deserve at the later stage of their life.”

Winners were announced at an awards dinner in Melbourne on 5 August 2014 and shared in a $30,000 prize pool, courtesy of long-term HESTA awards supporter, ME Bank. The Outstanding Organisation and Team Innovation Award winners each received a $10,000 development grant. The Individual Distinction Award winner received a $5,000 ME Bank EveryDay Transaction account and $5,000 towards further education.

HESTA is the leading super fund for health and community services, with more than 785,000 members and $28 billion in assets. More people in health and community services choose HESTA for their super.

To learn more about the 2014 winners visit hestaawards.com.au Proudly presented by:

Proudly supported by:

Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No.235249 Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321.

Outstanding Organisation Award: Feros Care, Queensland, for its innovative role in the delivery of smart and virtual technologies in Queensland, New South Wales, Victoria and Tasmania. The organisation supports seniors via group and individual video calls, online referral services, senior-friendly personal computers/tablets and ‘smart home’ safety installations.

Team Innovation Award: the Re3 Wellness Program — from Ageing Wisely in Western Australia — for developing an innovative wellness program to help older people maintain their health. The program provides simple lifestyle strategies that aim to improve physical and cognitive function, and emotional wellbeing in one holistic program, thus the name Re3 — Re-generate the body, Re-ignite the mind and Re-discover happiness.

Individual Distinction Award: Graham Custance — from Care Connect in Victoria — for developing a model of engagement and service provision that increased the number of Home Care Packages provided to Aboriginal Elders and built capacity in Aboriginal communities to access services that meet their specific needs.

2014 winners, left to right: Jennene Buckley representing Feros Care, Graham Custance from Care Connect and Paula Fievez representing Ageing Wisely.

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34 | FUSION

It takes a Community...

Arcare’s innovative dedicated staffing model

Since its release in July 2014, the short film “It Takes a Community” has been gathering momentum and getting attention both nationally and internationally. Filmed at Arcare Helensvale on the Gold Coast, “It takes a community” takes a close look at Arcare’s relationship-focused approach to celebrating and supporting old age.

T

he film was produced by Sociologist/Photographer Professor Cathy Greenblat, and directed by Corinne Maunder (Fire Films). Soo Borson, Geriatric Psychiatrist and Dementia Specialist features throughout the film outlining some of the key strengths in Arcare’s relationship-focused approach. It forms part of Cathy’s upcoming project, “Side by Side: Love and Joy in Long Term Dementia Care”, which aims to highlight selected aged care

communities around the world that are leading the way in terms of innovative and inspirational dementia care and support.

Arcare’s relationship-focused approach has been a long time in the making. In June 2012 Arcare carried out focus groups, interviews and working groups to find out about the things that matter most to the people who live in, work in and visit their residential communities. Arcare’s Strategy and Innovation Manager, Daniella Greenwood sums up the key findings from the research “It was all about the quality and depth of the relationships between people - that is where all of the good stuff happens”.

Arcare’s extensive conversations with stakeholders led to the creation of new organisational values and a model of care that reflected the centrality of relationships in the lives and wellbeing of residents, volunteers, staff and families. Borson comments that, “without cultivation of a close and caring relationship – that was as rewarding for staff as it was for residents - there would be no high quality care.”

Arcare’s Dedicated Staffing model is also outlined in the film, and it is clear that working with the same residents every time has a powerful effect on the quality of the relationships between staff, residents and families. These relationships are

FUSION | 35 featured throughout the film, and each vignette is sensitively enhanced by Greenblat’s powerful still photographic images.

Beyond words One vignette focuses on the relationship between a care staff member (Carolyn), and a resident Eric, who Greenblat describes as having “stopped using words 2 years ago”.

The film beautifully captures the ‘wordless’ intimacy between the two “I think we do have a special language, a special way of communicating, it’s not through words, again, it’s human touch – it’s just one human relating to another human” says Carolyn as she gently rubs Eric’s hands. Eric’s hands eventually relax at Carolyn’s touch as she tells him “I feel the blessed one, I feel the lucky one, you’ve taught me to be patient and wait haven’t you”. This theme of mutuality and reciprocity runs throughout the film.

The buddy program One initiative that Greenblat presents in the film is the Buddy Program, where staff choose a resident that they would like to get to know even better and spend time with outside of work hours.

Carol, a Personal Carer describes the 2-way relationship she shares with her buddy Fay “I like to think that Fay participates in more activities throughout the week so that when we meet in a fortnight she’s got things to talk about, which in turn makes me get up and do things and see things so that when I come, I’ve got things to contribute to the conversation.

So, it’s not a one way street with Fay and I”.

Beryl, a resident of Arcare Helensvale talks about her buddy Judy, “Judy took us different places, even to her home and she cooked a nice meal, and it was good”.

Throughout this interview Beryl and Judy chat

away together, laugh at the same time and finish one another’s sentences. Beryl describes another outing “We went to a park once and had fish and chips and there was children running around happy and I was happy because they were happy”, Judy interrupts reminding Beryl that “we ate with our fingers didn’t we”, and the pair laugh heartily together. Beryl and Judy seem like life-long friends, as Greenblat notes, “relationships between the residents, and the residents and the staff are really quite extraordinary”.

Community Arcare Helensvale is described as a ‘community’ by those who feature in the interviews and throughout the film it is evident that staff, residents and families very much care about and rely on one another.

One staff member tells the story of how she came to have her wedding at Arcare Helensvale “we wanted to do it here so that all of the residents could be part of it because they were the reason we met” says Lifestyle Coordinator, Belinda who continues on to describe having met her husband while on a bus trip with the residents.

Helensvale residential manager Karen Watt explains that “Being part of our Helensvale Community is about contributing as much love, empathy, understanding, care and service to the residents that live here, and when I say that, they all look after each other as well”.

Greenwood points out that “just because you have changed address doesn’t mean that you have assigned over your human rights, nor does it mean that you have given up your citizenship responsibilities”. It is this “do unto others” philosophy that comes to life in the little day-to-day events such as resident, Fay having her morning coffee each day with another resident who is feeling a bit down, and the resident gardener who is passionate about growing enough food to feed the whole

36 | FUSION

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FUSION | 37

“family”. It is within these community relationships that residents experience a sense of purpose and continuity.

Greenwood speaks passionately about the value of living in a residential community “these need to be seen as fantastic choices for families – not as a failing of families. Isn’t it a better option to live in a community like this, to get support when you need it, and to be part of a community and still a citizen who is needed”.

There is a definite spiritual element to Arcare’s approach, an observation that is shared by David Petty, the Executive Officer of Pastoral and Spiritual Support in Ageing (PASCOP), who has invited Greenwood to present Arcare’s approach at the Meaningful Ageing Seminar Series in Melbourne in October.

“What is most impressive to me” concludes Greenblat, “is that this was a change that was being affected throughout the company, that’s unusual. It’s a hard enough job to make a change in one place but to take a new philosophy, implement it across the entire company, that is something I think is really quite extraordinary” ■

Watch the Short film: It Takes a Community and Hear from Arcare’s Daniella Greenwood at LASA Congress

38 | FUSION

FUSION | 39

Alzheimer unease Why do so many dementia researchers hold to a single theory so fervently?

An unsettling new book throws light on entrenched beliefs

By David Le Couteur

I

n 1991, Allen Roses from Duke University discovered a genetic risk factor for dementia in older people, a gene called APOE. Despite a plethora of genetic research on dementia since that time, APOE remains the leading genetic risk factor for the most common cases of dementia worldwide.

Yet this year the world’s leading scientific journal, Nature, pointed out that Roses’s discovery has been “largely criticised or ignored” and research in this area has dwindled. Roses says that he has received no grant funding to study APOE and dementia since his discovery. It appears that he and his gene have been squeezed out.

Last year, in a letter to the British Medical Journal, fifty-two doctors argued that four medical researchers, including me, were “in danger of being an affront to the millions of people with dementia and their families” and risked “undoing much of the good done over recent years.” This impressive number of clinicians was responding to our view that plans to screen for “pre-dementia” ignore the drawbacks of making an early diagnosis of a disease without a cure.

What do these two anecdotes have in common? In both cases, the central dogma of dementia research had been questioned and in both cases the mainstream research and medical fraternity sought to stamp this out. There is only room for one theory of dementia and that is “the amyloid cascade hypothesis.” Roses had erred by finding an important dementia gene that did not support that hypothesis.

My colleagues and I had erred by writing a review commissioned by the British Medical Journal stating that screening for preclinical dementia based on the amyloid hypothesis is not useful and will lead to significant overdiagnosis of Alzheimer’s disease and overmedicalisation of ageing.

Why would the dementia research community uphold one theory with such fervour and exclude other views or questioning as heretical? Surely people involved with dementia research and healthcare would want to explore all possibilities, particularly since the problem is so important, the stakes so high and progress so painfully slow?

Enter the distinguished medical anthropologist Margaret Lock and her book The Alzheimer Conundrum. Lock, a McGill University sociology professor, has written several books that place the cultural, economic and social context of modern medicine and biotechnology under the microscope. When Lock applies her anthropological gaze to the problem of Alzheimer’s disease, the result is uncomfortable, captivating and unsettling. It should be absolutely compulsory reading for all people who deal with dementia.

Lock presents us with a rich tapestry of science, history, sociology and medicine, interwoven with transcripts of interviews with patients, carers and leading researchers in dementia and Alzheimer’s disease. The result is both knowledge and context, with context as the clear winner. In fact, any medical researcher or doctor would be wise to ask Lock to write a book about his or her chosen area before basing a career on what might turn out to be hubris and hope, or worse still, political and financial pressures. In this age of scientific supersubspecialisation, it is too easy to focus on, and believe in, the gene or the protein or the chemical – and totally overlook the wood for the trees.

Lock introduces her deconstruction by placing dementia research in the context of three broad and overarching tensions: brain versus mind; normal ageing versus pathology and disease; and genetic versus environmental causes of disease. Then she rapidly focuses on the central role of the amyloid hypothesis in directing, and perhaps stifling, research into dementia and Alzheimer’s. It’s important to be clear about the terminology here. To the layperson, dementia is easily recognised as confusion and forgetfulness in an older person. But according to the most recent set of definitions, it is possible to be perfectly normal and still be given a dementia diagnosis on the basis of new tests of unproven accuracy or predictive ability. Alzheimer’s disease has come to be regarded as the commonest cause of dementia.

The first case of Alzheimer’s disease was described by the neuropathologist Alois Alzheimer in 1906. He recorded the clinical features and brain pathology of Auguste Deter, a woman in her fifties who had died of dementia. Australian scientists have very recently obtained tissue from the slides that Alzheimer used and found that Deter’s early-onset dementia was caused by a very rare genetic condition. Alzheimer found microscopic plaques in her brain that contain an unusual protein called amyloid protein (an oxymoronic phrase because amyloid means starch-like, and proteins are not starch). These amyloid plaques are also very common in the brains of people as they get older, which is why the diagnosis of Alzheimer’s disease is now given to most older people with dementia.

Unfortunately, as Lock points out, the association between the symptoms of dementia and the presence of amyloid plaques in older people is not very convincing. Amyloid plaques and genes might well cause dementia in younger people, but in old people the causation doesn’t seem to hold. Lots of older people with amyloid plaques in their brains are perfectly normal and don’t develop dementia, and lots of older people with dementia don’t have amyloid plaques. Or if

40 | FUSION they do, these are often mixed up with other pathological changes, including those associated with ageing. Although there are said to be thirty-five million people with dementia worldwide, genetic causes only appear to apply in a few hundred families, and they are usually related to the genes associated with amyloid.

In other words, dementia is overwhelmingly a problem among older people yet the research has been dominated by the genes that cause dementia in young people. Perhaps this is a type of ageism?

Or perhaps studying the ageing process is just too hard.

Since 1991, when it was first published by John Hardy and David Allsop, the amyloid cascade hypothesis has held dementia research in an iron grip. On the basis of the genetic causes of dementia in young people, the two neuroscientists concluded that most dementia is caused by Alzheimer’s disease, which in turn is caused by amyloid plaques building up and killing nerve cells. If correct, the implications of this hypothesis are immense. If we can detect amyloid in the brain then we can detect dementia early enough to prevent it from progressing. And if we can remove the amyloid with antibodies or vaccinations or enzyme blockers, then we can prevent or even cure dementia.

Unfortunately, all clinical trials using treatments aimed at amyloid have failed. It has been pointed out recently that over one hundred clinical trials at a cost of over $50 billion in dementia have failed to show that any amyloid-based treatment has any effects. (This is all the more remarkable because by simple probability we would expect at

least some of the one hundred trials to reach statistical significance.)

Proponents now argue that we just need to give the treatments earlier, so trials are being commenced in those rare families with genetic causes of Alzheimer’s disease.

The need to diagnose dementia earlier so that we can start treatment earlier generates another commercial opportunity – testing to detect the presence of amyloid in normal people and/or for genetic variability that causes or predisposes to dementia. The latest imaging tests are claimed to detect dementia nearly twenty years before the onset of symptoms, and the only reason the tests aren’t too accurate, it’s claimed, is that many people will die before they develop dementia.

There’s a bigger question, of course. What is the purpose of performing screening tests to see whether people are at risk of developing dementia when there are no effective interventions? The usual response is that people want to know and be able to plan for the future. Lock responds with a quote from the anthropologist E.E. Evans-Pritchard’s book Witchcraft, Oracles and Magic among the Azande: “when the oracles announce that a man will fall sick… his condition is therefore already bad, his future is already part of him.”

A positive test means you go from being normal to being someone who will develop dementia – your future becomes your present. Yet we all face the prospect of dementia and frailty if we live long enough.

Another mantra of dementia research is that “dementia is not a part of normal ageing.” Lock shows that this statement is more

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FUSION | 41 political than it seems. It reaches into a semantic battle between those people who believe that diseases are separate entities and old people are just unlucky to have several at the same time, and those who believe there is a definable biology of ageing that underpins many of the problems that occur with ageing. Proponents of this latter concept believe in the “longevity dividend,” whereby strategies to delay ageing will also delay a whole suite of age-related diseases and disabilities.

Ignoring the role of ageing in dementia is equivalent to ignoring the role of tobacco in lung cancer.

Perhaps the amyloid hypothesis will be judged more favourably in time. It will just take one successful therapy to convert those who have tenaciously supported and defended the amyloid hypothesis into heroes. Meanwhile, as Lock points out, we already have promising approaches to reduce dementia – they just don’t have the commercial potential of amyloid-based treatments. Patients, after all, are customers too.

Lock concludes that “emerging knowledge in both epigenetics and epidemiology” strongly suggests that we should take “a public health approach, including lifestyle changes, reduced exposure to toxins, reductions in poverty, increased community support, and other variables…” This is likely, she argues, “to reduce the prevalence of dementia worldwide to a much greater extent than would an approach confined to expensive molecular micro-medical management of segments of those populations deemed to be at risk that happen to

be located in wealthier countries.” In fact, one of the first studies to show that physical exercise was an effective intervention was carried out by Australian scientists. And only now, after two decades of failed amyloid therapies, are serious, large-scale studies of interventions that target lifestyle and vascular risks being embarked on internationally.

The Alzheimer Conundrum reminds us about the real needs and lives of people with dementia and their carers. It asks whether research into Alzheimer’s disease, the amyloid hypothesis and genetic causes of dementia are truly cutting-edge, paradigm-shifting science or simply seductive hype with political clout that captures the public imagination and capital investment. While this attention means that funds are increasingly being directed to dementia research and care, the hype risks minimising and sidelining the elephants in the room: the role of ageing in dementia, the role of lifestyle interventions to delay dementia, and the pressing healthcare needs of people with dementia and associated multimorbidity, behavioural disturbances and carer stress. Lock reminds (and perhaps chastises) all of us involved in healthcare and medical research, no matter what the disease might be, that we should always make the science follow the needs of the patient, not vice versa ■ The Alzheimer Conundrum: Entanglements of Dementia and Aging By Margaret Lock Princeton University Press $45.95 This article first appeared in Inside Story www.insidestory.org.au

42 | FUSION

Psychological Injuries: Are we only seeing the tip of the iceberg?

By Travis Holland, Managing Director of Holland Thomas & Associates

P

sychological injuries can result from an incident involving aggression and/or violence where no physical harm has been sustained by the staff member.

So what does this mean for all the “minor” incidents that aren’t reported?

From the National Report: Home Care, Community Care and Outreach Staff Safety Survey 2013* filtered for the aged care sector we see that the majority of incidents involving aggression and/or violence resulted in minimal physical harm.

Of concern, at least 5% of incidents involved physical assault.

Note: To avoid complication, I will refer to the everyday use of the term “physical assault” rather than a criminal code definition.

There is a wide range of physical harm that can result from a physical assault. At one end is unwelcome contact,

e.g. a grab of the wrist where no physical harm has been done. In the middle of the spectrum are minor through to major injuries. At the far end of the spectrum are physical assaults causing extreme injury or even death.

I think most would agree that the majority of physical assaults in aged care are in the no harm to minor harm section of the continuum.

When a person is standing within arm’s reach and is yelling at the staff member, what is the difference between the aggressor continuing to yell at the staff member and that aggressor physically assaulting the staff member? The answer – about one second.

The challenge is that staff who are exposed to verbal abuse, and even threatening behaviour, cannot always tell when the aggressor will escalate from verbal abuse to physical assault.

®

FUSION | 43

Further, staff do not know which day is the day that a physical assault will result in serious physical injury rather than the more common outcome of no physical harm.

It follows that staff should always employ effective safety strategies to optimise the safety of themselves and the people they are supporting.

However we have not taken in to account the psychological injuries resulting from incidents involving aggressive or violent behaviours.

From the Survey, 23% of incidents involving aggression and/or violence resulted in the worker suffering a psychological injury. Of the staff who experienced one or more incidents involving aggression and/or violence, 26% suffered a psychological injury.

Remember that psychological injuries can result from an incident where no physical harm has been sustained by the staff member who has suffered the psychological injury.

Assessing risk for a single exposure to verbal abuse tomorrow might result in the risk being rated as low. Assessing risk for repeated exposure to verbal abuse each day of the week for multiple years will result in the risk being rated considerably higher partly due to the cumulative effect of repeated exposure to potential psychological injury.

Given the widespread nature of under reporting of incidents at the minor end of the spectrum (i.e. no one is physically injured), our appreciation of the number of staff who are exposed to psychological injuries may be just the tip of the iceberg.

This should be a significant concern for organisations as staff who are stressed are less likely to provide high quality support for their clients; are less likely to think clearly in stressful situations; are more likely to transfer that stress to the people they are supporting; will miss the early warning signs of escalation of aggression; and in general will make poorer

decisions about their safety and the safety of the people they are supporting.

Anecdotally, some staff have left organisations because of the psychological strain they were under and the lack of support they could access. Organisations should have

44 | FUSION processes in place to support staff as early in the injury as possible to optimise the wellbeing of staff and the organisation.

Understanding and discussion of psychological injuries is increasing amongst the Australian community. Staff are becoming more aware of the support and compensation available. In many instances, multiple incidents will contribute to a psychological injury however the cost of any workers compensation claim will fall on the current employer.

When talking about workers compensation, we need to be cognisant of the 50+% of staff in aged care who are engaged on a casual or part time basis.

For a member of staff who requires time off work, the cost of the claim is not simply the 10 hours per week the staff member works for Organisation A. Any other hours they usually work at Organisation B and Organisation C are also included as the worker is unable to perform those other shifts as a result of the injury. Organisations should be mindful of this when considering their exposure to future workers compensation claims.

Consider this hypothetical chain of escalation. Initially I am going about my day. Then I become unhappy about something. That unhappiness turns to frustration. That frustration turns to anger. I use my anger to physically intimidate others – intimidation/threatening behaviour. I start to verbalise aggressively – verbal abuse. I think of causing harm eg. hitting someone. I verbalise threats about hitting someone - threats.

I hit someone a little bit - physical assault. I hit someone a lot more – physical assault.

At any stage a staff member exposed to these behaviours may suffer a psychological injury even if no physical assault or physical harm has been inflicted.

In some instances, an aggressor will present behaviours for each stage. In other instances, the aggressor may skip stages to arrive at assaultive behaviour more quickly than anticipated.

Less serious aggressive behaviours can be indicators for more serious safety challenges that are coming. To this end, organisations should encourage a culture of proactive incident reporting. Increased reporting will enable organisations to better understand the prevalence of minor (eg. no one is physically injured) and often high frequency incidents that may contribute to psychological injuries in addition to identifying trends in aggressive behaviours. With this information, tailored strategies can then be introduced to minimise the risk of future harm.

For the wellbeing of staff and the people they support, organisations should open up the dialogue. What are you doing that works well and what doesn’t work? Are you doing some things simply because that’s the way you’ve always done them?

Is your practice focused on the wellbeing of the person you are supporting as an individual, or is it driven by the desire for standardisation of the services you deliver? Outdated procedures and practices may be undermining the wellbeing of the people they were designed to support.

Following an incident, support staff highly value the ability to debrief with their manager, acknowledgement and understanding. A supportive environment in which staff can openly discuss the challenges they are facing will place organisations in a strong position to better understand the safety challenges and improve the safety of their staff.

Organisations should then continue the conversation around the safety challenges of managing aggression and violence and the competing priorities of staff safety and client care.

Consideration should also be given to the total impact of incidents involving aggression and/or violence, including physical and psychological harm to all people concerned, time lost and money spent.

It is crucial for organisations to take action to ensure all staff receive training on a regular basis that achieves a level of competency and gives staff the confidence to manage all the safety challenges in their roles, including managing the safety challenges of aggression and violence.

Increasing the support offered to staff will improve the safety of staff and the people they support while assisting your organisation to differentiate itself as an employer and service provider of choice. ■ Travis Holland, Managing Director of Holland Thomas & Associates, will be presenting the concurrent session – Driving a cultural shift to enhance HACC support staff safety – at the LASA National Congress 2014.

Focused on innovative and sustainable solutions, Holland Thomas has developed contextualised training programs that not only deliver invaluable skills and techniques to manage the safety challenges of aggressive behaviours, but also enhance the emotional and psychological wellbeing of workers empowering them to feel confident and prepared for the challenges that lie ahead. *National Report: Home Care, Com¬mu¬nity Care and Out¬reach Staff Safety Sur¬vey 2013. www.hollandthomas.com.au/staff-safety-survey/

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46 | FUSION

aL Ce on n ti re n nanfe tio i Co ed

The voice of

all

aged services Winter 2013 | www.lasa.asn .au

FUSION | 47

The voice of all aged services

Taking your message to leaders across the entire industry every quarter both in print & online

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The voice of all aged ser .asn.au Spring 2014 | www.lasa

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49

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| www.lasa.asn .au

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Fusion: The Official Publication for LASA National Congress Subscribe at lasa.asn.au/fusion

TASMANIA

WESTERN AUSTRALIA

48 | FUSION

Gone with the Wind (PG) Showing this November

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Foxtel and some services are not available in all buildings/premises.

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Welcome to the LASA Employment Relations Advice Series

By Patrick Reid, LASA CEO

I

n August Leading Age Services Australia (LASA) launched a new National Employment Relations Service for all LASA members. Employment Relations Advice is a new information series which will provide all LASA members with employment relations advice specifically tailored to age service providers. This new member resource will be grounded in one of the core national advisory groups of LASA - the Workplace Relations Advisory Group (WRAG). As part of LASA’s work plan, LASA NSW-ACT convenes the WRAG with each LASA State actively contributing to the Advisory Group. WRAG will continue to guide and shape LASA’s response to workplace relations. Reform of the Australian industrial relations landscape has now completed its long transition to a truly national system.

The old principle of industrial relations being a combination of Federal and State jurisdictions has been transformed by the evolution of WorkChoices and the Fair Work Act 2009. The national system for employment relations now consists of a common component of Modern Awards and National Employment Standards. The 5 year transition to Modern Awards concluded on 30 June 2014. These minimum, common standards exist within a national framework for bargaining Enterprise Agreements, and any Agreement must then meet the Better Off Overall Test in relation

to the applicable Modern Award(s) and National Employment Standards.

The practical implications for all employers in age services is a common system that applies to all, with that common system both underpinning and shaping any bargaining environment for an individual provider and their staff. It is for this common system that Employment Relations Advice (ERA) has been designed to inform LASA Members - ERA will be the resource for LASA members for the national employment relations system. ERA will be used to clearly lay the foundation advice for age service providers of the newly transitioned national system, and members can expect ERA to provide ongoing information and up-to-date advice regarding: • Modern Awards and their rates of pay; • National Employment Standards; • Legislative requirements of the Fair Work Act 2009; • Occupational superannuation; • The harmonisation of workplace health and safety laws; and • Employment relations policy requirements I trust that all members will find ERA a positive member initiative, and LASA will continue to enhance its employment relations information and services for your benefit in the periods ahead. ■

FUSION | 49

MANAGING THE RISE OF SOCIAL MEDIA

By Damien Ryan, Executive Manager IR/HR LASA Victoria

S

tatistics show that four out of five of us now use some form of social media networking and that email use is decreasing as a consequence. The rise of social networking sites like Facebook and Twitter is often seen as a double-edged sword by employers due to the increasingly blurred lines they create between our professional and personal lives.

Social media can be a powerful tool to connect with customers and clients, and recruit new staff. Conversely, social media can cause a loss in productivity, with inappropriate online behaviour presenting a serious risk to the reputation of employers and individual employees.

Recognising these risks and opportunities, and with the view of protecting the interests of all concerned, the implementation of a social media policy is now essential to ensure employees, volunteers, contractors and agency staff are aware of their responsibilities.

When social media indiscretions are made, recent Fair Work Commission decisions provide some guidance for employers in relation to counselling or dismissing an employee. Recent Commission case outcomes involving an employee making disparaging online comments about their employer, manager or colleague, have often turned on the content and implementation of the workplace social media policy itself. These cases serve to highlight the critical importance of not putting off social media policy implementation.

In one such case, Linfox Australia Pty Ltd v Glen Stutsel, the company determined that the employee’s remarks posted on his Facebook page about two of his managers were “offensive, derogatory and discriminatory” and in serious breach of the company’s equal opportunity and diversity policies. However, in ruling that it was unjust to dismiss the employee and awarding reinstatement, the Commission pointed to the fact that the company did not have a policy on social media use and failed to take action against other employees who had posted comments.

The Commission noted in its decision that, “Unlike conversations in a pub or cafe, the Facebook conversations leave a permanent written record of statements and comments made

50 | FUSION

by the participants, which can be read at any time into the future until they are taken down by the page owner. Employees should therefore exercise considerable care in using social networking sites in making comments or conducting conversations about their managers and fellow employees.”

To ensure consistent treatment of policy breaches, employers should make a subjective assessment of whether there is a sufficient connection existing between the conduct in question and the employment relationship. For instance, does the conduct damage the ongoing employment relationship, jeopardise the interests of the employer, or breach the employee’s duties of good faith, fidelity, trust and confidence.

To be proactive in minimising the risk of such public venting jeopardising an employer’s reputation and/or giving rise to costly employee bullying, discrimination, harassment or victimisation complaints, social media policies should consider: • Defining social media and the ‘public’ nature of comments posted • Clarifying if and to what extent employees are able to access social media during work hours • Requiring that employees do not disclose or publish anything which is confidential, derogatory or contrary to the interests of the employer or clients • Identifying social media behaviour (both at and away from the workplace) that is and is not acceptable, and the disciplinary consequences of non-compliance • Requiring staff to take a common sense approach to social media use that does not interfere with their work • Ensuring staff do not speak on behalf of the employer and do not use the company logo unless authorised • Encouraging staff to maximise the privacy settings on social media sites • Consulting with staff on policy implementation and ongoing training It is also important to ensure the social media policy is not viewed in isolation of other workplace policies, such as bullying, harassment and discriminations policies. ■

Transitioning: Is it really over?

By Emma Patton, LASA NSW-ACT

F

rom 1 July 2014 employers across Australia are no longer required to apply the unnecessarily complex transitioning wage arrangements that have been in place since the introduction of modern awards in January 2010.

Transitioning arrangements applied to wages, penalties and other award conditions and required annual monitoring by employers to ensure compliance. Transitioning arrangements varied across modern awards with the phasing out of some penalties and the phasing in of new penalties.

Understanding how transitioning arrangements were to operate and requesting clear guidance and instructions on how to implement the new system was difficult and delayed.

Employers attempted to understand the new arrangements and muddled their way through new complex calculations.

For many employers the daunting and unknown future of modern awards and transitioning arrangements made enterprise agreements an attractive alternative.

For those employers who remain on the modern award system, the confusing transitioning wage arrangement period has now come to an end. Or has it?

to seek advice prior to implementing any change that would result in a reduction in an employeeâ&#x20AC;&#x2122;s wages or take home pay.

Staff Employed Prior to 1 January 2010

For members operating under an enterprise agreement you are encouraged to review the modern award rates of pay to ensure your agreement pay rates have not fallen below the minimum wages contained in the relevant modern award.

For members bargaining an enterprise agreement you are reminded that the modern award applicable to your workforce is the foundation for the Better off Overall Test (BOOT) applied by the Fair Work Commission (FWC) when reviewing an enterprise agreement for approval.

For staff employed prior to the introduction of modern awards employers are required to review and maintain take home pay arrangements, in place as at 1 January 2010, to ensure pre modern award employees have not suffered a reduction in take home pay as a result of the introduction of modern awards.

Staff Employed Post 1 January 2010 For staff employed after the introduction of modern awards, and before the conclusion of transitioning arrangements, employers were required to pay in accordance with modern award transitional rates of pay and modern award allowances. Many employers elected, to attract and retain employees, to offer staff employed after 1 January 2010 the same terms and conditions of employment that were in place for pre modern award employees.

Were an employer may now seek to review these arrangements, and above award conditions, LASA NSW-ACT encourages members

Staff Employed From 1 July 2014 For employees employed on or after 1 July 2014 an employer is only obligated to pay the new employee in accordance with wages and allowances prescribed by the relevant modern award. Any above award arrangement offered by an employer is discretionary.

Penalties and Shift Allowances Employers are required to review the modern awards that apply to their workplace to confirm what penalties and loadings apply from 1 July 2014.

Some penalties may receive a final adjustment as at 1 July 2014 such as the casual loading, Saturday, Sunday and Public Holidays penalties and shift penalties.

As each modern award may have been phasing in and up or phasing out or down penalties and allowances it is important to check each modern award to ensure compliance.

Enterprise Agreements

Modern Awards Wage and Allowance Tables To receive a copy of modern award wage and allowance tables please go to the FWC website www.fwc.gov.au or download our recently published LASA Employment Relations Advice 001 which includes links to all modern awards relevant to age service employers.

Members are also reminded that the FWC has a free subscription service that provides regular awards updates by notifying subscribers via email within 48 hours of an award update being posted. â&#x2013; FUSION | 51

52 | FUSION

LASA National Employment Relations Advices 2014 Have you got a copy?

S

ince the introduction of the new national LASA Employment Relations Advice series fifteen advices have been published including the following:

Date

Issue

Details

11/08/2014

N/A

Welcome and Launch LASA CEO, Patrick Reid, launched the new Employment Relations Advice series.

11/08/2014

001

Modern Award Wage Tables Details regarding the recent National Wage Case decision were provided in this advice including links to relevant modern awards.

13/08/2014

002

Fair Work Information Statement (FWIS) Members were advised that the FWIS had been recently updated, and reminded that under the National Employment Standards all new employees are required to receive a copy of the FWIS upon commencement.

15/08/2014

003

Right of Entry – Information and the FWC Entry Permit Check Page Details were provided in this advice on right of entry rulesas contained in the Fair Work Act 2009 and were reminded that they can check whether an entry permit is valid on the Fair Work Commission (FWC) Entry permit check page.

19/08/2014

004

The Aged Care Workforce Supplement This advice provided background information relevant to the Workforce Supplement and also provided details on the current status of the Supplement.

21/08/2014

005

Four Year Modern Awards Review Process With the modern award proceedings soon to commence in the Four Year Modern Award Review Process this advice requested members contact their LASA Association to discuss and provide feedback on the operation of modern awards in the business.

27/08/2014

006

Workplace Gender Equality Reporting - Consultation The Workplace Gender Equality Agency (WGEA) recently announced extending the date for public consultation on the new reporting requirements. The new closing date for public responses on the new reporting obligations introduced by the Workplace Gender Equality Act 2012 is 30 September 2014.

Members were encouraged to engage in the public consultation.

29/08/2014

007

Know Where the Line Is – AHRC Members were reminded that the Australian Human Rights Commission (AHRC) had developed and published new resources relevant to the launch of their Know Where the Line Is. This campaign has been developed to promote awareness of sexual harassment in the workplace. The advice also provided members with a link to the new resources available on the AHRC website.

02/09/2014

008

Heads Up – New SWA Resources This advice provides members with links to new resources available on the Safe Work Australia (SWA) website regarding their Heads Up campaign. The campaign is aimed at assisting and supporting Australian business leaders create mentally healthy workplaces.

04/09/2014

009

Superannuation Guarantee Rate Changes On 2 September 2014, the federal government suspended scheduled increases to the superannuation guarantee rate (SGR) to 2021. Members were advised that as a result of the passing of the Minerals Resource Rent Tax Repeal and Other Measures Bill 2014 the SGR will be set at 9.5 per cent until 2021 where it will then increase each year by 0.5 per cent until reaching 12 per cent in 2025.

08/09/2014

010

Enrolled Nurse Standards for Practice – Public Consultation On 7 August 2014 the Nursing and Midwifery Board of Australia funded a project lead by Monash University to develop enrolled nurse standards for practice. Members were provided a link to further information on the public consultation process and were reminded that the public consultation closes on 2 October 2014.

11/09/2014

011

AHPRA Social Media Policy In February 2014, AHPRA released a new Social Media Policy. This Policy became operational on 17 March 2014. Members were reminded of this new Policy and provided a link to download a copy of the Policy.

16/09/2014

012

Safe Work Australia Month: October 2014 SWA is promoting information and resources as part of their Safety Month campaign. This advice provided information on the resources available and links to access and download materials that can be used and developed for use in the workplace.

19/09/2014

013

AHRC Workplace Cultural Diversity Tool On 17 September 2014, the Australian Human Rights Commission launched their new, free, Workplace Cultural Diversity Tool. The Tool is a ‘how to’ guide to workplace cultural diversity, designed to help employers make the most of a culturally diverse workplace

22/09/2014

014

Workplace Gender Equality Reporting Requirements – Minimum Standards New Minimum standards have been set and will apply from 1 October 2014. Employers with more than 500 employees will be required to meet the new Minimum Standards and were provided information and links to further information on the new Minimum Standards.

30/09/2014

015

Community Services and Health Industry Council Website Resources Members were reminded of the rage of resources and information available on the CSHIC website and provided links to download further information on particular topics of interest.

For more information on our Employment Relations Advice, or to receive a copy please contact your LASA Office.

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FUSION | 53

54 | FUSION

Senior Techies: Working for young and old

By Merv Stewart

T

oday, 26% of Australia’s population are over 55 and as most people are aware this segment will increasingly represent a greater portion of the population. Most of this demographic know how to use the internet but they have missed the tablet and smartphone revolution; the primary platform to communicate both now and into the future with friends, family and business.

This sizable part of the population are not well equipped to communicate and be connected to one another and the community in the future. Unless we address this significant social issue we will find a quarter of the population suffering from digital exclusion.

This is something the team behind Senior Techies want to change.

Senior Techies is a new innovative social enterprise that is determined to proactively address digital exclusion with the aging population. Senior Techies run group learning events for seniors in schools, community centres and retirement communities to help seniors develop the necessary iPad and technology skills to become independent, confident and socially connected members of their family, friends and other online communities.

Uniquely Senior Techies uses local teenagers to deliver the training with seniors. This enables the program to address multiple social issues concurrently; • Building technology capability of older Australians on the new communication platforms to address digital exclusion and improve communication.

• Using young people as trainers, works towards bridging the growing divide between both younger and older people.

The young people share their technology skills, whilst elements of the program, in return enable the seniors to share their life experiences; both of which reinforce connections within the community.

• The program is designed to provide self-development opportunities for young people through a variety of roles they

can play within the events and program, to provide them with life skills outside of academic achievement and ultimately build self-esteem.

As CEO and Founder of Senior Techies Merv Stewart says, this is an issue that will have ripple effects in the community if not addressed “Research suggests that one in eight older Australians suffer loneliness. It needn’t be the case. Every older Australian should have the opportunity to use life-enhancing technology that can help them reconnect and stay connected with their communities, families and loved ones and avoid loneliness. They just need to be shown how, importantly in a non- threatening way that’s accessible for everyone” “When we run the events, it’s just inspiring to see the impact it has on the lives of the older person. It’s the simple things, like participants understanding what Facebook is and how they can use that as a window into their children and grandchildren’s lives to see their holiday snaps, or how to use free video calling such as Skype so they can keep visual contact with loved ones where either distance or mobility limits physical interactions – it keeps them connected” Older people who undertake the program also benefit with higher levels of engagement and mental stimulation, whether that be by accessing hobbies and interests on the devices or building self-esteem by feeling good about building their capability and not feeling they have been left behind.

Merv describes the role that young people can play in helping solve this problem “Generations have never been more disconnected. The connections between younger and older Australians is not what it used to be 30-40 years ago, which in turn limits our ability to connect to one another and really form a community”

FUSION | 55

“Using these devices comes so naturally to young people and provides them with great confidence. When they share these skills with seniors, technology becomes a less threatening for the senior.

It’s a win, win.”

“In the technology-driven world that we live in, it also enables young people to build the physical communication skills in delivering the program that increasingly is missing today. No one wants a generation of texters who don’t have the level of communication skills previous generations took for granted”.

Senior Techies have designed training programs and materials and already run several pilot events with great success. Each event has been oversubscribed, confirming the demand for the program.

The positive impact the program has had on the lives of the young trainers and the older people they’ve helped – that can now use their iPads to connect with their friends and family online, has been heartening and inspiring. As a result they are now seeking to extend the program across Australia and beyond.

The team to date have particularly focused on the Mornington Peninsula, Victoria approaching local schools to partner with in delivering programs and events and the response has been fantastic. Twelve secondary school leaders across the Peninsula, representing over 12,000 students, have signed up to deliver iPad training programs to older people. The school community love the idea that they can be a part of the solution in addressing this significant social issue – with the added bonus of providing an opportunity for their young people to experience the sense of achievement that comes from helping others.

Senior Techies are now seeking seed funding so they can roll out the training programs across the pilot region within the Mornington Peninsula in schools, local community centres and retirement facilities, and then extend into other states. They are also seeking to partner with retirement villages to run the events within their communities.

The ultimate goal of Senior Techies is to be able to provide subsidised training that’s available to every Older Australian; with the intent of improving the skills of seniors to use the new technological devices and communication platforms so they have improved ability to communicate and greater quality of life.

Ambitious? Perhaps, but Senior Techies is passionate and determined to play a leading role in addressing this emerging issue ….ensuring that no older Australian is left behind. ■ You can learn more about Senior Techies at www.seniortechies.com.au or if you would like to enquire about running events at your facility you can email Merv: merv@seniortechies.com.au

56 | FUSION

LASA puts industry workforce innovation on national stage

A

ccording to the Intergenerational Report 2010, a 300% increase in workers will be needed to reach the 1,000.000 required to care for an ageing population. To give this further context, the residential aged care workforce grew 29% between 2003 and 2012. This is in spite of the fact that the first of the baby boomers is only 68 with few needing care of any kind right now.(1, 2, 3).

The proportion of age services workers under the age of 35 has not changed since 2003, remaining at 18%. Correspondingly the median age for residential direct care workers is 48 years while for community direct care workers it is 50 years.(4) A significant proportion of workers have culturally and linguistically diverse backgrounds. On the plus side, fifty percent of these workers use their first language in the course of their work. However it presents a range of challenges that must be addressed to meet the needs of all stakeholders. These stakeholders include the workers themselves whose job satisfaction and safety relies on the ability to meet the demands of the role, aged care providers who operate within a compliance and funding framework that demands proficiency in the English language, colleagues who rely on verbal exchange and reporting mechanisms to meet safe practice and clients who depend on cultural understanding and communication to ensure that their needs are met at a vulnerable point in their lives.

Only 10% of the direct care workforce are male. Many of those find their way serendipitously into the sector through referral from friends, relatives or other close personal connections.(5) These insights into the current labour market, sit parallel with a rapidly ageing population, rising levels of acuity for those already in residential care, the need to tackle the complexities of advance care planning, a rising demand for care at home and in the community, and a generational change in expectations of care, coupled with a corresponding move to user pays/ user choice models.

The roll out of the NDIS will place further pressure on the age services workforce and indeed, the Assistant Minister for Social Services, Mitch Fifeld has stated that holistic policy approaches that meet the needs of both aged and disability services workforce are essential.

As the lines between aged and disability care blur this makes eminent sense. The first generation of people with disabilities are living to older age as a result of advances in medical technology, and many of the required skills, knowledge, attitudes and cultural capital are common to the workforce for both sectors. A number of LASA members are delivering services to both groups.

By Diana Fitzgerald, LASA Victoria

Another factor likely to further impact aged care workforce is the move by the acute sector to higher utilisation of personal care workers for meeting basic hygiene needs and other activities of daily living.

Health Workforce Australia has recommended an increase in this trend to ensure that health specialist’s time is expended effectively in a context of the rising cost of health care.

A number of reports and publications have declared the need for a nationally coordinated, locally implemented aged care workforce strategy. These date back at least as far as 2005, with the release of the National Aged Care Workforce Strategy by the then Minister for Ageing, Julie Bishop. The Productivity Commission Inquiry Report, Caring for Older Australians, 2011 and the National Aged Care Alliance made similar recommendations.(6) LASA Members have identified workforce as a priority concern through survey feedback and in other forums and networks over many years and workforce reform has been written into LASA national and various state strategic and business plans.

Various LASA initiatives, such as the consortia approach to an aged care nurse graduate program in Victoria and a right fit recruitment and training strategy in Queensland are aimed at addressing specific areas of skills shortage and attracting young and qualified people into the sector.

Regional networks of LASA members in many areas co-ordinate recruiting and retention efforts with a view to sustained workforce change.

Similarly governments of all persuasions have funded worthwhile programs such as the Aged Care Nurse Graduate Program, the TRACS initiative and the ACWVET training program.

These initiatives are to be commended, but unless they form part of a sophisticated, strategic approach that combines all elements of a holistic endeavour and vision to ensure a right fit, right mix, appropriately skilled workforce that has the capacity to provide cost effective and sustainable, high quality care, they risk fragmenting as the individual’s responsible for driving these programs move on, and governments change policies and priorities.

In addition the issue of quality training must be addressed with many reports(7) suggesting that training is variable with lots of initiatives that are not co-ordinated, nor measured effectively. This limits the benefits that can be achieved systemically.

Developing a national aged care workforce strategy relies on a ‘best evidence’ based suite of policies. It will involve smart, multifaceted and targeted recruitment and retention initiatives, review of job roles and scope, the development of new career pathways, as well as raising the profile of already existing pathways to an external

FUSION | 57 audience, and supporting well targeted innovative training, growth and development strategies including for those in management and those from non-English speaking backgrounds.

The strategy must also take account of the demographics on both sides of this coin; the characteristics of an ageing population and the age service workforce. For example what is the short and long term impact on the functional decline of older people and the corresponding need for highly specialised workers, if best evidence based enablement and wellness components are built into training for community care workers? These could include skills to facilitate and encourage older people with simple exercise techniques, evidence based falls prevention strategies and ‘brain training’ for people with established mild cognitive impairment.

The last three years have seen a number of aged care workforce projects undertaken at significant cost, where discernible outcomes in the significant areas of recruitment, skills shortage and workforce demographic appear at this stage to be limited. Many of the projects duplicated work that was already being done by the peaks and their members, and were seemingly based on a best guess, speed to market approach with learnings that have a limited application for a national evidenced based workforce capacity and capability strategy, with even less attention paid to the interface between capacity and capability building and an ageing population.

LASA is pleased that the Abbott government has undertaken to complete a stocktake of all of the aged care workforce initiatives that have been funded in the last three years. This approach should contribute to the existing evidence base, to inform future direction.

According to the latest NILS (2012) data, job satisfaction for workers is high across all areas with the exception of pay. Personal care workers in particular are highly engaged in training with 80 per cent of direct care workers engaged in one or more training courses in the previous 12 months.

This is backed up by a BUPA internal report; in which nurses reported that they found their jobs very satisfying and valued the career advancement opportunities on offer. Nurses working outside the sector however, had a negative view of aged care, considering it a ‘last ditch’ career choice.(8) The first indigenous aged care nurse graduate, located in Wangaratta, Victoria described a moment during her graduation speech where she stood proud, and asked two theatre nurses who were diminishing her industry of choice to have greater respect by describing the complex assessment and intervention required for a deteriorating older person with multiple co morbidities.

The consortia approach to an aged care nurse graduate program led by LASA with their members in Victoria has attracted more than 100 new RN’s to the sector from a cohort of more than 600 applications from around Australia and New Zealand with a welltargeted recruitment and selection methodology. Many of these graduates are placed in regional (skills shortage) areas. 27 have travelled the pathway from personal carer to registered nurse and into this one year highly specialised program offering 12 credit points to a Masters in Nursing (Aged Care) in a partnership with Monash University.

The collegiate methodology has seen more than 40 LASA member aged care providers work together through an industry reference group to establish guidelines for best practice in supporting a new graduate.

The average age of these graduates combined for the three years of enrolment to date is 31 years. The 2014 cohort has an average age

of 27 years, 21 years younger than the median age of all aged care workers.

The evaluation undertaken by Monash University (currently in draft), reveals that 88% of graduates from the 2012 and 2013 cohort have been retained at their host provider into their second year of practice.

The general level of job satisfaction in aged care, notwithstanding pay, evidences a clear disconnect between the attitudes of people working in the sector and those outside of it which is worthy of further investigation, and could inform a recruitment strategy and campaign.

The visible outcomes of the aged care nurse graduate program consortia led by LASA Victoria, with the capacity to be replicated nationally, point us to another potential element of a highly strategic evidence based approach to securing our future workforce capability and capacity. On a clear examination of the evidence already at our disposal and with the results of the stocktake to add in, there are bound to be many others. ■ LASA organised an aged care capability and workforce roundtable, hosted by Minister for Industry, Ian Macfarlane at Parliament House in September. A number of key innovative programs were presented.

This was followed by a submission to the Department of Industry to identify age services as a priority area for the Industry Skills fund.

Ian Asidera: From IT to Aged Care. Summitcare carer, representing the 10% of male frontline care staff

Barbara Johnson: First Indigenous Graduate (2013 LASA Aged Care Graduate Nurse Program)

Attendees of workforce forum in Canberra

References (1) Intergenerational Report 2010. Archive.treasury.gov.au/igr (2) Productivity Commission Enquiry Report, Caring for older Australians, 2011:349 (3, 4, 5) T he Aged Care Workforce Final Report, 2012, Australian Government, (Department of Health and Ageing) (6) Productivity Commission Enquiry Report, Caring for older Australians, 2011, National Aged Care Alliance, Aged Care Reform Information sheet, National Aged Care Alliance, Aged Care Reform Series – Workforce (7) Productivity Commission Enquiry Report, Caring for older Australians, 2011, Training for Aged and Community Care in Australia, Australian Skills, Quality Authority.

(8) Nurses viewpoint, Nurses working in aged care, BUPA.

58 | FUSION

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FUSION | 59

Why defining and directing culture is critical Organisational culture underpins everything we do in aged care

By Carla Beheram, Manager Special Projects, SummitCare

I

t may be obvious but it is worth remembering. These days, we can offer the latest in care strategies, the best accommodation and five-star dining, but it is our culture that determines how we progress, and whether we sink or swim.

SummitCare is a care and service provider to more than 1000 people across New South Wales. Our portfolio includes nine residential aged care centres and we recently launched a homecare service in Sydney.

Our long history began almost 50 years ago, as a family-owned business with one site in Randwick in Sydney’s east. Since then we’ve grown strongly – in fact, in 2012 we became the first Australian aged care provider to achieve the gold award under the Australian Business Excellence Framework (ABEF).

This continued private ownership, vast experience and high levels of care have seen SummitCare create a culture of friendship and warmth, focused on the needs of every individual – customers and staff members alike.

AN EVOLUTION SummitCare could quite easily have stopped right there. It is an excellent position to be a recognised leader in our sector, with a strong and vibrant customer-centric culture.

But our scope has broadened considerably, particularly with the addition of SummitCare HomeCare from 2012; a new residential care centre about to be built; and a legislative environment and strong societal expectations about customer-driven care.

A few years ago, we believed it was time to evolve our focus and culture to place all our energies on promoting wellbeing and the worth of the individual.

We wanted to emphasise to our staff that we were evolving from medical practices and care of the physical, to the support of the emotional, social and spiritual needs of our customers as well – and in so doing, providing even more care choices.

SummitCare also wanted to formalise this focus, spell it out clearly, make it central to our programs and ensure we lived it every day.

So over the past 18 months, we have researched and developed (and continue to implement) a culture and values-based Wellbeing Framework that underpins every activity of our organisation.

STEADY PROCESS There is no doubt that culture and strategy go hand in hand and if done well can lead to business success. We were determined our evolution would be done well.

Our strategy involved an organisational rebrand to Warmth Worth Wellbeing following significant research – including focus groups – that showed these were the attributes that most captured the way in which SummitCare operated.

This was overseen by a steering committee, which also took on the role of analysing the possible impact of this change of focus to wellbeing, or supporting our customers in a holistic sense. The committee included SummitCare staff from all work categories to provide a wide range of viewpoints and experiences.

A Wellbeing Framework was created by the steering committee to detail how SummitCare’s current processes could fit this approach, or be altered to fit. This was a comprehensive exercise, requiring an analysis of every aspect of our operations, and much credit needs to go to this dedicated group of people.

The Wellbeing Framework includes a focus on five key attributes of wellbeing: optimal health, meaningful activities, personal preferences, personal relationships and environment.

From here, we reached an important milestone on our journey to wellbeing when the framework was unveiled to staff. We created a roadshow, which was taken to all our residential centres, with presentations from SummitCare’s senior leadership team on our values and wellbeing strategy.

It is vital it is that this level of cultural change is driven from the top – and that this commitment can be clearly seen. It is imperative that staff are able to ask questions directly of their managers about what any cultural change means for them and their work day.

60 | FUSION

GUIDING THE WAY Our roadshow was received very positively by staff, and we have placed beautifully designed posters outlining the Wellbeing Framework throughout our centres.

SummitCare has developed values cards, which are pocket cards given to all staff to remind them of the way we expect them to work, in line with our wellbeing focus.

They are encouraged to use and reflect on these values cards in their daily work, and they carry this message: W – be welcoming at all times O – be obliging and willing to learn R – be respectful T – demonstrate teamwork H – be honest with yourself, residents and colleagues.

Staff are guided in their behaviours, with a range of tips provided such as ‘I am friendly and greet people with a smile’, ‘I am an advocate for consumers’ and ‘I am non-judgemental’ through to ‘I communicate in an open manner’. We believe this assists as a gentle reminder of how wellbeing can be lived out in our organisation.

SummitCare Wellbeing brochures have also been produced for staff and customers.

TOWARDS THE FUTURE We are realistic in our expectations. It make take another year or more to ensure SummitCare’s staff fully integrate wellbeing into their work practices. That point is reached, we believe, when team members give customer wellbeing top consideration in every aspect of their care.

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But wellbeing is not just about customers: for a number of years we have run an annual Wellbeing Week for staff, where they receive advice on work-life balance, nutritional information, massages and more – all aimed at promoting their wellbeing. We also reward those living out our values through staff recognition programs… and we learn how we could do better via staff feedback channels.

SummitCare is also working diligently to make sure every communication we produce, from forms to brochures to website messages, fits in our Wellbeing Framework.

Already, we are enjoying the response to our change of focus.

New customers undergo a wellbeing assessment, helping us understand exactly how we can best support them. Staff members tell me they have noticed a renewed enthusiasm due to our clearly stated approach – and they appreciate being able to support all the needs of an individual. New staff members join us with the full knowledge that SummitCare has a fresh and engaging approach to its services.

It means to us that our values of warmth, worth and wellbeing are living values, and not just some words at the top of a brochure.

We are renewing our care focus by providing wellbeing to everyone we support, and to ourselves as an organisation.

Where will this take us in the future? Well, it gives us some exceptional advantages: a thorough knowledge of who we are as an organisation; an understanding of why we exist; and a clear framework in which to operate.

I believe the next 50 years are looking bright for SummitCare. ■ Carla Beheram provides leadership, review and support to some of the many strategic projects across SummitCare, including implementation of the Wellbeing Framework, rollout of the electronic Care Management System and aspects of clinical governance.

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FUSION | 61

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62 | FUSION

Leadership: Do we motivate?

By Sue Wray and Claire Schmierer

“Management is doing things right; leadership is doing the right things” (Drucker).

We believe fearless leadership is doing the right thing right! To be an effective leader one must manage and lead.

“A leader is someone whose direction and approach other people are willing to follow.”

And therefore, leadership is: “Influencing others to follow a given direction.” (www.learn-to-be-a-leader.com. 2009)

L

eadership is not only about creating followers; it is also employed, bullying and harassment continue to be unmanaged, about creating leaders. (Ralph Nadar).Do we motivate and so the high staff turnover downward spiral continues. our staff? If we motivate them, how do we do this?

Ineffective leadership is negative and therefore engenders How do we ensure that the aged care industry will a negative response from staff: lack of motivation, unproductive, thrive with professional employees who are enthusiastic, innovative bullying and harassment in the workplace, low staff morale, and positive about working in that specialised care industry? lack of flexibility and high staff turnover.

“I have a dream” is the famous speech by Martin Luther Examples of bullying and harassment witnessed are: King (1963). This speech has reverberated around the world for 1. Yelling at the staff if they had not immediately attended generations. But what made Martin Luther King an “inspirational” to a resident’s care leader? What made people listen to what he had to say and 2. Using words such as disappointing, not up to standard, change the way in which they saw the world? Does a title, such or becoming agitated and using belittling statements in as Manager, Director, CEO, GP or President automatically entitle meetings towards staff in front of others an audience and others to listen, and act on what has been said?

3. Ringing a bell and expecting all staff to attend the care office Nelson Mandela, a political prisoner who became president and (like Pavlov’s dog1 ) where the 44 accreditation outcomes would be recited however, the staff practical skills of care elicited a worldwide outpouring of emotion upon his death was which were lacking were not addressed considered to be a leader of his people. Was it because of what Examples of leadership styles experienced: he had suffered or was there something deeper, more integral in the make-up of the “person” that persuaded people to listen?

Table 1: Motivating positive leadership Ineffective negative leadership With more than 30 years of acknowledgement for work performed belittling/demeaning combined experience of working in inclusive isolating aged care in various roles (Registered constructive criticism berating, negative comments Nurse in charge of high and low care units including dementia units; Facility competent lack of knowledge regarding industry/nursing Manager of differing sized Residential honest/open/transparent secretive, two-faced Aged Care Services for a number of Imaginative/innovative resistive to change different organisations; multi-site General Manager; and CEO; examples of varying inspiring deflating/lack of insight leadership abilities and styles have been integrity not honest, not fair witnessed; from exceptional to abysmal. democratic/consultative/participative controlling/dictatorial Poor leadership has left bullying and harassment unmanaged, resulting in staff trust Bullying/mistrust being victimised, feeling demoralised, empowerment disempowerment/micromanaging disempowered and helpless. As a fearless leads from fear consequence staff resign, new staff are

FUSION | 63 Stephen Covey talks about synergy (Covey, 2011) when discussing leadership (Table 2). Covey stresses being positive in relationships, listening, hearing what is being said, not always saying “no” as an automatic response.

Table 2: Covey’s examples of synergistic leadership responses Synergistic boss

Traditional boss

Idea

Complaint

I need to listen to this

Telling me how to do my job

Cry for help

Personality conflict

What can I learn here?

“I am here to help you” means they think I can’t do my job

These examples clearly demonstrate a difference in strategy and approach; positive versus negative, reception versus rejection.

Motivational leadership results in: high productivity, high staff morale, motivated and committed staff, promotion of team work and staff retention.

When leaders promote these positive attitudes and responses, they are able to “get the best from the team”. They identify roles for each team member and then encourage them to perform at their best, that is, the innovator, the worker bee, the thinker.

Effective, motivating leaders provide staff with a nurturing environment which promotes their professional practice and involvement. The team functions at a high level as the leader relies on the team (followers) and the team relies on the leader.

The leader’s role is to mentor and develop staff so they grow, professionally and personally, as they are the future of the Australian aged care industry.

A recent article by Jeff Haden TransForm: Dramatically Improve Your Career, Business, Relationships, and Life -- One Simple Step At a Time ’Good bosses have strong organisational skills. Good bosses have solid decision-making skills. Good bosses get important things done.

Exceptional bosses do all of the above -- and more. (and we remember them forever.) Sure, they care about their company and customers, their vendors and suppliers. But most importantly, they care to an exceptional degree about the people who work for them. And that’s why they’re so rare.´ “The positive leadership styles that I have experienced have guided me for the last eight (8) years and shine over me like a star in the sometimes very dark sky. These guiding stars have been the reasons I have continued on my journey in aged care, always striving to lead by example; adopting and embracing the positive leadership skills I have experienced and have seen modelled.”

(Susan Wray, August 2014) Leaders who are exceptional have developed refined these behaviours which have made them known as leaders in their fields, such as the venerated Tommy Haffey, Ita Buttrose and Fred Hollows.

In conclusion, when we motivate and lead fearlessly and positively; staff are empowered, team work is facilitated and the greatest outcome of all, residents and their families are happy with their care and home. ■

References: Covey, S. 2011. The 3rd Alternative, Simon & Schuster Drucker, P 2003 The Essential Drucker: The Best of Sixty Years of Peter Drucker’s Essential Writings on Management, Collins Business Jeff Haden TransForm: Dramatically Improve Your Career, Business, Relationships, and Life -- One Simple Step At a Time https://gumroad.com/l/YHadh www.learn-to-be-a-leader.com/what is leadership.html http://www.linkedin.com/today/post/article/20140630120036-20017018-10-thingsonly-exceptional-bosses-give-employees http://www.inc.com/jeff-haden/8-ways-to-be-memorable-boss.html 1. 1 890s Russian physiologist Ivan Pavlov used a bell as his neutral stimulus whenever he gave food to his dogs, they learned an association between the bell and the food and a new behaviour had been learnt.. http://www.simplypsychology. org/pavlov.html

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FUSION | 65

Financial viability post LLLB – finding the new “Low Care” option

Introduction

T

he industry widely accepts the aged care sector will be reshaped as a result of the LLLB reforms and the increase in Home Care packages delivered into the home.

A reshaped aged care sector will result in changes to the resident accommodation mix as it will be required to cater for increasing levels of higher acuity needs in the future. Aged care accommodation will become “higher dependency high care” as aged care services will essentially cater for high care needs, specialised dementia/memory support and palliative care services.

We examine the occupancy effect and viability of a move to higher dependency high care accommodation mix. Additionally, we also examine whether or not existing facilities can attract sufficient numbers of high care residents to fill the low care gap.

Reshaping of the resident mix is particularly relevant for those existing aged care operators who are currently catering for a higher proportion of low traditional care.

We contend that current operators with an accommodation weighting towards low care carry a high occupancy risk under LLLB and should seriously consider re-evaluating their portfolios to address future changes in accommodation demands.

We present in this article, a solution which provides for an effective accommodation alternative to ensure longer term sustainability for operators.

What are current demographic trends suggesting?

In May 2013, the then Federal Ageing Minister Hon. Mark Butler indicated there were plans to increase the number of nursing home beds by 80,000 in the next 10 years. Similarly, at the same time, LASA predicted that 83,000 new nursing home places would be needed over the next nine years. We take a look at what this actually means for the composition of the ‘future’ accommodation levels foraged care.

Implied high care resident growth of 161% - 174% Analysis of the above data indicates that historically approximately 6% of the population above 65 reside in aged care accommodation. Assuming this proportion remains relatively stable, it supports the projected increased requirement of 80,000+ additional aged care places (implying growth of between 42% 50%) between 2014 and 2024 as suggested by Butler and LASA. Prior to LLLB and the Home Care package increases, this outcome may be justifiable in light of a corresponding 65+ population growth of 37%. However, in a post-LLLB legislative environment with “ageing-in-place” at the core of policy direction, additional scrutiny should focus on the ‘implied’ growth needs of high care places.

In 2012 and 2013 the proportion of High/low care residents was 50/50 in relation to total residential aged care residents.

Accordingly, the required growth rate by 2024 to replace the 50% low care resident numbers into high care is between 161% and

Table 1 is based on actual data (where available) provided by the Department of Health up until June 2013 and the Australian Bureau of Statistics with the number of projected operational places based on the Federal Ageing Minister’s and LASA’s expectations spread evenly across their respective periods.

66 | FUSION 174% (extrapolating out the respective 2012/2013 proportion of low care residents through to 2024). The high care resident replacement growth rate in Table 1 assumes a continued “historic” level of approximately 6% of the population residing in aged care into the future.

The likelihood of this 6% continued trend is in our view questionable due to the following reasons: • An estimated allocation of 149,751 home care packages between FY2013 and FY2022; • “Ageing-in-place” and user pays funding strategy resulting in persons remaining at home for longer; • Ability to provide higher levels of acuity in the home environment; • The early trend since 1st July 2014 for a diminishing proportion of low care residents entering aged care; • An increase in the types of alternative accommodation options – including Assisted Living Units and Serviced Apartments; and • Increasing perception that aged care is a ‘last resort’ and is high acuity option only.

Decreasing proportion of population entering aged care Accepting the argument that less than ~6% of the 65+ population will move into aged care going forward, a decline to between say 4% or 5.5% in 2024 would result in a surplus of aged care places of between 19,522 and 90,577 (per Butler’s projections) or 35,767 and 106,822 (per LASA projections).

Surpluses of these amounts would lead to considerable occupancy concerns.

Table 2 Surplus Aged Care Places in 2024

What does this mean for an operator?

The analysis indicates that despite what could be assumed as considerable growth in high care residents and thus signalling that the low care resident ‘gap’ could possibly be filled, the outcome is actually considerably dependent on the current resident mix of a facility.

Table 3 - 50/50 High/Low care split

Take for example a 140 bed facility and in 2014, the resident mix is 25% Supported, 10% Dementia, residual beds split 50/50 between high/low care, and 100% occupancy. However in 2024, the composition remains at 25% Supported, Dementia increases to 15% and residual beds 100% High Care. To maintain 100% occupancy, the total number of high care beds needs to increase 83% to 84 beds (from 46).

Given our view that less than ~6% of the 65+ population will move into aged care, not achieving the 83% increase may result in high levels of bed vacancies in future years. Accordingly, we advocate actions be considered to compensate for this pending change in mix through consideration of alternate forms of accommodation.

The matrix below shows a range of high/low care proportions in our example facility and highlights whether or not it will experience likely occupancy issues over the next 10 years. Results clearly indicate that current facilities with a skew towards low care residents will experience more adverse occupancy outcomes.

Occupancy impacts on revenue While the above analysis assumes 100% occupancy, should occupancy rates decline the associated impact on revenues is potentially significant.

To demonstrate the extent of occupancy reductions, Table 5 examines the 105 non-supported beds in the 140 bed facility example and assumes all these beds are DAP paying residents.

Table 6 then examines the 105 non-supported beds, but with a 70/30, RAD/DAP mix. Both outcomes indicate a negative impact should occupancy decrease from 100%.

Assumptions: MPIR = 6.63% ; RAD Value = $350k ; DAP $63.58 per day

Serviced Apartments/Assisted Living Units – The “New Low-Care Option” We propose that the new “Low Care” option for operators is to fill the occupancy gap with an aged care accommodation hybrid such as serviced apartments and/or assisted living units overlaid with a care delivery model designed to manage increasing acuity needs. Furthermore, we propose these hybrid forms of accommodation are operated under the relevant State Government Retirement Villages Acts and care is provided through a combination of a fee for service and/or a home care funded package arrangement, where appropriate.

The primary benefits of this hybrid form of accommodation operating under the Retirement Villages Act(s) are: - Loan license/lease agreement payments are excluded from pension tests for residents; • Delivery of care can be tailored in terms of needs as they increase over time;

68 | FUSION

Table 4 - Occupancy Impact Matrix *Red indicates that there will likely be occupancy issues; green indicates there will likely be no occupancy issues.

Table 5 - 100% DAP paying residents

Table 6 - 70/30, RAD/DAP mix

• For the operator it is a user pays model with the capacity for payment flexibility by adjusting a Deferred Management Fee component aligned with the residents ability to pay; • Maintains residents’ independence for a longer period in purpose built accessible accommodation; • Provides access to community and community facilities to improve wellbeing.

With the above in mind, we compared the possibility of having serviced apartments/assisted living units operating under the Aged Care Act or the Retirement Village Acts and compared operationally and financially the impact of such an arrangement.

Sustainability Table 8 considers the cumulative cash flow comparison of operating serviced apartments under the various Acts.

It is clear that operating under the Retirement Village Act produces greater cash flows over the life of the asset due to the presence of the DMF. That said, operating under the Aged Care Act still presents a compelling alternative accommodation option.

Table 7 - Comparison

FUSION | 69

Conclusion A reshaped aged care industry under LLLB will result in an industry catering more to people with increasing levels of higher acuity needs.

In conjunction with “ageing-inplace” as a core policy direction, our view is that current projected requirements of aged care places is overstated given that the demand will likely decline.

Additionally, maintaining occupancy levels will be challenging if an operator has a skew towards low care places. A sustainable alternative accommodation option for such operators rests in a Serviced Apartment/Assisted Living Unit form, the new “Low Care” accommodation.

Premier Consulting Premier Consulting is a leading Aged Care, Retirement Living and Community Care consultancy firm with a primary focus to assist clients develop mission-driven, financially viable business strategies that meet their community’s needs. ■

70 | FUSION

What makes a Healthcare Leader?

Emotional Intelligence at Work

What’s the ‘right stuff’ to be a healthcare leader? It’s more art than science as David Goleman describes in his article in Harvard Business Reviews 10 Must Reads1. Through his research he has found that the most effective leaders have a high degree of emotional intelligence. IQ and technical skills are important but mainly as ‘threshold capabilities’ i.e. they are the entry-level requirements for executive positions.

W

ithout emotional intelligence a person can have a bright analytical mind and an endless supply of smart ideas but they still won’t make a great leader. Organisations are full of stories of highly intelligent, highly skilled executives who have been promoted into leadership positions only to fail at the job; and others with solid, but not extraordinary, intellectual abilities and technical skills, who have been promoted into similar positions only to soar.

Goleman’s research focused on how emotional intelligence operates at work. He examined the relationship between emotional intelligence and effective performance within the areas of self-awareness, self-regulation, motivation, empathy and social skill.

In his research Goleman analysed 188 organisations to determine which personal capabilities drove outstanding performance. He grouped the capabilities into three categories: purely technical skills like business planning; cognitive abilities like analytical reasoning and competencies demonstrating emotional intelligence such as the ability to work with others and effectiveness in leading change.

On analysing performance data it was shown that emotional intelligence played an increasingly important role at the highest levels of a company where differences in technical skills were of negligible importance.

1. Self-awareness Self-awareness means having a deep understanding of one’s emotions, strengths, weaknesses, needs and drives. People with strong self-awareness are honest with themselves and with others. They are neither overly critical nor unrealistically hopeful.

They recognise how their feelings affect them, other people and their job performance.

People with high self-awareness are candid and have an ability to assess themselves realistically. They are able to speak accurately and openly about their emotions and the impact they have on their work.

Self-awareness can be identified during performance reviews. Self aware people know and are comfortable talking about their limitations and strengths and demonstrate a thirst

for constructive criticism. By contrast people with low selfawareness interpret the message that they need to improve as a threat or a sign of failure.

2. Self-regulation The key to successful self-regulation is the ability to control or redirect impulses and moods together with the propensity to think before acting. Successful self-regulators still feel bad moods and emotional impulses, just as everyone else does,however they find ways to control them.

Self-regulation is important for leaders because people who are in control of their feelings and impulses (i.e. people who are reasonable) are able to create an environment of trust and fairness.

Self-regulation is important for competitive reasons. In today’s fast-moving and ever-changing environment people who have mastered their emotions are able to roll with the changes.

When a new initiative is announced they don’t panic. Instead they are able to suspend judgment, seek out information and listen to others.

Self-regulation also enhances integrity – both personal and organisational. Many bad actions that happen are a function of impulsive behaviour. People don’t necessarily plan to lie,exaggerate, or misrepresent situations. When an opportunity presents itself people with low impulse control just say yes.

By contrast people with high levels of self-regulation challenge impulses and build lasting relationships based on trust.

Leaders with emotional self-regulation therefore have a propensity for reflection and thoughtfulness; comfort with ambiguity and change; and integrity – an ability to say no to impulsive urges.

3. Motivation Effective leaders are driven to achieve beyond expectations –their own and everyone else’s. Many people are motivated by external factors (big salaries, impressive titles, being part of a prestigious organisation) however those with leadership potential are motivated by a deeply embedded desire to achieve for the sake of achievement. These people have a passion for

FUSION | 71 the work itself, they seek out creative challenges,they love to learn and they take great pride in a job well done. They are often restless with the status quo, want to do things better and are eager to explore new approaches to their work.

People who are driven to achieve are forever raising the performance bar. People who are driven to do better also want a way of tracking progress – their own, their teams and their organisations.

Whereas people with low achievement motivation are often fuzzy about results, those with high achievement motivation often keep score by tracking such hard measures as KPIs, sales results and market share.

People with high motivation remain optimistic when situations are against them. In such cases self-regulation combines with achievement motivation to overcome the frustration and depression that come after a setback or failure.

Motivation to achieve translates into strong leadership. When leaders set the performance bar high for themselves they will do the same for the organisation. Similarly a drive to surpass goals and an interest in keeping score can be contagious. Leaders with these traits can often build a team around them with the same traits.

4. Empathy Empathy means thoughtfully considering employee’s feelings,along with other factors, in the process of making intelligent decisions. It doesn’t mean adopting other people’s emotions as one’s own and trying to please everybody – because that would make action impossible.

Leaders with empathy understand the emotional make-up of people – they know what their people are feeling. People with empathy are attuned to subtleties in body language – they can hear the message beneath the words being spoken.

5. Social Skill Social skill is not just a matter of friendliness, rather social skill is friendliness with a purpose – moving people in the direction you desire.

Socially skilled people tend to have a wide circle of acquaintances and they find common ground with people of all kinds. It doesn’t mean that they socialise continually but it does mean that they work according to the assumption that nothing important gets done alone. Such people have a network in place when the time for action comes.

Social skill is the culmination of the other dimensions of emotional intelligence. People tend to be very effective at managing relationships when they can understand and control their own emotions and can empathise with the feelings of others.

Socially skilled people are adept at managing teams. They are expert persuaders – a manifestation of self-awareness,selfregulation and empathy combined. Good persuaders know when to make an emotional plea and when an appeal to reason will work better. Motivation makes such people excellent collaborators – their passion for the work spreads to others and they are driven to find solutions.

Socially skilled people may at times appear not to be working at work. They are chatting in the corridors with colleagues or

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72 | FUSION joking around with people who are not even connected to their ‘real jobs’ Socially skilled people don’t think that it makes sense to arbitrarily limit the scope of their relationships. They build bonds widely because they know that in these fluid times they may need help someday from people they are just getting to know today.

Social skill is a key leadership capability. Leaders need to manage relationships effectively. A leader’s task is to get work done through other people and social skill makes that possible.

Sample questions to include during interviewing, performance discussions and reference checking Self-awareness Tell me about yourself.

How would your colleagues describe you?…tell me more Tell me about your strengths and your limitations.

Tell me about a time when you received feedback.

Tell me about a time when you had a great success.

Tell me about a time when you made a big mistake.

Self-Regulation How do you handle stressful situations?

How do you relax?

Tell me about a time when you got angry. What did you do?

When do you feel most under pressure?

How do you handle multiple demands?

How do you achieve work/life balance?

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ENVIRONMENTAL SCAN

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Motivation What motivates you?

Why do you work?

How do you measure success?

What results do you achieve?

Tell me about some challenging goals you have set?

How do you overcome obstacles and setbacks?

What do you do to stay up-to-date with sector developments?

Empathy Describe a time when you had to deliver difficult news.

What do you do when someone comes to you with a problem?

Describe the people in your team and discuss what they need and how they feel.

Describe a time when understanding someone else’s perspective helped you understand them better.

What do you do to understand someone else’s behaviour?

How do you understand what your team members are feeling?

Social Skill Tell me about a time when you needed to influence someone.

Describe a difficult issue you had to deal with.

Tell me about what you would do to gain respect as a new manager.

Tell me how you build networks within your organisation.

How do you develop rapport with people?

How do you build relationships with people?

Summary In summary, successful healthcare leaders have highly developed emotional intelligence. They have self awareness –they know their strengths, weaknesses, drives, values and impact on others. They have self-regulation – they control or redirect disruptive impulses and moods. They have motivation – they relish achievement for its own sake. They have empathy – they understand other people’s emotional make-up. And they have social skill – they build rapport with others to move them in desired directions.

These first three components of emotional intelligence are self-management skills. The last two – empathy and social skill,concern a person’s ability to manage relationships with others. Successful leaders strengthen these abilities through persistence, practice and feedback. Emotional intelligence can be learned. The process is not easy. It takes time and commitment. ■

About the author We need to hear from you on current and emerging practices and priorities to help build the national picture of Australia’s care industry.

No one knows your work like you do, so what are you going to say?

COMMUNITY SERVICES & HEALTH INDUSTRY SKILLS COUNCIL admin@cshisc.com.au www.cshisc.com.au

Dr Glenn Carter, owner and Managing Director, Health & AgedCare Professionals

References 1. Notes from “What Makes a Leader?”. Daniel Goleman. HBRs 10 Must Reads.

The Essentials. Harvard Business Review Press. 2011.

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RedUSing the use of sedatives in Aged care

By Dr Juanita Westbury

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here has been much publicity over the past few years regarding the use of sedative medication in residential aged care facilities.(1) These medicines ‘sedate and calm’ and include the drug classes of antipsychotics (e.g. risperidone, quetiapine and olanzapine) and benzodiazepines (e.g. diazepam, oxazepam and temazepam). Although used to treat schizophrenia and bipolar disorder, antipsychotics are mostly prescribed in older people to treat behavioural symptoms and delusions in dementia. Benzodiazepines are used as sleeping tablets and for anxiety.(2) There are many good reasons to be cautious when using sedatives in older frail residents of aged care facilities. The main one is that they tend to offer modest effectiveness but can cause significant side effects. Antipsychotics will reduce agitation in about one out of five people with dementia but they are not effective for symptoms such as calling out or wandering.(3) When first started, benzodiazepines help residents sleep and reduce anxiety; however, many residents become tolerant to their effects after a few weeks, and they often become dependent on them.(4) It is important to recognise sedative medications can cause significant side effects.

Their use results in higher rates of pneumonia, stroke, falls, confusion and incontinence (3,4).

Before starting sedatives it is good practice to determine reasons for behavioural symptoms, anxiety and sleep disturbance.

Does the resident have an unmet need that may be contributing to their behaviour? Could they be in pain, over or under stimulated, reacting to their environment or a carer’s well-meaning approach?

Non-drug measures should always be tried first, including providing activities matched to the resident, promoting good sleep practice and examining ways to reduce anxiety levels. Even when sedatives are prescribed, these non-drug measures should be continued.

Of course, there are residents who will need these medications; however professional guidelines stress that sedatives, due to their limited effectiveness and high risk of side effects, should be reviewed on a 3 month basis with a view to reduction whenever possible.(5) These are the key messages of a Department of Social Services funded project called ‘RedUSe’ which simply stands for ‘Reducing Use of Sedatives’. LASA has helped to develop the RedUSe project, along with other bodies such as NPS Medicinewise, the Pharmaceutical Society of Australia, ACSA, BUPA Care and Southern Cross Care. RedUSe will be run in 150 aged care homes across the country over the next 2 years.

The RedUse project runs for 6 months. Each participant home is provided with an up-to-date audit of their sedative use, which is benchmarked against national home sedative use data. The RedUSe e-audit collects sedative medication data direct from

community pharmacy packing programs, including Webstercare, Fredpack, MPS and Minfoss. This e-audit report is then presented to nursing staff at two interactive educational sessions spaced 3 months apart. As an integral part of the project a champion nurse is appointed at each home. These champions promote RedUSe, but they are also an essential participant in the sedative review process, along with a trained pharmacist and the resident’s GP. Guidelines, resident and relative information and regular newsletters have been produced as supporting materials for the project.

So how is the RedUSe project tracking? To date we have received over a hundred expressions of interest from independent facilities which strongly demonstrates the willingness of the aged care sector to promote the quality use of sedative medication.

The first of four implementation waves is well underway, with many homes approaching the half-way mark. A total of 27 homes are involved in the first roll-out wave across SA, WA and Victoria.

Although we hope to release interim findings in due course, it has been noticed that the average rate of antipsychotic use across all wave 1 homes is not as high as reported previously; however, there has been a corresponding rise in the use of benzodiazepines, particularly oxazepam.

Recruiting for the second wave (due to commence in Oct/ Nov) is in full swing, with 40 New South Wales, Queensland and Tasmanian homes coming on board. If you would like more information about the RedUSe project please watch our You Tube video (link: https://www.youtube.com/watch?v=yIxC3IKu5PU) or send an email to reduse.project@utas.edu.au. We are actively seeking expressions of interest from any home wishing to participate. ■

References: 1. A lzheimer’s Australia. The use of restraints and psychotropic medications in people with dementia. Paper 38. March 2014. Available at: http://www.fightdementia.org.au/ research-publications/alzheimers-australia-numbered-publications.aspx 2. R ACGP. Medical care of older persons in residential aged care facilities (silver book). 4th Ed. 2006. Available at: http://www.racgp.org.au/your-practice/guidelines/ silverbook/ 3. N PS MedicineWise. Over use of antipsychotics in dementia - Is there a problem?

Sept 13. Available at: http://www.nps.org.au/publications/health-professional/healthnews-evidence/2013/antipsychotic-dementia 4. R econnexion. Benzodiazepines: side effects and long term effects. 2013 http://www. reconnexion.org.au/side-effects-and-long-term-effects/w1/i1023215/ 5. N SW Health. Assessment and Management of People with Behavioural and Psychological Symptoms of Dementia (BPSD): A Handbook for NSW Health Clinicians. May 2013. Available at: https://www.ranzcp.org/Files/Publications/AHandbook-for-NSW-Health-Clinicians-BPSD_June13_W.aspx

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FUSION | 75

A playful approach to dementia

By Jean-Paul Bell, Creative Director, Arts Health Institute

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ementia in its various forms strikes fear for many of us as we age. It’s bad enough adjusting to physical decline let alone the idea of ‘losing your mind’.

Dementia is also often surrounded by myths that often are not substantiated by the realities that come with the disease.

Much effort and money is spent on research to combat the varying forms of dementia that affect middle age people as well as the rest of our aging community. We know that neurodegenerative diseases are without a cure and we just need to treat the symptoms to maintain the best quality of life that can be possible.

The trend these days is for people who are ageing with or without dementia to continue to live at home. Living longer living better has been the government message and much funding has gone into this worthwhile policy. As a consequence, people are presenting later into aged care with a myriad of different health issues needing more specialised staff.

The Arts Health Institute has been involved in a number of interventions for the past three years using play and humour. Our staff enter nursing homes and work alongside the care staff to tap into each individual’s interests, social background and life history, which has shown to have the most profound and lasting effects for people who are depressed, agitated or self-isolating. Elders can develop greater confidence and start to socialise after years of self-isolation. Elders who have been non-verbal have come alive, reconnected and established communication within the care facility with staff and family. For instance, one person would hide in a cupboard and care staff could not get near until one of our Play Up valet’s used a gentle approach with a puppet. Slowly the resident started to engage with the puppet, then the valet, then the care staff and now goes on bus trips.

The work that we do in aged care is part of a global trend involving the arts to bring theatre, music, dance, literature and visual art to a community isolated from the world outside.

Many inspirational people from both inside and outside the aged care industry continue to do great work. Dan Cohen’s work in the United States is tremendous and ground breaking. The trailer for his documentary, Alive Inside received 10 million hits on YouTube.

It shows a man with dementia come alive listening to his personalised iPod play list of music that brings back important memories. Oliver Sacks also offers comments on this trailer. https://www.youtube.com/watch?v=8HLEr-zP3fc Having more creative and artistic programs with personal individualised connection brings people to life, it does wondrous

things for elders who have lost much with this debilitating disease.

The arts can only do so much, in reality the change that really matters has to come from within the aged care industry itself.

The clinical task orientated approach to care has to evolve into something more connected, socially engaging and enriching for not only elders in care facilities but for their carers as well. The industry is very aware of the tsunami that is approaching aged care of a generation who is well educated, much travelled and have had much more choice than the more stoic generation that preceded them. There will be more to life than Bingo that’s for sure.

A few aged care organisations have been on the path of change for some time. Blue Care in Queensland have been successfully using a customer service model for staff known as ‘The Fish Philosophy’, authored by Steve Lundin and based on the experience of the world-famous Seattle Fish Markets. This is a simple but effective mantra promoting more social engagement from staff from using the four fish principles.

1. Play Work made fun gets done, play is not about toys and games, it’s about your state of mind making everyday tasks different, fun and challenging.

2. Make their day People can’t be too busy to think about someone else.

3. Be present Move being present up the list of priorities.

4. Choose your attitude If you look for negativity you will be sure to find it.

Let’s hope the cure for dementia is upon us soon and in the meantime why not commit to making the world of aged care more fun and engaging. ■ The Arts Health Institute is a national organisation that brings the arts and healthcare together to change worlds. Their programs are guided by the evidencebased research and build programs that scale across multiple sites and in the community setting. Their annual National Play Up Convention will be held at Sydney’s Luna Park from 24th and 25th November.

76 | FUSION

Energy optimisation for continuous patient care

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ontinuous, reliable energy is important in the aged care sector in order to ensure that the best outcomes and safety of patients is met. Australiaâ&#x20AC;&#x2122;s ageing population only makes this more of a focus.

According to the Australian Bureau of Statistics (ABS), between June 30 1993 and June 30 2013 the proportion of people over the age of 64 has increased from 11.6 per cent to 14.4 per cent and those 85 and older has nearly doubled from 1 per cent to 1.9 per cent.

In order to ensure quality care is provided for the growing population of older Australians, aged care operators and facilities managers must prioritise energy efficiency, while maintaining a high standard of care for patients. Energy efficiency in aged-care services results in reduced operating and maintenance costs, reduced system and equipment failure and lower energy consumption and carbon emissions.

For facilities operators, it is often a priority to ensure that saving energy does not sacrifice the quality of care they provide. As such, Energy Action has designed a number of energy procurement, contract management & energy reporting and energy efficiency solutions aimed at cutting down costs and driving performance.

Many aged care facilities start with wanting more cost efficient electricity and gas rates and most facilities managers are unaware that the energy component of their electricity and gas bills are negotiable. Depending on your energy requirements there are a number of tools available from which to build an energy procurement solution that identifies your consumption needs and offers the best type of procurement for your facility. The options include an online reverse auction, a group buy or a tender.

Energy Action works with all the major energy retailers who bid to win the contract and provide you with energy services at the best possible rate.

Once energy procurement is finalised, it is equally important to monitor energy contracts to ensure the correct charges are applied and energy use is being optimised for the most energy efficient operation of your aged care facility. Ongoing contract management and energy reporting services provide contract administration for single or multiple sites, energy reporting across different facilities, bill validation and annual network tariff reviews, which have proven to identify significant savings on energy costs in many circumstances in excess of the benefits obtained via improved procurement outcomes.

FUSION | 77 According to the NSW’s 2012 Energy Saver aged-care toolkit, the aged care sector consumes 7.8 million gigajoules a year. As demand for aged care services increases, so too does energy consumption. Energy efficiency solutions can result in energy savings of up to 40 per cent.

With the network charges portion of your bill becoming more significant, it is timely to consider options to generate electricity onsite to offset a part of your consumption.

Examples include onsite generation projects, such as biogas, solar power and cogeneration & trigeneration technologies, tuning of existing plant systems and lighting retrofits. These ensure ongoing energy saving benefits, while reducing your reliance on grid stability, which can be particularly attractive for owners of healthcare facilities.

Energy Action has assisted a number of aged care facilities, including Ramsay Health Care and Healthe Care with their energy management requirements by reducing their energy costs and optimising the energy efficiency of their facility’s operation without compromising patient care.

Case Study 1: Ramsay Health Care Outcomes • Strategically took advantage of current market conditions to lock in beneficial future contract terms; • Achieved a saving of $611,814 (2.4 per cent of total energy spend) over life of future contract; • Streamlined contract end dates.

Ramsay Health Care is one of Australia’s largest healthcare providers. The global hospital group operates 151 hospitals and day surgery facilities in Australia, the United Kingdom, France, Indonesia and Malaysia and treats more than 1.4 million patients a year. In 2012 and 2013, Ramsay Health Care was recognised as one of the Global 100 Most Sustainable Corporations in the World.

Since 2008, Energy Action has provided Ramsay Health Care with ongoing energy procurement and management services. These services have enabled the organisation to achieve the best available energy rates for the substantial energy requirements of all of its healthcare sites across Australia.

In March 2011, the major healthcare provider used the Australian Energy Exchange (owned and operated by Energy Action) to secure its energy contracts for the second time. Despite the fact that the company’s energy contracts were not due to expire until 2012 - 13, Energy Action identified advantageous market conditions and advised the company to pre-purchase contract terms, effectively locking in future prices.

This strategic decision allowed the healthcare provider to take advantage of excellent short-term energy rates - a result of excess generation in Queensland at the time.

The company was able to achieve a significant saving of $611,814 (or 2.4 per cent of its total energy spend) over the contracted terms - as opposed to an increase in its energy costs, which would have been the more likely scenario had it not prepurchased contract terms.

The process also allowed the company to streamline the end dates of its energy contracts in the eastern states, ensuring future ease of administration and time savings when the energy contracts need to be renegotiated.

In addition to using the Australian Energy Exchange to procure energy, Ramsay Health Care also used Energy Action’s Contract Management & Energy Reporting Service for all of its healthcare sites. This service is powered by Energy Action’s very own technology platform, Activ8. Through this service Energy Action has enabled the company to monitor its energy usage and achieve further cost savings.

Energy Action has also conducted bill validations for each of the company’s energy contracts, as well as energy audits for each of its sites. In doing so Energy Action has identified practical, low-cost opportunities for the company to make substantial energy savings. These have been achieved by making changes to the air-conditioning, upgrading ventilation, changing light bulbs, refrigeration, compressors and introducing variable speed drives at Ramsay Health Care facilities around Australia. For more information see www.energyaction.com.au ■

Sources http://www.abs.gov.au/ausstats/abs@.nsf/0/1CD2B1952AFC5E7ACA257298000F2E7 6?OpenDocument http://www.lasa.asn.au/aged-services-in-australia/ http://www.ramsayhealth.com/about-us/default.asp http://www.ramsayhealth.com/news/Global-100-Sustainability-List-2013.aspx http://www.corporateknights.com/sites/default/files/Global100Release_Final_Jan25(1). pdf http://www.healthecare.com.au/67/Our-Business https://www.arv.org.au/about-us http://www.environment.nsw.gov.au/resources/business/Aged-CareToolkit.pdf

78 | FUSION

The Palliative Approach Toolkit

By Professor Liz Reymond MBBS (Hons), FRACGP, FAChPM, PhD Director, Brisbane South Palliative Care Collaborative, Metro South Health, Queensland

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here is agreement across Australian Government policymakers, peak professional bodies in aged care and palliative care and carers that residents in residential aged care should be able to age and, if possible, to die ‘in place’.1,2 There is also agreement that residential aged care management and staff need to be supported to provide high quality end of life (terminal) care for this growing and vulnerable population.

The National Rollout of the Palliative Approach (PA) Toolkit project is helping to address this by building the capacity of residential aged care facilities (RACFs) to deliver high quality end of life (terminal) care. The project is being led by Brisbane South Palliative Care Collaborative working in partnership with the University of Queensland/Blue Care Research & Practice

Development Centre, Leading Aged Services Australia, the Australian & New Zealand Society of Palliative Medicine and the Royal Australian College of General Practitioners.

Since the start of the project in late 2012, the project team has developed several new PA Toolkit resources and an accompanying 1-day training program for RACF managers and nursing staff on how to use the PA Prof Reymond and Toolkit resources. participants, PA Toolkit “The project has been very successful workshop, Brisbane and almost 2000 staff at more than 1110 facilities have been trained in how to provide high quality palliative and end of life care for their residents”, comments Professor Liz Reymond, Director, Brisbane South Palliative Care Collaborative.

“The consistent delivery of high quality palliative and end of life care, which is based on the best available evidence, is key to maintaining the satisfaction of residents, families and staff in relation to day to day care provision,” says Professor Reymond.

Why implement a palliative approach in residential aged care?

“A palliative approach offers many benefits to residents, their families and the residential aged care team and it’s encouraging to hear from many of our workshop participants that they have updated, or are starting to update, and put policies and procedures in place to improve end of life care for their residents” says Professor Reymond.

Some of the benefits include: • Offering the resident and family consistent and continued care by staff with whom they have developed a rapport and positive therapeutic relationship.

• Facilitating advance care planning so a resident’s values, beliefs and preferences for future health care are documented.

• Increasing the involvement of the resident and their family in decision-making about care.

• Encouraging open and early discussion on death and dying.

• Providing opportunities, especially for improved control of pain and other symptoms, in a setting that is familiar to the resident.

• Reducing the potential distress to residents and their families caused by a transfer to hospital.

• Reducing the number of residents admitted to hospital as staff increase their skills to manage the palliative care of residents in the facility.

FUSION | 79

What is the PA Toolkit?

The PA Toolkit is a practical, easy to use set of resources designed to assist aged care providers to develop a model of palliative care in their facility and implement a comprehensive, evidencebased palliative approach to care Selection of the PA Toolkit for residents. The PA Toolkit is resources underpinned by a framework of care that illustrates how a resident’s estimated prognosis can be used as a trigger to implement the three key processes, i.e. advanced care planning, palliative care case conferencing and end of life (terminal) care.

The PA Toolkit includes a range of practical guides, self-directed learning packages, educational DVDs, and clinical and management resources. These resources are all freely available online at http://www.caresearch.com.au/PA Toolkit.

The PA Toolkit was originally developed and pilot-tested in 2009-10 as part of the Comprehensive Evidence Based Palliative Approach in Residential Aged Care (cebparac) project led by the UQ/Blue Care Research & Practice Development Centre. Under the current project six new clinical, educational and management resources were added to further support the implementation of a palliative approach into policy and practice in residential aged care.

Aged care staff are invited to register for free palliative care and advance care planning workshops delivered by Decision Assist. Hosted by registered nurses with extensive advance care planning and palliative care experience, the workshops are being held nationally and are specifically designed to meet the needs of staff working in both residential and community aged care settings.

Three thousand copies of the PA Toolkit have been printed enough to ensure that each approved residential aged care provider will receive a copy. The initial distribution is only to facilities that participate in a training workshop so staff learn how to use the resources, however, a wider distribution will commence later in the year.

While the series of 1-day workshops is almost complete, some additional training will be available in Victoria over the coming months provided by the Victorian Palliative Care Consortia. Details of the workshops are available at http://www.caresearch.com.au/ PA Toolkit.

If you would like more information please contact Gillian Davies, PA Toolkit Project Manager, at patoolkit@health.qld.gov.au.

The National Rollout of the PA Toolkit project is funded by the Australian Government Department of Social Services under the Encouraging Better Practice in Aged Care (EBPAC) initiative. ■

References 1. Palliative Care Australia. End of Life Care is everyone’s affair – tackling the challenge of ‘end of life’. Submission to the National Health and Hospitals Reform Commission, Canberra, 2008.

2. Abbey, J. The reality for aged and community care and end of life. Presentation to A Matter of Life and Death: Confronting the New Reality, Palliative Care Australia National Stakeholder Forum, March 2008, Canberra.

For further information, including how to register for a workshop in your area, call the Decision Assist aged care training line on (03) 9088 1252 or visit the website www.decisionassist.org.au Decision Assist telephone advisory service

80 | FUSION

Positive Outcomes for people with behavioural and psychological symptoms of dementia (BPSD)

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eading to the first annual Ministerial Dementia Forum LASA articulated positive outcomes for those people with dementia, and more specifically, for those with behavioural and psychological symptoms of dementia (BPSD). LASA agrees that Dementia is not a single condition.

Rather it is an umbrella term that encompasses a range of conditions that affect memory, thinking, behaviour and the ability to perform everyday activities. LASA therefore promotes the adoption of better practice dementia care and support in both residential care and care and support in the home.

Jitka Zgola has been quoted as saying that the aim of effective care is to support quality of life that respects the dignity, identity and needs of both the person in care and the care giver.1 Henry Brodaty describes why behavioural and psychological symptoms of dementia (BPSD) are important; because BPSD distresses people with dementia and caregivers, increases rate of institutionalisation, has a higher rate of complications in hospital and a faster rate of decline with associated increased mortality.2 Further, Brodaty purports that people with BPSD are more likely to be physically restrained, receive antipsychotic medication, and negatively influence other residents. BPSD increases the cost of institutional care for persons with dementia and the symptoms, especially aggression and calling out, increase nurse/carer stress.

The behavioural and psychological symptoms of dementia are described as: • Agitation • Aggression • Calling out/screaming • Disinhibition (sexual) • Wandering • Night time disturbance • Shadowing • Swearing • Depression • Anxiety • Apathy • Delusions • Hallucinations • Irritability • Elation/euphoria3 LASA believes that the outcomes of care for people with severe BPSD will be impacted by a variety of care and service options, tailored for the individual.

There is no one right mode of care delivery that will solely impact on positive outcomes, indeed research identifies a range

of biological, psychological and environmental factors that can be implemented to assist residents and carers. Interpersonal relationships are at the core of care delivery and those caring for people with BPSD require capacity, knowledge and capability to effectively implement those strategies best prescribed by a person’s medical practitioner, developed in consultation with the care team, the person and their family.

LASA suggests that positive outcomes will be gained when the extensive research findings are better translated into care options and implemented more widely to mainstream home and residential care settings. Those positive outcomes would include a reduction in the type and frequency of the symptoms described above.

LASA supports activities where an appropriate biopsychosocial-spiritual approach is utilised, including appropriate medical interventions, such as medication management4, which are implemented in a manner that supports both the person and those they live with. Early intervention, the acknowledgement and management of triggers to BPSD, and the evaluation of care options are vital for active care delivery.

More globally, what people are looking for is that which Zgola described; the demonstration of a quality of life that respects the dignity, identity and needs of both the person in care and the care giver.

How then can this be achieved in the budget restrictive environment that faces the industry today?

The June Ministerial announcement ended the Dementia and Severe Behaviours Supplement for residential aged care from 31 July 2014. This Supplement was designed to provide essential resources for the care of people with severe BPSD. The Supplement was used by aged care organisations to: • Assess, monitor and evaluate persons with behaviours that greatly impacted their quality of life to ensure they are receiving the best possible care in the most appropriate environment for their needs, • Deliver dementia specific education for staff and education in associated/related topics, • Offer supported lifestyle programmes to permit individual/ group engagement with residents, • Provide additional, specialised staff to care for those living with dementia, and • Provide additional diversional therapy to appropriately address severe behaviours and implement Dementia specific activities.

FUSION | 81 Regrettably some of these initiatives may no longer be able to be provided in the funding vacuum.

Much was discussed at the Ministerial Forum, however what appeared to be missing was the identification of the resources available now and into the future for dementia care more generally and the differentiation between dementia as the umbrella term and the more specific cohort of people who will from time to time, as part of their journey through the dementia spectrum, display severe behavioural and psychological symptoms of dementia (BPSD).

Little emphasis seemed to be placed on the care needs of people who remain at home with BPSD and the specialised skill set required of the family carer and paid carer. Also little discussion was held in relation to the prevention or lessening of the display of severe BPSD. LASA sees a pragmatic approach to the issues that face the Minister in relation to the short and medium timeframes.

The long term approach needs to bring together the information that currently exists. For example, there is a wealth of information amongst the Aged Care Funding Instrument (ACFI) data that should be interrogated to assist in identifying the level of the population that may be at risk of developing severe BPSD. However it is widely accepted that the subsidies paid via the ACFI do not fully capture the cost of care needs of residents exhibiting severe and complex behaviours5 and this needs to be considered in any short term solution. To not fully utilise this data set and not meet the policy initiatives outlined when ACFI was implemented close to a decade ago, is a regressive step for the industry.

There seems to be no formal evaluation of the range of initiatives that are currently available to support people with severe BPSD and no obvious mechanism to disseminate the translation of research into practice and learnings from that research.

Some providers appear to be unaware of the extensive work summarised in the briefing document prepared for the Forum, they have no way of accessing the information, let alone the services identified. For example, the variability in the way the Dementia Behaviour Management Advisory Services (DBMAS) are provided across the nation is confusing, and what each of those services see as their core business can also differ from state to state.

The Forum also identified that many providers are concerned over the obvious differences for rural and remote services and it has been suggested that this section of service level should attract a different method of solution than urban services may consider.

LASA would prefer to see support provided to those facilities that can demonstrate a developing skill set that can meet the needs of those people with BPSD and the links to support services within the system.

LASA strongly supports positive outcomes for people with dementia, and more specifically, for those with BPSD. LASA has called on the Government to: • Reinstate appropriate funding for those residents living with severe dementia, • Commit to transparent guidelines, assessor training and clear protocols for accessing dementia funding, • Work with LASA to ensure funding is effectively targeted, reaching the individuals who display severe BPSD, and

Attention aged care business owners Did you know that between 1 October – 14 November 2014, you can nominate your preferred workers compensation provider?

we’re making workers compensation easy

As an Australian owned mutual, Employers Mutual’s specialist services not only help people get their lives back after workplace injury but also can help your business save money.

If your current provider is not making your workers compensation easy, make the switch to Employers Mutual today.

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82 | FUSION • Commit to consultation with aged care providers, particularly regarding any decisions presenting sovereign risk to viability. ■

2. http://www.fightdementia.org.au/common/files/NAT/2011_Nat_AAconference_

References

3. http://www.fightdementia.org.au/Search.aspx?usterms=BPSD

1. http://www.fightdementia.org.au/common/files/NAT/20020700_Nat_IP_ PersonalPossible.pdf

Brodaty2.pdf

4. LASA is an active member of the Reducing Use of Sedatives (RedUSe) Project. https://www.pharm.utas.edu.au/reduse/ 5. http://www.dss.gov.au/sites/default/files/documents/07_2014/eligibility_ guidelines_february_2014.pdf

Managing Extended Non-Work Related Illness or Injury

T

he process of lawfully and fairly managing the extended absence of an employee with a non-work related illness or injury can be difficult to navigate.

Whilst for work related illness or injury the return to work obligations under the State based accident compensation acts provide a clear process for providing pre-injury or suitable employment– no such guidelines exist when an employee’s absence is non-work related.

Nonetheless, there are some general steps employers can follow to manage non-work related absences to mitigate the impact on business operations.

Firstly, employers need to be aware that section 352 of the Fair Work Act 2009 (Cth) prohibits the dismissal of an employee because they are temporality absent from work due to personal illness or injury. Under regulation 3.01 of the Fair Work Act Regulations 2009, an absence is not considered ‘temporary’ if it extends for a period of more than 3 months, or the total absences of the employee equate to more than 3 months within a 12 month period. Any absence on paid personal/carer’s leave does not contribute towards this 3-month threshold.

Although termination of employment after this 3-month threshold would not be unlawful, it still must be seen to be fair, and simply waiting for this time to pass does not help to proactively manage instances of an extended absence, or pattern of absences.

Employers are entitled to a reasonable amount of information to enable them to assess whether an employee is capable of safely returning to work and performing their duties on a consistent basis.

When an extended absence occurs an employer should write to the employee outlining the history of absence(s) and seek a meeting to discuss this concern from both the perspective of the employee’s personal wellbeing and the impact the absence(s) are having on the overall efficiency of the workplace.

Depending on the discussion at the meeting, or in instances where a meeting is not possible, the employer should request in writing that the employee provide a report from their treating medical practitioner that answers the following questions: 1. The employee’s current capacity to perform their full duties; 2. If the employee is unable to perform their full duties, the anticipated timeframe by when they will be fully fit to undertake these duties; and 3. If they are unable to perform their full duties, any recommended limitations or restrictions to their duties or hours of work, and the recommended period for which these limitations or restrictions should apply.

The answer to these questions will enable an employer to determine whether the employee is fit and safe to return to work and fulfil the inherent requirements of their position, and/or enable the employer to examine whether alternative safe duties can be provided for a defined or ongoing period.

In instances where either a medical report is not provided, the inherent requirements of the position cannot be fulfilled for an extended period, and no reasonable alternatives for redeployment or job modification exist, the employer should seek a further meeting with the employee to discuss these conclusions and seek any additional information from the employee which might be of assistance before making a decision about their ongoing employment.

Managing the matter in this way should enable more informed steps to be taken to address the absence(s) and mitigate their impact on normal business operations. Noting that where an employer has solid evidence of the inability of an employee to perform the inherent requirements of their position, the employer will generally have a valid reason for termination. ■

FUSION | 83

2015 Executive Study Tour Program Studying and Advancing Global Eldercare

Now taking Expressions of Interest Bookings open 30th September 2014

Switzerland

New Zealand

Boston/Toronto

16 - 26 May 2015

July/August 2015

November 2015

How is Switzerland dealing with challenges of the future?

Study of New Zealand’s CCRC Model

North American Quality Systems

Tour includes Auckland, Tauranga & Rotorua.

Inclusive “Arctic Polar Bears” pre tour to Churchill, Manitoba

Tour includes Zurich, Benra & Basel

Visit the new look sagetours.com.au to express interest and secure your priority booking!

For enquiries, contact study leader Judy Martin via email jmartin@agedcare.org.au or mobile 0437 649 672.

84 | FUSION

FUSION | 85

Book Review: Live and Laugh with Dementia: The essential guide to maximizing quality of life Author: Lee-Fay Low BSC PSYCH(HONS). PHD

Laughter really is the best medicine.

W

orldwide over 45 million people suffer with dementia. That number is expected to increase to 75 million by 2030.

Many of these people are at the epicentre of a circle of grief and loss, as their primary carers and extended families struggle to come to terms with how best to care for those they love.

For these people the idea of ‘living and laughing’ with dementia might seem at odds with the daily reality of the disorder.

But new research shows that not only does using humour as therapy reduce difficult behaviour in sufferers, it also improves the happiness levels of the patients and their carers.

Lee-Fay Low is a leading researcher in the field of dementia and the author of Live and Laugh with Dementia, a new book which aims to help sufferers live good and happy lives.

Her premise behind the book is that just as we need exercise to keep our body’s muscles strong, flexible and working well, we also need to exercise our mental muscle (brain) to strengthen and maintain our neural capabilities. In Live and Laugh with Dementia Dr Low shows us how we can tailor activities to suit the needs and abilities of dementia patients who are unable to initiate activities themselves, and help them to: • Maintain their relationships with others • Maintain their self-identity • Slow the decline of mental function by providing physical and mental stimulation • Stave off boredom • Experience happiness and pleasure.

Hopeful and inspiring, Live and Laugh with Dementia supports people to improve their relationship with the person with dementia.

Ideal for both family and professional carers, not only does it contain suggestions for activities and how to tailor them, but it also covers a host of ideas that will empower family and friends to re-engage with sufferers, allowing them to build new relationships,

spread the load of care and add richness to the lives of the sufferers as well as meaning to their own.

Live and Laugh with Dementia also contains tips for people with mild dementia in order to empower them to stay active and keep control of their lives as much as possible.

“This insightful book focuses on what is important in the everyday life of the person with dementia and the family carer and explores the practical things we can all do to make our communities more dementia friendly.” Glenn Rees CEO Alzheimer’s Australia

About the Author: Dr Lee-Fay Low is a leading researcher in the field of dementia, and is passionate about ensuring that people with dementia enjoy the best quality of life possible. Currently Associate Professor in Ageing and Health at the Facility of Health Services, University of Sydney, Dr Low led the first high-quality study of humour therapy for people with dementia. Her interest in dementia began close to home, as her grandmother had vascular dementia.

From our reviewer: This book is about living, enjoying life and sharing special moments with people who have dementia. The book is so easy to read, Lee-Fay has the uncanny knack of translating academic knowledge into useful information that can be used by a range of people caring for those with dementia.

Exisle RRP $29.99 Publication Date September 2014 For more information, please contact Alison Worrad on: (02) 4998 3327, alison@exislepublishing.com Also available as an eBook.

Live and Laugh with Dementia is available from www.exislepublishing.com.au and wherever good books are sold.

86 | FUSION

Product News Our Services to Regional Aged Care Facilities Qualitycare Nursing Agency is an organisation that was created about 11 years ago in response to the recognised needs for increased services within aged care, acute care, disability and mental health. The agency consists of a large number of all kinds of nursing staff who are able to meet this challenge. Our staff are highly trained and suitably experienced in their respective fields of work. Our services are precisely customer focused and we work with our clients to achieve their perspective goals.

We are proud to say that through providing quality services to our clients, we have established an excellent reputation since the inception of the agency in 2003. We cover the whole of the Sydney Metro region, Central Coast and Hunter region and South Coast in New South Wales. Now we are also providing our services in the ACT, Adelaide and Melbourne metros.

We have developed a regional coverage formula to help out those facilities which are not usually covered by other nursing agencies.

We offer to temporarily relocate our nursing staff to our potential regional clients in NSW, VIC and SA, (and in other National areas too), for block booking on a weekly roster, as a replacement to your staff on long-service/maternity leave. We aim to work with individual clients on each specific requirement just to make it happen for them.

Just drop us an email or talk to us.

We as an organisation are moving forward rapidly and are able to provide precisely what our name says – Quality Care.

NSW: Suite 1-2, 947-949 Victoria Rd, West Ryde, NSW 2114 (HO) PH: (02) 8819 6636 VIC: 294 The Lake Boulevard, South Morang, VIC 3752 M: 0430 047 074 SA: 3/14 Bradbury Street, Parafield Gardens, SA 5107 M: 0432 710 010

Employers Mutual and LASA are supporting Australia’s aged care services As a trusted workers compensation claims manager for over 100 year, Employers Mutual understands the diverse support needs of our aged care service partners.

Through our experienced aged care services teams, Employer Mutual provides the specialist claims management expertise our partners need to optimise work health and safety, deliver positive return to work outcomes and help injured workers get their lives back.

We are proud of our involvement with LASA and the joint development of aged care focused programs such as our Gateway to Resilience and Organisational Wellbeing (GROW) initiative.

GROW is supported by Employers Mutual in partnership with LASA and the University of South Australia. The GROW study program is aimed at increasing the resilience and wellbeing of staff within the aged care sector, utilising a research-based approach. Quantitative and qualitative research by the University of South Australia has commenced and is focused on providing an analysis of the workplace health and safety culture within South Australian aged care facilities.

The findings from this research project will assist Employers Mutual and our aged care service partners such as LASA improve the psychosocial safety climate within the aged care industry.

As an Australian-owned mutual company, Employers Mutual is committed to providing ongoing support for our members. We reinvest part of our profits back into our Member Benefits program to provide

our members with access to a range of tools and services, designed to help prevent and reduce workplace injuries.

Employers Mutual provides employers with local and industry specialist support teams as well as access to • Results driven claims services • Free online WHS management tool • Free online workers compensation management tool • Free online e-learning courses and management tool • Complimentary professional training courses • Free Risk consultancy services • Free Return To Work consultancy services

For more information about Employers Mutual, please visit www.employersmutual.com.au We help people get their lives back

FUSION | 87

Certus Management Information System (CMIS) by Electrolux • Maintenance intervals (all actions are logged) • Error alerts (recommend actions provided) Just as significant, CMIS presents these statistics in an easy-tounderstand graphical format on your computer into programs such as Microsoft Excel.

CMIS can be installed in up to 30 machines in one location – which means users can optimise the performance of a network of washerextractors, tumble dryers and ironers.

Importantly, data can be examined and be used to identify and remove any wastage, therefore minimising costs

How to fine-tune for maximum profits and efficiency Minimising cost, maximising efficiency, and complying with stringent hygiene regulations are three key fundamentals every professional laundry’s strives to achieve.

Electrolux’s easy-to-use Certus Management Information System (CMIS) is a software package which provides laundry professionals with vital information about their laundry equipment in order to meet these requirements.

CMIS provides the following process information;

CMIS keeps a complete log of all maintenance work performed on your machine. The logged maintenance statistics tell you what was done, when and by whom. In additional it will alert you to minor problems and/or human errors. Importantly, you automatically receive messages on your PC suggesting ways to solve these problems. This feature is especially useful when trying to determine if you are dealing with human error or an actual equipment fault.

Complying with regulations More and more laundries are having to comply with tough regulations.

A key requirement of these regulations is validation. CMIS generates extensive reports direct to your PC that provides this process validation and proof of compliance, therefore ensuring customer demands and government regulations are meet.

Easy to learn – easy to use Trained Electrolux personnel will install CMIS for you and provide appropriate training. The actual downtime caused by installing CMIS is minimal, usually no more than a few minutes for each machine – which means most medium sized laundries can be fully equipped in less than one day.

• Statistics (running hours, idle time, machine usage, cost calculations) • Total consumption (water, energy and detergent)

For further information or to receive a free brochure contact Electrolux Professional on 1300 888 948 or email sales@electroluxlaundry.com.au

• Process validation (printable reports)

REALISE PERFORMANCE SPECIAL OFFER the “LASA code “LASA FUSION” when registering and offoff MentionMention the code FUSION” when registering andget get10% 10% (on top of the early-bird rate!) (on top of the early-bird rate!)

Realise Performance is conducting the 17th Aged Care and Community Services Executive and Administration Remuneration Review

• Sound data and analysis to inform strategic plans and decisions • Historical trends in remuneration practices • Feedback loop to further improve data quality and timely reporting

The survey assists in ensuring that your remuneration packages remain cost effective and competitive, by providing you with:.

• Expansion of HR and Finance job families to include support roles

• Comprehensive information on remuneration and benefits within the Aged Care and Community Services sectors

• Data on the administrative function

• Analysis of positions within the job families based on industry trends • The ability to compare your remuneration levels with industry levels, and determine the appropriateness of your organisation’s remuneration levels • A clear understanding of your remuneration benefits and costs

• Data on Assistant Manager roles in all care streams

• Data on the payroll function within the HR job family

Please contact us directly for a registration form and your special discounted rates.

P: 02 8624 3300 E: contact@realiseperformance.com.au

88 | FUSION

Why Join the Aged Care Quality Association?

Aged Care Quality Association (ACQA) delivers a completed quality package for those who are passionate about the care they deliver to their care recipients. ACQA has fourteen years of experience in the Aged Care Industry and has been collaborating with the Joanna Briggs Institute for the last four years. ACQA believes that their evidenced based program is unlike anything else on the market as it provides a quality audit program based on evidenced based practice. ACQA supports aged care and home care accreditation standards, the National Safety and Quality Health Service Standards and ISO 9001.

It also provides a means for the sharing of information and a Quality Activities program including benchmarking.

Active QMS provides ACQA with a ‘cloud based’ IT platform which is being constantly updated. This platform provides a means to integrate evidence based management of quality, safety and continuous improvement. Cloud based solutions are a great fit for small to medium size organisations, as you only need an internet connection to access the program and you can access this program on a variety of devices.

Network meetings are another strength of ACQA. The support offered through these network allows the members to actively contribute to and review the ACQA audits and keep abreast of changes in the aged care industry.

For organisations who use ACQA the distinct and consistent advantage is having a “one stop shop” for all your quality activities.

For more information go to www.acqa.org.au

Positivity is contagious: Bridging the gap to improve employee attraction and retention Organisations (and industries) that face the challenge of attracting and retaining talent need to ensure that once they have identified a candidate they need to work towards reducing on-boarding costs (including time to on-board) and increase the candidate experience in order to minimise higher turnover.

Many organisations now realise that retaining quality employees positively affects their bottom-line and overall operations. The question is … how do I attract the right talent?

Positivity is contagious. The hard and soft costs associated with high staff turnover are significant and not always fully visible or acknowledged. Increasing employee retention not only helps to drive these costs down it increases productivity while also boosting employee morale and loyalty.

Positive employees are not only advocates of an industry but also strong advocates of an employer.

An organisation may have two “A” workers with different motivations.

One worker may be more interested in the money they are earning while another is more focused on climbing the career ladder. The organisation can capitalise on both talents by helping them achieve their goals. But how?

Rather than dehumanising the employee relationship technology can be used to increase retention by assisting with everything from career planning and rostering … based on employee skills, preferences and career aspirations. Technology as an enabler also helps employees take some control in suppling and sourcing information ranging from address details through to training, certifications, licenses as well as scheduling holidays, accessing pay slips etc.

NGA’s Preceda HR and payroll solutions scalability and flexibility is regarded, by many, as key to supporting business growth. Along with its robust compliance with SOC1 (Sarbanes-Oxley) and Australian Privacy legislation, as a single source of truth Preceda grows with organisational requirements scaling and integrating with leading HR systems such as RosterLive and Successfactors.

Globally NGA Human Resources has helped hundreds of Aged Care customers, and well over 600 organisations in Australia, optimise and streamline core HR, rostering and talent management. Give us a call today: you’ll be surprised of the efficiencies we can bring to your HR.

Visit www.ngahr.com.au for more information.

FUSION | 89

Healthsite The Government’s recent Living Longer Living Better reforms are the genesis for Healthsite entering into aged care and providing websites at a low cost with no upfront fees.

Since July 1, aged care homes have been required to publish their accommodation prices with descriptions, giving consumers the opportunity to make more informed choices.

Aged care facilities without an effective, responsive website are getting lost in the increasingly competitive marketplace.

Consumers that were looking at two to three facilities are now looking at four to five, and they are going online as their first reference.

Providers should look to use the mandatory publishing of prices as a catalyst to improve their overall presentation on the web.

Consumers are concerned about more than just prices. Sons and daughters want to know where their loved ones will be living and to be confident with their choice.

Now that they have more choice, the consumer is more prudent than ever.

If you’re not on the web, you’re missing out on a big chunk of consumers who are seeking information.

Healthsite has been designing and developing websites in the healthcare space for over ten years. They support a diverse range of businesses including physiotherapy, dentistry, optical and general practice services.

Healthsite has partnered with Aged Care Online to bring clients clean, optimised websites offering new clients a $150 + GST per month ongoing plan with no upfront costs.

Aged Care Online director Ben Hannemann said “The company is proud to be partnering with Healthsite in providing clients with a reliable and cost effective web design service.”

Healthsite will be exhibiting at the LASA National Congress in October.

If you would like further information about Healthsite’s services please call Lachlan on (03) 9525 2292 or visit www.healthsite.com.au

Nocospray new Ebola Treatment & Prevention NOCOSPRAY brought to you by Equipmed, is a complete disinfection technology without harmful chemicals. NOCOSPRAY combines a Hospital Grade disinfectant with a revolutionary HPV delivery system, destroying 99.9% of all harmful bacteria, viruses, funguses, moulds and yeasts. Based on Hydrogen Peroxide vaporisation, it leaves no residues and requires no additional labour.

Protect the health of your patients and staff by containing organism outbreaks easily and efficiently. The HPV generated by the NOCOSPRAY technology will attract itself to bacteria and viruses in the air and on surfaces, causing a chemical reaction that will destroy them. Nocospray’s latest use is for Ebola Containment & Prevention.

OUTBREAK CONTAINED SAFETY FOR EVERYONE! H2O2 vapour is biodegradable within minutes and breaks down into microscopic air and water particles, making it a much more

environmentally friendly method of disinfection.

Because NOCOSPRAY is having a chemical reaction with compounds on the cell membrane of viruses and bacteria, it is impossible for the organism to develop resistance, as the same chemical reaction will take place every time.

Outcome: Total surface and air disinfection with little-to-no effort.

For more information call 1300 668 755

Confoil’s Pack and Seal systems Confoil’s Pack and Seal systems are designed for busy kitchens and are ideal for Aged Care and Meals on Wheels organisations.

Comprising of custom packaging, lidding and machinery solutions, the options can be tailored specifically to your kitchen layout, staff ratios, cooking methods and the packaging requirements of your clientele.

Meals are packed using aesthetically pleasing paperboard or pulp trays, and act as a natural insulator, meaning the packaged meals are pleasant to handle after heating.

The trays are never brittle and can withstand temperatures of –40°C to 210°C Importantly, the transparent heat sealable lids allow the meal to be viewed, and the generous film overhang allows for simple removal of the lidding.

Packaging options within the range are varied, from large and smaller portion single serve meal sizes, to pulp containers with 2 or 3 separate compartments.

Dessert and soup specific packaging are also available. Many of the trays can also be custom printed with your company logo, corporate colours or message.

To complete the system, a choice of cost effective heat sealing machinery is available, from ergonomic benchtop sealers to inline automatic models.

Contact Confoil for more information or to arrange a consultation to discuss your unique requirements.

Ph: 1800 786 340 or http://ad.confoil.com.au/packandseal/

90 | FUSION

SOLAR IS SMART FOR AGED CARE BUSINESS With payback periods on Commercial Solar Power Systems now under 3 years in some cases, interest in Solar Power and associated energy-saving items such as Commercial Solar Hot Water and LED lighting has escalated rapidly.

Solar Depot has developed a strong reputation as a leading supplier of solar energy solutions for Aged Care and Retirement Facilities.

Last year, South Australia’s largest private operator of Commonwealthfunded aged-care facilities, Padman Healthcare, undertook two major installations through Solar Depot. This included a 99kW system at its Flagstaff Hill “Skyline” facility and a 99kW system at its Lockley’s “Empress” facility which amount to energy savings of approximately $113,000 a year. These two examples are good representations of the fast payback periods and reductions in operational costs that operators can achieve when considering a correctly engineered Commercial Solar installation.

Padman Healthcare have since rolled out further installations, engaging Solar Depot to fit out numerous other sites.

Solar Depot is currently working with various developers and facility owners on solar installations, including the second largest roof mounted array in Metropolitan Adelaide. This being the Living Choice apartments at Fullarton. In this case residents within the facility reap the benefits of reduced electricity costs under a power purchase arrangement. Here the model is not purely about reducing a reliance on the grid but has a commercial model attached to it which relates to delivering cost savings to residents that pay for power.

The market for commercial solar from 30kW-100kW can involve complex Power Network augmentation in some states. Solar Depot has

an SAPN pre-approved solution that makes grid integration a trouble free process in South Australia that is significantly cheaper than those offered by the few competitors operating in the commercial solar arena.

If you are considering commercial Solar for your facility, examine prospective suppliers history and reputation as well as capabilities that should encompass, design and installation of commercial grade solar power systems with options of grid-backup and generator support.

A good supplier should deliver a total lifecycle approach to projects.

From design, to construction, monitoring, maintenance and expansion, it is important to have a renewable energy project that is effective, efficient and reliable for your facility.

Solar Depot uses their proprietary software application to measure a project’s expected efficiency, output, CO2 offset and cost under various circumstances, amongst many other things. This paired with a financial matrix that demonstrates cash flow, break even and return on investment figures for your facility that will give you the confidence of an accurate understanding of what your system will do for your financial position, now and into the future, all prior to it being installed.

Query your prospective Solar supplier on their ability to provide this data so you can forecast savings and calculate an accurate return on your investment before you commit.

Solar decisions can be complicated, but a well trained and experienced company will have the knowledge and the tools to demonstrate a perfect solution for your business and believe us, when you see the results, it really is a ‘no-brainer’!

Padman Skyline - Flagstaff Hill 99kW delivering $54,000 of savings in the 1st year

“We are South Australia’s Commercial Solar Experts” We have helped hundreds of S.A. businesses reduce operating costs. In the past 6 months we have installed enough commercial solar to save those businesses nearly $500,000 over the next 12 months!

ASA , L e at th ference s u See nal Con . 70 o o Nati Booth N

Our competitive advantages are: • 10 year history in Solar Industry • ISO 9001-2008 Quality Assurance • Comprehensive cashflow modelling • Customised System design • Low cost SAPN integration hardware • A thorough knowledge of Peak Lopping and KVA impacts renewable energy systems for commercial applications

www.solardepot.com.au

Ph 08 8382 7555

Because your staff need to concentrate on patient care Hills Health Solutions brings together the patient care expertise of Merlon, Questek and HTR. By integrating them into a single health-technology platform, we allow health care managers at hospitals and aged care facilities to focus on patients.

We bundle leading edge solutions for patient entertainment, phone service, nurse call, radio pendant systems and security. Weâ&#x20AC;&#x2122;re applying ingenuity, not just to make life easier for patients, but also for the healthcare professionals who take care of them.

hills.com.au