LASA Fusion Spring 2016 by Adbourne Publishing

The voice of aged care Spring 2016 | www.lasa.asn.au

Re-imagining aged care Also in the issue:  Aged care financing  Mergers & acquisitions  Antimicrobial stewardship

Image courtesy of Sergey Nivens/Shutterstock.com

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CONTENTS The voice of aged care

5 NATIONAL CEO UPDATE

Spring 2016 | www.lasa.asn.au

7 CHAIR UPDATE OPINION 8 LASA Directors share their views

FEATURES 24 Is increasing competition the right approach?

27 Improving medication management

29 Cranbrook Care’s 2020 vision 37 Better Practice Award winners 45 Come age with us: the EDITOR

FEATURES

Katie McKeown E: editor@lasa.asn.au

20: Re-imagining aged care standards

LASA NATIONAL

Hoffmann Method

TECHNOLOGY & INNOVATION 61 How technology is changing community care

Sean Rooney CEO PO Box 4774, Kingston ACT 2604 E: seanr@lasa.asn.au

63 3D printed dinners BUSINESS MANAGEMENT 67 M&A transactions – fundamental factors

70 Rolling through Reform 73 FBT changes: alternate options for salary packaging

ADBOURNE PUBLISHING PO Box 735, Belgrave, VIC 3160

74 Understanding the new season in aged care

Adbourne PUBLISHING

Advertising

Melbourne: Neil Muir (03) 9758 1433

Adelaide: Robert Spowart 0488 390 039

Production

Emily Wallis (03) 9758 1436

DESIGN

77 New pension assessments

49 : A residential care community with a difference

78 Marketing: selecting a creative agency

HEALTH & WELLNESS 81 Antibiotic resistant superbugs

Administration Tarnia Hiosan (03) 9758 1431

in RACFs

EVENTS 87 SAGE tours for 2017

DISCLAIMER Fusion is the regular publication of Leading Age Services Australia (LASA). Unsolicited contributions are

89 WHAT’S NEW

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.

BUSINESS MANAGEMENT 65: The legalities of security cameras

NATIONAL UPDATE I

CEO

| NATIONAL UPDATE

MAKE YOUR VOICE HEARD DURING

REFORMS REVIEW At the end of August I provided LASA Members with an update about our advocacy activity in relation to a number of aged care policy issues the current Government needs to act on. Sean Rooney Chief Executive Officer Leading Age Services Australia

hree stand-out issues are the ACFI changes and the recent modeling that was shared with us; the upcoming home care changes of which a number of issues require resolution prior to the Stage 1 changes coming into effect on 27 February 2017; and the aged care reforms review. The outcome of this Review will have a long lasting impact on all future – and possibly past – policy and legislative changes impacting all aspects of aged care. It is therefore critical that the review is thorough, informed by data from industry and offers practical solutions that Government acts upon. On behalf of our Members, LASA has provided advice to the Department on areas that need to be considered in the Review, which might not have been picked up through the legislative process. We have received confirmation that our suggestions will be covered in the Terms of Reference, which signals a positive step in the direction of true collaboration between Government and industry. Some of the major reform initiatives that have sought to improve consumer choice and satisfaction, community care options, dementia care and support for carers need to be carefully considered against their objectives. For every objective in the original reforms, the question must be asked, “Have these changes resulted in the expected outcomes?” In any instance where the answer is not a definitive “yes”, the Government must demonstrate accountability and work with the peak bodies, providers and professional associations to fix the problem, or reform the reforms. We must also consider the impact of the Reforms on other programs such as the NDIS, and consider whether the age

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For every objective in the original reforms, the question must be asked, “Have these changes resulted in the expected outcomes? requirements for the NDIS to determine eligibility should be linked to the Age Pension. As an industry, this legislated review of the reforms is our opportunity reflect on the impact of the reforms to date, consider what we have learnt on the journey so far, and identify what needs to change into the future. To do this effectively we will need to work together to contribute data and evidence that supports our views on what is working and what is not, and informs future policy directions. A legislated five-year performance review of any Government program is not to be taken lightly. A successful review will demonstrate and quantify achievements to date, identify areas for improvement, and reveal issues and opportunities that have not previously considered. A successful review will provide an evidence base upon which ministers, policymakers, providers and consumers can make informed decisions with regards to setting future policies, programs and practices for the age services industry. For industry to actively help shape the next five years of reforms we need to demonstrate our own commitment to the process and act responsibly. It is our duty and our right to do so. LASA is currently designing an engagement process to ensure all Members can have their say in the Aged Care Reforms Review process. ■

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CHAIR

| NATIONAL UPDATE

LASA’S FIRST AGM AS

A UNIFIED NATIONAL PEAK BODY The aged care sector’s marquee event, LASA National Congress 2016, is in the final stages of preparation and I look forward to engaging with the age services industry on the Gold Coast from 9 -12 October.

ASA National Congress 2016 promises to provide a thought-provoking program and a wonderful opportunity for stakeholders within our industry to move away from their demanding daily cycles and to network and share insights with one another. Over three days, the conference theme Imagining Age Services – No Borders, No Boundaries will allow delegates to explore and discuss how our industry has experienced, and is still working through, an extraordinary period of change. Change is a constant in our sector and one we are also experiencing first hand within LASA. Members will be aware that the federated LASA states unified on 1 July 2016 into one national LASA organisation. The fundamental driver for unification was to strengthen the representation and service capability of the previously discrete LASA state entities, with a focus on the provision of a united, strong and respected national voice on aged care policy. LASA’s first Annual General Meeting (AGM) as a unified organisation will be held on Sunday 9 October as part of the LASA National Congress program. The ongoing debate over changes to the Aged Care Funding Instrument (ACFI) will be one of the key issues facing members and there will be opportunities to discuss these concerns at our first unified LASA AGM. Other key issues on the agenda include Chairman and CEO updates, LASA strategic directions and the election of a Director.

Dr Graeme Blackman OAM Chair I LASA

In August, the LASA Board of Directors called for nominations from within our membership for a Victoria/Tasmania based Director on the new LASA Board. The AGM will be our members’ first opportunity to participate in the voting process for a directorship of the unified organisation. We have received several high quality nominations and I am confident that the successful candidate will provide a strong Victorian/Tasmanian voice at the unified board table. It is proposed that a series of amendments to the Constitution of LASA will also be put to members as a Special Resolution at the AGM. Three months post-unification, it is timely to address some of the issues within the Constitution to better reflect the purpose, governance composition and membership structure of the new organisation, as well as to remove some transitional clauses that bear no further relevance to LASA post-unification. Post the recent Federal Election, our inaugural CEO Sean Rooney has been working hard to address issues of importance to our members, most notably on ACFI and aged care funding issues. Through his diligence we have received support on these issues from Parliamentarians. I have no doubt Sean’s perseverance will ensure aged care funding issues receive a greater profile and priority in the new Parliament. ■

OPINION

CHANGES IN

AGED CARE

It’s been a tricky year full of change for aged care. And there are still plenty of changes ahead on the road to a different – and hopefully – better system for millions of Australians needing care or support.

ver the past two years, aged care funding has been cut to the tune of $3.1 billion, and the recent election campaign served to highlight that aged care was not front-and-centre of the national agenda.

More Federal funding cuts mean that we all have to do more with less, so the challenge for 2017 and beyond is on. By 2025, there will be close to half a million Western Australians aged over 65, an increase of almost 50 per cent. And there are more than 1.1 million Australians in aged care, so it’s an issue that will demand the national spotlight more and more.

But there was good news too. Sweeping changes announced by the Federal Government to the home care system will empower consumers and support a more diverse and market driven service industry. When it comes into effect in February 2017, the abolishment of the current Federal Government managed Aged Care Approval Round (ACAR) system will change in favour of a flexible funding package provided direct to the eligible consumer. Consumers are being offered greater choice in home care service providers and this ‘shake-up’ in the industry could lead to long-term benefits for consumers and care providers alike.

It’s a major challenge for our industry – the most pressing issues are to address how we adequately plan for and fund aged care services when they are not a priority for those who pull the purse strings at the Federal level.

The need to move from a highly regulated home care system to one that better responds to the needs of our ageing population is a positive one that will relieve some pressure from our healthcare system.

We saw both major parties scrambling to manage the country’s booming aged care sector at a time where funds are low and older Australians are demanding, and deserving of, a sustainable solution to their healthcare needs.

Older Australians deserve to have flexibility and choice of home care providers and greater flexibility in managing their government-subsidised support package to suit their individual preferences. Now we must ensure that the people who need home care understand what the changes mean and that they have sufficient information to make wise, informed choices to make sure they receive the best care possible.

For nearly 4.6 million voting Australian baby boomers and their families, it must have been a disappointment that neither major party made their aged care policy an election platform. The only public debate on the issue was largely led by aged care industry groups when Malcolm Turnbull announced $1.2bn of sweeping cuts in the 2016 Budget. The majority of cuts were made to the Aged Care Funding Instrument (ACFI), which assesses the level of funding for each resident admitted into residential care. Further cost savings were achieved by the Government through changes to means testing and the pension, while the Dementia and Aged Care Services Fund had $20 million stripped from the funding over four years.

Michelle De Ronchi Chief Operating Officer St Ives Home Care & LASA Board Director

I’ve recently been appointed to the inaugural Board for Leading Aged Services Australia (LASA). Hence, it is part of my role and that of the national peak body representing all age service providers such as St Ives Home Care, to continue to work together for the wellbeing of all older Australians. As industry representatives, we need to help ensure older Australians are aware of how the impending changes may impact their individual circumstances. Australians currently or potentially requiring home care need to be planning for their own care if they want to stay at home as they get older.

OPINION

Innovation in our industry is a must, so that we can keep up with the growing needs of our baby-boomer generation. Providers, as well as changing the way they do business to better meet consumer needs, are also looking towards solutions presented by new care technologies, such as remote health systems. Those embracing new technologies and systems are seeing efficiencies, a safer work environment for staff and clients and better healthcare outcomes. Consumers will enjoy the flexibility to change providers if needed without having to recommence the process, and this is a great step forward that should be embraced and supported. For older Australians, being able to stay in their own home on their own terms is so important. It’s something that St Ives Home Care has supported. Improving independence, social participation and overall quality of life is central to our work and vision. What’s encouraging is that the aged care industry is responding to rapid social change by fostering competition among providers. The result is improved services and innovation. Less than a year from now, the home care sector will be in the midst of reform, and there will be further changes to these

Image courtesy of Diego Cervo/Shutterstock.com

processes explored as part of the second stage of Home Care reforms in July 2018. Collaboration and communication will be paramount going forward. If the issues surrounding waiting times and quality of care are to be addressed and resolved, then everyone in the equation needs to be on board. Let’s hope that as we navigate through the second half of 2016, that the Federal Government starts to steer the aged care ship to a place where every older Australian has choice, security and quality care in the twilight of their lives. ■

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OPINION

THE AGED CARE ROADMAP –

CAN WE GET THERE? In April 2015 the Australian Government tasked the Aged Care Sector Committee, an advisory group which, amongst others, included relevant provider, consumer and workforce representatives, with developing a roadmap that sets out future reform directions for aged care.

n simple terms, the Aged Care Roadmap, which was released in March 2016, seeks to deliver a pathway to a system where older people are valued and respected, and where they, along with their families and carers, have access to competent, affordable and timely care and support services through a consumer driven, market based, sustainable aged care system. Specifically, the Roadmap sets out short term (within 2 years), medium term (3-5 years) and long term (5-7 years) goals with the final destination delivering: • A framework that empowers consumers, their families and carers to be proactive in preparing for their future care needs • A single government operated assessment process that is independent and free, and includes assessment of eligibility, care needs, means and maximum funding level • Access to care and support as needed regardless of cultural or linguistic background, sexuality, life circumstance or location • A community that is dementia aware and dementia care is integrated as core business throughout the aged care system • A single aged care and support system that is market based and consumer driven, with access based on assessed need • A single provider registration scheme that recognises organisations registered or accredited in similar systems, and that has a staged approach to registration depending on the scope of practice of the providers • Sustainable aged care sector financing arrangements where the market determines price, those that can contribute to their care do, and government acts as the ‘safety net’ and contributes when there is insufficient market response

Robert Orie CEO I Sir Moses Montefiore Jewish Home & LASA Director

• A well-led, well-trained workforce that is adept at adjusting care to meet the needs of older Australians • Greater consumer choice which drives quality and innovation, responsive providers and increased competition, supported by an agile and proportionate regulatory framework

Funding cuts undermine Government’s vision for the future If we are to achieve the vision of the future painted by the Aged Care Roadmap then, clearly, there is considerable further analysis and policy development that needs to be undertaken, particularly in relation to Government affordability and the balance between user pays and the provision of Government funded services. It is simply impossible for the aged care industry to embrace the goals and aspirations of the Government’s Roadmap whilst at the same time facing ongoing cuts to critical care funding due to tightening Government fiscal policy. Since 2014 the Government has made a number of changes to the Aged Care Funding Instrument (ACFI), the assessment tool under which Government funding is allocated to aged care providers, which has resulted in an estimated $3.1 billion being cut from critical care funding over the next 4 years. This estimate is based on analysis undertaken by providers as well as industry and financial experts and is far greater than the Government’s forecast following the May 2016 budget announcement. The changes to ACFI have specifically impacted on funding provided to those with challenging behaviours and, more recently, to those requiring complex health care, including those with chronic pain, degenerative disease, severe arthritis and complex wounds.

OPINION

There is no doubt that the quantum of the funding cuts is sufficient to severely undermine confidence in the industry, will negatively impact on investment and will test the viability of many providers operating in the sector. As the NSW state representative on the LASA Board and recently appointed Deputy Chair, a nomination I was honoured to accept, I assure all LASA members that the Federal Board, in conjunction with LASA Independent Chairman, Dr Graeme Blackman OAM, and LASA CEO, Sean Rooney, are focussed on holding the Government accountable for the accuracy of the financial modelling associated with the changes to ACFI. Image courtesy of hkeita/Shutterstock.com Furthermore, LASA is committed to having funding redirected back into ACFI. This includes, but is not limited to, exploring After all, this is completely consistent with the Aged Care alternative saving measures and consumersâ&#x20AC;&#x2122; capacity to make Roadmap which envisions a system where financing a reasonable contribution towards their cost of care. arrangements are sustainable, where the market determines price and where those that can contribute towards their care do so. â&#x2013;

NEWS

NEWS Winners of HESTA national aged care awards An QLD sub-acute care program that piloted a program to better manage clinical deterioration in residents; an organisation that launched health and wellness centres in SA and NT; and a Victorian aged care professional who pioneered better wound management were the winners of the 2016 HESTA Aged Care Awards. The winners were recognised for their exceptional contribution to improving the quality of life of older Australians in three categories: Outstanding Organisation, Team Innovation, and Individual Distinction. HESTA CEO, Debby Blakey, said the three winners reflected the vital work of aged care professionals in meeting the challenge of providing high-quality care and support to the growing number of older people in our community. “Our winners each have an amazing story about how they are making real differences to the lives of older Australians,” Ms Blakey said. “We are proud to acknowledge the outstanding levels of professional excellence they’ve achieved and give the individuals, their organisations and the aged care profession, the recognition they deserve.” Team Innovation Award Sub-Acute Care Program PresCare – Alexandra Gardens North Rockhampton, QLD For their pilot program to better manage clinical deterioration in residents — avoiding unnecessary hospitalisation while maintaining high standards of quality care. Within the first 12 months of the project, the number of residents transferred to hospital decreased by 50% and the total number of days residents were in hospital decreased by 57%. PresCare Alexandra Gardens Facility Manager, Sandra Thomson, said the program had significantly increased resident satisfaction. “The people we care for don’t want to go to hospital, they can feel lost and scared in an unfamiliar environment,” she said. “Through this program, our skilled staff are able to conduct a comprehensive assessment and an informed decision can then be made to keep them in the facility rather then send them to hospital.” The value of the pilot was demonstrated in 2015, when Cyclone Marcia hit Rockhampton and Yeppoon and all hospitals

and emergency services in the region were struggling at full capacity. For five days, the facility did not have power and staff continued to care for residents in up to 40 degree tropical heat, with high humidity and no air-conditioning. The Sub-Acute Management guidelines allowed staff to identify residents deteriorating due to the risk of dehydration, with early treatment avoiding the need for hospital transfers or loss of life. The 12-month program was evaluated by Central Queensland University (CQU) who looked at the improvements in health outcomes and the economic benefits of the program. There are plans to expand this pilot to other facilities, with the potential for it to be rolled out across the industry. Outstanding Organisation Award Southern Cross Care (SA & NT) Inc. Parkside, SA Southern Cross Care launched Health & Wellness Centres (gyms) in 13 residential care homes that are coordinated by qualified fitness coordinators providing individualised fitness programs aimed at improving residents’ strength, fitness and general wellbeing. The Centres were part of an organisation-wide focus on promoting quality of life for all residents through healthy ageing interventions that support their physical health, social relationships, psychological and spiritual wellbeing. Ultimately, this helps give residents a sense of empowerment over their general health and wellbeing at a vulnerable time of their lives. Southern Cross Care Director Operations, Jo Boylan, said they have seen extraordinary positive changes in residents, with a 54% reduction in fractures in the first year of the program. “We are all about keeping our people mobile so they can keep doing all the things they enjoy in life,” she said. “Our health-forall approach means that, not only residents, but staff as well can use the gyms, which gives them access to fitness facilities that they may not otherwise have, and which are free.” A popular initiative among residents — up to 50% attend the Centres — with personal fitness plans tailored to their individual needs. A bonus of establishing the Centres was that it enabled Lifestyle and Care staff to expand their skills by completing fitness certificates. Individual Distinction Award Camille Koch Macedon Ranges Health – Gisborne Oaks Residential Aged Care Gisborne, VIC Camille won her award for her work improving wound management through the establishment of a multi-disciplinary Wounds Resource Team — leading to improved practice, a reduction in the severity of wounds and better documentation.

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After identifying a gap, the Registered Nurse took the initiative to research and implement changes to existing wound management practices. She has become a champion for change around policies, procedures and documentation, ensuring the broader team at Macedon Ranges Health is educated on best practice wound management strategies. Camille said she started her nursing career working in the acute care surgical ward where she saw older patients with severe wounds. “I really wanted to prevent residents from developing wounds that require hospitalisation and the Wound Resource Team aims to prevent and manage wounds holistically and in an evidencebased manner,” she said. The Wound Resource Team now provides holistic and multidisciplinary wound management and consists of Registered Nurses, Enrolled Nurses (EN), Personal Care Assistants (PCA’s) Occupational Therapists, Dieticians, a Clinical Nurse Manager, Podiatry and District Nursing. “This award acknowledges the work done by the whole Wound Resource Team. Macedon Ranges Health continues to support further innovation in wound management and prevention, bringing in a broad range of skills from specialist allied health professionals.” Fourteen finalists were celebrated at an event in Canberra on 4 August 2016, where the three overall winners were announced. They share in a $30,000 prize pool generously provided by longstanding Awards-supporter ME with each winner receiving $10,000 from the bank for further education or team development.

IRT takes out three Australian Business awards National seniors’ lifestyle and care provider, IRT Group has been recognised as a three-time winner in The Australian Business Awards 2016. The organisation is one of Australia’s largest community-based providers of aged care, home care and lifestyle communities and won two Community Contribution awards and an Employer of Choice award. “It’s an honour for IRT to be recognised as a multi-award Winner for Community Contribution and Employer of Choice in The Australian Business Awards 2016,” IRT Group Chief Executive Nieves Murray said. “The Community Contribution awards are a wonderful recognition of the work we do enriching the lives of older Australians through our IRT Foundation and our innovative lifestyle community, Kemira at IRT William Beach Gardens.” Ms Murray said IRT Foundation is helping to make Australian communities more age-friendly by empowering and enabling older people. “We do this by arming them with better information from new research, supporting age-friendly community groups, addressing barriers to workforce participation and shifting perceptions of ageing through our YouTube channel The Good Life and Speaker Series,” she said. Kemira at IRT William Beach Gardens, Kanahooka was IRT’s second Community Contribution award winner. In describing Kemira Ms Murray said “it’s a special community where ageing people with intellectual disability and their primary carers can age together in a supportive environment. “Kemira features 12 universally designed villas, a community centre and respite centre that were co-designed with disability service providers and is a great example of social innovation to address an unmet need,” she said. Ms Murray said that being an Employer of Choice was part of the secret to IRT’s success. “Attracting and retaining the right people helps enable us to deliver on our commitment to give back to the community,” she said. “This is the third year running IRT has won an Employer of Choice award and it’s a testament to the value we place on our employees — we pride ourselves on customer service and we support our employees to do the best job they can.”

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Montefiore Chair of Healthy Brain Ageing wins ‘Nobel Prize for Ageing’ UNSW Scientia Professor Henry Brodaty AO, has been awarded The Ryman Prize, an international prize that rewards the best work in the world that has enhanced quality of life for older people. “Professor Brodaty has had a stellar career working tirelessly over 30 years to combat dementia. We are truly fortunate to have Professor Brodaty as our research Chair and the benefit that brings in terms of enhancing the quality of life of our residents suffering from this disease,” said Montefiore President, David Freeman AM. Professor Brodaty is the Co-Director of UNSW’s Centre for Healthy Brain Ageing (CHeBA) and works closely with Montefiore Home in a funded research position with the purpose of identifying better practice in terms of dementia care and to enable this research to be transferred, in a practical sense, to the delivery of care services at the various Montefiore campuses.

Arts Festival shines light on retirement villages Tasmania’s population is the oldest in Australia and it’s ageing the fastest. While media pundits screech in horror about the state’s immanent transformation into a ‘retirement island’ VILLAGE asks, “Would that really be such a bad thing?” Created in collaboration with the residents of Launceston’s retirement communities VILLAGE comes to Junction 2016 to take you past the manicured lawns and behind the lace curtains to discover what life in a retirement village is really like. VILLAGE is the creation of a team of Melbourne based artists, Brienna Macnish, Clare McCracken and Robert D Jordan. Over the course of a year the artists have been having conversations with people in Launceston. Filled with tragedy, humour and a surprising amount of song, the interviews have opened the door into the world of retirement village living. “Like other developed nations around the world Australia is facing a transformation of its population. Whether this change is for better or worse is a highly contested topic. The voices often absent from the debate are those of older people themselves,” said artist Brienna Macnish. “The best retirement villages are those where the economic, social and cultural participation of older people is encouraged and facilitated. Within the context of our rapidly ageing population the retirement village is a particularly good place to start thinking about what a world looks like with more older

people, and how our wider communities can become more inclusive of this valuable demographic”. VILLAGE sits within a context of significant social change, however; at its heart the project seeks to foster intergenerational empathy and connection. Through an audiodocumentary that shares the stories older people and a series of participatory events that bring a younger audience into the world of retirement village living VILLAGE is a gesture towards how intergenerational connection within our communities might begin. For more information visit junctionartsfestival.com.au

ATO announces SuperStream extension for small business The Australian Taxation Office has announced it will be extending the compliance deadline for small businesses to adopt SuperStream until 28 October. While more than 450,000 small employers have already met their SuperStream compliance obligations, the ATO will be working with those still struggling to adopt the payment standard to ensure they are ready by the October quarterly super payment date. The ATO last year identified 22 industries that were at risk of not meeting their SuperStream obligations, including hospital and aged care businesses, and will be working with these businesses to ensure they become SuperStream compliant by the deadline. Deputy Commissioner, James O’Halloran says the ATO is encouraged by the already strong adoption from small businesses. “Through the ATO’s ongoing engagement with small businesses, we understand some need more time to implement their SuperStream solution or to work with a

NEWS

SuperStream expert to find a solution that suits their needs,” Mr O’Halloran said.

reduce administrative costs and eliminate duplication and inefficiencies.

“The ATO will not be taking compliance action against small businesses who missed the 30 June deadline and will continue to work to support them to get SuperStream ready.

The changes prescribe routine servicing activities for fire protection systems and equipment to help ensure these are kept in proper working order, and identifies a clear and compelling system for categorising defects.

“By providing this flexibility, small businesses will have another four months to make the changes and ensure they are compliant by 28 October.” Mr O’Halloran said many businesses that have taken the time to find a SuperStream solution and have it up and running are experiencing the benefits, including an average time saving of 70 per cent in meeting their superannuation obligations.

Under AS1851-2012, defects are classified as follows. • Critical defects render a system inoperative and are reasonably likely to have a significant adverse impact on the safety of building occupants. For example, an impaired water supply, which is unable to provide water to a sprinkler system.

You can select how your business becomes SuperStream ready. Options include using a payroll system that meets the standard, a super fund’s online system, a messaging portal or a super clearing house like the ATO’s Small Business Super Clearing House (SBSCH). The SBSCH is a free, optional service for small business with 19 or fewer employees, as well as businesses with an annual aggregated turnover of $2 million or less.

• Non-critical defects include a system impairment or faulty component that is unlikely to critically affect the operation of the system. For example, a local alarm bell that isn’t working.

Your business may already use one of these options to pay super, and you may only need to initiate a few simple changes to be SuperStream ready.

“As we shift to a nationally consistent approach to fire safety, aged care providers are encouraged to evaluate how their fire protection systems are maintained,” Mr Lynch said.

“Accountants and bookkeepers can provide this expert SuperStream advice. Support is also available from your super fund, payroll system provider, messaging portal provider or by contacting your super clearing house,” Mr O’Halloran said.

“With infirm and often immobile residents, aged care providers have unique fire safety requirements. It is vital that they take all appropriate steps to ensure fire protection systems operate as intended in the case of a fire emergency,” he said. ■

Small businesses that need help with their SuperStream preparation can use the ATO’s employer checklist or register for a webinar at www.ato.gov.au

Routine servicing of fire protection systems The Victorian Government has adopted Australian Standard AS 1851-2012 Routine service of fire protection systems and equipment for all new and existing buildings, making it the last of all Australian states and territories to do so. The change is an opportunity for aged care operators with facilities across multiple states to streamline the maintenance of fire protection systems and equipment across all operations, according to fire protection specialist Wormald. “Historically, the routine servicing of fire protection systems and equipment has been regulated differently in each state and territory,” said John Lynch, general manager of business services at Wormald. “For those aged care providers operating across multiple states or indeed nationwide, this meant taking an inefficient, siloed approach to fire safety.” The move to bring Victoria in line with other states and territories means businesses can improve fire safety measures,

• Non-conformance defects include those features that are missing or incorrect and are required to facilitate ongoing routine service, but do not affect how the system operates. For example, missing or incorrect zone block plans.

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SINGLE QUALITY FRAMEWORK LASA recently published revised Policy and Position Papers with an emphasis on working towards an industry whose focus is on continuous quality improvement rather than regulation or compliance. The aim is for a standardised level of quality and safety that enjoys a high level of public confidence1.

he Government is developing an end-to-end, marketbased system with the sector, where competition, and ultimately the consumer, drives quality. This includes developing a single aged care quality framework with:

models of service delivery. The need to ensure consumer safety, choice and flexibility, with consumers being treated with dignity and respect, were highlighted as central platforms for a quality framework for aged care and the delivery of services within it” 5.

• a single set of aged care standards, differentiated by service type;

Using the National Health Performance Framework (2nd ed.) as a guide, quality, in the context of age services, could include, access to care that is determinates acceptable to the care recipient, with effective outcomes, achieved efficiently for the consumer, provider and tax payer, on an equitable basis, and in a safe manner6.

• streamlined quality accreditation processes across residential and community aged care; and • improved quality information to help consumers to make choices about the care and services they need. LASA contends that to deliver the highest standard of quality age services, providers need policies that support competition and drive innovation and investment, without the introduction of additional red tape. LASA has written that as part of the 2015-16 Budget, the Government committed to consider options for establishing an open market for accreditation services, and implement a cost recovery process for residential care accreditation. The development of a single set of aged care standards is now underway2. But what is quality? Quality is a multi-faceted concept which has been defined in different ways3, however a definitive concept and vocabulary of quality is elusive. People interpret quality differently and few can define quality in measurable terms that can be operationalised4. In reporting the results of the ‘quality dialogue’ survey, the Australian Aged Care Quality Agency (AACQA) stated: “A clear message from the consultations was that there is no single or agreed definition of quality in aged care. However, there was a strong and shared understanding about the key factors that positively influence quality of care and, in turn, quality of life. There was strong support for and reference to the concept of active ageing. Consistent themes related to the need to shift the focus of service delivery from ‘doing for’ to ‘doing with’, facilitating holistic, flexible, co-design

LASA has also advocated that accreditation and safety regulation needs to be an adjunct to quality improvement. That is, where a set of standards has been developed, they should reflect a level of quality and safety that is acceptable to the Australian population. Quality improvement and the demonstration of high levels of quality are domains that a provider can distinguish their service from others, whether it is in Home Care or Residential Care. Measuring compliance to the standards is a role for accrediting bodies whereas non-compliance is the domain of the regulatory environment within the Department of Health. LASA has consistently articulated that there should be a separation of power between standards setting, the accreditation process and any actions or sanctions for noncompliance. With past Budget announcements LASA firmly believes the independent provision of accreditation services will lead to improved services and support working with the DoH and the AACQA in how best to ensure this occurs in a timely manner. LASA advocates that a contestable quality improvement process, through independent accreditation body/ies be available to the age services industry. In doing so, LASA actively participates in discussions and decisions on a national aged care quality framework through representation on the Quality Advisory Group, the Quality

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Indicators Reference Group, the Aged Care Standards Technical Advisory Group (TAG), the Aged Care Complaints Commissioners’ Consultative Committee, and any other relevant committees. The TAG is at the point of consulting with a small number of service providers to continue the development of a single set of aged care standards. Aged care providers are represented on this Advisory Group by the National Aged Care Alliance (NACA) representative, Ms Kay Richards, LASA National Policy Manager.

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More work and broad consultation will be undertaken over the next 12-months; however, it is hoped the new standards will support the end-to-end single quality framework. In addition to the new standards, LASA has been involved in the implementation of clinical indicators and the trialling of measures of quality of life and consumer experience. It is very early days yet to consider the success (or otherwise) of implementing a voluntary National Aged Care Quality Indicator Programme. Indicators are developed to be an additional tool for quality improvement, with LASA supporting the development of a suite of performance indicators that are relevant to service provision and in concert with a continuous quality improvement framework. LASA actively lobbies on how performance data will be displayed and used on My Aged Care (not in a “Trip Advisor” format), including evidence based methodology with sufficient statistical rigour for data analysis. Only when this is in place, can meaningful data be available to support consumer choice. LASA advocates that the collection of performance data is of no greater impost or additional burden than is otherwise undertaken as part of normal business assessment. Many services are already collecting data to support quality improvement outside the National Programme. Where this is the case, LASA suggests that this should be indicated on the My Aged Care website, to enable consumers to see what quality activities are undertaken by a particular service. Should an open market for accreditation processes be implemented, NACA members felt (at their last meeting) that the following dimensions should be included in any new system: • Some providers have duplication of accreditation services (due to having a range of services in different sectors, residential care, home care, disability etc) and this needs to be streamlined;

• There needs to be a distinction between compliance and quality. This can be translated into meeting compliance responsibilities under accreditation and demonstrating and competing on quality, in an open market; • Government does not need to be involved beyond compliance; • There needs to be a competitive tendering process; • The positive aspects of the current system, such as education, needs to be kept; • The question of how will a new system interact in the disability space was asked; • There needs to be mutual recognition of other accreditation activities across the system; • There needs to be a safeguard on quality and safety; • There needs to be an assurance of forward thinking based on the past; and • There needs to be a move to a more competitive market place as currently providers have no choice with a monopoly system. LASA supports the premise of a single quality framework, one that: • increases the focus on quality outcomes for consumers; • recognises the diversity of service providers and consumers; • reduces the complexity of regulatory compliance for providers; and • reduces unnecessary red tape by minimising duplication between the standards, other provider responsibilities and other Commonwealth, state and territory legislation, and recognising other regulatory mechanisms including health and disability as appropriate. ■

References 1L ASA Position Statement - Provision of Quality Care and Services http://

• The education component of the current system should not be lost – the sharing of experiences and learnings need to be continued;

www.lasa.asn.au/wp-content/uploads/2016/08/LASA-2016-policies-and-

• Consistency across multiple accreditation services needs to be guaranteed;

uploads/2016/08/LASA-2016-policies-and-position-statements-final.pdf

• There is a conflict of interest where the funding body and the accreditation services are one organisation. Any accreditation service should have JAZ-ANZ or equivalent accreditation; • There needs to be transparency of compliance outcomes;

position-statements-final.pdf 2. LASA Policy Statement - Quality http://www.lasa.asn.au/wp-content/

3. Australian Institute of Health and Welfare (http://www.aihw.gov.au) 4 https://totalqualitymanagement.wordpress.com/2009/08/27/definition-ofquality/ 5. The Standard https://www.aacqa.gov.au/for-providers/education/thestandard/february-2016/QualityStandardFebruary2016.pdf 6. Australia’s Health 2014 Australian Institute of Health and Welfare (http:// www.aihw.gov.au)

Sampling 4th May 9th May 13th May 20th May 3rd June 17th June 1st July 29th July 12th Aug FEATURES (baseline) (baseline) (Day 1) (Day 8) (Day 22) (Day 36) (Day 50) (Day 78) (Day 92) location Room B

Legionnaires’ disease causes severe pneumonia and is a major health risk linked to poor water quality in aged-care facilities. Legionella bacteria, which cause this infection, are common in potable water distribution systems, but are particularly problematic in the complex pipe networks of hospitals and aged-care facilities where vulnerable populations are also more likely to contract infections. A combination of factors leads to heightened risk in these settings. For example: extensions and renovations can create ‘dead legs’ in pipe networks, where reduced water flow creates an ideal environment for Legionella colonisation and growth; installation of thermal mixers to decrease scalding risks also creates areas of warm water ideally suited to Legionella growth; and water softeners, installed with the intention of improving water quality, also happen to remove the chlorine residual from the water. Together, these factors and others add to the challenge of maintaining adequate water quality in aged-care facilities. In order to address the problem of water-borne infections in the elderly and immunocompromised, water quality management plans are increasingly being implemented in Australian aged-care facilities. Newly developed guidelines, such as the enHealth Guidelines for Legionella control in water distribution systems in health and aged care facilities (Australian Government, 2015), underline the importance of operational controls such as the installation of continuous in-line disinfection systems for limiting Legionella bacterial counts and other microbiological risks. Over the past few months, exciting results have been obtained using an on-site electrochemical water disinfection system to control Legionella in an Australian hospital and aged-care facility. In May 2016, an inline Ecas4 water disinfection system was installed at the North Eastern Community Hospital (NECH) in Adelaide, where water quality monitoring had previously indicated

100

500

600

<10

Room D

100

<10

Room E

<10

100

<10

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<10

200

<10

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<10

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<10

600

<10

Table 1: “Legionella species” counts before and after installation of the Ecas4 disinfection system (analysis conducted by the hospital’s regular NATA accredited testing laboratory).

systemic Legionella contamination of the water distribution system. The residential aged-care facility at the NECH is joined to the main hospital and provides permanent and respite accommodation for 84 residents in a purpose-built facility. Substantial investment in building works have resulted in significant structural changes to this facility over the last 40 years and increased the complexity of the water distribution system. In an attempt to decrease the risks of waterborne disease, the hot water at the NECH was previously heated to 80 °C, but despite the high energy costs, this approach proved to be insufficient, and Legionella and microbial cell counts continued to exceed potable water quality guideline limits. In order to proactively manage this risk, an in-line Ecas4 water disinfection system (subject to worldwide patent) was installed at the NECH. This technology facilitates continuous dosing of a dilute disinfectant solution (the Ecas4 Anolyte) into the hot and cold water distribution systems to provide continuous disinfection without altering the potability of the water. This continuous dosing facilitates the control of microbiological contaminants, including pathogens such as Legionella. In addition, it can also help prevent the build-up of biofilms (sessile microbial communities) that are commonly found on the surfaces of pipe materials and typically implicated in increased microbiological risks. The Anolyte solution produced by the Ecas4 system is pH neutral and contains active chlorine, mainly in the form of hypochlorous acid, which is a powerful disinfection agent. Continuous in-line dosing of the dilute Anolyte solution is safe for humans and suitable for use in potable water. Due to its neutral pH, it is also less aggressive on treated surfaces and infrastructure than other disinfection agents such as bleach. Installation of the Ecas4 dosing system at the NECH was preceded by baseline sampling of the tap water throughout the hospital to determine the initial

contamination level and facilitate verification monitoring of the disinfection process. Samples were collected every 1-2 weeks for analysis (Table 1). By the third postinstallation sampling event (Day 22 post installation), consistently improved water quality was observed throughout the system, with no positive Legionella plate counts recorded thereafter. The positive effect on the water quality following installation of the Ecas4 system was further confirmed by Legionella qPCR analysis, a DNA-based method which is significantly more specific and sensitive than the plate count method and highly reproducible (Figure 1). 2000 Legionella spp. (Genomic Units/ml)

Decreasing water-borne pathogen risks in Australian aged-care facilities

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Figure 1: DNA-based Legionella species quantification data for water sampled from the hot water taps of basins in 11 hospital rooms; the same 11 basins were sampled on each occasion.

The qPCR data, obtained thanks to an independent verification program by researchers at the University of South Australia, clearly showed that the Legionella counts decreased significantly following installation of the Ecas4 system, and a consistently low Legionella cell count was achieved within 2-3 weeks of continuous treatment. Water management optimisation at this facility is ongoing, and the next steps will include a monitored, progressive decrease of the hot water temperature to save energy and reduce the heat stress on infrastructure and equipment. Check the Spring 2016 issue of The Australian Hospital Engineer (pp. 63-66) for further details.

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MORE COMPETITION MAY NOT BE THE ANSWER TO REFORMING THE AGED CARE SYSTEM Rhonda Lynette-Smith Senior Lecturer, Economics Dept I Senior Fellow, Law, University of Melbourne Ian Martin McDonald Emeritus Professor I University of Melbourne

More competition in the delivery of human services, as recommended by the Harper Inquiry, is likely to increase the variety of services available, reduce the price of services and may encourage innovation. However, when it comes to the aged care sector, competition may not necessarily result in better care, due to market failures.

he Harper Inquiry, which was tasked with ‘kick starting’ the process of balancing competition, argued that human services should also be subject to competition. However simply restructuring the sector to create competition will not necessarily deliver efficiency or the type of service that the community requires. Competition will only deliver these outcomes if the market is working well – when consumers and those who supply aged care are actively engaged in the market. However consumers might not be able to find the right aged care provider if their choices are limited by lack of information, a high cost of switching between suppliers or if the alternative service providers to choose from are no better.

Economists would likely describe residential aged care as “an experience good,” meaning that the exact nature of the service is not known until after purchase, and often not for some time after that. Lacking knowledge about the quality of service, consumers make choices using indicators that may not be good proxies for quality – such as the physical appearance of the residential facility, the friendliness of the management staff, and location (relative to their former home, family and friends). If, however, residents or their families subsequently discover that service quality is unacceptable, it’s likely that they won’t shop around for a better supplier. There are several reasons for this. Residents may lack knowledge about the quality of services provided by alternative suppliers and even if that information

is available, they may lack the cognitive ability to assess it. For frail, elderly residents, the upheaval of switching may be too great both physically and mentally. It may require considerable help from family and friends. Residents may lack the financial resources to make a switch as often that means that their financial position will be reassessed under changed (more stringent) conditions. Furthermore, many aged care residents wish to maintain contact with relatives and friends not just for social interactions but also for help in making decisions. In addition, service providers have often been chosen at least in part because of location advantages which may be lost with the move to an alternative supplier. This is particularly important in rural areas.. Statistics on switching are not readily available, are somewhat dated (2009) and are difficult to interpret. In 2009-10 it appears that only 2% of all departures from a given residential aged care facility were to relocate to another facility. Whether 2% is low is hard to judge. And even if it is, it could mean that residents in general are happy with the quality of care. The Harper Inquiry report shows that even if competition delivers efficiency gains, it may not deliver services of the desired type or quality and it may result in some groups in society being disadvantaged. The report cautioned that:

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Removing barriers that would have prevented new suppliers entering the market is a classic way to increase competition and in aged care this may be helpful. However, this alone would not guarantee quality of care. If consumers, lacking evidence on quality of care, place too high a weight on fees and the physical appearance of facilities in making their initial choice then the new entrants could compete by providing a grand appearance to attract consumers and forcing down the quality of service to cut their costs. The system could end up with an unbalanced package of price and quality. Labour costs are a major component of costs in residential aged care. Competition that focuses excessively on reducing the costs of running these services may lead to the employment of part time and poorly trained labour. Senate inquiries and government reports into aged care have raised concerns that low pay means many employees work double shifts or several jobs and so they may lack

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commitment to ensuring high quality care. Inadequate resources may result in a lack of supervision and insufficient coordination of staff leading to residents lacking continuity of care. If competition is ineffective in ensuring quality of care, indeed if it may have the opposite effect, are there ways to ensure that residential aged care services of appropriate quality are supplied? There are already some regulations intended to address these issues but based on the submission to the current Senate Inquiry, it would seem either that they not enforced, are easily side-stepped or are simply inadequate. If competition to deliver services to Australia’s ageing population becomes more intense, increased regulation that is carefully targeted will be necessary to ensure quality of service. This will need to be supported by effective monitoring to ensure compliance and could be supported by an industry code of conduct with specific, easily-assessable and mandatory targets related to service quality. ■ This article was originally published on The Conversation, 27 May 2016. It has not been altered in any way. More information at www.theconversation.com

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“Governments should retain a stewardship function, separating the interests of policy (including funding), regulation and service delivery,” whilst also recognising the need for “ensuring minimum standards of quality and access in human services.”

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FEATURES | ACCESS THE DESIGNER Helen Kelleher graduated as an Occupational Therapist from Sydney in 1965. Her first appointment as an OT was at the Mount Wilga Commonwealth Rehabilitation Centre, Hornsby, in Sydney. Due to family commitments and living overseas, Helen’s career path was put on hold for several years. Upon returning to Canberra, after several years living overseas, Helen joined the Mobile Unit of The Rehabilitation Team at the Canberra Hospital in 1973. In the two years with the unit she made home assessments and arranged the supply of equipment for clients. This gave Helen a more thorough understanding the needs and difficulties faced by clients with the equipment that they had at this time. After eight years running a day care program for the aged and disabled, Helen moved back into the hospital environment working at Queanbeyan Hospital. Her duties included Home Modifications as well as working with patients on the wards and in the Day Care Centre.

THRONE ACCESSORIES It was while working in the Home Modification area that Helen identified a deficit in the design of some of the equipment. She saw that the safety aspects in accessing the toilet for many of her clients were not being adequately met by any of the equipment available. The most obvious challenge Helen identified was that other rails required patients to pull themselves up, a very difficult task for the frail, aged and those with back injuries. The Throne rails are positioned much closer to the body allowing patients to push up more like they do when sitting on a chair. Having exhausted enquiries in her search for suitable equipment, Helen set about developing her own ideas with safety and comfort high on the agenda. She was encouraged to learn that existing porcelain bowls had the strength to hold a rigid fixture that she knew was the answer for people with disabilities and physical restraints. Helen commenced designing a prototype Rail and continued to develop the Rails until the highest safety aspects were met as well as ease of transportation. The initial design was so well received that Helen set about refining the model to accommodate people with a full range of disabilities including sports injuries as well as rails and steps especially for children.

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RECONCILING MEDICATION RISK AND THE ROLE OF THE PHARMACIST

Gerard Stevens AM* Aged care and community pharmacy share a significant common goal: ensuring your residents get all the benefits from their medication while minimising any risk of harm. By better understanding each other’s policies and procedures we have a better chance of meeting this goal and ensuring facility compliance with Accreditation Standard 2.7 Medication Management.

et one of the most important factors in providing objective evidence of this process – effectively and accurately managing the medication profile – is poorly understood by most stakeholders.

It’s easy to understand why an accurate medication profile of a resident is crucial to maintaining optimal health outcomes. But it’s also easy for discrepancies and discordance to arise when multiple medications, busy health professionals and changes in interfaces of care are involved. We all know the potentially grave consequences of getting this wrong. But there is a lack of understanding in the time and effort that goes into ensuring a patient’s medication profile has been effectively reconciled. That is, it accurately reflects what the patient is supposed to be taking at the time of administration.

Challenges in accuracy There are many issues that can get in the way of a patient’s accurate and effective medication profile. Every change in medication and dose has the potential to generate errors or discrepancies within the profile, but this is compounded when multiple medications are involved. Likewise, every transition of care offers opportunities for confusion. This all occurs in an environment where each health professional involved in ongoing care has their own daily pressures and routines. So it usually falls on the pharmacist to accurately reconcile the medication profile, minimise the risk of medication incidents and support compliance to Accreditation Standard 2.7.

Business pressures Like RACFs, community pharmacies are under enormous financial pressures during a long period of significant government-enforced change to the way they practice. A common business response to such pressures is to review all operations to make them as efficient as possible, including ensuring that they contribute to business profitability. At my pharmacy, Metropolitan Pharmacy Services, about 70% of what we do to provide medication management services to RACFs has nothing to do with packing medication into Webster-pak or Unit Dose 7 systems. Much of that 70% involves the ongoing management of the patient’s medication profile, including the crucial task of medication reconciliation. Also involved is the constant and time-consuming requirement to chase doctors for scripts owing on medication already dispensed. This is essential to ensure continuity of medication supply to residents. According to the health bureaucrats there is technically no such thing as an owing script. The regulations say we are not allowed to dispense without a valid prescription (apart from emergency supply of a few days) but sticking to the regulations would mean far too many frail residents would have their health threatened without their medication. A missed medication could also lead to non-compliance with Standard 2.7.

Remuneration review The King Review into community pharmacy is an important initiative whose goal is, among other things, to review community pharmacies’ models of remuneration. This is a timely review and I have recently written to pharmacies that

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use Webstersystems to ask them for feedback that can inform Webstercare’s own submission to the King Review. I’d like to share some of the comments that have come back, most of which specifically refer to the lack of understanding of, and acknowledgement for, what goes on in the background to effectively manage a patient’s medication profile. • “GPs consistently overestimate the ability to adhere to medication therapy accurately and even the preparedness of their patients to implement prescribed therapy.” • “Funding for medication reconciliation exists within the acute sector. Increasingly hospital pharmacy departments instruct their clinical pharmacists to reconcile medications on admission (we receive phone calls from hospitals) but not even all hospital pharmacy departments are on board with this process.” • “The process of medication reconciliation is often viewed as a cost and not an opportunity.” • “There are situations where medication mishaps are common. These include transition in and out of the acute sector, therapy prescribed or ceased by specialists (here I allude to hand-written scripts, no access to a patient’s medication profile during consult, no follow-up letter by specialist), and confusion around generic brands. Medication reconciliation is almost mandatory yet performed infrequently.”

Electronically generated charts An important measure to support a more efficient and safer medication use pathway is the adoption of electronically generated charts. A good number of RACFs have already begun benefiting from the efficiency improvements to medication administration and safety benefits to patients. Key to this is the ability of electronically generated charting systems to better and more efficiently manage residential medication profiles, including reconciliation. Electronically generated charts enable a resident’s medication profile to be stored in a single ‘source of truth’ instead of having to be cobbled together from various sources. Now more than ever, it is in the interests of all aged care health providers to work together from a common multidisciplinary platform. By understanding and acknowledging the roles of others in the medication use pathway, and using a common information platform, we can meet the medication needs of the elderly, maximise efficiencies and minimise risk. ■ For more information about medication reconciliation, go to www.shpa.org.au/lib/pdf/practice_standards/QG-Medication_ reconciliation.pdf *Gerard Stevens AM is founder and Managing Director of leading medication management systems company Webstercare.

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TOWARDS 2020:

TAKING CRANBROOK CARE INTO THE NEXT DECADE AND BEYOND Do any of you ever think back to the first time you experienced aged care? Do you remember walking into a facility and how you felt? What you saw? What stayed with you?

fter being in the industry for so many years, I hate to say it but we can become desensitised, some sadly jaded. One of my pet hates is the saying ‘but this is aged care’ and using this as an excuse for not going over and above. It’s simply unacceptable. Are we losing sight of our customer – the resident, and their loved ones around them? In addition to Lansdowne Gardens and William Cape Gardens, Cranbrook Care is opening two new aged care residences in 2016, in Sydney’s inner west – Bayswater Gardens and northwest – Bella Vista Gardens. Whilst we currently employ 250 staff, over the next 12-month period we will have a family of over 400 staff, a 60% growth in a 12-month period. Our ethos has always been Wellbeing, Security & Excellence. To ensure we deliver this and more, we have been seeking professionals outside of the aged care space, who are bringing fresh energy, enthusiasm and sometimes rather brutal honestly on how we can do things perhaps differently. Having so many fresh faces in the industry is a great reminder for us to take a pause and go back to basics in our rewarding industry. This, of course, doesn’t mean our industry isn’t delivering exceptional care and service; merely, our new residents expect more and need more than ever before. To deliver on this we need to push our mindsets, go that extra mile

Kerry Mann CEO I Cranbrook Care

and deliver a care and service offering never before seen in this industry. If we dine in a fine dining restaurant, we walk in knowing what experience we will be having. We will be greeted by a host, a Sommelier will ensure we pick the right wine, the plethora of staff will fuss over us in an immaculate environment all while we enjoy amazing cuisine. And should any of these elements not be perfect, don’t we let them know it! Why should aged care be any different?

The senses should be evoked in all the right ways, the staff attentive, experienced, warm and welcoming – a memorable experience. We need to push the barriers, step up our game. It can be done, because we are doing it. All our staff at If we dine in a fine dining restaurant, we walk in Cranbrook Care, whether they be Administration, knowing what experience we will be having… Kitchen, Housekeeping, Why should aged care be any different? all levels of Carers are

undergoing rigorous service training. We are more than care. The industry is more than care. Training as we all know is paramount, but this should and must include delivery exceptional service. Answering the phone with professionalism, making a delicious tea just like our resident requests or even pre-empting their request and delivering it with a smile, communicating with our residents’ loved ones. Every little detail counts.

We are not just striving for outstanding standards in our built environments and locations, but also in the physical, social and emotional care we provide our residents right along the spectrum of care, from at-home services to retirement living to residential aged care.

We are continuing to hone our personal touch for which Cranbrook Care is known, harnessing our people with a focused approach in an industry that’s all about individuals, customer care Training as we all know is paramount, and being nimble enough to but this should and must include delivery adapt to changing demands and expectations. exceptional service.

Recently I met a lady named Sue who is considering aged care for her mother. She was overwhelmed, and I know we all meet ‘Sues’ on a daily basis. What made Sue different was that at each of the five residences she visited, they all explained the industry in a different light. Some places were frankly rude and Sue commented, “It’s not giving the industry a positive ‘feel-good’ moment”. Why are we not on the same page, singing from the same song book, explaining and presenting our industry in a positive light? I asked Sue to come and talk to some of our staff about her experience with our industry. Our staff were not only disappointed but taken aback by her comments, and it was a stark reminder about why we are here and what is important and reinforcement of what we should not be doing. Let’s not lose sight of this.

Sue said, “Sure a residence can have luxuries or state-of-theart ‘whatever’ but what about the care? I want to know that my mum is getting the best possible care she can. One thousand thread count sheets is a wonderful luxury, but how often are they changed? That’s what I want to know!” We hear the industry is ‘booming’, but what sort of service are we offering? Are we doing the best we can and then more? I know at Cranbrook Care we are. Aged care is changing, many of our customers require more than ever before, and are willing to pay for exceptional service.

As in the hospitality industry, our clients’ expectations are high, but we welcome that. They are looking for superior accommodation, cuisine, locations, activities and personal attention. Location and architectural design are very important considerations for us across our residences. A new ensemble of architects specialising in lifestyle-centred living are helping to create communities incorporating attractive spaces to encourage outdoor activity and social interaction and settings to find the ideal balance between privacy and community engagement. Just like building a new family home, it’s equally important in the seniors’ sphere to design for optimal health and wellbeing using bespoke design elements, such as natural light, tranquil outlooks, relaxing colour schemes, intelligent layouts, superb finishes, interior fit-outs and leading safety features. As an industry I’d like to think we can all lift our service offering, look at the customer’s needs, wants and, most importantly, point of view. We are all creating wonderful environments, our industry is exciting and for me incredibly rewarding; we are making a difference and by committing to go that extra mile, we can make even more of a difference. ■ For more information visit www.cranbrookcare.com.au

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SUCCESS OF STEP FORWARD –

TOGETHER PROVES CO-PRODUCTION IS THE RIGHT APPROACH Over the last three issues of Fusion we have followed the Step Forward – Together initiative and six of its 10 pilot sites, where residents and clients have worked in collaboration with care providers to create wellness and enablement programs that actually work. Kelly Gray, Project Lead and a consultant for CommunityWest shares her thoughts on the project outcomes.

o-production has been a growing interest in Australia because of the benefits it offers organisations and consumers. Co-production has been used in local government and community services in the UK and Europe for the last 15 years with great success.

been interested in co-production for many years and wanted to explore how it applied to the Australian aged care context. Our role was to educate and support ten pilot organisations and staff, with COTA’s role to educate and support consumers and carers involved in the project.

Co-production goes beyond consulting and engagement processes. Working with consumers at a strategic level to plan, design, test and review services is going to be essential in an increasingly competitive environment where consumers choose who they want to purchase services from.

After substantial interest from the sector CommunityWest selected 10 aged care providers to be part of the project, ensuring a blend of residential and community providers, and those who would work with diverse groups of consumers.

Too often I see agencies consulting people about their needs but not involving them in the design and testing stage which results in a lot of ‘should have worked/ didn’t work’ failures in attempts to innovate or improve services. The Step Forward – Together project was initiated by CommunityWest, in partnership with COTA Australia, supported by funding from the Department of Health. CommunityWest has

Narrowing the field down to 10 was really difficult; we had many high quality applications indicating the growing appetite in the sector to explore new ways of working with consumers. Each pilot site project was different, however all focused on aspects of wellness and enablement they wanted to improve for the people they support. Each had a project steering committee comprising of staff and consumers. We worked closely with each pilot site through the program to ensure Pilot Leads (left to right): Kelly Gray – CommunityWest; Frank Naso – Society of Saint Hilarion; Mel Ottaway – Uniting Communities (back); Fiona Lovejoy – Centacare Community Services (front); Joseph McCarthy – Novacare Community Services; Deanne Garner – Jubilee Community Care; Sally Kingdom-Barbosa – St Bartholomew’s House; Judith Henriksen – Calvary Community Care; Carlo Calogero – MercyCare; Diane Graham – WestCoast Home Care; Ana Mubaslat – Uniting AgeWell; Emer Long – CommunityWest

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co-production was done authentically and stayed true to the six principles. The pilot phase finished in May 2016, and we have made a documentary about the learnings and outcomes, including interviews with staff and consumers which can be viewed at www.communitywest.com.au CommunityWest is also producing a ‘how to’ toolkit and guide for the aged care sector, based on the learnings from the Step Forward – Together project. This toolkit will provide organisations with a framework, process and tools to implement co-production, and will be available from September 2016 as a free resource downloadable from the CommunityWest website. There are many lessons from the pilot site journeys involved in Step Forward – Together including: 1. Co-production takes more time than consultation 2. Allocating resources to the project will ensure its success 3. Working on operational and tangible projects is easier than broad or strategic 4. People leading co-production processes need group facilitation skills 5. Working as ‘equals’ is a difficult concept to cement into practice given historical passive relationships Feedback given to COTA Australia from working with the pilot sites and their consumers has been broken down to the following key points: 1. Co-production was more effective where a peer education session was held with consumers prior to projects commencing 2. Peer education provided the foundations of understanding wellness 3. Co-production is driven by the provider and is contextual 4. Be clear with consumers about their role and the expectations As part of the Step Forward – Together project, COTA Australia is now undertaking a nation-wide rollout of peer information sessions on wellness, enablement and co-production. These have been developed from the pilot phase to provide consumers with an understanding of wellness and enablement, and encourage involvement in co-production with service providers. And while there were plenty of anticipated benefits, there were a number of unexpected benefits that came from the pilot sites too, including: • Being involved made a positive impact on the wellbeing and quality of life of consumers • Consumers involved have become loyal customers of the organisation

Uniting AgeWell (left to right): Anika (staff member); Anne (consumer); Marma (consumer); Ana (Pilot Lead)

• Organisations now have a previously untapped resource of committed and motivated consumers for future projects • Co-production promotes innovation And comments from the pilot leads such as: “I think everyone should give it a go. I think there’s a lot to be learnt by it, whether you use it all the time, or just for specific projects. It’s a useful way to evaluate and review how you run your business and the services you provide. You need to ask yourself, are you providing services that people want? It’s no good having all the bells and whistles if that’s not what people want. I also think for starting a new service it would a great approach to avoid those ‘avoidable’ mistakes we all see with 20/20 hindsight. “What this challenged us to do was think differently. I don’t think we could have achieved the same outcome with traditional methods of consumer involvement and consultation. “Co-production aligns with the aged care roadmap so if people don’t adopt this, they will be the ones who will struggle to survive. It’s about listening to people, meeting their needs, ensuring services are individualised and everyone’s opinion is sort after. It’s the future. Whether you like it or not.” The Step Forward – Together project has demonstrated coproduction offers the aged care sector a range of benefits which cannot be achieved through traditional methods of consultation. There are not only benefits for the organisation, but also for staff and consumers involved. ■ For more information about the Step Forward – Together project or co-production contact CommunityWest on (08) 9309 8180 or visit www.communitywest.com.au. If you’re interested in doing co-production, contact COTA in your state or territory.

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BETTER PRACTICE AWARDS 2016

On 18 August aged care providers from across Australia were recognised at the Better Practice Awards ceremony. The Awards celebrate projects, initiatives or programs that act as exemplars for other aged care service providers and to encourage continuous improvement. They recognise and disseminate better practice and innovation in the sector.

ASA congratulates its Members that were finalists in these prestigious industry awards, and applauds the winners for their commitment to continuous improvement and innovation:

• Annecto Inc • BaptCare • Good Shepherd Lodge Ltd • Hall & Prior • Integratedliving Australia • KinCare Health Services • Mercy Health Residential Aged Care • Monash Health • Resthaven Incorporated • Sapphire Care • Sir Moses Montefiore Jewish Home • The Whiddon Group • Vasey RSL Care Below we profile three of the winning projects and programs implemented by LASA Members which can also be viewed at www.aacqa.gov.au/for-providers/promoting-quality/betterpractice-awards

Annecto Inc, NSW Improving accessibility through cultural safety Home Care – Metropolitan, 30-79 places Award descriptors: Leadership and culture, Enablement, Communication and engagement About the program The Sydney Aged Care Scoping Study, (Burns and Aldis, 2013) describe cultural safety as the position of the Aboriginal person and their identity within social, economic and political systems. Unsafe Cultural practices in any environment, may lead an older Aboriginal person to believe

that it is unsafe and not accessible to them, their family and community. We started the project by establishing the following objectives that we wanted to achieve: • To have more Aboriginal identified referred assessed by the Aged Care Assessment Teams • To meet priority access special needs groups as outlined by the department in the aged Care allocation for western Sydney; and • Give a voice to Aboriginal Stolen Generation Elders and other older Aboriginals so that their concerns fears and needs were appreciated and appropriately responded to. As a service provider, we identified the need to step back into the community to identify the barriers that restricted those who for whatever reason found the aged care system unaccessible. Though we are not funded to undertake this type of community outreach particularly before the person chose to become a consumer, we nevertheless consider this to be an important work and part of the organisation’s purpose and principles. Through our engagement with the ageing Aboriginal community, we developed concerns about the accessibility and function of home care support to older Aboriginal people. Together with our Aboriginal identified organisations that we have partnered with, we observed culturally unsafe practices within the delivery of aged care services, including the current consumer directed model of care for home care packages. Consequently, the main aim of this project was to explore the ramification of cultural safety as the highest barrier for older Aboriginal people accessing aged care in urban regions, and more specifically in western Sydney. Secondly, it identified a series of recommendations that were then implemented to create a safe cultural space for potential Aboriginal identified aged care recipients.

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There is ‘not a significant body of knowledge among the general population about how to care for older Aboriginal people.’ (Keleher, 2003:372). Through our work in Blacktown local government area, which has the highest population of Indigenous Australians living in a metropolitan area of a major city, we found that it was almost impossible to meet the priority access requirements set by the Department for the ATSI special needs group as there was almost no Indigenous ACAT assessment carried out. Further to the above, we found that other local government areas had similar if not worse gaps of ATSI assessments. In order to better understand the situation, we held conversations with Aboriginal elders to find out if they knew about the different kinds of age care supports available to them and why weren’t they going through the assessment process. The response was that most Aboriginal Elders and/ or their family did not know about the Home Care Packages; and the people who knew about it found the assessment process to be culturally inappropriate. In 2012, the government released national ageing strategies for people from CALD backgrounds and for the LGBTI community. Interestingly, no such strategy currently exists for the Indigenous community that we are aware of, in fact there is very little research carried out to form an Indigenous aged care policy. Lessons learned • Do not presume that your models are culturally safe for Aboriginal people • Create an opportunity for Aboriginal community members to have input into your service engagement, design, feedback and understanding of what they anticipate is a priority as an Aboriginal person • Celebrate and enjoy Aboriginal culture • Identify cultural safety as a priority for consumers • We continue to advocate with the Department of Human Services and the Aboriginal and Torres Strait Islander Commissioner Mick Gooda for a National Aboriginal and Torres Strait islander Aged Care Strategy similar to the CALD and LGBTI strategy. • We identified that attending, participating and supporting key Aboriginal cultural events built a trust with potential and current aged consumers • We have active involvement in several local Aboriginal events such as, Aboriginal Grand Parents Day in Glebe, through to NAIDOC events, Sorry Day events, and

organising one of the only Aboriginal specific NSW Seniors Festival events in 2016. • Partnerships with Aboriginal Elders identified the value of supporting Aboriginal identified organisations in a concrete and real manner – this included our partnerships with Babana Aboriginal Men’s Group, and participation in their Suicide Prevention Day, and Coloured Diggers event, which recognises Aboriginal ex-servicemen on Anzac Day. • When working with an Aboriginal identified person, a whole of family approach is needed. • The planning process can take longer than for a nonAboriginal person, as it is essential to build trust to ensure positive outcomes for the Aboriginal consumer. • Inter-generation historical fear and trauma has created a number of barriers for the Aboriginal older person to overcome to access suitable and needed health services.

As a service provider, we identified the need to step back into the community to identify the barriers that restricted those who for whatever reason found the aged care system un-accessible….we observed culturally unsafe practices within the delivery of aged care services, including the current consumer directed model of care for home care packages. Sustainability We have undertaken a Reconciliation Action Plan where we receive feedback and evaluation of our Sydney programs and projects which includes representation of the CEO and at least one Board Member. A working group has been established to oversee the partnership with Kinchela Boys Home Aboriginal Corporation, with representation from the CEO and Management of both organisations. Changes include building the Capability of KBHAC to develop its monitoring and service evaluation for its Aboriginal participants in its disability service provision. Management receives regular review and feedback from the Aboriginal Liaison Officer. For more information contact Michael Hercock, westernsydney@annecto.org.au or phone 02 8047 0909.

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There is a growing need for Aged Care Nurses. Get specialist qualifications with ACN. Australia’s population is ageing. Elderly patients present with a range of comorbidities, chronic health requirements and complex wounds. The Australian College of Nursing’s Graduate Certificate in Aged Care Nursing has been designed by aged care experts and equips nurses with the knowledge, skills and attributes required to meet the complex health needs of the older person, across a range of health care settings. Our course is delivered online over a ten week term, allowing nurses to balance their work and study commitments. This course covers: assessment of the older person, clinical issues in the care of the older person, and professional issues, along with a range of electives such as, healthy ageing and dementia care.

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Baptcare The measurement of Client Experience Residential and Home Care – Metropolitan/Regional, 80 + beds Award descriptors: Leadership and culture, Communication and engagement, Technology Through the exploration of innovative approaches to engage our clients to ask what truly matters, and the development of new ways to test and measure their experience, we have commenced a journey to improve and design services that will not only meet their needs, but exceed expectations. What we did With Client Experience an essential component of the organisation’s strategic direction and the Net Promoter Score chosen as the high level key performance indicator for how our clients experience our services, our move from satisfaction surveys was seen as paramount to success. The Net Promoter Score is a strong indicator of loyalty and growth, and measures the willingness to promote our organisation. Evidence suggests that the reason this is such a strong indicator is that when a customer recommends an organisation, they are placing their own reputation on the line. The use of the Net Promoter Score in healthcare has highlighted that although clinical reputation is important, the emotional experience is a key element in the willingness to recommend; with our clients’ narrative throughout our project further evidence of this. Companies with world class loyalty have a Net Promoter Score of 75-80% We knew that to improve the Net Promoter Score we would need to identify what the key drivers of the score were for each of our client groups. We believed that to do this we would need

to seek what truly mattered to our clients and thus completed a deep dive of our clients across the organisation. This deep dive collected narrative from our clients and occurred through a number of mechanisms: 1. Leadership conversations: Baptcare leaders engaged in phone conversations with clients, gaining real time insight into how our clients and carers experience our services, and displaying organisational leadership and commitment to improving client experience. 2. Client Discussion Groups: In collaboration with Lifestyle teams a number of discussion groups with residential service clients were completed, these included such topics as “What is dignity?” 3. Experience story telling: Clients across all service types were visited on a 1:1 basis collecting the narrative of their experiences and seeking answers to questions to gather data on how our services make clients feel and what truly mattered. These included questions such as “What do you want to feel like when staff leave your room?” As the organisation moved toward a customer experience model, the quality team explored the opportunities that might exist beyond the client experience surveys. This included an analysis of both the advantages and disadvantages of the traditional satisfaction survey format. Current research is now revealing that clients may well be satisfied with the outcome of a service or care, even though they received an indifferent or poor service. Satisfaction is often equated with gratitude for care or services, rather than a description of an experience during care or services. Our goal is to engage with our clients to develop a suite of survey tools which will cascade from the Net Promoter Score for each service type and reflect what truly matters rather than what makes our clients families satisfied. For more information on this program contact Michael Wilson, mwilson@baptcare.org.au or phone (03) 9831 7319.

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During the individual and group training sessions, we applied continuous improvement strategies to adapt and enhance our products to meet the needs and expectations of customers. At the trial’s conclusion, participants reported a marked increase in their technology use for social connections. This trial demonstrated that technology is an enabler, providing the opportunity to bring people together for shared learning and companionship. Our rapidly changing and technology-dependent world, coupled with people living longer, is escalating social isolation amongst older Australians. Findings from Galaxy Research show that social isolation is at epidemic proportions, with up to 45% of seniors reporting they experience loneliness. We trialled a social technology product with a tablet device, data, social connection platform, coaching and IT support. We launched our model at five community events in four different regions, attracting 400 customers and family members. Everyone who attended had the opportunity to express interest and/or enrol in a trial of the model. Each community event was facilitated by employees with IT or customer service experience. Image courtesy of Robert Kneschke/Shutterstock.com

KinCare Health Services Pty Ltd Improving social connectedness through technology Home Care – Metropolitan, 80 + beds Award descriptors: Communication and engagement, Social participation, Technology We started exploring the appetite for social technology in older people through a pilot in 2014. Following that success, we applied for a grant through the Department of Social Services (now Department of Health) to co-produce a new social technology model with our customers. We wanted to understand whether technology could improve the social connectedness of older Australians at risk of social isolation.

From these events, we signed up 100 tablet users to participate in our social technology model trial. Most of these customers were in their 70s and 80s. All participants received a home visit to set up, customise and introduce the device. We used these visits as an opportunity to understand users’ goals and determine what they were seeking from the device and program. These home visits were supplemented by group and/or individual training sessions, assessment of levels of skill and motivation and ensuring users understood how to access IT troubleshooting support if they ran into difficulties. Coaching was provided by employees with experience in IT and customer service, as well as home care workers who attended an in-house Tech Lead training program focussing on how to support one-on-one learning.

Our model’s aim was to provide opportunities for older people to meet like-minded people, develop friendships, learn new skills and improve connections with family, friends and community through the use of technology. The technology, classes and community events provided the opportunity to bring people together, thereby reducing social isolation.

We are continuing to support customers who participated in the trial and are now offering our social technology support model in our home care packages and in our private services. We have also developed a Bring Your Own Device (BYOD) model which is attracting interest from existing and new customers.

Our social technology model included a tablet device, data, social connection platform, coaching and IT support. We launched our model at a series of community events, during which participants had the opportunity to express interest and/ or enrol in a trial of the model.

In addition, we have established a Help Desk with business hours support for our social technology support customers so they can either email, phone or message if they need help with their devices.

All participants received a home visit to set up, customise and introduce the device. This was supplemented by group and/or individual training sessions and access to IT troubleshooting support.

We are committed to continuing with our model and will further monitor the experience of our customers and the efficacy of the model through regular customer satisfaction. ■ For more information contact Gavin Hudson, gavin.hudson@kincare.com.au or phone (07) 3442 2600

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Better Aged Care without reliance on government funding. Welcome to the future. The Aged Care industry is undergoing major change. Government funding has been reduced, directly affecting patient care. Yet in this time of less, one Aged Care organisation is promising more. Xtra Aged Care and Xtra Home Care. Xtra Aged Care is an Allied Health company working throughout Australia for a stronger financial future for operators through more personalised care for residents.

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COME AGE WITH US:

AN INDIVIDUALISED APPROACH TO OVERCOMING COGNITIVE DECLINE Applying a scientific approach to understanding the ageing process in people as individuals led Hoffmann World founder, Catalina Hoffmann, to designing a new model of care with huge success across Spain, South America and South Asia. Next stop: Asia Pacific.

hree minutes in to a presentation that Catalina Hoffmann is delivering to delegates at the 2016 Ageing Asia conference and it is already clear that she does not accept barriers that stand in her way.

In the darkened conference room in Singapore’s famed Marina Bay Sands Convention Centre, full of eldercare executives and innovators from across the world, Ms Hoffmann shares her journey to success, that began as a young woman in her 20s who questioned how older people are cared for when she saw her own grandmother’s experience in Spain’s institutionalised aged care system. “Twelve years ago ageing in Spain was the worst thing that could happen to you. Your independence was gone, your

quality of life was reduced to the walls around you, and any hopes and dreams unfulfilled were never going to be realised,” she said. “I thought to myself, why do we accept this? And I told my mother that I was going to change things.” After completing a degree in Occupational Therapy, specialising in cognitive stimulation, Ms Hoffmann began working on the theory that rehabilitation and preventive treatment required an approach that included physical, cognitive, psychological and social aspects. Seeing an opportunity to improve the lives of thousands of elderly people in her country alone that would be supported by

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a unique business model, Ms Hoffmann sought backing from financial institutions but faced the first of what she discovered to be many systemic barriers. “I was told to go away by more banking institutions than I can recall. I was very young and working with elderly people. People laughed at me and asked why do I not instead work with babies and children. Why bother with old people, they said. I had created a new method to improve people’s quality of life and everybody thought it was my father who had created it. To be young and a woman is not easy in Spain. I had to overcome many hurdles,” she said. It took just one bank manager to see the business case for supporting Catalina’s dream and her own determination and commitment, and in 2003 she began delivering Spain’s first

therapeutic and rehabilitation services for elderly people in a day care setting under the business name Vitalia. By 2010, Vitalia had expanded from its original facility in Madrid to include 11 additional franchise centres throughout Spain. Four years later Hoffmann World was launched and the company began to look to other countries where eldercare could use a shake up. Joint ventures were opened in Mexico and Colombia in 2015 and they are now looking to Asia Pacific, announcing at the Ageing Asia conference their imminent launch in India.

The Hoffmann Method The Hoffmann World Corporation has grown to become a group of companies focused on the management of wellness and health of people from retirement age onwards. Its clients are typically classified into four types – ‘Social elders’ who are recently-retired and are still independent; ‘Elders with some pathology’ who are typically over 60 and need special care due to a specific health concern; ‘Fragile elders’ who are over 80 and are otherwise in good shape; and ‘Palliative patients’. “The Hoffmann Method is a rehabilitation and preventive treatment method with physical, cognitive, psychological and social benefits, designed specifically for older people. It is registered as a scientific work in intellectual property, which requires rigorous evidence and evaluation by independent scientists,” Ms Hoffmann explained. The principles behind the Hoffmann Method are about rehabilitating people through activity, meeting the needs of the individual, no matter their age, physical or cognitive condition. The professionals who work in the day centres and outreach programs must hold healthcare diplomas and be qualified in the Hoffman Method, and are trained to adapt materials to people’s specific needs. These materials include cognitive, physical, neuropsychological and social stimulation to improve brain activity. Delivered alongside and with respect to any medication the individual has been prescribed, the Hoffmann Method combines the stimulation of the cognitive, physical, neuropsychological and social areas delivers measurable improvements in the senior’s brain activities. “Now we face a revolutionary way of understanding the aging process, a pioneering perspective that solves prevention problems at its different stages. We know the adult brain can relearn by performing physical, cognitive and neuropsychological exercises.” “Clinical results demonstrate that through the use of the Hoffmann Method, the improvement of the brain’s neuroplasticity is possible in adult life. These assertions are supported by data from clinical trials, and more than 6,000 cases over 10 years,” Ms Hoffmann said.

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Sometimes though it is simply a case of asking people what they want to do – what goals did they have in life that they want to fulfill, what do they love. “Martina was my very first client at my Vitalia Day Care Centre. She was 90 years old and her health was very deteriorated as she was suffering from depression. Her son was the one who brought her to us although no one in the family had much hope for her, but after five intense years of work under the Hoffmann Method and giving her a lot of love and care, Martina was a new person, full of energy, happiest as ever and incredibly active. She passed away at the age of 102 with all her cognitive abilities.” “Another client, Don Luis came in with his daughter with great anguish because he had been a Notary for 70 years and had lost the ability to sign due to Parkinson’s Disease. His wife had incapacitated him and he was very distressed, he felt that his life no longer made sense. He refused to be a dependent. Upon his arrival at Vitalia, I asked him what did he really want. “This is the first time someone is kind enough to ask me that,” he replied. So I began to work with him on his cognitive abilities, designing a personalised treatment based on the Hoffmann Method. He worked hard and had a lot of fun at the same time. I remember spending very enjoyable times together and he managed to sign again! Of course he could not return to practice as a Notary, but he became a happy retired man, in love with life again.”

The Hoffmann Method provides answers to prevention, early detection, recently-diagnosed and advanced pathology, and its training model is the foundation on which the success of its day centres have been established. “Science evolves, and our method is scientifically-based. We are dependent on continuous innovation and have embraced technology into our methods. The Hoffmann Method encourages the use of a variety of materials that exercise cognitive function and daily activities including touch screens, video games, tablets and robots. These are used alongside traditional materials like speech, music, culture and art therapy.” In 2015 the Hoffmann Group unveiled a suite of programs designed to aide cognitive impairment through language, memory, culture and fine motor skills; new treatment programs for stroke and Parkinson’s rehabilitation; as well as protocols for daily activities such as showering, medication, emergency situations, conflict case plus others. The training arm of the business complements a prevention and rehabilitation program that can be delivered in people’s homes, and the Hoffmann neurological rehabilitation program. The Hoffman Method will be launching in Australia in 2017. ■ For more information contact Ana Garcia De Baranano at ana.garcia@hoffmannworld.com

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DESIGN

A RESIDENTIAL CARE COMMUNITY

WITH A DIFFERENCE A commitment to enhancing the lives of residents living with dementia, supported by rigorous research and innovation has led to an award-winning development in north Brisbane. What the houses will look like

ntimate, home-like surroundings where people can be involved in their daily routine – and particularly in decision making – improves the quality of life for people living with dementia, according to current research. The research highlights the ongoing issue of design that is driven by underpinnings of a medical model at the expense of a social, person-centred service. It was with this in mind, that the Synovum Care team were determined to offer a new

paradigm for care and services; where residents will be able to live as normal a life as possible. In early 2015 Paynter Dixon Queensland were engaged by Synovum Care to undertake master planning, design and construction of a new 120 bed small scale living development in Bellmere, Queensland. Paynter Dixon’s selection was largely based on its commitment to design

DESIGN

the site. Ms Chadwick is very clear that “each house is autonomous, with its own budget and team. They do their own menus, cooking, cleaning and laundry, and they call on a clinical team if they require clinical assistance.” A fully functional domestic-type kitchen and laundry enables residents to be engaged in supported cooking and laundry activities, facilitating greater independence in daily living activities.

Relationships-based Model Site plan of Synovum Care’s Bellmere project with indicative gardens

that supports and enhances life for people with dementia. A year later, the design – the result of a fantastic clientconsultant collaboration – won the 2016 Best Silver Architecture – Residential Award at the 4th Asia Pacific Eldercare Innovation Awards.

Project Development Seeking to change the way in which people with dementia are care for and accommodated, the Synovum Care team led by Managing Director Natasha Chadwick, together with the team from Paynter Dixon Queensland, reviewed research literature and participated in site visits to other facilities, including the De Hogeweyk Dementia Village in the Netherlands, seeking inspiration for an approach to small scale living in the Australian context. The resulting care, staffing and financial model that has evolved from these investigations has been progressively monitored through the development of two pilot houses at Synovum Care in Wynyard (Tasmania). The outstanding results strengthened the resolve of the team to progress to a larger project. The site at Bellmere is a 1.852 hectare gently sloping block in a suburban area within the northern reach of Brisbane. Site works for the residential community commenced in July 2016 and once complete it will consist of 17 domesticscaled homes, nestled in a beautiful and interesting landscaped environment supported by a community and administrative centre at the entrance. The design is suitable for people of all care needs, including those with severe dementia.

Small Scale Living Empowering older adults to maintain their ability to complete daily self-care and household tasks, and supporting them to enjoy what they are still able to do, is an important aspect of the Synovum Care vision. The designed environment and care model are intrinsic to delivering an enhanced rather than a diminished life for people with dementia. Synovum Care’s Bellmere small scale living model will be ‘households’ of seven residents, supported by House Companions (multi-skilled staff) in individual homes across

The relationship-based nature of this care model is actively supported by meal sharing around a central table, with residents deciding what they want to eat and when. The replacement of institutional routines with a more relaxed approach enables residents to live their own lives as they wish – doing what they want in their own time. Each resident will have their own single bedroom and ensuite, providing privacy and dignity, with shared social areas in each house being the living rooms, kitchen and dining areas, as in most family homes across Australia. With such beautiful weather in Queensland, the integration of indoor areas with the surrounding gardens will be maximised, with plenty of natural indoor light and easy access to outdoors via the porch or patio.

The Outdoor Environment The design intent of the outdoor areas is to create a familiar suburban setting that supports social opportunities between residents living in different houses, and promotes resident independence and familiar routines. Each home will have its own fenced ‘backyard’. However residents will have free access into and out of these areas. The approach to each home will be via a front path past the letterbox to a front door, just as you would expect to see in an Australian suburban street. Centrally the gardens will form a ‘streetscape’ with a roadway, street lamps and walking paths. The roadway will provide access for facility golf buggies and emergency vehicles only, with visitor and staff car-parking at the front entrance. The themed gardens have been planned with points of interest to engage and stimulate residents as they journey towards the community administrative building. These include parks with seating, a men’s shed, a chook pen, a formal garden, children’s play equipment and an alfresco eating area adjacent to the café. The entire site is secure. Once a visitor has parked their vehicle, there is a single entrance through a welcoming foyer in the community administrative building, providing a sense of security for residents and a safe area for people living with dementia. Fencing will be discretely integrated into gardens, and will cleverly utilise the natural contours of the ground to create an overall feeling of openness.

DESIGN

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DESIGN

Master Planning Workshop with Natasha Chadwick (Synovum Care) Andrew Spilar (PDQ) and Shane Chadwick (Synovum Care)

Community Engagement Assimilation with, and contribution to, the surrounding community is important to Synovum Care and a core aspect of its service. The community administrative building will feature services such as a hairdresser, barber, café and a wellness therapy centre that will welcome residents, families and the local neighbourhood. From the minute a visitor enters this care community light, energy, colour and vibrancy will be evident. The wellness therapy centre will promote enablement and re-ablement programs as well as clinical support for residents and older adults in the community, and will include a gym area, consultation rooms, dental services and a spa. The café will have a coffee service window opening to the external carpark for early morning commuters. A ‘corner

store’, theatre, music room and activities room provide additional venues for residents and families to enjoy social activities. The overall vision for Synovum Care Bellmere is to provide an attractive, safe and engaging place for older people requiring aged care support to continue to live the life they have been used to, and to feel respected, valued and fulfilled. Synovum Care is an Approved Provider with Government subsided residential aged care bed licences, making access to this exciting new model of residential aged care living an affordable option for older people and their families. ■ For more information contact Kerrie Storey or Erica Lambert, Paynter Dixon Queensland (07) 3368 5500

DESIGN

IN THESE CHANGING TIMES Debbie de Fiddes I Principal de Fiddes design

Design is one of the key critical components in providing a successful aged care and retirement facility. In these changing times it is important to explore what is happening in different parts of the world and review how are we doing things in Australia and could we be doing them better?

recently travelled to Budapest to speak at the International Alzheimer’s conference and thought I would take the opportunity to visit the Netherlands to take a look at the facility everyone is talking about – de Hogeweyk.

What’s special about de Hogeweyk? De Hogeweyk is a secure village designed specifically for residents with dementia. The village incorporates a theatre, supermarket, restaurant, pub, hairdresser etc. There are 23 residential houses each with six or seven residents. Residents are grouped together according to their similar interests and backgrounds and the houses are modelled according to these parameters. This style of care obviously works: the overall atmosphere is one of contentment and the residents seem very happy. The tours undoubtedly highlight the facility and the level of care it is possible to achieve. I was very fortunate to have Eloy van Hal as my tour guide and interpreter. I bombarded Eloy with questions the entire time and was particularly interested to know what didn’t work and if de Hogeweyk had the opportunity to do it over again what would they do differently. One issue is the entrance, which is also the only exit. The design is such that the main internal boulevard leads directly into the entrance/exit. During my visit I noticed a resident giving the poor receptionist a very hard time. The lady in question had just recently gone to live at de Hogeweyk and was still becoming accustomed to the village. De Hogeweyk is currently looking at ways to camouflage the doors leading from the main boulevard into reception. What was impressive during that confrontation was how the receptionist handled it. All staff and volunteers receive three years of training and it was obvious he knew exactly how to handle the situation. De Hogeweyk have also removed the carpet in the individual houses and replaced it with vinyl. Whilst vinyl is practical it

can lead to a noisy environment. To deal with the acoustics issue de Hogeweyk installed a noise cancelling device that worked extremely well. As I mentioned, each of the houses are designed to suit lifestyle types of the residents. I was invited into the house styled for residents of affluence and happened to walk in whilst they were enjoying high tea. All residents were sitting around talking, laughing and generally looked like they were having a good time. Eloy purchased a bottle of wine from the on-site supermarket to give to the residents as a gift for allowing our visit, a perfectly normal gesture as if you were visiting friends! Kitchens in the de Hogeweyk houses are normally integral to the dining room; however, that wasn’t the case in this particular house. Eloy explained that these residents typically would have had hired help and therefore wouldn’t have been involved in domestic duties and rarely would have used the kitchen. The house design itself is very simple and includes shared bathrooms. This is something that is becoming an issue as resident families are beginning to ask for a private ensuite. The other facilities such as the restaurant, supermarket, theatre, pub and cafe were all very impressive and certainly not token gestures. The design would fit into any urban setting and all the facilities are used by the community. The integration, however, lacks direct connection to the community. The security of the residents and ease of use by the community could have been designed in a better way to incorporate both. I believe the success of de Hogeweyk can be translated into larger vertical living, which is the preference in design here in Australia.

Back to basics – The Green Farm Another impressive facility we visited just outside Amsterdam was a small green care farm called

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DESIGN

Image courtesy of Lisa S./Shutterstock.com

“Reigershoeve”. The facility provides 24-hour nursing home care for 27 people living with dementia. They also have an impressive adult day centre.

Most of the work around the farm is completed by volunteers and Reigershoeve provide an impressive workshop that most men would envy!

The facility consists of four houses with an upstairs barn style accommodation for use by resident families if necessary. Whilst we were not permitted to enter their houses we were given information regarding the interiors. Interestingly, at Reigershoeve each resident had their own ensuite.

The children’s playground is so successful that the local children ask if they can come to play on a daily basis. They also have conversational pits for family and friends, exercise areas for the body and mind and much, much more.

When you entered the day centre it felt immediately comfortable and was a mix of eclectic furniture and fabrics. The design was simple but rich in flavour.

Whilst the designs were interesting and certainly had some take away ideas, I couldn’t say that was the key feature.

The outdoor spaces were impressive with an abundance of growing veggies and a mini zoo! There were chickens, ducks, goats, sheep, bales of hay, mini tractor and even a small lake. Whilst all residents are encouraged to participate in the every day activities of the farm, it is by no means compulsory; it is their choice.

So what’s different?

The extraordinary thing about these places was the emphasis on normal life. I didn’t feel out of place and I certainly didn’t feel like I was in an aged care facility. It felt like a natural environment and a day like any other. Successful design is in the ability to translate that feel into our model here in Australia. This is the change we have to strive to make. ■

DESIGN

THE DESIGN AND FUTURE OF SUSTAINABLE COMMUNITIES

Professor Laurie Buys and Dr Desley Vine Senior Living Innovation, Institute for Future Environments, Queensland University of Technology

The post-war generations, particularly baby boomers, differ from previous generations in fundamental ways and communities will need to respond to changing social and consumer expectations.

Image courtesy of gyn9037/Shutterstock.com

DESIGN

ore than any preceding generation, the baby boomers have had nearly every aspect of life redesigned to improve each of their life stages. Their course through adult life has been marked by change, challenge and transformation. By their sheer force of numbers, they are a demographic bulge remodelling society and the later stages of their lives will be no different. As a group, baby boomers are directly challenging traditional expectations of ageing and their preferences centre on independence, flexibility and consumer and lifestyle choices, particularly ongoing participation in the wider community. Clearly, the baby boomer generation and those that follow are expecting to live a full life by actively ageing within their community. To meet the needs of this growing group of engaged citizens, we will have to adapt to the demands and expectations for well-designed community infrastructure, services and products. Some may believe that this is easy to deliver, however embedded within many conversations focusing on community infrastructure is a clear lack of any expectation that older people will make meaningful and valued contributions to the community. Such ignorance is fed by a popular culture, where people of advancing years are seldom seen in movies or on television or in the media more generally and if they are, their portrayal often reflects the negative cultural attitudes toward ageing. What results is a poor understanding of ageing at a societal as well as an individual level until of course, we achieve the success required to reach this life stage ourselves.

to enjoy ongoing participation within wider society, through optimising opportunities for health, participation and security. If we place the emphases on participation supported by health and security, the foundational principle for delivering community infrastructure becomes community participation and engagement.This re-focus may help to change the conversation, so that we, as a society, have an underlying expectation and core belief that all people regardless of age are valued community assets who deliver economic and social benefits to the society. Age-Friendly Cities adapt their “structures and services to be accessible to and inclusive of older people with varying needs and capacities” (WHO, 2007, 1). The complex and multi-layered interactions between the built, natural, technical and social environments are significant for creating and facilitating opportunities for sustained community engagement. Conversely, poorly designed community infrastructure can result in unintended consequences by inherently building-in insurmountable barriers to community engagement. Sustainable communities are designed with and for all residents, regardless of age.Meaningfully engaging all citizens in the design of community infrastructure and ‘really’ listening to their voices will be critical for many communities. An example of the importance of such engagement was realised recently with unintended design consequences to a recently built community

Stereotypes and myths about ageing are common and while we are critical of cultural or gender stereotypes many of us accept age stereotypes without question. Such stereotypes reflect cultural attitudes that make people of longevity feel invisible and devalued. Who wants to define themselves by their age or wants to be thought of as old? It is an obvious rhetorical question but what if people regardless of age were considered as citizens at particular life stages capable of contribution rather than defined as ‘seniors’ or ‘elderly’ with the associated limitations that usually accompany such labels. At the mention of the word ‘senior’, many conversations immediately take on a health and medical focus – or highlight the financial burdens of ageing. It is our contention that such a dominating focus is unhelpful. The World Health Organisation (WHO), through their Active Ageing and Age-Friendly Cities policies, has recognised issues like the living environment and participation as having a major effect on the health and wellbeing of people and yet be beyond health and medical care. The place where people live and participate matters and it may matter more in our advancing years than at any other stage of life. Our built environment moulds our behaviours, our participation, it shapes the contours of our daily experience and determines our access to the things we want and need in our lives. The WHO calls to action all such sectors that have a direct influence on the determinants of health. Active Ageing was developed by the WHO to directly address the goal of maximising the opportunities for people of all ages

DESIGN

centre. Residents felt excluded from participating in the design process and penned their feelings in the lyrics below. This song was performed by the residents in April 2016 (lyrics were shortened for privacy), clearly voicing their frustrations:

Critical to creating and achieving sustainable communities will be designing from the key principles of value, contribution and engagement, and including all people in the design process. ■

We have got a – brand new centre Now we find that – we’re not meant ta Go into it – in our scooters And that decree we find just does not suit us!

• The value and contributions of people of all ages will be imbedded in an age-friendly focus across all levels of government, incorporated into all policies

Interlude: We have minds – we know what suits us It’s not – always what they give to us We want freeedom to hear the facts And then what is their impact

and programs, particularly infrastructure delivery • Programs and services will be designed and delivered with participation as the key outcome – supported by health and security

Instead – they foist upon us Things that – are not our choice for us They think – they know best for us who’re old To do just what we’re told

• New housing and accommodation options and models will be available and accessible • New transport types and transport systems will

As the current cohort is starting to protest, community leaders can expect baby boomers to take up the fight – but much louder! The baby boomers are the longevity economy and they are a powerful economic force. They provide vast opportunities to create solutions that help people as they age. Part of these solutions will be sustainable community infrastructure that is designed and delivered to facilitate participation for all residents.

INSPECTION INSPIRATION INNOVATION

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• Regulatory requirements • Labour structures • Technology/equipment requirements Our clients include • Public Health and Emergency Services • Aged Care – public and private • Private health • Local government

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DESIGN

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TECHNOLOGY

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TECHNOLOGY

THE TECHNOLOGY START UP CHANGING

COMMUNITY CARE DELIVERY

Start ups like Better Caring are shaking up the community care landscape by cutting out the middle man and eliminating costly overheads. Ahead of drastic changes to home care funding arrangements in February 2017, how will your business compete with the next generation of industry disrupters?

Image courtesy of goodluz/Shutterstock.com

ike most other successful innovators, Peter Scutt saw a problem, identified a gap in the market and set out to fill it. His problem was personal one that will affect many Australians at some point in life – how to ensure his parents received the best possible, affordable care in their home as they grew older. And so he and co-founder Tony Charara created Better Caring, a two-way online marketplace connecting care givers with care recipients across Australia. “We were struggling to provide adequate support so they could continue to live independently in their own community,” Scutt said in an interview with Start Up Smart, a blog run by national digital publisher, Private Media. “I had to deal with these problems, and my conclusion was that the industry didn’t work well for my parents or the care workers. This made me realise that this industry was crying out for change.” The advent of the modern share economy, or peer to peer services, is most commonly attributed to share

accommodation provider, AirBNB, and share ride service, Uber. The huge success of these industry disrupters meant it was only a matter of time before direct service models were introduced into other service based industries such as home care. Like other web-based peer to peer services, Better Caring effectively replaces the services of an agency or provider with its website and booking platform that connects people who require in-home or community care with nurses, care and support workers in their area. While a team in the background still carry out the same background checks and on-boarding process that any agency would do, in the eyes of a consumer it can offer greater value for money because it does not have costly overheads of a large HQ or permanent staff. It also offers total transparency about its fees and charges, with the workers setting their own rates that are advertised clearly on the site and Better Caring taking a 15 per cut – five per cent of the service fee charged to clients and 10 per cent of the fees paid to the worker, in a similar business model to both Uber and AirBNB.

TECHNOLOGY

Offering a simple, clear pricing structure and enabling people to secure services online via their phone, tablet or computer is going to be a key differentiator in February 2017, when consumers have greater control over where their home care funds can be spent. Service providers that enable people to book and pay for their care online in the same transaction as when they begin their search will have the upper hand because consumers are more likely to try something different if it is a convenient option and you make it easy for them to do so. This means providing instant payment options via your website. The level of control that consumers want over payment options extends to selecting who they receive their services from and knowing there are no hidden fees or costs. “Today’s consumers have a wealth of resources at their fingertips. No matter where they are in the world, they can access an infinite number of customer reviews, blog posts, and competitor websites. Even if they’re standing in the middle of your brick and mortar storefront, far away from a computer, they can still place orders — right then and there — from your competitors,” says Neil Patel, author of Understanding Consumer Psychology. Better Caring’s engagement model also offers benefits to employees, in what is increasingly a job seekers market. By allowing care workers to operate their own small businesses

Care and support workers can create their own profile that outlines their experience, qualifications, availability, hourly rates and interests. Consumers can then search, compare and choose the right care worker for their needs. According to its website, all care workers using the Better Caring platform undergo a strict on-boarding process, including reference and qualification checks, police checks and verification of any specific requirements for nurses and those providing personal care. They also have comprehensive insurances arranged on their behalf. There is a “rigorous” selection process to make sure all care workers listed on the site are safe and qualified, Scutt says, with only 700 of the 2000+ applicants so far meeting the requirements to then be listed on the site. While Better Care has only been available in Sydney since its launch in 2014, it has just undertaken a series B investment round which has returned $2.3 million that will be used to expand the service nationally. ■

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and connect directly with those needing care it avoids the cumbersome and costly IR framework at the same time as giving consumers the ability to specifically select their care worker.

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TECHNOLOGY

3D PRINTED DINNERS ARE ON THEIR WAY

Over the next two years 3D food printing is expected to make the leap from futuristic technology to a mainstream household item, bringing with it a revolution of culinary options for people who struggle to swallow.

he use of 3D food printing has already been trialled in nursing homes in Germany, and earlier this year in a world first a pop up restaurant opened in the UK serving only printed food.

The Food Ink. travelling restaurant will soon be bringing the byFlow printer to cities around the world including Dubai, Seoul, Rome, Paris, Las Vegas, Toronto, Berlin, Singapore and beyond. Not only was the food was made locally by 3D printers: the restaurant’s fixtures and fittings were too, from the knives and forks the diners used, to the chairs they sat on. Dubbed “print-out pop-ups,” the unique dinner series delivered as a partnership with locally renowned chefs, it is serving a platform for a conversation about the future of sustainable food, nutrition, and health. Through live demonstrations as the food is prepared it is displaying first hand how emerging technologies are rapidly challenging and changing the way we eat, create, share and live.

Dr Kjeld van Bommel is a research scientist with TNO, the Netherlands Organisation for Applied Scientific Research, and for the past five years he has been working at the forefront of the new technology. Among his projects is EU-funded research which aims to create 3D-printed vegetables and meat from puree for elderly patients in nursing homes. In an interview with the ABC Van Bommel said that while you need food to print food—raw ingredients in the case of printed biscuits or melted chocolate for printed chocolate—there is an additional benefit to printing purees. Ingredients can be added to ensure that each portion fits the dietary needs of each patient, with customisable levels of fat, vitamins, minerals and protein. “You tell the printer to mix the ingredients in different ratios and every portion is then sent to the printer and different products come out with different compositions and that’s something that regular technology cannot really do,” he said. ■

In Europe, supermarkets are already testing 3D printed customised cakes, restaurants are offering printed desserts. While chocolate and sweets are easily created using the printer, healthier foods can also be made to order. “We know that for food printing you need paste materials – it cannot be too liquid but it also cannot be too thick, so that’s very important. Also we can help with making the designs – we know exactly how the printer adjusts to what type of designs, it’s really a collaboration. The chefs know about the flavours, we do the technical part,” a ByFlow spokesperson said. German company, Biozoon, is harnessing the power of 3D printing to create seneoPro, a range of 3D-printable powder mixtures that melts when eaten. The main target for this new 3D-printable food are elderly patients who suffer from dysphagia, or the inability to swallow. Such a technology would definitely reduce the risk of choking, and the 3D-printed nature of seneoPro means that caregivers and family members can very easily create all types of dishes. You can also add colouring agents and texturisers to make the food even more appealing.

Image courtesy of Tinxi/ Shutterstock.com

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www.itacconference.com.au 28–30 November 2016 ITAC – Pullman EmpowErIng Albert Park, Melbourne CArE TEChnology ITAC 2016 Conference Audience ITAC is relevant to a broad range of aged care managers and care providers including: • • • • • • • • • • •

Chief Executive Officers Chief Information Officers Care Managers Carers Directors of Nursing Healthcare Administrators Government Policy Makers Hostel Supervisors Industry Partners Operation Directors and Managers Operational Staff

Go to www.itacconference.com.au to register online. 64

Registration www.itacconference.com.au

Now Open For further information contact:

Jane Murray ITAC 2016 Conference Manager c/- Corporate Vision Events T: 08 8981 5119 E: itac@itacconference.com.au

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THE USE OF SURVEILLANCE

IN AGED CARE FACILITIES In 2015, the Aged Care Complaints Commission reported that over 10,000 complaints were made, two per cent of which related to allegations of abuse. The Australian law does not currently provide for a definitive or uniform legislative framework for the use of surveillance devices in aged care facilities.

Dominique Egan Partner I TressCox Lawyers

Image courtesy of Vasin Lee/Shutterstock.com

n response to the rising reports of elder mistreatment, there has been an increasing call for surveillance devices to be installed in aged care facilities to protect residents from abuse and to ensure accountability on the part of staff. The debate concerning the use of surveillance devices within aged care facilities has gathered momentum following recent media attention of a case of elder abuse in South Australia. The South Australian Government is calling for reform and has called for the Commonwealth to introduce uniform, regulatory changes in the sector.

Workplace Laws The use of CCTV cameras by employers in New South Wales is governed by the Workplace Surveillance Act 2005 (NSW). Under the relevant provisions, any use of CCTV cameras must be clearly visible; signs must be displayed to notify of

ongoing surveillance; staff must be provided with written notice 14 days before a camera is operational; and the use of records obtained is stringently managed. Under the Surveillance Act, it is illegal for surveillance to be carried out in toileting and bathing facilities. Along with New South Wales, Victoria and the Australian Capital Territory also have workplace surveillance legislation. The laws in Victoria hold employers to higher standards in relation to notice requirements, mandating the â&#x20AC;&#x2DC;express or implied consent of each party to the activityâ&#x20AC;&#x2122; as opposed to the mere provision of notice.

Private Activities In Victoria, the Surveillance Devices Act 1999 prohibits a person from using an optical surveillance device to monitor

BUSINESS MANAGEMENT

a ‘private activity’ to which they are not a party if not all the people conducting the activity have given their consent. A conversation or activity is ‘private’ if it occurs in circumstances that reasonably indicate the parties desire it to be heard or observed by themselves only, and when they may reasonably expect that they will not be heard or observed by someone else.In terms of private activity, an activity is private if it occurs indoors.

Of course, that does not make the balancing of interests any less complicated.

In New South Wales you may install an optical surveillance device within premises with the consent of the person/s concerned.

• Care homes should be willing and able to install surveillance cameras within a resident’s room with their consent;

In Western Australia and the Northern Territory a person may not use optical device to view or record a private activity without the consent of the person/s involved. In Queensland, a person cannot use an optical surveillance device without consent of the person/s concerned if they are in a private place or engaging in a private act. This includes bedrooms and bathrooms and includes activities such as bathing and dressing. In South Australia, legislation which is yet to commence operation allows a person to use an optical surveillance device without consent to record or view a private activity if it is in the public interest to do so.

A balance of interests There is a tension between balancing the rights and needs of residents to be safe with their rights to privacy, as well as balancing those rights with those of employees and carers. In circumstances where aged care is a national industry, if there is to be regulation of the use of surveillance in aged care facilities, a national approach would appear to the sensible course.

In a recent research paper published in the United Kingdom1, seven principles to guide the ethical use of surveillance in facilities were identified: • Surveillance cameras are appropriate for common areas in care homes;

• Surveillance technologies must be clearly visible or known to be present; • Staff should be educated on their responsibilities in relation to surveillance; • Access to all data gathered should be restricted; • All data gathered should be treated as if it is owned by the resident; and • Intrusion should be minimal. While the use of surveillance devices within facilities may ensure greater accountability for staff and carers, this must be balanced with the privacy rights of residents, carers and staff. ■ For more information contact Dominique Egan on (02) 9228 9261 or email Dominique_Egan@tresscox.com.au

References 1. Malcolm John Fisk, (2015) “Surveillance technologies in care homes: seven principles for their use”, Working with Older People, Vol. 19 Iss: 2, pp.51 – 59

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M&A TRANSACTIONS

FUNDAMENTAL FACTORS The Australian aged care sector has seen considerable ‘mergers and acquisitions’ activity in recent years. This has been driven by healthy market conditions, increasing consumer demand and consolidation. However, the industry remains fragmented. Operators are still seeking economies of scale, in some cases as a step towards listing on the ASX.

he benefits of consolidation are considerable, such as more efficient administration systems, lower procurement costs and more flexible staffing rosters. The trend towards consolidation is therefore likely to continue. For organisations looking to merge, acquire, or be acquired, there are a number of key divestment challenges to consider as part of developing a divestment plan.

Engaging Consultants– Factors to Consider It is important to engage appropriate consultants, at the right time. For example, if communications are a key focus, consider engaging a consultant at the outset, rather than being reactionary. Similarly, if offers are to be benchmarked, assess the currency of valuations held, taking into account the likely lead time of obtaining meaningful valuations from a valuer with experience in the sector. Wherever possible, look to engage consultants that are a good fit at an organisational level. For example, if your organisation is a small, privately owned or not-for-profit operation that intends to divest one of its facilities, look for advisors with expertise and experience in acting for similar clients and transactions.

Divestment Process If you are divesting, understand the impacts of the various approaches to a sale and in turn, the likely pros and cons. For example, if confidentiality is fundamental, a private process would be preferable to a public sale process, but regard then needs to be had to how broadly the net is cast on making approaches to interested parties. Will you be criticised for not allowing broad participation? Will you potentially miss out on higher financial bids? And how will you maintain competitive tension?

Due Diligence Do not underestimate how much time and resourcing is required to carry out sufficient due diligence. This exercise is

Solomon Miller Principal I Russell Kennedy Lawyers

critical in identifying potential gaps, obstacles and required actions (e.g. identify necessary third party approvals and assess possible treatment of key contracts). Thorough due diligence is never wasted time – extensive commitment typically pays off as a transaction progresses when you can answer respondent queries and articulate a clear position on key issues. Surprises are an unwelcome distraction during negotiations, they disturb momentum and can easily give a respondent leverage, particularly when negotiations are advanced. Importantly, the extent of your commitment to due diligence will: • Inform key sale terms and facilitate development of divestment strategies. • Translate into respondent confidence and the ability to negotiate without distractions.

Clarity of Offering During the due diligence undertaking, you will need to have clarity about the assets offered and any that are excluded. The impact of this on the purchase price allocation and tax consequences should be well understood before you commit. Distinguish preferred outcomes from non-negotiables and consider the impact on pricing. Make sure to articulate any absolute non-negotiables early such as deferred payments, treatment of employees, personal guarantees. This includes understanding the impact of a respondent seeking to avoid some assets (e.g. refusal to take on a supply contract and any resulting pay-out to terminate the contract). Know the point at which you are prepared to walk away if it comes to that.

Meaningful Evaluation Criteria Ensure the evaluation criteria reflect divestment objectives (e.g. financials, core competencies, timing of completion). It is best to do this by developing evaluation criteria that are readily

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measurable. Time frames are important and will help you keep on track. If things are not working out as you’d hoped within the set time frame, a review of strategy, purpose and intent may be necessary.

your suppliers, involvement of unions, the Commonwealth Department of Health, media etc).

Doing this early in the process is important, because if you are looking to divest and have people knocking at your door already, the temptation of a quick sale may see you backed into a corner down the track.

• Understand the risks of a divestment process and identify actions to mitigate these risks (e.g. processes to keep information confidential, staff morale, use of retention bonuses to keep and incentivise key staff).

Clear Communication

• Rationalise any divestment thresholds imposed by a respondent (e.g. minimum refundable accommodation deposit levels).

Identify and implement an appropriate communications strategy. Clear communication to staff, residents and other stakeholders during what will be a time of change for everyone is critical. If you do not have the appropriate skills in-house already, engage a consultant to assist with this because getting it wrong will cost you down the line. At a bare minimum, map out key announcements, third party notifications and information updates against the appropriate audience (i.e. staff and residents and their families,

Additional Risk Management Challenges

• Further, be aware of the impact of representations and warranties under sale terms (e.g. business complies with laws, no litigation) and develop appropriate controls (e.g. make appropriate disclosures to respondents). In conclusion, on developing a divestment plan, don’t lose sight of the underlying objectives for divesting or merging – those objectives should inform all key steps. Allocating appropriate resources to the process should pay off in the long run. ■

OPTIMISE CARE TO THE ELDERLY WITH THE 2016 AMH AGED CARE COMPANION 2016 Aged Care Companion Book Release. This companion is a valued, practical and easy to read reference for nurses and carers who are dedicated to helping the elderly. It contains the latest evidence-based information and is useful when reviewing medication and other activities aimed at improving patient outcomes. There is information on the management of more than 70 conditions common in older people, including dementia and its behavioural symptoms, delirium, cardiovascular diseases, fall prevention, osteoporosis, COPD, insomnia, depression and wound management. It also contains general principles on the use of medicines in older people. The May 2016 release contains new content including a topic on actinic keratosis, information on the process of deprescribing, which is important for optimising the use of medicines in older people, along with a simple diagrammatic guide to inhaler devices with links to instructions for use and considerations for choosing a suitable device in older patients. Other topics reviewed include asthma, COPD, gout, hypertension, dyslipidaemia and dyspepsia. To take advantage of this highly discounted offer & save over $40 - please contact Sales at AMH on 08 7099 8800 or email sales@amh.net.au to place your order NOW! Online version also available. For more info go to www.amh.net.au. 68

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ROLLING THROUGH REFORM

hose of us in the aged care community have been living the reality of this maxim and will continue to do so for the foreseeable future.

StewartBrown has spent 78 years assisting clients through intense periods of change and this current period is potentially the largest and most sustained change to the operation of aged care we have seen. As such, aged care providers have to consider the approaches they take to not only running their services, but also how they listen to what the business and their clients are telling them. Traditional annual budgets and the ensuing updates to the budget, are the primary tools in use today to manage the financial and operational performance of aged care providers. When business is stable and remains essentially unchanged day to day the standard yearly budget with a three-year predictive forecast was sufficient for service planning and resourcing. However, when business is in an unstable period combined with fluctuations of income type and security (a.k.a reform and federal budget cycles), is this the best method for understanding what the business is telling you? What we do know about the annual budget method is: • Budgets are generally out of date before the year starts • A great deal of effort is put into establishing them • A great deal of effort is spent explaining variances The primary issue in using an annual budget is that you are always looking backwards – you spend the next 12 months explaining variances to a model that was out of date in the first place. Those providers feverishly preparing their 16/17 budgets will empathise with the increasing time it takes to create a budget that is generally out-of-date by the time it is completed, leaving an organisation, and in most cases a governance board, without a truly functioning plan for much of the fiscal year. Who out there is about to deliver a budget that they know will be almost obsolete as it is delivered? From our conversations we know of quite a few.

Patrick Reid Director Aged Care, Community and Disability StewartBrown

It was John F Kennedy who said: “Change is the law of life. And those who look only to the past or present are certain to miss the future.” Basing our business assumptions on things remaining the same might provide an illusion of comfort but there is no future in spending our present worrying about our past. The changes to aged care through reform and demographics has meant that CEOs, CFOs and Boards must consider how to better prepare the financial data required to inform an ongoing cycle of planning, conducting, evaluating and updating their services. This is where using a rolling forecast comes in. The forecast is forward-looking and allows boards and management to confidently undertake target setting and using KPIs to measure the performance of the organisation – holding both financially accountable to strategy and operations. Interestingly, it is almost entirely management who crave this accountability and more than once we have heard audiences say, “Most of us (in the room) agree with you – but you have to convince the Board that this is the way to go”. Increasing compliance around RADs and other aspects of aged care should be driving Boards to ensure their information and measurement of performance is contemporary to prevailing conditions in the sector. Aligning KPIs and the rolling forecast can do this better than almost any other method. Many of our high performing clients have utilised StewartBrown to begin moving their traditional budgeting process from the annual budget preparation and delivery to a rolling forecast model that will enable the organisation, its management and Board to become more agile and considered in business planning process and execution. Essentially the components of the rolling forecast: • Provide a combination of actual performance blended with the forecast • Are predicated on the key business drivers • Provide improved clarity beyond the calendar/fiscal year

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• Allow management and Boards to be informed on a regular, pre-determined basis

• Quality of information required for decisions and their consequent reaction time;

• Facilitate rapid forecasting of position if key internal or external business drivers change – e.g. ACFI reductions, occupancy changes, new acquisitions or builds.

• Alignment of operations to any changes being seen on the ground;

Moving your budget process to a rolling forecast, while not a trivial task, will provide a number of key benefits that allow decision making and implementation to be more aligned to the true operation of the service. The relative stability of the rolling forecast means that information for decisions is dictated by real business drivers such as service cycles (length of stay, package utilisation), competitive forces, price sensitivity, changes to government funding, reform and regulation cycles and technology adaptation to name a few. Typically these real issues cannot be taken meaningfully into account for the traditional budgeting process but are critical for managing future operations. Implementing a rolling forecast will provide many benefits to an organisation in terms of:

• Better identification and management of core and non-core activities; and • Better granularity when determining or estimating costs and timelines. A rolling forecast approach with allow boards and management to focus on making more informed decisions, having far reaching implications on their ability to meet or exceed their strategic goals and overall mission. In a sector struggling with change and reform, requiring organisations to undergo significant adaptation, the adoption of a rolling forecast approach will provide a true competitive advantage to you and your organisation. ■ For more information contact Patrick on 0410 537 759 or email patrick.reid@stewartbrown.com.au

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AGED CARE AND RETIREMENT LIVING WE CAN SUPPORT YOUR ASPIRATIONS ANZ is proud of its proven success in supporting the growth aspirations of our Aged Care & Retirement Living clients. Our industry specialists apply their expertise across the private, public and not for profit sectors to develop a strong understanding of our clients’ requirements. To find out how we can work together and structure a solution to fund your growth agenda, speak to one of our specialists. NATALIE SMITH

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FBT AND ENTERTAINMENT

BENEFITS CHANGES The 2015 Budget measure aimed at limiting the amount of meal entertainment and entertainment facility leasing benefits (entertainment benefits) that can be provided by Public Benevolent Institution (PBI) employers to their employees is now in its first year of operation, effective from 1 April 2016.

f you are someone – whether as employer or employee – who has historically taken advantage of the concessional treatment of entertainment benefits, and you have not made changes to your arrangements, then you should immediately consider making changes. Previously, PBI employees had a fringe benefits tax exemption cap of $31,177 (in 2017 figures), and you did not need to count entertainment benefits towards this cap. In effect, you could salary sacrifice as much as you wanted on meals at hatted restaurants and major celebrations.

Adam Craig Senior Manager Tax Consulting Nexia

• newspapers and periodicals provided for business use • work-related preventative healthcare, such as flu vaccines • work-related counselling, such as that provided through an employee assistance program • health insurance premiums • optical aids for screen-based equipment • awards for occupational health and safety achievements. Image courtesy of Monkey Business Images/Shutterstock.com

Now, you can only salary sacrifice up to $5,000 in entertainment benefits in a year, which sits outside of your $31,177 exemption cap, or, if you exceed $5,000 in entertainment benefits, the excess is counted as part of the $31,177 exemption cap. While the concession is not as generous as before, a $5,000 concession is still a concession, and so still of value. But you probably need to take a more considered approach to your salary packaging and remuneration practices if you want to gain maximum value.If you are not already taking advantage of the car parking concession, then that is one you should also consider. Additionally, you should consider the full range of benefits that are exempt for everyone. These include: • work-related items, such as portable electronic devices, if the item is primarily used in the employee’s employment • long service awards • subscriptions to trade or professional journals • membership fees for corporate credit cards and airport lounges

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We’ve noticed a significant increase in provider groups reviewing their strategic plans – preparing for the new season of deregulated aged care. In this article we present four key themes that we trust fertilise your plans if you are working on your strategic plan.

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1. Stay, Grow or Go

his really is the core question for providers, once you answer this it really sets the course of your strategic plan. If your answer is go then it’s pretty much engage some professional assistance to help you sell or merge your operations. If you want to grow then given that supply is limited this almost dictates that you need a duel strategy of acquisitions (people who want to go) and greenfield development. If you are in the stay group then once you decide whether this means stay the same absolute size you are now or stay the same relative size (market share) you too can develop your strategy.

2. Your place in the garden Understanding the market in which you operate is a critical first step. We recently worked with a provider in NSW and when we looked at who is in their corner of the garden we were surprised. %

Population

2016

2026

Total 70+

8,150

11,250

Government 8% planning

652

900

Utilisation rates

775

1,105

Difference

-123

-205

Forecast

619

955

Shortfall on 8%

-33

55 (oversupply)

Demand

Supply

Shortfall on utilisation -156 rates

-150

An interesting aspect of this analysis is that the opportunity depends on how you forecast demand. Typically people use the Government supply ration of 78 places/1000 people 70+. However this is not actually a measure of demand, it’s a mechanism by which the Government rations the supply of places to ensure universal access while at the same time managing the cost to the budget.

Aged Care places

Services

Places

Provider 1

302

15.1

Provider 2

187

9.4

Provider 3

176

8.8

Provider 4

171

8.6

Provider 5

155

7.8

Provider 6

153

7.7

Provider 7

143

7.2

4. Who eats what you produce

Provider 8

142

7.1

Provider 9

4.9

Provider 10

4.3

So you’ve decided to stay in the sector and you want to stay relatively the same size, so you decide to build or extend your facility. There’s still one important question to answer and that is who are your customers? The pie chart shows the postcode for residents of a metropolitan facility over a three year period. In this case 50% of residents come from outside of the local area (>10km from the facility). This has important implications for how you structure and promote your service.

In this example there is only one dominant player. While this is positive at one level it is likely that over time competition for residents will increase.

3. Understanding the opportunity While knowing who is in your section of the garden is helpful the really important information to have is how intense is the competition for customers going to be? The following table is an assessment we did for another provider on the likely supply and demand for residential places in their area over the next decade.

We prefer to use an implied level of demand based on utilisation rates. As can be seen in the above example the forecast demand on the 70+ basis suggests over supply while the demand based on age utilisation says there is an opportunity for an additional service.

Developing a strategic plan for your aged care services is like being a gardener: as aged care enters into the next phase of deregulation we trust these four key themes help you prepare your facility for a rich harvest in the season ahead. ■ For more information contact Bruce Bailey on Bruce.Bailey@rsm.com.au

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COMPARE THE PAIR

AGED CARE OR CARE COMMUNITY There are big changes to the way the age pension will be calculated from 1 January next year. The changes apply to the asset test and are expected to affect around 350,000 Australian pensioners.

Rachel Lane Principal I Aged Care Gurus

urrently, a person or couple who exceed the asset test threshold have their pension reduced by $1.50/ fortnight for every $1,000 of assets over the threshold.

$400,000, the retirement village has a market price of $400,000. The retirement village are happy to discount the exit fee for a higher purchase price.

How will it work after 1 January 2017?

Let’s compare the pair. If Shirley moved to the aged care facility today her pension entitlement would be $499/fortnight today, reducing to $394/ fortnight after 1 January. Shirley’s means tested care fee would be $47p.d now and:

There will be an increase in the asset test threshold, enabling some pensioners to receive more pension. For those who exceed the new threshold their pension will be reduced by $3/fortnight for every $1,000 of assets. Or put another way the reduction to the pension under the asset test will double.

If Shirley moved to the village today paying $400,000 her pension entitlement would reduce to just $272/fortnight and after 1 January her pension would be lost entirely. Shirley’s cost of receiving a home care package would be $9.93/day.

The new Asset Test Thresholds will be: $250,000 for a Single Homeowner (up from $209,000) $375,000 for a Couple Homeowner (up from $296,500) Higher thresholds apply to non-homeowners.

Why does it matter? Well, people who downsize to a retirement community or aged care facility often pay less for their new home than they get for their old one – banking the proceeds. And while this strategy can free up capital, it is important to understand the impact this will have after 1 January 2017. The fact that retirement communities can offer more flexible payment arrangements and the difference in the means testing for home care packages versus residential aged care may make care communities a much more attractive proposition post 1 January.

But if Shirley negotiated with the village to pay a higher purchase price ($850,000) for a lower exit fee, her cost of a home care package would remain the same at $9.93/day but her pension would increase to $874/fortnight and she would have significantly more capital if she ever needs to move again. Even if the aged care facility had a RAD price of $850,000, the retirement village may still be more affordable. ■ *Ongoing costs – Aged Care Facility based on Basic Daily Fee and $10/day personal expenses *Ongoing costs – Retirement Village based on Home Care Package Basic Daily Fee $9.93/day, general service charge $100/week, $250/week personal expenses. ^Figures correct at 1 July 2016 and are subject to change

Aged Care Facility $400,000 RAD

Retirement Village $400,000

Aged Care Retirement Facility Village $850,000 RAD $850,000

Means Test

$17,184/year

$0/year

$14,793/year

*Ongoing Cost

$21,261/year

$21,824/year $21,261/year

Total

$38,445/year

$21,824/year $36,054/year

$21,824/year

Her home is worth $900,000 and she also has $100,000 in the bank, and $10,000 worth of personal assets including her car.

Pension Now

$12,974/year

$7,072/year

$22,724/year

Pension 1 Jan^

$10,244/year*

$0/year

$22,724/year*

Capital Position -$24,000 2 years

-$40,000

-$19,000

-$17,000

The aged care facility Shirley is considering has a RAD price of

Capital Position -$61,000 5 years

-$120,000

-$48,000

-$40,000

Case study Shirley is a pensioner who is weighing up moving to a care community (receiving a home care package) or moving into residential aged care.

$0/year $21,824/year

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CHOOSING A

CREATIVE AGENCY Justine Metcalfe Co-founder and Creative Partner I YOLO

ver the years, several of my clients have confessed they felt overwhelmed searching for the right creative agency. Where to start? What questions to ask? Who’s good? Who can you trust? All are good questions. Choosing a creative agency should be an exciting and energising time. If someone working in the aged care industry was looking for a creative agency, here’s the advice I’d happily give them:

1. Don’t buy an agency that ‘sells’ Buy an agency that encourages conversations and listens more than it speaks – particularly at the first meeting. No one knows your business better than you. Look for an agency that spends its time trying to understand your challenges and ambitions – what success looks like for you, what keeps you up at night. Great creative agencies don’t just create shiny campaigns and websites – they solve real business problems. They create short and long-term strategies to grow your business. They build and rebuild brands from the inside out.

2. Great work is born from great relationships From over 20 years of experience – I know this to be true. Great relationships are a two-way street, based on reciprocal honesty and trust. Don’t look for a ‘yes’ person. Look for a creative agency that’s not afraid to challenge you and your thinking. An agency that doesn’t just answer questions, but thinks about better questions to ask. Look for a partner that’s collaborative, proactive, innovative and last but not least – enjoys having a good old laugh from time to time. Every now and then, you’ll hit a speed bump. Ask yourself before appointing an agency, ‘Are these the people I’ll want to call when I have a problem? Are these the people I’ll want in the room solving it with me?’

3. Only buy what you need If you need to create a small ad in the local bowling club quarterly newsletter, you might just need a freelance writer and designer. If you’re looking for new logo with an $800 budget, you might need a designer with branding experience. If you have a more complex project, you’ll need a creative agency. And if you have to watch your budget, look for a small to mid-sized agency with big agency experience and lower overheads. That way, you won’t find yourself paying for a senior UX designer, when you have a print-based campaign to produce.

4. Meet the people working on your business Unfortunately, some agencies wheel in the big guns only for initial meetings. After the business is awarded, they’ll be replaced with juniors and never seen again. Working in aged care isn’t for everyone. It requires a special creative agency and team members. An agency suited to the aged care sector would be fascinated with human behavior, connection and storytelling. Aged care requires creative agencies with an emotional intelligence to their thinking and their work. Some life experience in the category may also bring an additional layer of knowledge and experience.

5. Never underestimate passion in a partner Look for a partner agency that’s genuinely interested in aged care. Ask them straight out why they’re interested. You’ll quickly weed out the businesses there just to make a buck. From my experience, when an agency is genuinely passionate about the work they’re doing, they’ll always go above and beyond to deliver. Passion is contagious, and its magic rubs off on everybody.

BUSINESS MANAGEMENT

6. Look for creative achievers, not hotshots

8. Search outside your comfort zone

Always consider the problem an agency was trying to solve before judging their work. It’s easy to be distracted by the ‘creative’. The success of a campaign isn’t the art direction or catchy headline – it’s whether the work solved the strategic problem it was tasked with. Look for an agency with a successful track record.

7. Don’t chose an agency by their rate card These days, we all need to keep a close eye on budgets and resources.Just because an agency is the cheapest – doesn’t mean they’re the best for the job. Avoid making short-term campaign savings at the long-term cost to your business. Short-term savings can be a false economy. To better understand value as opposed to costs, try to get an understanding of how the agency approaches project budgets. Don’t be afraid to ask what they can deliver for various budget levels.

If you want fresh thinking, don’t be afraid to travel to different states to find it. These days, we’re all accessible 24/7 on our mobiles, email and team portals. Next, look beyond the usual agency suspects. Agencies ‘specialising’ in a category can be a good and bad thing. The good thing is you know what you’re getting. The bad thing is you know what you’re getting. Different perspectives abound at different agencies. Finally, avoid working with an agency that represents your competitors. Competitive bank brands would never work with the same agency. Why would aged care be any different? ■ YOLO (‘You Only Live Once’) is a creative agency passionate about creating human connection and using strategic creative thinking to solve business problems. For more information contact Justine Metcalfe on Justine@yolo.net.au or phone 0422 945 830.

ADVERTORIAL

Free to attend Seminar 5 Steps to Chemical-Free Cleaning in Aged Care Director of Duplex, an aged care cleaning solutions company, Murray McDonald, is traveling throughout Australia in 2016 - 2017 presenting his workshop, 5 Steps to Chemical-Free Cleaning Aged Care. This training is free to attend for aged facilities, managers, environmental services managers, infection control coordinators and cleaning staff. Early bookings receive a free copy of Murray McDonald’s book, 5 Steps to Chemical-Free Cleaning in Healthcare (valued at $19.95).

Murray McDonald will be presenting on the “Duplex 5 Steps method” which is based on the following: 1. Identification: Pre-planning and cleaning product gaps 2. Assessment: Auditing and looking at your current cleaning processes 3. Planning: Developing goals, managing objections and formulating a cleaning program 4. Implementation: Practical touch point cleaning, training and consistent workflow 5. Evaluation: Auditing against benchmarks Early bookings are encouraged as there are limited spots available depending on your state. HOW TO REGISTER To register your interest, email info@duplexcleaning.com.au or call 1800 622 770 and be notified as to when Murray will be presenting in your local area. For more information on Duplex steam cleaning equipment and aged care cleaning solutions, visit www.duplexcleaning.com.au/infectioncontrol

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HEALTH & WELLBEING

AGEING & SUPERBUGS:

FIGHTING ANTIBIOTIC RESISTANCE IN RESIDENTIAL CARE FACILITIES High rates of antibiotic use in residential aged care facilities (RACFs) is widely recognised as a problem within the aged care industry, and health experts believe this is contributing to the increase of antibiotic-resistant bugs in the general public.

n an Australian first, a joint collaboration between the National Centre for Antimicrobial Stewardship and Australian Infection Surveillance Centre – Aged Care saw RACFs surveyed about the use of antibiotics by residents last year. The ‘Aged Care National Antimicrobial Prescribing Survey’ (acNAPS) aimed to estimate the prevalence of infections and the appropriateness of antimicrobial use using data from 186 RACFs across Australia between June and August 2015. Residents were included if they had at least one suspected or confirmed infection and/or were receiving at least one antimicrobial on the survey day. The results were alarming. Released a few months ago, the survey found a total of 975 antimicrobials were prescribed for 824 residents – a total of 11 per cent of residents were using antimicrobials, but only 4.5% had a suspected or confirmed infection. Most were prescribed in RACFs were for urinary, respiratory, skin, or soft-tissue infections but one in five patients were given antibiotics as a preventative measure. The five most commonly prescribed antimicrobials were cephalexin, clotrimazole, amoxycillin-clavulanic acid, trimethoprim, and chloramphenicol. “The big issue for us is that we know that if you’re continually exposed to antibiotics and you select out what we would call a multi-resistant organism, it’s not just that patient that’s at risk, it’s actually the other patients in the facility that are at risk,” said Professor Karin Thursky from the National Centre for Antimicrobial Resistance Stewardship in an interview with the ABC. The survey found nearly 22 per cent of prescriptions were given to residents who had no signs or symptoms of an infection in the week before they started the course of antimicrobial medication. It also found: • 32% of antimicrobial prescriptions did not have an indication documented.

• The most common reason (18%) for antimicrobial prescriptions was unspecified skin infections. • Topical antimicrobials were frequently prescribed, accounting for 37.0% of all antimicrobial prescriptions. • 65% of antimicrobial prescriptions did not have a review or stop date documented. • 31% of antimicrobial prescriptions had been prescribed for more than 6 months. Of these, 98% did not have a review or stop date documented. For residents who did show symptoms of an infection, about two-thirds of prescriptions were deemed inappropriate. Reasons included inadequate documentation, no review or stop date documented or the were being used for reasons that didn’t meet the standard indications. NPS Medicinewise is taking a lead role in educating Australians about antibiotic resistance and believes the survey is a vital first step in addressing what appears to be a bigger problem of misuse of antibiotics in aged care facilities than expected. “Many of the findings are of tremendous concern,” NPS Medicinewise spokesperson, Aine Heaney said. “With the data on antibiotic use in RACFs only recently becoming available as a result of the Aged Care National Antimicrobial Prescribing Survey, we have for the first time a snapshot of RACF antibiotic use. With some unwarranted use being highlighted, it provides a wakeup call on how much work there is still to do to prevent the spread of antibiotic resistance. The data can play a crucial role in helping staff and policy makers to work together to ensure these life-saving medicines continue to work,” she said.

Education is key More facilities need to be engaged in antimicrobial stewardship, Ms Heaney said, including by participating in future acNAPs projects. “To prevent and contain antimicrobial resistance, it’s crucial that antibiotic use is monitored well and seriously, and that any inappropriate use is minimised,” Ms Heaney said.

HEALTH & WELLBEING

“Implementation and monitoring of appropriate antibiotic prescribing guidelines in RACFs is a priority area. Nurses, carers, doctors and pharmacists all have an important and accountable role to play in responsibility for antimicrobial stewardship.” “A large part of antimicrobial stewardship is about prevention and infection control. Accreditation standard 4.7 requires facilities to have an effective infection control program, which includes identification and management of individual care recipients’ specific infections. Facilities can meet the standards by being more proactive in their stewardship activities,” she said. The next version of the Aged Care Standards will likely include a section on antimicrobial stewardship, though exactly what will be required of RACFs to meet this standard is not yet known.

How you can help today Everyone needs to be aware of inappropriate antibiotic use, and active in encouraging drug reviews for patients. Find ways to implement teamwork and good communication to kick start your antimicrobial stewardship, particularly with unnecessary use for urinary tract infections, and skin and soft tissue infections. Some questions that can assist in day-to-day care of residents: Why are the antibiotics needed? What are the common adverse effects to watch for? What monitoring and reporting should I undertake? • Ask how you can play a role in tracking and reporting, with provision of feedback about local antibiotic use and resistance to clinical providers. • Take advantage of the resources available to nursing staff, carers, residents and families about antibiotic resistance and ways to improve antibiotic use from www.nps.org.au.

Surveillance of MDR infections In an article published in the Australian Family Physician in April 2015, Ching Jou Lim, Rhonda Stuart and David Kong made a strong case for surveillance of antibiotic use and infection patterns to take preventive action against the rise of antibiotic resistant bacteria. Existing surveillance activities in Australian RACFs have focused mainly on monitoring infection rates; limited attention has been given to antibiotic use or resistance patterns with next to no data relating specifically to RACFs prior to 2011. “In Australia, an integrated surveillance system for monitoring infections in RACFs, which would be useful to guide antibiotic prescribing and infection management, remains to be established,” they wrote, arguing that understanding local

epidemiology of infections and antibiotic use in the RACF setting is needed because it differs to patterns of use in the community. “Most of the residents of RACFs are vulnerable to infections because of frailty, poor functional status, multiple comorbidities and compromised immune systems,” they said “In addition, the close living proximity and frequent nurseresident or resident-resident contact will facilitate the spread of organisms in the RACF setting. This coupled with regular patient transfers between acute-care hospitals and RACFs further augments the infection burden among residents in RACFs, compared with community-dwellers.” In Australian aged care facilities there is a growing trend of MDR GNB. A cluster of carbapenem-resistant Acinetobacter baumannii, which has not been reported in the RACF setting elsewhere, was identified by Lim et al who conducted their study in four RACFs in Victoria. Unlike other MDR bugs, GNB is less commonly associated with recent hospitalisation but prior exposure to antibiotics, particularly broad-spectrum antibiotics such as fluoroquinolones seems to be one of the most prominent risk factors, they found. NPS Medicinewise confirms that analysis of data has firmly established that there are a number of organisms in the Australia community of particular concern. Data show 10.8% of S. aureus infections in the community are MRSA. Community strains of MRSA now cause a significant number of infections in the community and are resulting in hospitalisation, with community-associated MRSA clones (including those in aged care facilities) now overtaking hospitalassociated clones in hospital-onset staphylococcal sepsis. E. coli is the most common cause of UTI and septicaemia. At present Australia has low rates of resistance to fluoroquinolones in E. coli compared with other countries, reflecting the restricted use of this antimicrobial class locally. By contrast, E. coli resistance to the beta-lactams available in the community, including amoxicillin, amoxicillin-clavulanate, cephalexin and the third-generation cephalosporins is increasing. Cephalexin is being widely used for UTIs and skin and soft tissue infections, although it is not recommended as a first-line treatment for these indications. Macrolide, tetracycline and trimethoprim–sulfamethoxazole resistance in S. pneumoniae is now 20–30%, limiting secondline treatment options for bacterial lower respiratory tract infections in the community. According to Lim et al, awareness of the emerging trends of multiple-drug resistant (MDR) infections is pivotal to guide antibiotic treatment among this high-risk population, and will not only help prescribers to select the right antibiotic but guide targeted infection control interventions.

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Until tracking and reporting via an integrated surveillance system is in place RACF staff can still be taking action to help improve antibiotic stewardship, Ms Heaney says. “Until this is established facilities can be proactive in using current structures and resources to examine what’s happening in their facility or region.” “Is there an established Medicines Advisory Committee? Could the local pharmacist be involved in looking at drug utilisation? Has the Primary Health Network or GP practices been engaged?”

action. The Australian Government’s Antimicrobial Resistance (AMR) Strategy (2015-19) represents the first national crosssectoral response addressing antibiotic resistance in Australia. This strategy outlines seven objectives that aim to minimise the impact of AMR. One objective is to develop nationally coordinated surveillance of AMR and antimicrobial usage across all health settings, including RACFs. Meanwhile, the National Centre for Antimicrobial Resistance Stewardship hopes to increase participation in future surveys to better monitor the prevalence of infections and prescriptions. For more information about the survey visit www.naps.org.au. ■

Why antibiotic use differs in RACFs Reasons why antibiotic use is higher in RACFs are highlighted by Lim et al as being due to difficulties in forming a clinical diagnosis of infection. This is because common symptoms of infection among elderly residents are delirium, falls, functional decline and behavioural changes, in the absence of fever. “Not surprisingly, early antibiotic therapy is often preferred ‘in case’ RACF residents deteriorate, which may lead to antibiotic initiation without confirmed infection,” they wrote. “Difficulties in establishing symptoms, because of underlying resident cognitive impairment, language barriers and frequent turnover of nursing staff in RACFs, further complicate the decisions for antibiotic prescribing.” They also found that diagnosis of infection often leads to the transfer of patients from RACFs to hospitals, yet research has shown that frequent referral of residents to hospitals can led to poorer clinical outcomes. “Thus, these are reasons to encourage infection management within RACFs to avert hospital admission. Timely management of infectious syndromes, including prudent antibiotic prescribing, in the RACF setting is crucial to ensure optimal care of the residents,” they wrote.

Resources to improve skills and knowledge To help health professionals maintain their knowledge in this area NPS MedicineWise has tools available which reflect the latest evidence on antibiotic use and antibiotic resistance. These learning products allow nurses to develop and maintain their skills and reflect on their current practice and generate solutions and improvements at a facility level to improve patient care: • Case study: Urinary tract infections: exploring antibiotic treatment (1 CPD hour for nurses) • Online course: Antimicrobials: catheter-associated urinary tract infections • Online course: Antimicrobials: community-acquired pneumonia • Online course: Managing UTIs in aged care (1 CPD hour for nurses) • Medicines use review: Antibiotics in urinary tract infections: ensuring appropriate use (Phase 1 = 8 CPD hours for nurses, Phase 2 = 4 CPD hours for nurses)

Antimicrobial stewardship

• Webstercare report: Antibiotics for urinary tract infections

With antibiotic resistance a priority issue for the World Health Organisation, Governments around the world are now taking

• H ealth professional publication Medicinewise News: Appropriate use of antibiotics in aged-care facilities.

UNIQUE FLOORING “Committed to service and quality” Today’s aged care environments demand fresh, contemporary design and highest quality finishes while complying with regulatory policies and guidelines without compromising on style. Unique Flooring can offer aesthetic solutions for all aged care flooring that offers sophistication, safety and maximum comfort for residents and staff.

Visit our website at www.uniqueflooring.com.au or please call Mark Gannon on (02) 9838 7011 to find out how we can customise your hotel.

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2017 PROGRAM Studying and Advancing Global Eldercare

Tailored seniors living tours since 2006

New Zealand April

Industry Study Tours for Seniors Living Executives

Switzerland September

2017 Study Program

USA November

NOW OPEN!

To register or for more information visit sagetours.com.au or contact Program Manager Judy Martin judy.martin@thomsonadsett.com mobile +61 437 649 672

India February

Are you interested in a SAGE tour tailor made for your organisation? Contact us today to find out more.

EVENTS

BUSINESS MANAGEMENT FOCUS

FOR SAGE TOURS IN 2017

Capping off a year of celebration to mark its 10th anniversary, SAGE tours has released its fresh, diverse program for 2017.

here will be a special focus on business development with the 2017 program kick-starting with an inaugural trip to India hosted by CommonAge. There are 53 countries in the Commonwealth with only a few such as Canada, Australia, UK and New Zealand having well developed aged care and retirement support systems. The majority are developing nations where older people face many challenges and where support services are at early stages of development. CommonAge supports the development of support services for older people throughout the Commonwealth and have achieved some notable early success in advancing this important ambition. “The CommonAge SAGE INDIA tour is aimed toward business development opportunities in aged care, including operations, dementia and residential aged care design,” said SAGE program leader, Judy Martin. “Visiting multiple organisations, this tour will involve two weeks studying the Indian aged care system, engaging at CEO and senior executive levels, and with industry experts and peers while enjoying the amazing landscape and the sights of Northern India. Key outcomes of the tour will include seeing innovation in India’s Northern region aged care and retirement businesses, learning about India’s aged care business and being exposed to new partnership opportunities.” Other 2017 tours include a return trip to Switzerland where SAGE delegates will visit Zurich, Basel and Berne and participate in the bi-annual International Federation of Aging (IAHSA) conference in Montreux. SAGE is also considering a tour to Atlanta, Georgia (USA) timed for delegates wanting to attend the Leading Age USA conference in New Orleans. People are invited to express their interest in this tour by contacting SAGE directly on the details below. For anyone considering joining a study tour in 2017, SAGE offers delegates a unique experience through its strong connections with aged care associations around the world, which result in warm, welcoming hospitality and access to industry leaders wherever you are. Katie Sloan, IAHSA Executive Director, has joined SAGE tours in the past and says the focus on executive management, leadership and networking is key to its program success. “I think the key difference for SAGE participants is the personal recognition of the professionalism, leadership and dedicated

industry focus. SAGE delegates visit and see an organisation working and be in a place of work doing things like talking to senior executives, staff and residents, understanding why they made certain decisions, how they work, how they deliver care, the place of care, looking at service models, staffing programs. There is nothing like that available internationally except on a SAGE Tour.” “For me the most powerful thing that happens is the blending of cultures, of experiences and of different approaches. At a conference I once listened to a Sister Lucia from a remote aged care facility in South Africa bring her audience to tears as she described the daily work schedule and care routines she and her staff do, but she was also uplifting. SAGE has visited her facility and that experience has changed the lives of both her residents and staff, and many tour delegates.” SAGE is planning another tour to South Africa which will be hosted by one of South Africa’s aged care leaders, the IAHSA’s immediate past Chair, Margie Van Zyl. Current President, Marcus Riley, is a former Director of LASA. “SAGE formed a partnership with IAHSA many years ago and this partnership has been instrumental in linking Australian aged care providers to a broader international market,” Ms Martin said. Delegates on the upcoming trip to Netherlands and Lyon, France will be participants in the IAHSA Leadership Retreat as part of the SAGE Program. For Chris Straw, the Managing Director of SAGE partner Thomson Adsett, seeing first hand what other countries are doing with technology in aged care is what sets SAGE apart from other study tours. “Technology is advancing so rapidly it’s hard to keep up, so joining a SAGE tour is a great way of seeing first hand new ideas at work and then being able to talk those ideas through with fellow industry travellers to see whether they would work here,” he said. “The business contacts LASA members make on the SAGE tours are invaluable. Not only at a relationship and commercial level, but in being able to then connect people and organisations together that have common interests. The broader our network of contacts, the more we can do this sort of thing which benefits LASA members.” ■ For more information about SAGE’s 2017 program email Judy Martin at Judy.Martin@thomsonadsett.com

EVENTS

LASA National Congress

2017

15â&#x20AC;&#x201C;18 OCTOBER 2017, GOLD COAST

SEE YOU BACK HERE IN 2017!

Sponsorship & exhibition opportunities now available

Call for abstracts open 1 February 2017

Program live & registration open 7 June 2017

P: 02 6230 1676 E: events@lasa.asn.au

Abstract submissions close 5 April 2017

Early bird registration close 6 September 2017

www.lasacongress.asn.au

WHAT’S NEW

WHAT’S NEW ASSA ABLOY ASSA ABLOY Hospitality has served as the leading global technology provider of access control and Energy Management Systems (EMS) for over 35 years. As a provider of advanced security technology solutions and specialised access control expertise for the senior

Cyber Crime Have you heard of Cybercrime? It is the second most suffered crime in Australia. More than just individuals being targeted by hackers, now businesses and professionals are the big victims.

living sector, we know what it takes to unlock a true feeling of security for residents and their caretakers. Our electronic locks ensure secure and convenient access, while also guaranteeing that staff members are able to maintain a high level of security throughout a facility, via the use of audit trails. Our solutions have been designed to put safety first, while increasing operational efficiency and convenience. Residents and staff can also expect a seamless access experience that saves time and enhances the value of your facility.

For more information on ASSA ABLOY Hospitality solutions and how they can benefit your operations, please contact our office at 1300 796 233 or visit www.assaabloyhospitality.com

MCA Insurance Brokers have Cyber Risks Insurance to help protect your residents, your business and yourself from cyber harm. What does our Cyber Risks Insurance cover? • Personal and Corporate Liability in the event of a breach.

Traditionally it was personal information, credit card details and medical records which were stolen. Now it is corporate data, Intellectual Property, customer databases and client medical files, which can be used for blackmail, ransom and more.

• Liability for data loss, such as client files and medical records.

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• Cover for media content, cyber extortion and network interruptions

What happens to your Aged care business if your residents’ data is stolen and shared online? How will you survive ransomware and extortion threats? Can your business survive time offline as investigations are made? Will you be able to afford the costs of liability from data protection laws and the consequences of losing corporate information?

A lot of time and money can be lost if you are not secured and insured. Cyber Forensic investigations can shut down your operations and your reputation can be damaged, causing you to lose residents and so much more.

Staff training for ACFI documentation is important The ACFI changes coming in January 2017 flag a need for staff to be fully trained to ensure you are receiving your maximum funding through documentation that is accurate and reflective of the assessed care needs of each resident. It is important the training you offer staff is undertaken by a reliable contemporary trainer with a well-founded understanding of the ACFI. Lyn Turner from National Care Solutions is the trainer of choice for

• The costs for penalties and fines incurred • Repair of reputation • Upgrading and increasing security after the event

Call MCA Insurance Brokers – 1300 625 565 or email us – agedcare@mcains.com many Approved Providers. Lyn can work with your staff in an action learning environment to ensure all stakeholders are working towards the same goal of recognising the assessed needs of their residents and documenting appropriately to ensure ethical claims that are upheld at validation. In recent months National Care Solutions has been delivering training across the country and achieving great outcomes. In tandem with this training has been the opportunity to find some exceptional outcomes in terms of increased funding through reviews. Your ACFI Appraiser needs to stay up to date and do these reviews regularly to ensure any change in care needs is reviewed through assessment and care plan review and any additional funding claimed through an ACFI re-appraisal. Don’t let your Appraiser and your site down. Act now to put in place further training to ensure your staff are documenting not only correctly for ACFI but also for the purposes of meeting the Accreditation Standards. Lyn is happy to come to your site to work with your staff to ensure you are claiming for any funding you are entitled to.

WHAT’S NEW

• the increasing influence of the increasing star rating websites for aged care; and

The Lifestyle Profit Multiplier Did you know that the loss of just one occupied bed in a residential aged care facility can lead to profitability falling by over 15%? Given that residential aged care standards ensure that care is ‘a given’, and that location and amenity is largely fixed for an operator, resident lifestyle will be the single most determinate of the viability and success of residential aged care operators of the future. If occupancy drops by just one bed in an average Australian facility, with an average mix of residents, EDITDA (or profit) will plummet, over 15%.Operators lose all the income, yet, cannot adjust their costs.

• the move towards user pay and the appeal of additional ad-hoc purchases by innovative CDC residential operators with resort like offerings. With the consumer wielding the power of choice, operators will find consumer appeal (lifestyle) essential for occupancy. Low hanging fruit for operators striving to improve their lifestyle program, include putting in management KPI’s for lifestyle initiatives, including: • a culture of resident centric care and consequent facility reputation; • driving the use of volunteers, both for profit and not-for-profit, be it a concert by school children, or people from the local community to visit and talk, or encouraging families and friends to be more active at the facility; • publishing the lifestyle program, in real-time as a home page item on a facility website. The first question a prospective resident and their family should be asking is “Can I see your lifestyle program?”. Increasingly, desktop research will short list facilities for potential consumers. Gone are the static websites with polished marketing written scripts on culture and latest care methodology. Consumers will cut through and see the substance value that speaks to the activity in the facility; • more product and service offerings (user pay), which not only diversifies revenue streams, but also encourages people to relocate to aged care facilities earlier than they otherwise might have;

Residential aged care facilities who do not have strong occupancy will not be sustainable. Further, aged care facility occupancy will experience further downward pressure in the future with:

• more of the extras: gardens, pets, visiting pets, inclusion of high care on the edge of activities and visiting shops; and

• bipartisan political support for older Australians choosing their own care services through market – based mechanisms;

• the ability of the facility to respond to consumer directed options, on staffing, meal and shower times, making the facility closer to a home lifestyle.??

• the ever present threat of bed licence deregulation and money following consumers, not operators with homecare taking the lead in February 2017; • homecare operator competition warming up with increasing CDC focus and technology improvements keeping people out of residential care, and the cost effectiveness of homecare;

In high occupancy centres, profitability KPI’s can be largely discarded, managers only need to be measured on sticking to agreed rosters, quality of care and lifestyle initiatives, profit will take care of itself.

Introducing the latest from Japan – The Hug, a Mobility Support Robot Hug is designed with supporting people who face mobility issues. It allows you to move a person from bed to wheelchair or wheelchair to the toilet. Hug assists when needing to transfer a person to a sitting position or in situations where standing for a period of time is required, such as getting dressed. Hug supports those who have the ability to stand on their own, but for a particular reason, have limited mobility when standing. Hug is ready to use, anytime. Hug does not use a sling or harness, which means no consuming setup time. Hug does not only raise a person, but brings them forward in a sliding motion to stand, effectively distributing their weight to the backs of the heels and allowing the person to feel comfortable while standing up. The Hug allows and gives people their dignity as they are reluctant to move because they do not wish to burden others with heavy lifting. The Hug robot can now take over the lifting work that has been the domain of care workers to ensure less physical stress and the avoidance of back injuries.

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