Lasa Fusion Summer 2015 by Adbourne Publishing

The voice of all aged services Summer 2015 | www.lasa.asn.au

Clinical Focus:

Achieving excellence in care services Implementing a national aged care indicator program

Practical innovations from the frontline

Young nurse leaders in aged care

LASA launches its policy platform

The voice of all aged services Summer 2015 | www.lasa.asn.au

CONTENTS

34 Summitcare: Our golden approach

5 CEO Report

36 LASA CEO launches Decision Assist

7 Chair Report

38 Staying healthy in the heat

8 SA Report

39 Practical innovations from the frontline

10 NSW-ACT Report

41 Young nurse leaders in aged care: The answer to future health workforce nightmares

13 QLD Report 14 VIC Report

44 WA’s payroll and land tax legislation under review

16 WA Report

47 Aged care manual handling assessment tool

18 LASA Congress 2014

49 Policy Development – The long road forward

21 Limited evidence for nurse-patient ratios in residential aged care in Victoria

53 Policy Statements

25 Sustainable organisations in the community sector 29 Leading Age Services Australia strengthens member engagement

68 Stewart Brown – Aged Care Financial Performance Survey June 2014 – Summary 85 Palm Springs dementia think-tank 87 Product news

31 Implementing a national aged care quality indicator program

EDITOR

Justine Caines National Government Relations and Communications Manager

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

LASA Victoria Trevor Carr CEO Level 11 600 St Kilda Rd Melbourne VIC 3004 E: trevorcarr@lasavictoria.asn.au

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

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

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

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

Adbourne

Adbourne Publishing PO Box 735 Belgrave, VIC 3160

Advertising Melbourne: Adelaide:

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

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Report from the CEO 2014: The year in review Patrick Reid Chief Executive Officer | Leading Age Services Australia

he decision of the Abbott government to move ageing from health to the Social Services portfolio was welcomed by LASA. This was on the basis that as a significant policy area there could be more emphasis placed on wellbeing, the social determinants of life quality and intergenerational approaches to ageing. We all know social policy is hard, we also know that we reap the best rewards from collectively working on challenging tasks, something that the government nor bureaucracy have really embraced with aged care. Whilst I acknowledge we are all working through landmark reforms I believe there have been many missed opportunities on both sides, government and providers, to harness industry to establish a co-designed policy response and recent meetings with Ministers has increased LASA’s resolve to provide answers to government as we continue to show leadership in all key areas. The year was slow to start with Minister Fifield’s office placing a permanent ageing adviser in March. National Office was busy with Accommodation pricing and the launch of the Aged Care Industry IT Council’s (ACIITC), ICT Vision; a seminal piece on harnessing ICT to create sustainable age services and launched by Minister Andrews. As our industry moved through the reforms we were met with the duplicity of Budget 2014. The re-purposing of the Workforce Supplement was certainly welcome news, however this came with the ‘body blow’ of the removal of the Aged Care Payroll Tax Supplement, at a cost of $653 M. In June we received the equally shocking announcement that the Dementia and Severe Behaviours Supplement would cease on July 30. Over $700M taken from a critical industry already operating with funding well below demonstrated care costs. Our response was swift and firm and our advocacy has not ceased at both state and national level. Whilst we understand the Government’s desire for fiscal restraint when one delves deeper into the cost of market failure in aged care it is immediately evident that claimed savings can quickly evaporate. A prime example is the cost differential between residential aged care funding and that of an overnight stay in a public hospital; with a full concessional resident receiving just under $200 and the national average overnight hospital stay around $1200, the expertise and safety of aged care comes at one sixth of the cost. LASA has worked hard to keep workforce and skills training high on the agenda. In September we brought together members from across the country to demonstrate the innovation and

untapped potential within our industry. This day was hosted by Minister for Industry, Ian Macfarlane, who is administering the newly established $467M Industry Skills Fund. LASA will be submitting a funding application based on cogent arguments as to why age services must be a priority area and how industry is well placed to receive transitional workers and also showcase our export capabilities; particularly now as a result of the Free Trade Agreement with China. In October I was proud to host LASA’s 3rd annual Congress in Adelaide. With just shy of 1000 delegates we produced a highly practical and engaging program where delegate feedback overwhelmingly said that they left armed with a replenished mindset and toolkit to enable them to operate successfully in the transforming environment. The great success is testimony to our committed membership, dedicated staff, fantastic sponsors, exhibitors and naturally, delegates. Thank you all. In December we saw the ACAR results announced. The overall operational ratio at 30 June 2014 was 111.3 places per 1,000 people aged 70 or over, comprising 82.2 and 28.7 places for residential and home care respectively. It is important to note that this is operational ratio is lower than that of 30 June 2012 of 111.8 places. Essentially this means that supply has seen a marginal decrease, when naturally it should be increasing. We will take the co-design approach to Minister Fifield and look to assist him in his promise of reforming supply and therefore ACAR. As an industry leader we know there can be a more equitable process and are prepared to partner with government to achieve this. As Minister Fifield has alluded to there is great opportunity in being part of such a prosperous nation that finds its people living longer. To date age services, health and the governments that administer them are operating in silos. This is neither productive nor sustainable for the long term. LASA looks to 2015 to be characterised by the development of a meaningful and practical partnership between government and industry, something that will challenge aged care providers to think bigger and put their energy into being an active participant in change, as only then can industry create its own future and reach its full potential. It we seize this opportunity we can be sure that older Australians will receive the care and services they deserve and will demand as part of the new CDC era. I wish you all a blessed festive season and a prosperous 2015 and I look forward to working beside you to support your dedication and commitment to quality age services. ■

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FUSION | 7

Message from the Chair Dr Graeme Blackman OAM Chair, LASA

y experience and commitment to age services certainly played a role in my decision to take on the role as Chairman of LASA; however what I found most attractive was the vision that was the essence of the creation of LASA. In the lead up to forming LASA an overwhelming number of industry leaders recognised the critical importance of creating a single voice in order to establish the prominence and influence our industry deserves; for me this is a critical task. Ageing is increasingly important, both socially and economically, and a divided industry can never take the position it requires to meet demand whilst we walk in different directions and allow ourselves to be pawns in the all too common game of political or single interest division. LASA’s vision is based on the five pillars of: Access Quality Workforce Economics Capability LASA will work with Minister Fifield to evolve the ACAR process, transforming supply to a contemporary market and demand based process. In a recent meeting with Minister Fifield I was encouraged by his engagement on a specific commitment with industry to a co-designed approach to policy. This collegiate approach will ensure the practical realities of frontline care and housing are first and foremost in the minds of policy makers. Minister Fifield’s recent speech to CEDA made a clear commitment for the Government ‘to move closer towards that vision of greater consumer choice, of the money following the individual, of businesses freed up to do what they do best... and that today is the start of a conversation about how we might get to the destination’. In our recent discussions with Minister Fifield both Patrick and I advocated a partnership model as an essential component to the ever present challenges of providing age services. LASA’s position on quality is clear, age services are becoming part of the integrated health model. As this move takes place our industry must be supported in a similar fashion to the acute sector. This will allow us to meet demand and ensure our expertise in caring for older Australians is maximised and precious health resources are appropriately utilised. A perfect example is the fine work of Kincare with Hospital in the Home projects; a great opportunity for age service providers to meet the demands of older Australians to live in their home for as long as possible while reducing the impost on the public hospital system. Workforce is the obvious standout, as carers we are nothing without our human capital. LASA has taken the lead on workforce

development and innovation. I am proud to see Patrick chairing the Aged Care Sector Committee’s Workforce Advisory Group; this group is itself a result of LASA’s advocacy. Our work will continue in 2015 as it has before in showcasing the innovation of our members, be it in attracting younger workers and health professionals, reducing unnecessary hospital admissions or advancing care delivery through new staffing models. It is increasingly apparent that our church and charitable providers must operate their service(s) within a sound business model in the mantra that ‘although we are not a business, we must be businesslike’. At this juncture our industry is tied to government as our primary funder, regulator and legislator. It is critical that a level playing field remains as only then can we strive for consistent quality of services provided and LASA supports an industry that receives sufficient funding for the care and services they provide. Concurrently we support the co contribution of consumers with a capacity to pay; and a robust safety net to ensure vulnerable older Australians do not suffer without access to healthcare and vital social services. The various decisions to remove an array of funding from the sector, culminating in the removal of pre-entry leave subsidies in MYEFO, further underscores the need to be businesslike but also points to the long held tenet of the need for funding stability and competitive neutrality in the highly regulated age services industry. Capability remains our greatest strength and asset and yet the real challenge to convince our current government. As we move to an era of consumer directed care our service providers must be able to meet the demands of their clients. Infrastructure such as information and communications technology is the top priority and will increase our efficiency and productivity. Furthermore, low hanging fruit such as linking age services to the Personally Controlled Electronic Health Record will bring quick, clear benefits and is long overdue. In meeting with both Minister Andrews and Fifield I have asked that they take leadership and support LASA’s work, particularly through the Aged Care Industry IT Council (ACIITC) to ensure that these key areas of infrastructure support and systems integration are achieved and recognised within age services if nowhere else. To our members and readers I wish you all a very happy, blessed and prosperous New Year. I look forward to further developing the outstanding work of your LASA, to ensure a strong industry voice that never shirks from its responsibilities to older Australians. ■

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South Australia Report Mixed messages are not helpful Paul Carberry Chief Executive Officer | LASA SA

t the time of writing, the sector has had exactly five months experience of life under the largest batch of reforms to take place in age services since the arrival of the Aged Care Act in 1997, and has had time to contemplate the changing dynamics of our sector, which have accelerated in earnest during 2014. Overall, the shape of the age services sector has changed considerably in the period immediately before and after the reforms. We have seen some significant ownership changes this year and changes to the capital structures of some of the top players. Private equity organisations have accomplished significant consolidation of the sector, and two aged care organisations are now listed on the ASX and, at the time of writing, a third is about to. Nevertheless, unlike others sectors, aged care is by no means dominated by large players, with the top 10 organisations by residential bed numbers accounting for less than twenty percent of the total. At a policy level, it seems that the government is intent on running a tight fiscal policy with respect to aged care, expecting (hoping?) that the 1st July changes, providing the sector greater access to consumer-funded income and capital, will allow sustainable growth. The Commonwealth has estimated that $31 billion of investment will be needed in aged care over the next decade, to meet growing demand and to renew and refurbish existing stock. In this respect, the Commonwealth needs to understand that investors, whether private or NFP, do not like uncertainty, and they do not like nasty surprises. So why has the government delivered both of these outcomes in recent times? In a June media release discussing the maximum accommodation supplement, Minister Fifield said: “The Government has an overriding duty to all taxpayers to ensure measures are managed within budget and we will continue to carefully monitor the efficacy and sustainability of all programs.”

Really? What message does that send to the providers and lenders who are contemplating new aged care developments or “significant refurbishment” investments? Not a good one I would suggest. The government needs to give a clear and unequivocal assurance that the real value of the supplement will be maintained, and that the rules for significant refurbishment approvals will be interpreted in the spirit they were intended, which is, to give providers incentive to upgrade their building stock so that older Australians will have the standard of accommodation and amenity deemed by government. Then there was the Budget announcement that the Payroll Tax Supplement, which has existed many years for good reasons, will be removed as from 1st January. This was a nasty surprise par excellence. In making its recommendation to remove this subsidy the National Commission of Audit said: “...some providers may struggle to continue without this subsidy” Did our Ministers read that bit? Have they worked out who these providers are, and what the government is going to do about it if the Commission’s warning proves correct? Did they think about the impact this decision might have on future investment decisions? And, perhaps most importantly of all, having delivered a nasty surprise as good as this one, what other surprises do they have in store for the sector? Those whom the government needs to invest that $31 billion would like to know. To fix this ill-considered mistake, the government should announce that the Payroll Tax Supplement will be immediately reinstated, for the very good reasons it was introduced in the first place. They might also consider telling us that they won’t do anything like this again, but will instead consult the sector and other stakeholders on future policy changes, and will carefully consider the outcomes of any changes they do make. ■

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NSW-ACT Report Caught between competing levels of Government Charles Wurf Chief Executive Officer | LASA NSW-ACT

he industry has been subjected to a number of financial shocks over the past twelve months. From the cessation of vital Supplements, to the ongoing requirement for the retrofitting of fire sprinklers in all New South Wales facilities, there have been requirements and challenges presented to the industry from both the Federal and State levels of government. But are our current relationships with the different levels of government effective? Should we as an industry be more provocative in seeking the delivery of aged care, and the greater health care and related human services responsibilities, under one level of Government? The announcement of the cessation of the Payroll Tax Supplement in the May 2014 Federal Budget demonstrates that currently one level of government can unilaterally make a change to policy, directly related to another level of government, which has ramifications to the viability of a significant portion of the industry. Through the cessation of the Payroll Tax Supplement private aged care providers, representing more than one third of the industry, have been caught in financial limbo. The Federal Government refuses to continue to support the Supplement, and State Governments are not providing any indication that they will accede to provide relief to the industry from Statebased payroll tax after 1 January 2015. Aged care providers must be focussed on delivering care. It is wrong to have this industry, whose core reason for being is caring for some of the most-frail people in our community, be subjected to a revenue turf-war between two levels of Government.

Such a situation should not have occurred in the first place, let alone the current position where the industry, led by LASA, is itself trying to coordinate two levels of government toward a rational position. In 2015 we must pursue greater ‘clarity of government’ in responsibility for age services, and the Federal Government’s commitment, made in June 2014, to work with the States and Territories on a White Paper on the Reform of the Federation offers this opportunity. The White Paper must be embraced by the industry, particularly as one of the stated objectives is to, “reduce and end, as far as possible, the waste, duplication and second guessing between different levels of government.” This would be welcome for as recent years demonstrate, reluctance to take fiscal responsibility for the true cost of aged care has been bi-partisan. Much of the disjointedness of the implementation of the Government’s aged care reform agenda, for instance, can be traced back to the previous Government’s ‘cherry-picking’ of the recommendations of the Productivity Commission Report, Caring for Older Australians. During 2014 LASA has been at the forefront of engagement with government and other key leaders regarding the future of Australian aged care policy. Only through LASA’s voice, on behalf of all providers of aged care, has the industry avoided some problematic decisions of governments around Australia. We will be in much better stead as an industry if government duplicity, of both responsibility and bureaucracy, is curtailed. In 2015 we can and will continue to pursue this, and I look forward to progress with the Reform of the Federation White Paper. ■

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FUSION | 13

Queensland Report A balanced approach to compliance and accreditation Barry Ashcroft Chief Executive Officer | LASA QLD

ompliance and accreditation are no strangers to our industry, and for the safety, security and well-being of all of those accessing and delivering age services, that is how it should be. Increasingly however, the age services industry is being subjected to regulatory reform that brings with it the very real risk of discouraging and stifling innovation, investment and growth; threatening sector viability and longevity, and placing the care and accommodation needs of ageing Australians in jeopardy. Many Queensland members will be aware that in late 2012, the Queensland Government commenced a review of the Retirement Villages Act 1999; resulting in 37 reform recommendations being made by the Transport, Housing and Local Government Committee (the Committee). LASA Q and Retirement Living member representatives played an integral role in the Ministerial Working Party responding to these recommendations; requiring hours of concerted effort in order to provide a detailed and truly representative response. As a result of this ongoing consultation, regulatory changes were proposed in a Regulatory Impact Statement (RIS) with the policy objective of identifying the balance of prescription and flexibility needed to ensure the workability of any regulatory change or to ensure the welfare and interests of residents are protected without compromising the viability of the industry. The following 4 key issues, identified by the Office of Best Practice Regulation, were pinpointed as the primary focus of the RIS and any subsequent regulatory reform: • Village Closures • Early payment of exit entitlements • Best Practice in RVs • Alternative financial models Thanks to the significant contribution and dedication of members and staff, LASA Q has now submitted our response to the RIS, and are committed to keeping members apprised of further developments as they arise. In a similar vein, the Queensland Department of Housing and Public Works also recently advised that as part of its Compliance and Education Program for Retirement Villages Scheme, it intended to randomly visit villages in order to complete a survey style audit.

LASA Q has always welcomed the opportunity to participate in open discourse with the government, particularly regarding regulatory reform, and on every occasion has recommended against any regulatory reform that is unnecessary or counterproductive in meeting the accommodation and care needs of older Queenslanders, and /or that limits innovation and reduces progressive alternative options for the future of our industry. Prior to the roll out of compliance visits, having fostered a mutually beneficial and respectful relationship with the department, LASA Q was successful in procuring the Resident Committee Questionnaire and Scheme Operator Questionnaire, which was forwarded to members in advance to assist with their preparations. Finally, in bringing all the accreditation and compliance ‘elements’ together, LASA Q’s recent exclusive Retirement Living luncheon gave members the opportunity to ask questions about the Department of Housing and Public Works’ newly implemented Compliance & Education Program, as well as meet and network with Mark Francis, Executive Director and Registrar, Office of the Registrar and Terry Green, Manager of the Residential Services Unit from the Department. The experiences of provider members Churches of Christ regarding their introduction of quality systems via the International Retirement Community Accreditation Scheme’s (IRCAS) program also provided participants with an engaging insight into areas of focus, and was complimented by a comprehensive explanation of the accreditation process by Quality Innovation and Performance (QIP). Significant interest has been expressed in establishing a process of data sharing between the department’s compliance unit and QIP in a true spirit of continuous improvement – refreshing in an increasingly burdensome age services regulatory environment. Achieving workable, practical and beneficial accreditation and compliance outcomes for all stakeholders can seem like an insurmountable task, but our Queensland Retirement Living Manager’s leadership and our members experience is proving otherwise. Harnessing the knowledge, expertise and commitment of all involved has been integral to the successes to date, and I look forward to further progress that can be achieved in this space. Together we are One Industry. One Voice. ■

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victoria Report Our vision for working with State Government towards a viable Victorian age services industry Trevor Carr CEO | LASA VIC

any age services providers who work to meet the needs of older Victorians in local communities are facing an uncertain future. Due to Commonwealth Government Budget measures and legislative changes, numerous Victorian providers are now confronting challenges such as increased costs and future planning limitations due to high levels of uncertainty. One of the strengths of Victoria’s age services sector is the number and diversity of small private and non-for-profit providers addressing distinct local and community need. LASA Victoria believes that the Victorian Government has an important role to play in supporting smaller age services providers and maintaining the diversity of the industry. In

addition, the Victorian Government can support the industry through the development and implementation of policies and programs that broaden and strengthen the service response for older people across a range of portfolio areas. We acknowledge that the Victorian government has a number of established plans and processes that enable improved service delivery for older people, and LASA Victoria also recognises the participation of the Victorian Government in other national reform processes that have a current and future impact on the health and community service system.

Our State Election Blueprint for age services In order to continue with, and build upon, these foundations for the future viability of our age services industry here in Victoria, we have recently sought to further develop and strengthen our working relationship with the Victorian Government around a number of key priority areas through the delivery of our first State Election Blueprint. The Blueprint outlines opportunities for the Victorian Government to support the sustainability and growth of our industry through increased investment, enhanced planning and greater collaboration. The key priority areas addressed in the Blueprint, and the corresponding recommendations for action, are as follows: 1. Planning for future age services infrastructure • Exempt aged care providers from Payroll Tax to boost distribution of GST revenue • Ensure that State Government-owned land and other appropriate vacant land can be allocated for age service infrastructure in the design and planning of urban renewal sites • Enable and plan for age services infrastructure in Melbourne growth corridor planning. 2. Housing for disadvantaged older Victorians • Develop an Affordable Housing Strategy that aims to increase the supply and diversity of housing options for older Victorians • Initiate a housing program assisting older Victorians to downsize from larger to smaller housing which more effectively meets their needs and living circumstances • Introduce a stamp duty concession scheme for older Victorians • Implement a state-wide service approach for older people experiencing homelessness informed by the findings

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•

of Homelessness Innovation Action Projects currently undertaken by community aged care providers Expand specialist supported accommodation and care services for people aged 50 years and older with substantive psychosocial conditions related to premature ageing such as early onset dementia, acquired brain injury and substance abuse disorders. 3. Retirement Villages: ‘Six Month Aged Care Rule’ The Victorian Government to provide Financial Mechanisms to support small retirement village providers address the impact of the ‘Six Month Aged Care Rule’ The Victorian Government to develop legislative amendments to reduce or alleviate the impact of the ‘Six Month Aged Care Rule’ on Retirement Village providers The Victorian Government to work with LASA Victoria and other peak bodies to monitor, resource and support Retirement Village providers to remain viable and to retain the diversity of the industry and its capacity to meet local community need. 4. Working together to address elder abuse Invest in a tailored elder abuse training and professional development program for residential aged care and home care and support providers Develop a high level, leadership advisory council, including cross-sectoral representation, to drive community awareness, policy reform and change.

5. Senior Victorians at the centre of State Government policy • Extend and strengthen the work of the Commissioner for Senior Victorians • Boost and develop whole-of-government policy mechanisms to implement and deliver better outcomes for older Victorian citizens. 6. Targeted Infrastructure, workforce and service coordination support for age services in rural and regional Victoria • Develop and improve home-based service responses to socially isolated older people living in rural areas outside of the major regional centres • Improve and increase access to GPs and specialist services after hours • Improve and increase funding and specialist services for older people with challenging behaviours • Improve and increase access to suitable, qualified staff (especially Registered Nurses). LASA Victoria is committed to working with the Victorian State Government across these priority areas to improve the capacity of age services and the health and community service system to deliver quality outcomes for an increasing number of older Victorians. ■ The full State Election Blueprint can be downloaded from our Policy, Research & Advocacy Library via lasavictoria.asn.au/member-services/policy-researchadvocacy/

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WESTERN Australia Report LASA WA – World view Beth Cameron Chief Executive Officer | LASA WA

n the west of our fine nation, we Western Australian’s are known for our cosmopolitan and global point of view, situated as we are near Asia to the north and gazing across to India, the Middle East and Africa – those nations set to shape global geo-politics for the next generation. China has had a massive influence on WA in the past decade – our resource boom gradually turning the state a sublime shade of fluorescent orange. So it is with great interest we follow the progress of the three North Asia FTA’s, and specifically the FTA with China. Aged care was a surprise winner of the Australia-China Free Trade Agreement, the final draft being reviewed and prepared for signature in 2015. Trade Minister Andrew Robb says, “If you run an aged care home in Australia, once this deal is in place... you’ll be able to open up one or 100 (in China) if you like, own 100 per cent of it, make profits out of it.” Indeed, if signed as drafted, the FTA means Australian owned aged care facilities will have unprecedented access to Chinese markets. We wait to see the detail on the agreement, but I have flagged with Department of Foreign Affairs and Trade (DFAT) that it is incredibly important for us to recognise the importance of every aspect of aged care as we engage with international markets. Home care, residential care and independent living are all important services for individuals to have access to, and we provide each of these services well. In the DFAT briefing on the agreement, it was explained that the Chinese people saw education as a public good, that it was almost offensive in their view to think that anyone would seek to make a profit from education. They suggested that we would face

similar challenges in health and aged care. The many of you that have worked with and in China will know that this is a culture as respectful of the elderly as we are of youth. There are great opportunities for Australia to learn from China’s approach to ageing and older citizens. St Ives CEO Michael Heath put this beautifully in his statement on the agreement: “We consider this a great opportunity for growth, and the chance to share the considerable expertise and skills providers like ourselves can bring to international markets.” “The Chinese culture is particularly compassionate towards caring for their elderly, as we already experience with our Chinese clients and our Chinese carers, and it is a value we at St Ives share.” How fantastic to see aged care take centre stage in the most important FTA Australia has negotiated in recent history. Aged care is also set to be a key component of our next big FTA, with India. We look forward to engaging with our Chinese colleagues to collaborate in providing the very best aged care. 干杯 ■

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LASA CONGRESS

2014

Congress 2014 was an outstanding success. Over 900 delegates took with them the latest insights and innovation from across the country and the globe. The program enabled delegates to ‘think globally and act locally’ making LASA Congress not only the premier networking experience but also a practical education event. This was confirmed with fantastic feedback. Abstract submissions open on January 15. The theme is Co Design: Tomorrow’s Age Services. Join with LASA in leading industry to reach its full potential. www.lasacongress.asn.au

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LASA Congress 2015: Call for abstracts opens 15 January

20 | FUSION

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Limited evidence for nurse-patient ratios in residential aged care in Victoria

By David Wright-Howie, LASA Victoria

he incoming Labor government in Victoria, elected on 29 November 2014, has committed to have nurse to patient ratios in hospitals and aged care facilities enshrined in legislation. Victoria introduced nurse-patient ratios in the public sector in 2001 after an Australian Industrial Relations Commission arbitrated decision. Australian and international research literature provides no conclusive or strong evidence to support mandatory nurse-patient ratios as a sustainable and appropriate staffing methodology for residential aged care. There is also insufficient evidence that nurse-patient ratios lead to improved patient or resident outcomes. Currently, California appears to be the only other place in the world that has legislatively mandated patient-to-nurse ratios for its hospitals, effective from July 2003. Although several American states have recently introduced new legislation to meet the demand for more nurses.1 A recent review of the Californian system reported that, although the nursing staffing legislation resulted in higher use of registered nurses, in most hospitals the ratios had no clear impact on nurse-sensitive patient outcomes (such as pressure areas, deep vein thrombosis and postoperative sepsis).2 Other American research generally does not support any evidential link between ratios and better patient or resident outcomes. Instead, many researchers focus on diversity of needs between facilities and emphasise the importance of ongoing education to quality of care.3 The U.S. policy literature also raises the issue of higher costs associated with mandated ratios and the unlikely provision of additional funding to offset this. In one example of a medium-size hospital that has on average 100 adult medical-surgical patients. An increase of just one hour of additional care by a registered nurse per day at $40 per hour would increase costs by $4,000 per day and $1.4 million dollars annually.4 It is possible that the requirement to increase the number of registered nurses without receiving additional reimbursement for care may result in decreases of other personal care staff. This may

in turn lead to additional burdens of registered nurses as they are then forced to assume non-nursing care tasks.5 American hospital associations have opposed ratios on the grounds that it reduces scheduling and staffing flexibility as well as the lack of additional payments. They have called for a more balanced approach through increased monitoring of nurse staffing, improved recruitment and retention approaches and development of undergraduate nursing education.6 The Australian Productivity Commission in its landmark report Caring for Older Australians concluded that the imposition of a simple staff ratio is a relatively blunt instrument, particularly given that the care resident profile of every facility will be ever changing. Such ratios become particularly problematic for small facilities, and a rigid application of ratios could create operational difficulties for these facilities.7 The Productivity Commission also noted that imposing mandated staffing ratios could lessen incentives for providers to invest in innovative models of care. Innovations such as through the application of technology and redesigning work practices, will be important in assisting the aged care sector to meet the expected increase in demand for services.8 It was also acknowledged by the Productivity Commission inquiry that the introduction of staffing ratios in aged care where there is not currently the capacity to meet the requirements imposed would present some difficulties.9 Determining and maintaining an appropriate level and mix of staff is especially problematic for those working in the residential aged care sector, where resident needs are complex and recruitment and retention of staff is challenging. Despite the repeated suggestion in a large number of publications of a distinct relationship between staffing levels in residential aged care and outcomes of improved well-being in residents as well as staff satisfaction and staff turnover, no evidence exists that substantiates these claims for these outcomes.10 What is clear is that the determination of staffing should take account of resident mix, environmental design, staff expertise, model of care and other contextual factors that influence care.

22 | FUSION Research evidence and industry consultation indicate that leadership, participatory management and staff development are clearly linked to quality outcomes and recruitment and retention of staff. There is also evidence that a professional decision-making framework regarding scope of practice, rather than a limited, task-focussed approach, improves staff satisfaction without compromising public safety. Balancing clinical and social care in an economically responsible way requires a more diverse staff mix than an all qualified nursing staff. Victoria’s diversely managed residential aged care sector provides significant scope for the exploration of new staffing principles based on contemporary thinking and practice which utilises resources efficiently and effectively to deliver quality outcomes for residents and improved job satisfaction for staff. ■

and Harrington, C., Kovner, C., Mezey, M., Kayser-Jones, J., Burger, S., Mohler, M., Burke, R., Zimmerman, D. (2000) ‘Experts recommend minimum nurse staffing standards for nursing facilities in the United States’, The Gerontologist 40(1), 5-16 4. Welton, J, (2007) ‘Mandatory Hospital Nurse to Patient Staffing Ratios: Time to Take a Different Approach’, The Online Journal of Issues in Nursing (American Nurses Association) 5. ibid 6. American Hospital Association (2005) Taking the pulse: The state of America’s hospitals, American Hospital Association (2006) National Uniform Billing Committee and American Organization of Nurse Executives (2003) Policy Statement on Mandated Staffing Ratios 7. Productivity Commission (2011) Caring for Older Australians (Report No. 53, Final Inquiry Report, Canberra) p370 8. ibid 9. ibid

References 1. Welton, J, (2007) ‘Mandatory Hospital Nurse to Patient Staffing Ratios: Time

10. Hodgkinson B, Haesler EJ, Nay R, O’Donnell MH, McAuliffe LP (2011)

to Take a Different Approach’, The Online Journal of Issues in Nursing (American

‘Effectiveness of staffing models in residential, subacute, extended aged care settings

Nurses Association)

on patient and staff outcomes’, The Cochrane Collaboration (John Wiley & Sons Ltd)

2. Spetz, J., Chapman, S., Herrerra, C., Kaiser, J., Seago, J.A. and Dower, C. (2009)

‘Assessing the impact of California’s nurse staffing ratios on hospitals and patient

11. Victorian Department of Health (2010) Innovative workforce responses to a

care’, California Healthcare Foundation

changing aged care environment (Aged Care Branch, Victorian Department of Health,

3. See Graf, C., Millar, S., Feilteau, C., Coakley, P. and Erickson, J. (2003)

Melbourne)

‘Patients’ needs for nursing care’, Journal of Nursing Administration 33(2), 76-81

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Sustainable organisations in the community sector

By Sandra Hills, CEO Benetas

reating active, purposeful, yet sustainable organisations in a modern fiscal environment is no easy achievement; least of all for not-for-profit or for-social-profit organisations. As community organisations, we often see the best and worst of the financial world. Organisations are exposed to real-market challenges, with its associated competitiveness and rigour, yet are constrained and reliant on government for regulatory direction and revenue. As a group, community organisations navigate a complex web of revenue and tenders cobbled together over time and across the spectrum of government and private investment. In aged care, in particular, we are resourced through the provision of government funding of aged care places and home support services. By design, this occurs on a competitive basis, however for all its good-planning and thought it does leave a complexity for organisations to unravel when they choose to grow and expand their services. Community organisations, just like any other group, profit or not-for-profit, are susceptible to market realities and changes. This is even more pronounced for aged care organisations, following the introduction of recent consumer focused reforms. How do we then ensure organisations maintain long term viability in a complex environment? At the root of it, it’s about strategy, structure and staff. For Benetas, this has involved the development of a strong strategic plan, informed by the organisation’s vision, mission and commitment to supporting the role of spirituality in the ageing experience, as well as a well-developed understanding of emerging trends, sector needs and business acumen. Summarised in our recent Strategic Plan: Towards 2019, we have a clear focus on where we are now, where we’re going, and how we’re going to get there. It’s important to consider reform as an opportunity, never a burden. Recent reform has provided a focus-shift for aged care providers. More than ever before, consumers are given greater choice of care management and costs. Benetas has resolved to make this a positive change and to use reform to guide us to provide better services and opportunities for clients.

In fact, when we compare the values underpinning these changes with our mission, we find it aligns nicely. Benetas has had a long-standing customer-orientated approach. That’s evident in our care for our clients, our staff and from how we operate within the sector. These values are not new to Benetas; they have been what have guided us for years. In fact, our commitment to the customer experience is what we think sets us apart as an organisation. At Benetas we are dedicated to continuously improving all our customers’ experiences throughout the aged care journey. Our Customer Experience Program, including the Benetas Customer Centre, has been designed to support the Benetas vision and ensure we are meeting the needs of our clients and their families. It’s also our responsibility to support our clients through aged care changes. How we respond to the changes associated with reform, and how we do this in keeping with our values and still grow in a sustainable form; these are the questions that can make or break an organisation. The answer must come from a conscious decision to not just be a service provider now, in the present tense, but to be a sustainable organisation that will provide services for years to come. That must be the driver of decisions and strategy. The next part is how we shape and provide services. One of the biggest challenges we face is to resist the temptation to apply for tenders, or other opportunities, for services that we simply aren’t resourced to provide or that are inconsistent with our strategy. Sometimes the most difficult thing to do is to say ‘no.’ So how do grow our organisation and financial portfolio? Through planned investments which match the direction outlined in our organisation’s strategic plan. At Benetas, a significant amount of this growth is generated by mergers and acquisitions. This is a strategic priority for us, and aligns with our focus on good business practice. Mergers and acquisitions represent a secure process for organisational development. They generate positive cash flow immediately, relative to developments that are often capital intensive and can require years of hard work to develop substantial revenue results.

26 | FUSION In 2012, Benetas acquired two residential aged care facilities and a retirement village operated by Gippsland-based operator, Grace Bruce. This was a good fit for Benetas; contemporary facilities, marketable, and provide an opportunity to service a broader area. In addition, the acquisition satisfied Benetas’ strategic direction and met with opportunities to expand our geographic and serviceprovision portfolio. It fit with where we were and satisfied where we saw ourselves in the future. At the start of this year, Benetas acquired the In Home Nursing and Support service delivered by BASS Care (Boroondara Aged Care Services Society). This decision was made after we had identified trends in home care which indicated a growing need for complex community care, and we saw this as an opportunity to expand our service delivery into this area. Rather than start the service from scratch, we drew on existing back of house resources and knowledge to support the program to transition to form a key part of Benetas’ service delivery. Building and maintaining a sustainable organisation also requires an understanding of, and investment in staff. Organisations need to ensure departments are resourced appropriately, and are clear on their objectives. You need to start by having the right people at the top – the Board. Board members can be drivers for change, visionaries and innovators; and they need to understand and live the organisation’s mission. As a community organisation, we are all too familiar with the challenges of staff recruitment and retention. One of the most effective ways we have responded to this challenge is by investing in our staff and what employment at Benetas can offer. It’s important to understand the balance of rewards and benefits that are received

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28 | ADVERTORIAL

Ratings and reviews to complement listings for Aged Care Online

ustralian aged care providers now have the opportunity to present their services to customers on an online platform that supports user reviews and certified ratings. Aged Care Online have been promoting aged care services to consumers across Australia for over 10 years. In September, the group relaunched the website, complete with user reviews and a rating system to enhance the consumer experience. Aged Care Online managing director Ben Hannemann and business partner Michael Lenkic came up with the additional functionality after observing the impact of social media on consumer decision making. The User Review system allows consumers to comment and share their experiences with a nominated aged care facility, while the Aged Care Rating System (ACRS) offers independent qualification based on industry standards. ACRS was launched earlier in the year on April 15 in Melbourne. The system has since been presented to industry delegates at a national roadshow hitting Sydney and Perth. Millennium Aged Care Placement Consultants and Ansell Strategic partnered with Aged Care Online to front the initiative, which promises to give consumers more transparency when weighing up residential care alternatives. Based on current industry standards and a detailed knowledge of consumer expectations, the three parties compiled a consistent set of criteria from which to review aged care facilities. The criteria consists of four components: physical form, resident input, resident services and staff culture. Ansell Strategic director Cam Ansell, speaking at the Sydney and Melbourne launches, said care was purposefully left out of the criteria to avoid the challenge of a UK peak body, who led a similar model a few years ago. “There’s a huge amount of subjectivity that goes on when you try to appraise the value of care,” Mr Ansell told audiences in Sydney. “So this system is primarily around physical form and non-care services,” he said. To generate a star rating a provider must first register their facility on the Aged Care Ratings website and complete an online questionnaire. An accredited ACRS representative will then visit the facility to objectively verify their results.

Mr Hannemann said he is confident the new system will provide considerable assistance to consumers in weighing up their residential care alternatives. “Finding a suitable aged care home for someone is a stressful, complex task and the introduction of the Aged Care Ratings System to assist in evaluating provider options is something we see as overdue,” Mr Hannemann said. He said the system will be equally beneficial for the providers, as it allows them to showcase their services against a consistent industry benchmark. The ACRS has been trialled in Victoria, New South Wales and Western Australia with BlueCross, SummitCare and Aegis Aged Care Group respectively. SummitCare CEO Cynthia Payne spoke at the NSW launch on June 11, offering a showcase of the organisation’s experience with the rating system. Ms Payne said consumers are likely to rely on independent advice to help guide their decision making, with or without a rating system. “I want to be part of something where I can help craft the conversation, rather than being on the end of something that is quite unintelligent, unhelpful and creates fear in the mind of the consumer,” she said. BlueCross Manager for Client Relationships Julie Maya said the group remain enthusiastic about the potential of a nationwide aged care ratings system in validating to consumers the quality of their residential aged care service offerings. Speaking at the Melbourne launch, Ms Maya said the ratings received under the new system gave BlueCross a “health check,” providing an opportunity to compare self-review with an industry benchmark. Mr Hannemann said the rating system, in combination with consumer reviews, will enhance the offerings of Aged Care Online to both providers and consumers. “We are giving aged care providers a way of validating their aged care offerings, while maintaining some control over what they choose to have published,” he said. “We encourage providers to promote their good news stories and happy client testimonials on our website because we know consumers respond well to this.” “Our clients can now choose from traditional advertising, independent ratings and consumer reviews, or some combination of the three, to get their message out to consumers.” ■

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Leading Age Services Australia strengthens member engagement By Kay Richards, LASA National Policy Manager

ince inception, LASA has encouraged communication to and from the LASA Board. One way this has been achieved is through the establishment of LASA advisory groups. The seven groups represent key areas and include: • Communications Advisory Group (CAG); • Home Care Advisory Group (HCAG); • Fusion Editorial Advisory Group (FEAG); • Housing and Retirement Living Advisory Group (HRLAG); • Residential Care Advisory Group (RCAG); • Rural, Remote and Special Needs Advisory Group (RRSNAG); and • Workplace Relations Advisory Group (WRAG). As with many interest groups, some of the advisory groups are more active than others, however each group functions according to a set of generic Terms of Reference (TOR) which are customised to the particular scope of the group. Generic guidelines were originally developed to support how the groups would function and how the TOR would be implemented. In particular the purpose of each group is to provide expert advice to LASA in relation to external policy matters identified by the advisory group or delegated by the LASA national office or CEO leadership group. This advice can take the form of: • Developing draft industry policy positions; • Reviewing and amending existing policy positions; or • Reviewing, commenting and providing input to emerging issues and/or submissions. Advisory groups also act as a discussion forum across jurisdictions on current and emerging issues within their portfolio. Advisory groups are convened, and chaired, by an appointee of the national CEO and where possible, a state staff officer, a member representative from within each state and a national office appointee constitutes the membership. It is vital that LASA is well represented by state staff members, but even more important are the member representatives that support the advisory groups. These members are the linchpin and serve as the conduit from those working at the frontline to the LASA national office and the LASA Board. Important to keeping the advisory groups active and relevant are the convenors, and these have been chosen by the LASA CEO because of the person’s passion, expertise and position. These are: • CAG – Justine Caines, LASA, Communications and Government Relations Manager; • HCAG – Kerri Lanchester, LASA QLD, Manager Community Care and Retirement Living; • FEAG – Justine Caines; • HRLAG – Barry Ashcroft, LASA QLD, CEO;

• RCAG – Loula Koutrodimos, LASA NSW & ACT, Manager Business Services; • RRSNAG – Sandra Glaister, LASA QLD, Manager Residential Care; and • WRAG – Emma Patton, LASA NSW & ACT, Manager Employment Relations. Convenors also play an important role in ensuring member views are reflected in agenda items for each advisory group meeting, and the people listed above are key staff members who are part of state committees that gather intelligence from their member organisations. To support Convenors a LASA Advisory Groups Convenor Guide was developed with the aim of outlining the overall requirements of the role of convenor, as well as some helpful tips and advice to assist convenors to successfully execute their duties. The LASA National Policy Manager has the task of linking the seven advisory groups to ensure they are working to and supporting the strategic direction for LASA and coordinating the meeting process. A major function of the advisory groups is to advise on policy development and the TOR clearly identify the criteria on which policy is developed and it is advised that a policy suggestion should meet at least two of the following criteria: • It is a core and current or emerging issue for the age services industry; and/or • It has been referred to the advisory group by the Federal Board, CEO leadership group, or national office; and/or • It has been determined to be a policy priority area during the course of a review by the advisory group; and/or • It is reasonably anticipated to be an issue that will be addressed in the near or medium term by government and is relevant to the age services industry. Within this edition of Fusion the first tranche of LASA policies have been published and is a testament of the collegiality and cooperation of LASA offices and valuable member input; culminating in the development of these eleven policies. With governance structures and reporting mechanisms being strengthened as LASA matures, members can now see updates from each convenor within each edition of Fusion and these reports mirror the information provided to the LASA Board. Without the support of LASA state staff and the members representatives for each of the advisory groups, the communication process would not be functioning as well as it does. Like all major projects, processes can improve. It is the aim of the LASA national office to keep the advisory groups active, relevant and enable them to be as described above, the conduit to the LASA Board to inform and recommend policy actions to improve the care and services provided to older Australian, to enable them to live well. ■

30 | FUSION

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FUSION | 31

Implementing a national aged care quality indicator program By Kay Richards, LASA National Policy Manager Maree Cameron, Manager Quality Improvement Ageing and Aged Care Branch, Department of Health (Victoria)

or more than two years the now Department of Social Services (DSS) has been working with a National Aged Care Alliance (NACA) Reference Group to develop quality indicators for residential aged services. It has been a long road; with little progress over the last 12 months since NACA provided feedback to the DSS via an Advisory Paper in January 2014. The original advice from NACA drew on the Alliance’s Blueprint for Aged Care Reform (February 2012) that aimed to provide meaningful and publicly available quality indicators to support people in making informed decisions about their care. Initial thinking was informed by work undertaken by Campbell Research and Consulting and supported by a number of experts participating in the Reference Group and work already underway in Victorian Government Aged Care Facilities. It was initially heralded that quality indicators would be published on the My Aged Care website by 1 July 2013; this timeline has obviously not been met. Consumer representatives advocated for publicly available data to assist consumers in making a choice for a residential service, an aspiration that LASA supported, however another purpose for quality indicators that LASA strongly advocated was that they were used to support quality improvement processes and were not the panacea for determining quality of care. Not to rehash old history, nor provide a chronological list of events, the upshot of preceding work culminated in Minister Fifield announcing in May 2014 that three quality indicators included in the Victorian Quality Indicators Program for residential aged care will be piloted: • Prevalence of pressure injuries; • Incidence of use of physical restraint; and • Prevalence of unplanned weight loss. Also to be developed will be quality of life/consumer experience indicators for aged care. KPMG Australia have been engaged to work with the Department of Social Services on further development and piloting of the indicators. It is envisaged that the KPMG process will include: • Research and review • Consultation • Quality of life indictors and home care indicators – indicator development and definition • Piloting

• Implementation planning for 1 July 2015. It is obvious that the timelines set by DSS for the work to be undertaken by KPMG is ambitious, especially since NACA has been working on this project for years. However LASA, as a member of the Aged Care Sector Committee has supported the introduction of voluntary reporting of selected indicators. What has not been considered by DSS is any additional workload this might impose on the industry. Many services already have mature clinical indicator collection systems as part of their quality improvement programs, however for national program to be successful, the definition of an indicator, and its collection and reporting processes must be consistent across each participating facility; something that currently is not in place and something that will mean additional training, collection processes and reporting outside what is currently undertaken. As part of the pilot process a sample of at least 160 residential services will be recruited to participate in three data collection cycles of a 4 week period with three weeks break between cycles. This will commence in February 2015. Significant support from KPMG will be provided to the pilot sites. Data gleaned from the pilot will not be for public distribution. In addition to indicators for residential services, KPMG have also been tasked with developing indicators for home care services. Further information for home care will be provided as the project progresses. The DSS have proposed a new Quality Indicators Reference Group be formed to provide policy advice on the implementation of quality indicators. Part of the terms of reference for this group is to provide advice about the implantation arrangements for the adoption of quality indicators – including the impact for consumers, their families and carers, approved providers and other stakeholders, that minimise the administrative burden on providers while maximising the provision of transparent and meaningful data to consumers. Additional advice from the Reference Group will also consider consumer information about the quality indicators for publication at the service level on My Aged Care and information for participating services. As LASA represents industry in the development of a national Quality Indicator program we can gain insight by looking at the Victorian experience, where indicators were introduced in 2006. Maree Cameron, Manager Quality Improvement Unit, Ageing and

32 | FUSION Aged Care Branch, Victorian Department of Health provides an overview of the experience in Victoria and reveals Are they the right indicators? Is it worth the effort? What will happen to the data? How can you trust everybody to play by the same rules? These are obvious questions you would expect of any proposed indicator program. The same sort of questions that Victorian public sector residential aged care providers asked when invited to participate in the Victorian Department of Health’s, aged care quality indicator program in 2006. Eight years later, the unequivocal response from those same providers is that the indicator program makes a difference to the care and quality of life of residents. Whilst voluntary, the program continues to have a 100% participation rate. This highlights how embedded the indicators are within current quality and governance frameworks of the health services that operate the 186 services. So how did this positive engagement and commitment to the indicators happen? The first question was can we do better, and if so, how? There was no argument about the potential to improve and there was agreement that an indicator program could assist. But the program needed to be underpinned by evidence and make sense. Health services were already experienced in using indicators for driving patient safety, but there was no consensus about what indicators to use in residential aged care services. Everybody was clear; any indicators needed to be relevant to the quality of care for residents and be valid, reliable and easy to collect. La Trobe University was duly contracted to research and develop options for piloting. Apart from the ubiquitous literature review, consultation and engagement of sector leaders and staff at the coalface was key. This commenced in late 2003 and it was 2006 before all services reported their quarterly indicator data. A key lesson has been that indicators are complex and success takes time. The five areas where indicators continue to be collected are; falls, unplanned weight loss, use of physical restraint, pressure injuries and nine or more medicines. All issues of significance with potentially catastrophic impact for older people living in residential aged care services. The program is supported by defined business rules and definitions to aid consistency and clarity of understanding. But like any indicator program, there will always be some common issues. These include occasional differences in how data is collected and interpreted. For various reasons, not everybody will have the same level of engagement at all times. Taking a balanced view and accepting the inevitability of variation in any indicator program, supports a healthy approach to the way in which this is addressed. Encouraging consistency with positive levers like ongoing research, collaboration, training and support will always yield better outcomes than a forensic approach that risks negative and perverse reporting behaviours. Unwavering from the outset and critical to the success of this program has been continued clarity of purpose and intent. The indicators were always designed to provide an evidence base for local service improvement rather than departmental performance monitoring of individual services.

Transparency and openness without threat of punitive action supports continuing engagement and greater likelihood of honest reporting. After all, an indicator is just an indicator and will not provide a definitive measure or absolute answer. For this reason, services participating in the program are required to publish their own performance against the indicators in their annual quality of care reports. These are publicly available and provide services the opportunity to communicate their successes and efforts to improve in other areas. The real benefits of an indicator program is when it creates a culture of enquiry about what the data tells us and what we do with the information. It’s this culture that continues to shape the work around the indicator program. Validation research has provided confidence about the benefits of the program, and how improvements could be made. Research developing evidence-based reference ranges for each indicator was in response to services wanting to benchmark their performance, beyond ‘the average’ to strive for excellence. Current research by Monash University is seeking to better understand the quality use of medicines to identify potential gains. The nine or medicines indicator dataset informing this study is considered the largest of its kind, unmatched within existing Australian or international literature. This is an important step to understand how a longitudinal data might be used to transform how care and services are provided. The data also informs sector training and investment priorities. Most importantly, it shows significant results for residents with reductions in pressure injuries, falls, use of physical restraint and no increasing weight loss (despite changes to resident acuity). This assumes, that overtime residents experience, less pain, potential infections with increased independence, dignity and well-being. At the heart of this, we must always remember that the numbers are about residents and the interrelationship between services and the systems of governance and care. Interestingly, despite service diversity (a mix of size, location and resident profile) adjustment has not been required, with no statistically significant difference in the data to date. As a cautionary note, indicators are not the panacea for everything. They are just one part of the quality improvement jigsaw puzzle and where other strategies such as improving health literacy and better utilisation of evidence are required. Recent conversations with public sector leaders continues to confirm that participating in a program grounded in evidence within a supportive and collaborative environment drives better outcomes for residents. So where do you start? Assess sector and organisational readiness. Look to existing evidence and identify what is practicably measurable and ready to collect. Engage with sector leaders and support early adopters to succeed. The intention was always to further develop the suite of indicators to include those previously recommended. This was deferred pending clarity around Commonwealth directions for national indicators and is now being reconsidered. ■

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34 | FUSION

Summitcare: Our golden approach By Clare Ward Marketing Manager Summitcare

ummitCare is continuing to celebrate another historic win, taking out its second Gold award at the Australian Organisational Excellence Awards 2014 presentation dinner at Etihad Stadium in Melbourne in November. The award again places the organisation firmly on the national and global stage, as SummitCare remain the first and only Australian aged care provider to reach this level. The 2014 Gold award follows our 2012 Gold award and the Silver received in 2009. CEO Cynthia Payne has praised the entire SummitCare team for its deep and genuine support for older Australians and their families. She says this has been underpinned by the Australian Business Excellence Framework (ABEF), which has driven positive change throughout our organisation – and led to our outstanding wins. “The Business Excellence Framework works to create the right conditions in the organisation to ensure sustainable and aligned improvement,” she says.

“It places strong emphasis on the role of customers and other stakeholders and core interested parties. Through deep listening and a focus on their interests, desires and issues, SummitCare has been able to year on year improve performance across a range of indicators.”

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The awards recognise businesses that have adopted excellence frameworks and increased productivity as a result, according to the keynote speaker at the awards evening, Dr Ziggy Switkowski, AO. “The Australian Organisational Excellence Awards provide an external perspective and an endorsement that organisations are achieving sustainable improvement,” he says.

Framing priorities Embracing the ABEF is something SummitCare can trace back to 2005 – a time, Cynthia says, when there was a recognition “that there needed to be a better way of ensuring SummitCare would be able to always deliver on its promise”. She says while the accreditation process was important, it did not help harness a complete leadership and management systems approach. “When we came across the ABEF it just spoke naturally to the way we were working without a clear focus.” The framework is based on nine Principles of Business Excellence, which are interpreted by individual businesses using seven categories: leadership; customers and stakeholders; strategy and planning; people; information and knowledge; process management, improvement and innovation; and results and sustainable performance. Cynthia says it has become the overarching focus for all SummitCare does, and works in synergy with our care standard, food safety compliance and balanced scorecard. “We reflect on it regularly and use it in our planning,” she says. The principles in the ABEF are “instinctively right”, Cynthia says, and the framework speaks to all businesses of all sizes. “If excellence and productivity is what your organisation is trying to achieve, then I say why aren’t you looking at the ABEF to help guide your frame of reference. Every organisation needs those kinds of tools to get the alignment around their prioritisation, thinking and decision-making.”

Strong results Organisations are evaluated on their use of the ABEF, and the most successful may go on to win an award. But this cannot occur until rigorous independent assessment of every aspect of operations is completed. In 2014, SummitCare underwent its third evaluation of this kind, with six evaluators going over the business across three days. They examined information and evidence we provided; spoke with residents, staff and the Board and management team; and visited all Sydney sites, including examining our HomeCare operations. Cynthia says there may have been some nerves in the lead-up, but it was a relaxed and honest exploration of SummitCare. “As I said in the lead-up – we’re not doing anything different. This is us and we’re just simply explaining the evidence pathway around what we do.” Following the visits, an evaluation report is created and organisations can use this to identify strengths and areas of potential improvement. “It gives a shared understanding about what the organisation is trying to achieve. A standalone strategic plan might have key result areas, but that’s not enough to get a high-performing organisation.” Cynthia says although organisations that apply the ABEF will become high performers, she was nervous that the amount of change

at SummitCare over the past two years would not see it receive a Gold award. “But we still went ahead …. I said we’ve just done a major repositioning, there’s a lot at stake for our industry in terms of major reform, and the customers we’re dealing with today are not the customers for tomorrow. Therefore, now is the right time to check in that we’re heading in the right direction.” The 2014 Gold award confirms we have indeed been travelling the right path. To give back as a long-term operator in the excellence space, Cynthia has also become a board member of the recently created Australian Organisational Excellence Foundation, chaired by Harry Xydas of the Doric Group. The foundation has been accepted as a member of the Global Excellence Council (GEM Council). Overall, she says, the success SummitCare has enjoyed was summed up well by our Director, Peter Wohl, during the 2014 evaluation process. “Peter spoke very freely about his passion for the organisation, his pride in why it does what it does, and how it’s fully transparent,” Cynthia says. “We are genuinely an inclusive organisation. Everybody understands their roles and there is a deep values structure that underpins the entire organisation. That’s what business excellence asks you to embrace – and that’s what an organisation should be doing.” ■

36 | FUSION

LASA CEO launches Decision Assist

By Warwick Ragg Project Officer LASA

oodwin Aged Care Facility, in the Canberra suburb of Ainslie, was the venue for the Official Launch of the Decision Assist Project. Over 80 people, including a large contingent of Goodwin staff, were in attendance Decision Assist aims to build capacity, linkages and access to palliative care and advance care planning services for older Australians by providing support and education to aged care providers and general practitioners. A highlight of the launch was Decision Assist Chair, Assoc Professor Bill Silvester, interviewing Goodwin Nurse Practitioner, Tamra Macleod. Tamra was able to give her real life positive experience of using the Decision Assist telephone advice line.

Tamra said â&#x20AC;&#x2DC;I work as an aged care nurse practitioner and for Goodwin and I have used the Decision Assist telephone advisory services twice now, once for palliative care advice and that was followed up with a GP calling the service, and I have also called them for some advice around advance care planning. Both times it was fantastic.â&#x20AC;&#x2122; LASA CEO, Patrick Reid, fulfilled the dual roles of providing an aged care sector view of Decision Assist, then formally launched the project and led the cake cutting with the Decision Assist Consortium Members. The consortium is made of representatives from Leading Age Services Australia, Aged and Community Services, Queensland University of Technology, University of Queensland, Caresearch,

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Austin Health, Palliative Care Australia, and Australian and New Zealand Society of Palliative Medicine. A key extract from Patrick’s comments, in his capacity representing the Aged Care Sector, follows: As the population ages those in care have more complex medical and psychogeriatric conditions. It is essential that the older person receiving care, and their families, are clear on what their expectations of care are and what can be delivered, either in a residential aged care facility or in a person’s home. This is part of the conversation that Australians must have about ageing. How you live your life should not be left to chance, at any age, but especially when you may not be in a position to make the decision. LASA was formed on an imperative of helping older Australians to live well. Inherently, this must include helping them die on their own terms and with dignity. To do so effective planning, including the family, at a calm and convenient time is paramount. Making a collective and informed decision, and appropriately documenting it in an Advance Care Plan, is a sensible pathway which the sector will continue to promote and facilitate.

In formally launching the project Patrick provided the following: I acknowledge the major investment by the Government, via the Department of Health, in this consortium project. This commitment will be invested across a range of key areas, including: • A specialist palliative care telephone advice line; • An advance care planning advice line; • One central website, including a substantial resource section incorporating clinical tools and guidance; • A suite of projects supporting Linkages between aged care and specialist palliative care providers; • Training for aged care provider staff; • Targeted workshops for GPs; and • A smart phone app is under development. The project is governed through the consortium and operates under university supervised ethics and incorporates comprehensive evaluation frameworks. Patrick specifically thanked Goodwin Aged care for their hospitality. More information on Decision Assist can be found at www.decisionassist.org.au and the specialist palliative care and advance care planning telephone advice lines can be accessed by dialing 1300 668 908. ■

38 | FUSION

Staying healthy in the heat

By Amiria McKinnon, Communications Manager, The Whiddon Group

taying Healthy in the Heat is Whiddonâ&#x20AC;&#x2122;s program around heat awareness, preparedness and response. The program was implemented in early 2013 following advisory communication from the (then) Department of Health and Ageing around preparing for and responding to adverse heat events. As a provider operating across regional, rural and remote NSW with services regularly experiencing heat periods climbing above 35 and into the 40s, Whiddon saw an opportunity to review and reform existing emergency management practices and develop a best practice response to heat related incidents. Staying Healthy in the Heat is based around a three step process that involves team members, clients, their families and the community to ensure that we are all aware of and understand how to stay safe in heat periods. Staying Healthy in the Heat begins with a pre-heat season audit in September, followed by a communication and awareness campaign in October and then the activation of the program during heat periods. The pre-heat audit prompts the DCS and Maintenance officer to fully review the built environment, including looking at equipment and supplies, including kitchen hydration supplies. The communication and awareness campaign reminds staff and clients of our procedures and ensures awareness of common heat related illness symptoms and treatments, and heat is on the agenda at each handover and team meeting to ensure that it is front of mind. The communication and awareness campaign reaches beyond

our residential homes, with community care clients, carers, family and staff receiving resources packs with information about how to stay healthy in the heat. Our teams and clients understand a predicted daily temperature of 35 degrees C, particularly if it is to last for three days or more, triggers the activation of our Staying Healthy in the Heat program.

Heat awareness email alerts: To assist our operational team to be aware and prepare for heat periods, an automated email alert was generated from predictive weather temperatures originating from the Bureau of Meteorology. This email was coded to send location specific alerts to each residential or community care manager, and an overview of all Whiddon locations to our Management team.

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Case study: The Bureau of Meteorology recognises that Australia can have very high temperatures and heat waves that lead to heat exhaustion, and even death, particularly among the very young or old. In Australia and other countries, heat waves are responsible for more deaths than any other natural hazard but are mostly underrated because they are viewed as a passive hazard in contrast to the more catastrophic hazards such as tropical cyclones or bushfires. In Narrabri, where temperatures in the warmer months regularly rise above 35 degrees and have been as high as 40+ in the past year, Whiddon trialled a purpose built hydration trolley to understand what impact it could have on supporting clients in residential care to increase their fluid intake to reduce heat related incidents and illnesses. The hydration trolley and program was trialled as part of Staying Healthy in the Heat over a 12 month period, with results and feedback demonstrating improved hydration levels, improved skin integrity and increased client comfort. The Narrabri team recognise hydration as an important part of the meal service and catering and clinical teams worked collaboratively to introduce the program to staff and residents, providing training around why the program was being introduced and talking to residents about the importance of fluids as part of their nutrition and wellbeing. Fluid intake became part of the residents’ nutrition and hydration program, and staff began to formally monitor fluid intake, particularly during heat wave periods.

To encourage residents to keep their fluid intakes up, our catering team looked at how they could make beverages appealing for clients who tended not to drink large amounts of fluids. The hydration trolley was stocked with a range of non-alcoholic beverages and the team acknowledged that for older people with dementia, colour and texture can improve interest in fluid, so they introduced special items like milkshakes, iced coffees and fruit crushes. With the trial achieving great results and being embraced by both staff and clients, Whiddon are now looking to modify the design based on feedback and then roll out the idea of a mobile drinks trolley to all residential services in 2015 as part of Staying Healthy in the Heat. ■

Practical innovations from the frontline By Amiria McKinnon, Communications Manager, The Whiddon Group

Implementing a systematic review process to improve end of life outcomes in aged care

hiddon’s Death Screening practice was developed following recommendation in 2011 by the NSW Coroner that deaths in residential aged care should be systematically reviewed. Following the implementation of the practice in late 2012, Whiddon were awarded a 2014 Better Practice award in recognition of their implementation of a systematic review process to improve end of life outcomes for clients. The Death Screening practice, which was developed by General Manager Clinical Risk, Llyr Otto, encourages continuous improvement across the industry and transparency around how end of life processes are managed within residential care. The implementation of the screening process has lead to further improvements, including improved liaison with emergency services; changes in care requirements following a fall or incident; improved education for staff around recognising deterioration; improved communication with, and understanding for, families around end of life care; and an environment of knowledge sharing and continuous learning for staff who are encouraged to share results and discuss concerns with relevant clinical staff.

To ensure a comprehensive and consistent approach is taken, Whiddon’s Death Screening practice provides a strict framework, including tools and criteria, for screening. A senior Whiddon clinician examines client records against the criteria, including those outlined in the Coroners Act (NSW), and if needed, a more detailed investigation is undertaken. The whole process is completed within 14 days, with findings then reported on in monthly reports and used to identify and develop systems to improve the quality of the end of life care. Comments from panel members at the Better Practice awards commended the practice as a positive step forward that shows a maturing of the industry with response to a recommendation by a key stakeholder. The development of the process is recognised as “an objective, systems based approach to an issue facing aged care for many years. Results from this should be understood and applied across the industry”. Since the Better Practice awards, Whiddon have had enquiries and shared resources around the practice with other providers, viewing this as an opportunity for industry wide improvement. Those interested in learning more about the process or accessing tools developed by Whiddon should email l.otto@whiddon.com.au ■

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Young nurse leaders in aged care: The answer to future health workforce nightmares By Renee Callender BoN, MPhil ( c ), Registered Nurse at Warrigal, NSW

After seeing Renee’s poster presentation at the Australian College of Nursing’s national forum LASA invited her to write for Fusion. It is inspiring to see a new graduate have an experience so positive that they are moved to present at a conference. Positively Renee is not the only new nurse graduate to be surprised by the clinical and professional experience of aged care nursing. Barbara Johnson who was the first Indigenous nurse graduate of the highly successful LASA Victoria program recounted her experience within aged care with passion to federal parliamentarians at a recent LASA initiated workforce development forum in Canberra. Ironically DSS have ceased funding to the LASA Nurse Graduate program.

ince beginning my registered nursing career only 10 months ago I have been thrust into a role many new graduate nurses misunderstand, fear, or resolve they will never be a part of; aged care. Many nursing students see aged care as slow paced, lacking autonomy and fear they will lose their ‘nursing skills’, how wrong they are… Ever since gaining employment and liaising with hospital based nurses I have seen a completely different side to nursing, a side I love and I am beginning to shine in; but one that is often misunderstood by hospital based and student nurses. I have witnessed registered nurses (RNs) consoling grieving families and ensuring the comfort of their loved ones in their last days and sometimes years on this planet. This is the side of aged care that young nurses should be looking forward to working in, this is true nursing. Sure, we may not be constantly priming IV lines, setting up ECGs or using ventilators, but I have never seen more skill than a palliative aged care nurse giving closure to a grieving family and being the advocate for those that cannot speak for themselves. However, making aged care nursing appealing to new nurses is hindered by the stigma surrounding aged care in the general nursing community. I have witnessed one RN in charge of 140 residents and 18 staff members have to juggle multiple declining residents, without a doctor available, who had to make the decision to send one resident to hospital as she had fallen and had increasing confusion. The RN was contacted by the said hospital who inferred she was only sending the resident their way to reduce her workload. The hospital then called back two hours later to tell her the resident was now in ICU as the cause to her fall was acute septicaemia – no apology was offered for their original misguided belief. I recently submitted a poster presentation at the Australian College of Nursing’s, National Nursing Forum entitled “Young nurse leaders in aged care: the answer to future health workforce nightmares” I aimed to shine a new light onto aged care RNs and

their role in ensuring continuity and quality resident and patient care, to inspire those younger nurses to consider taking on aged care in a new graduate capacity, exposing the potential for leadership growth, and to clear the air on the misconceptions of the role and pressures of registered nurses in aged care.

We need newly graduated RNs According to the Australian Nursing and Midwifery Federation 2009 “Nurses in residential aged care“ report, the total number of residential aged care staff would increase by around 14.1% to 91,621 by 2020, severely lacking the 56.8% increase in demand. The proportion of staff older than 45 is predicted to rise from 22.8% in 2008 to 28.8% in 2020. Moreover, if the decline in nurses as a share of the total continues until just next year (2015) and then halts, by 2020 the ratio of residents per nurse will roughly double (and residents will be older) and RNs will need to supervise three rather than two personal carers, on average (The Australian Nursing and Midwifery Federation, 2009). Therefore, an aged care nurse needs to have a broad knowledge of everything in order to provide complete holistic care. Just some of the specialties that aged care nursing encompasses include: • Mental health nursing • Neurology • Wound management • Drug and alcohol rehab nursing • Respiratory • Cardiac • Urology • Palliative care • Emergency medicine • Diabetes management • Gynaecology and so much more. Along with these specialties, insight into and knowledge of allied health is essential for the RN to support their residents

42 | FUSION Nurse co-workers who handle unbearable situations with grace and calm, providing closure for families and are role models for newly registered nurses.

Why do we struggle to attract RNs and keep them?

in a holistic manner; Allied health areas include: Occupational therapy, physiotherapy, speech pathology, dietetics, social work and WH&S. The RN role encompasses all of the above specialties whilst maintaining a constant team leader role for staff, presenting vast leadership opportunities and room for upward career growth. For those hesitant to start a career in aged care as they think they might lose their registered nursing skills, I encourage them to understand the reality is quite the opposite. The saying that has stuck with me after one delegate read my poster presentation is “Your nursing skill is the way that you use yourself as a therapeutic tool for a patient or resident, you can learn specific tasks as you journey through your career but these do not make your nursing “skills”.” Sure, aged care nursing may not see as many invasive procedures, we don’t prime IV lines or cannulate, but we essentially do everything else that hospital staff are able to do (unless of course in a ‘specialty area’ of nursing, where nurses are given specialty training to complete regardless.) No matter what field or specialty a general nurse may work in, as 80% of hospital patients are elderly, they will end up looking after older people anyway. We also have more of a say in what treatments our residents receive as opposed to hospital patients. We work very closely with GPs and they discuss with them the best treatment for a resident, rather than being told what the treatment will be. We are the ultimate patient advocates, especially as most facilities do not have medical officers or GPs on site and it is the RNs responsibility to determine if they need to be called, or a patient needs to have their care needs escalated. Put simply, the buck stops with us. It is incredible how rewarding working in aged care really is. Aged care nursing is an example of true nursing, the way it was supposed to be. In caring for every aspect of the patient, not just one area; you have the opportunity to impact on an individual’s quality of life and help to make them comfortable in their final moments. I can tell you there is no greater honour and nothing more special. Knowing the right thing to say to the loved ones of an older person, especially when close to death certainly takes time, but I have learnt from some incredibly skilled and compassionate nurses.

So what does this specialty offer new RNs? Aged Care is such a comprehensive, multi-faceted nursing role. The patients (better known as residents) often have multiple comorbidities, and other issues, and the facility is their home for the rest of their lives.

Aged care nursing is a field of nursing that generates a considerable amount of stigma and misunderstanding amongst the nursing community, comparable to the stigma faced by mental health nursing even 10 years ago. I presented an example of common quotes heard in aged care, by aged care nurses in the poster presentation in order to get the general nursing community talking about the way they view aged care nursing. “Don’t you lose all of your nursing skills and just do paperwork?” “Nurses only look after residents, they only send them to hospital to reduce their workload.” “I’m starting to get older now and my body is hurting from working in the hospital system, I’m thinking about retiring to work in aged care” – This one personally made me laugh. I take, on average, 12,000 steps a day in my workplace.

Lack of new graduate interest in aged care It is widely recognised that if newly registered nurses (RNs) are supported within their transition to the workforce, they are more likely to remain in nursing, and even more likely to stay within the specialty area that offered them the support. There is such a shortage of young energetic nurses in the aged care field, and it is rare to find a newly graduated nurse who has chosen aged care as their first option. This is to the detriment of a unique specialty. My university did teach gerontology, but not until the third year of the degree, when students had already made up their minds where they would like to go with their careers. No wonder new RNs tend to avoid choosing aged care as a career. Why would you when other specialties are portrayed as more exciting? Most newly graduated nurses do not know that aged care graduate transition support programs exist near them. This can occur by universities largely focussing on graduate programs within the hospital system. In some areas however, supported aged care programs do not exist, but some managers will attempt to provide supported positions for new RNs without a specific program. This presentation was inspired by the lack of supported new graduate RN positions and aimed to encourage aged care managers to hire graduates and invest in them as they are recently well educated and experienced in a variety of fields, bring creativity and innovation and a willingness to learn if offered the opportunity. These are the managers and leaders of the future! Within my poster presentation I aimed to shine a new light and the nursing community talking about aged care RNs and their role in ensuring continuity and quality resident and patient care; and specifically to inspire younger nurses to consider taking on aged care in a new graduate capacity. The aim was to expose the potential for leadership growth, to encourage universities to review their curriculums to focus more on an ever expanding industry, and to enlighten general nurses on the challenges aged care nurse face. ■

References Australian Nursing Federation (ANF) 2009, ‘Ensuring quality, safety and positive patient outcomes’, Issues paper.

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44 | FUSION

WA’s payroll and land tax legislation under review

By Tirzah Anglin, LASA WA

n 2012 the Chamber of Commerce and Industry in Western Australia (CCIWA) successfully argued to the State Administrative Tribunal (SAT) that it was a charity. Not only did the CCIWA receive a payroll tax exemption from the State government but when the government unsuccessfully appealed the SAT decision, it also had to pay interest on the previous five years’ worth of payroll tax the industry group had been reimbursed.

And following the CCIWA’s legal success, another seven organisations successfully argued that they too should be payroll tax exempt. In order to stop these organisations from continuing to claim an exemption, the WA Parliament introduced legislation that extended payroll tax provisions. Having regard to the general law definition of charitable purpose, and taking into account the Constitution and a detailed consideration of the activities of CCIWA, the Tribunal concluded that CCIWA was carried on for the promotion of trade, commerce and industry generally and mainly for a purpose beneficial to the community. It is no secret the WA finances are not healthy. At the moment, debt stands at $9,598 per Western Australian (which is $2,000 per person more than in Victoria and New South Wales). Given rises in gas, electricity, water, vehicle registrations, hospital parking charges and the introduction of parking fees at train stations, there is little more that the government can do to meet its growing deficit. In other words, it was only a matter of time before the government and the Office of State Revenue (OSR) looked at reviewing tax exemptions for charitable organisations which is what happened when it introduced the ‘Taxation Legislation Amendment Bill 2014.’ LASA-WA gave evidence to the Parliament’s Legislation Committee into our concerns with charities being affected by the legislation. CEO Beth Cameron said that not content with abandoning WA’s for-profit aged care providers hit with $16 million a year in additional Payroll Tax, the state government was now attacking not-for-profit (NFP) aged care providers. Currently, NFP aged care providers are exempt from payroll tax and land tax but the change in legislation only guarantees exemption for those that ‘relieve poverty or provide religious or education services’. In other words, aged care is not exempt from the WA government’s tax grab.

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And, it is not only aged care that can find itself paying more taxes, NFPs that provide services including para medical services may also find themselves hit with payroll and land tax bills. If the government had no intention of ever asking NFP aged care providers to start paying payroll and land tax, then why not include aged care as an exemption? And the Treasurer is on the record as saying ‘the State Government’s intention is to legislate to narrow the scope of State tax exemptions’. While not accepting LASA’s request for aged care to be specifically exempt from the legislation, the government did make a compromise to exempt Public Benevolent Institutions (PBI’s). The OSR told the Committee that of all but one charitable aged care provider in WA was a PBI and that that one, was awaiting PBI classification. The Committee’s final report did nothing to alleviate LASA’s concerns. (See opposite). LASA-WA asked for nothing more than certainty for aged care providers and the people in their care by specifically asking the government to exclude aged care from paying payroll and land tax. It is unfortunate that at the time of going to print, the exact opposite is a real possibility. Even though it will be a desperate government that comes after NFP aged care providers, with the State’s finances the way they are, that is exactly the situation we have. ■

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Page 19: Finding 4: Office of State Revenue accepts that ‘legitimate’ charities may unintentionally be excluded from taxation exemption but considers that this is mitigated through the Ministerial discretion in the Bill to reinstate taxation exemption. Page 44: However, Office State Revenue advised that not-for-profit aged care providers are not fourth limb charities and are ‘highly unlikely’ to fall within the scope of the Bill and, therefore, lose taxation exemption. Page 44: Finding 11: A majority of the Committee is reassured by Office State Revenue’s advice that ‘the purpose of care for the aged is accepted as falling within the relief of poverty limb’ (the first limb of charity) and that aged care providers are ‘far more likely’ to be ‘pursuing purposes under the first limb’ than the fourth limb of charity. The Committee recommended that the Government confirm that not-for-profit aged care providers do not fall within the scope of the Bill and therefore will not lose taxation exemption.

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Aged care manual handling assessment tool By Damien Ryan, Executive Manager – Workforce & Safety, LASA Victoria

he prevention of injury and illness to staff in aged care workplaces is a shared value across LASA members. Despite the manual handling policies, procedures, equipment and training in place, claims information for the sector identifies that more than 50% of compensation claims relate to manual handling injury, with the majority of these involving the handling of residents by carers or nurses. Manual handling describes a wide range of activities such as lifting, pushing, pulling, holding, throwing and carrying. It also covers repetitive tasks including packing, typing, assembling, cleaning, sorting, using hand tools, and operating machinery and equipment. Many jobs involve some form of manual handling and while most manual handling does not pose a risk of injury, some manual handling is hazardous and may cause musculoskeletal disorders. Musculoskeletal disorders are an injury, illness or disease of the musculoskeletal system that can occur over a prolonged period of time, or be due to sudden strenuous or unexpected movements. Musculoskeletal disorders include: • sprains and strains of muscles, ligaments and tendons • back injuries, including damage to the muscles, tendons, ligaments, spinal discs, nerves, joints and bones • joint and bone injuries, including injuries to the shoulder, elbow, wrist, hip, knee, ankle, hands and feet • nerve injuries or compression (e.g. carpal tunnel syndrome) • muscular and vascular disorders, and • soft tissue hernias. As an initiative to help members continually improve manual handling prevention strategies, a new health and safety tool specific to Victorian residential aged care facilities was released by the Victorian WorkCover Authority (VWA) in September last year.

The development of the Aged Care Facility Resident Handling Assessment Tool was initiated and overseen by the Aged Care Stakeholder Forum, a partnership between LASA Victoria and the VWA attended by 20 industry representatives. The Audit Tool focuses on the prevention of manual handling injuries to staff involved in people handling and provides an organisation wide approach to implementing systems relating to resident handling aids and equipment, resident assessments, staff training, building and work environment, work organisation, workplace culture, and system evaluation. The self-assessment tool provides a process to identify gaps against manual handling minimal compliance, improved performance and best practice levels in the residential aged care sector. Whilst not a VWA Inspector tool as such, LASA Victoria has been advised that inspectors could ask to see results of employer self-assessments. For a PDF copy of the Audit Tool go to: http://www.worksafe. vic.gov.au/forms-and-publications/forms-and-publications/aged-carefacility-resident-handling-assessment-tool The Audit Tool has now been placed on a mobile application or ‘app’ called iAuditor (it should be noted that VWA does not endorse or make any other claims regarding this product). iAuditor is available for both android and apple devices and is free from the Apple and Google play stores. Apple devices used to trial the new app have proved much quicker than older android devices with less memory capacity. This app allows the Audit Tool checklists to be completed and made available publicly through its ‘library’ feature. The app enables users to send their final workplace reports via email in a Word or PDF format for printing. Alternatively a printing option is available at a cost. To use the tool simply download the iAuditor app, go to ‘library’ in the menu section and select the ‘Aged care facility resident handling self assessment tool’. ■

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Policy Development – The long road forward By Kay Richards, LASA National Policy Manager

Background

f you use Google Search and enter policy development about 444,000,000 results appear. Obviously, there is a plethora of advice, detail, commentary and opinion on how policy is developed, presented and used. One might ask why it is important for LASA to develop policy statements and what use might they serve? In his presentation to LASA Congress, LASA Chairman, Dr Graeme Blackman OAM, outlined the five pillars which will shape LASA as a stronger and more influential voice of all age services; helping older Australians live well. Dr Blackman said “our collective age services skills and knowledge places us in a position of profound importance as a resource to drive national policy”. He continued that LASA has “consistently taken a leading role, be it in the development of policy, advocacy to government or in the dissemination of concise advice and information to members; Access, quality, workforce, the economics of the industry, and capability drive LASA’s strategic intent.” To support LASA’s strategic direction, the LASA Board committed to developing a range of policy statements that would support and assist in articulating the intent of LASA members. A policy statement can either confirm a particular policy stance, argue an alternative viewpoint, propose topic areas that are not in the current arena or raise issues that LASA considers sufficiently important for future deliberation and in which LASA seeks to play a leadership role. The use of policy statements is therefore varied and LASA provides them to and on behalf of members. They can be used by individuals to support professional development, used by member organisations to better articulate their thinking on specific topics, such as when making formal submissions; in advocacy to inform local, state and federal parliamentarians, or to merely define a level of thinking and articulate a position. No matter the use, it is important to know the genesis of the policy, and for those who want to use and support the policy to have confidence that the process of development was rigorous, based on consensus and holds authority from the LASA Board.

The Initial Process Over the last 12 months, LASA has undertaken its own policy development process within a framework of wide consultation and targeted feedback utilising a range of methods. This article summarises the process journey which resulted in the first tranche of Policy Statements being endorsed by the LASA Board and published to members and to a wider audience.

In wanting to firstly ensure that the LASA national office staff members had a consistent view of why and how the policy statements were to be developed and presented, it was pertinent to brainstorm views. Like the 444,000,000 results presented in the Google search it was interesting to hear the differing views within the office. It didn’t take long however, for each member to be on the same page, given we had clear guidance from LASA’s Mission, to be the national advocate for a robust and sustainable industry advancing the wellbeing of all older Australians. The national office wanted to deliver a real world focus and engage decision makers in understanding the industry’s true issues. An initial template was developed to capture a broad brush of thinking on particular topics. The template asked a range of questions: • What is the draft policy statement topic area? • Why propose a policy, is it a problem or why is reform needed? • Is there independent or other reliable research that can be quoted from sources we are prepared to acknowledge as credible? • Is there an industry imperative to act e.g. economic impact, capacity to do job efficiently, can it be an election issue? • Is there community or consumer support for the issue? • What do other stakeholders think? • Do the opposition or cross bench parties have a view that can create support? • List a concise summary of key or preferred outcomes. LASA’s first ‘policy’ was a dramatised view on the use of red and green lollies; an attempt to ensure those participating in the development phase could see the logic behind the questions and how thinking might be displayed in the first draft of a policy. Interestingly no-one argued against our recommendations about the use of red and green lollies in age services, however the policy did met its objective of helping people formulate policy ideas. Following discussion with the LASA National Advisory Groups nine areas were identified, which at that time, were regarded as important to the industry to focus upon: 1. Access to Care 2. Alleviating Red Tape 3. Care in Accommodation – Retirement Living 4. Consumer Directed Care (CDC) 5. Cost of Care – Diversity and Special Needs 6. Newly Built or Significant Refurbishment 7. Provision of Quality Care and Services 8. Residential Accommodation Pricing

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9. Workforce A range of other topics were also canvassed at the inaugural LASA Policy Forum in April 2014 and a further policy area was developed; Innovation and Technology. The policy forum brought together 60 people from across Australia emanating from the Federal LASA Board, Provider nominees from each state jurisdiction, State CEOs, advisory group convenors and selected industry participants. The forum ‘stress tested’ the policies for relevance, desirability, timeliness and political opportunity. During the course of debate a strong sense of agreement, opposition or alternate views on each policy resulted, allowing the LASA advisory groups and Federal Board to primarily hear the members views, and assist them in better articulating policy that would be congruent with member intent. A vigorous, and sometimes strident debate provided a wealth of information that assisted the national office staff to further develop the policy intent into a consolidated set of outcomes that would be sought from the dissemination of the policy statements. To ensure a rigorous framework of consultation was observed, these outcomes were redistributed to the forum participants to ensure their views were captured correctly. LASA had a clear goal of ensuring comprehensive collaboration was undertaken but in a streamlined method to ensure the final documents could be presented to the LASA Federal Board in a timely manner. To achieve this, a project schedule using a Gantt chart was developed, with sign off from State CEOs. The project schedule included the redistribution of the outcomes as referred above, with a follow-on to LASA advisory groups, state CEOs and boards and finally to the full membership for feedback. LASA staff were also invited to speak to State based specialist groups to better articulate specific topic areas and give a briefing on how and why LASA chose to develop the policy statements. It is of little substance to provide a set of outcomes without background supporting information and a statement of intent to

introduce the topic area. It was recognised that policy statements have various uses; be it to be displayed on the LASA website as statements of what LASA believes; preparation documents for lobbying activities; or information for politicians, consumers and the general public as described above. A ‘one-page’ Policy Statement was developed which resulted in outcomes being stated, text that provided background, research and appropriate referencing, and a list of conclusions that LASA sought from articulating the policy intent. These ‘one-pagers’ were distributed to members more broadly and to better focus feedback and commentary, a short survey accompanied their distribution. LASA was interested to know whether members: • supported the policy position; • considered the policy relevant to their business/mission; • considered the policy, if successfully implemented, would be of benefit to their business/mission; and • would use the policy to initiate discussion with local, state or federal politicians/government. The survey also pursued up to three areas that the member would most want to see LASA develop into the future. This is the first time that age service providers across Australia have ever been invited to so widely participate in the development of policy and to articulate their thinking in such a concise manner. With commentary and feedback provided via the survey, LASA national staff were able to finalise each policy statement and present them to the Federal Board for ratification. The Board took two meetings to make their final decision to ratify the policies, this demonstrated their commitment to the process and evidenced their assurance that the policy statements would stand LASA is good stead. LASA recognises the significant contribution the LASA Advisory Groups have provided, the input from State CEO and Board members and most importantly the very valuable counsel from members. LASA gratefully thanks all who have been involved in the process.

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Having described the process above, there will always be times when such a comprehensive process cannot be undertaken and to the first tranche of 10 policies submitted to the Board, an additional policy was developed in response to a Board request. This enabled the Board to ratify the 11 policies displayed on the following pages.

Where to from here? Taking advantage of the LASA Congress held on October 2014, members of the LASA Advisory Groups were able to meet each other, members of the CEO group and members of the LASA Board at the inaugural meeting of the LASA advisory groups. The meeting was held to review the policy development process that LASA has undertaken as the LASA national office staff wanted to learn from what we had undertaken and streamline the process where required. It is LASA’s intent to continue with a rigorous process, and the consultative framework established from the methodology described above, to further develop a second tranche and ongoing sets of policy statements. The national team took advantage of the meeting to seek feedback on what members considered as important topics for the next tranche of priority areas for development of either policy or position papers. As a starting point the meeting was advised that the decision to develop a policy should meet at least two of the following criteria: • It is a core and current or emerging issue for the age services industry; and/or • It has been referred to the advisory group by the Federal Board, CEO leadership group, or national office; and/or • It has been determined to be a policy priority area during the course of a review by the advisory group; and/or • It is reasonably anticipated to be an issue that will be addressed in the near or medium term by government and is relevant to the age services industry. With the information provided through the member survey, future policy development might include areas such as, employment benefits, mandatory reporting requirements, home care pricing/fees, funding for care of people with dementia, research informing policy and translating it into practice, promoting best practice, and the accreditation process – compliance versus quality of life. Other topics considered at the LASA advisory groups meeting included, transitioning from acute to subacute care, export capabilities, topics pertinent to the Aged Care Sector Committee, and areas not addressed from the Productivity Commissions report, to name a few. Members are invited to not only provide other topic areas for consideration, but are always welcome to participate and actively contribute to the development of future policy statements and to review the current statements to ensure they remain relevant, active and of interest to members and others. It is envisaged that each policy statement would be systematically reviewed on an annual basis and it is envisaged that the second Policy Forum will be held in the second quarter of 2015. ■

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Policy Statement: Access to Care Outcomes: To enable all Australians to have access and choice of high quality aged services through timely access to a broad range of appropriate residential, community and retirement services. An age service industry that supports and responds to the needs of all Australians regardless of their culture, background, location or entry point. The COAG Reform Council recently reported that people are waiting longer to enter Residential Care and access Home Care Packages, with the proportion of people taking nine months or more to enter high residential aged care being 3.3% in 2008-09 and increasing to 14.1% in 2012-13 and the proportion of people taking nine months or more to start EACH increasing from 7.7% in 2008-09 to 20.2% in 2012-131.

consumer to understand what their contribution to care and services would be when accessing aged care services. This is a premise that time has shown to be incorrect. However, the flexibility offered to consumers, via the 28 day rule to determine whether they wish to make the accommodation payment via an annual or daily fee in residential services, will increase provider unease about certainty of capital.

ACAR is described as a ‘competitive assessment process that allocates aged care places to those applicants who best demonstrate they can meet the needs of the ageing population within a specified aged care planning region’2.

To ensure that sufficient investment commitment in maintaining, improving and expanding the aged care residential base, Government must ensure that adequate support for aged care services are maintained and appropriately increased in line with cost of living as community expectation increases.

However, LASA argues that market forces, resident mix and the prevailing competitive environment should be deciding factors that encourage the expected growth for the next 20 and more years. It is obvious that the ACAR process is not keeping up with demand. An immediate audit of provisional licences, a realignment of planning ratios with a focus on regional impacts and a determination of whether some allocated licences should be cancelled should be undertaken. This would inform the creation of a more transparent and realistic allocation process. With an ever increasing amount of information available to prospective care recipients (through My Aged Care and other avenues) the consumer is now well placed to make informed decisions as to how and where they access care and services and an arbitrary calculation should not interfere with consumer choice.

Access to care should be based on assessed need and urgency through a consistent assessment process undertaken via the Gateway. The provision of care and services for people needs to be delivered on an assessed needs basis consistent with the Schedule of Specified Care and Services in residential and home care services and care and services outside the Schedule will be negotiated between the person and the Approved Provider as identified in the Resident and Home Care Agreements.

References 1. Healthcare in Australia 2012-13: Five Years of Performance Report to the Council of Australian Governments 30 April 2. http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-

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LASA seeks: • The allocation of aged care places through the Aged Care Approvals Round (ACAR) be transitioned to better allow market forces to dictate where and how many aged care places should be distributed • Aged care places be adequately funded to meet demand and service level requirements • The new funding arrangements be simplified, including the assets and means testing arrangements, and annual and lifetime capping • Access to care should be based on assessed need and urgency, through a consistent assessment process undertaken via the Gateway but not to the disadvantage of those groups who have diverse and additional needs • Providers who receive an allocation of packaged care should not receive a further allocation until the original allocations are commissioned. Allocations are to be returned after an appropriate time period if they have not been used • For the purpose of the care contribution means test, money paid to the Approved Provider in the form of a RAD should be exempt

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Policy Statement: Alleviating Red Tape Outcomes: To provide an aged service industry that safeguards quality and innovation enjoying a high level of public confidence without unnecessary regulatory red tape and compliance. To provide a high quality aged care industry whose focus should be on continuous improvement rather than regulation or compliance. The Federal Government has provided Ten Principles for Australian Government Policy Makers as the initial implementation framework for its commitment to Boost Productivity and Reduce Regulation. The aged care sector recognises the commitment of the government and needs to clearly articulate a range of areas that can be identified as candidates for red tape reform. The baseline rationale for such reform is supported by the substance of the Productivity Commission’s Caring for Older Australians report in 2011. …the current aged care system contains a plethora of unnecessary, complex and burdensome regulations. Many of them relate to quantity and price restrictions and over-reaction to specific incidents. Problematic governance arrangements have also inhibited best practice regulation. LASA acknowledges that providers who receive funding from government, or that provide a service that impacts on a consumer, have a higher level of obligation than they would otherwise have in areas without the same burden of public expectation. There is nevertheless a separation between efficient and responsible compliance and self-perpetuating bureaucracy. Given the mood for regulatory reform, it is timely to revisit the compliance burden applied, even to highly funded or highly consumed areas of activity. Equally, areas with less responsibility for public reporting and compliance need to be assured that the level of regulation is appropriate and efficient.

Year on year, additions to the regulatory burden by government are felt heavily by the aged services industry. A ‘clean sheet of paper’ approach that applies only a level of compliance burden commensurate with a realistic expectation of the risk or the level of community responsibility is the most prudent outcome for regulators and providers. The intent of certification has been reached, that is to encourage an improvement in existing building stock and provision of minimum standards relating to space and privacy. The remaining scope for certification, those that relate to design and construction of new and substantially renovated aged care buildings are appropriately regulated (predominately state based) and or governed by other instruments, such as the Building Code of Australia. There are a range of areas of prospective interventions that will reduce red tape, this process is under active development by a National Aged Care Alliance (NACA) Red Tape Reduction Working Group. LASA notes, for example, that there are a large number of forms submitted to the Department of Social Services requiring the provision of known and often repeated information; there is no sensible reason why such forms cannot be prepopulated with information to assist the efficiency of the provider. LASA supports recently announced government policy to remove the requirement for building certification, this acknowledges the (unnecessary) dual compliance regime and sensibly allows governance of building standards to be administered by the states.

LASA seeks: The Federal Government deliver on its commitment to Boost Productivity and Reduce Regulation to the aged care sector by: • Meeting its commitment to make publicly available Regulatory Impact Statements on all relevant legislation • Creating a transparent and competitive regulatory framework that minimises government impact on best business practice informed by the Ten Principles for Australian Government Policy Makers • Ensuring regulatory compliance is commensurate only with the level of public funding provided and/or the responsibility to the consumer. It should not place an unjustifiable burden for no additional material outcome on the aged care system • Implementing the recommendations in respect of regulatory compliance of the Productivity Commission report Caring for Older Australians • Ending building certification requirements

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Policy Statement: Care in Accommodation – Retirement Living Outcomes: An age service industry which supports and responds to the needs of all Australians regardless of their culture, background, location or entry point. A financially viable age services industry capable of meeting the demand and changing needs of our ageing population that provides consumers with sustainable choice in how they meet their care, lifestyle and accommodation needs. LASA supports the government policy of expanding Home Care to assist older Australians to remain living at home for as long as possible and to introduce more choice and flexibility for people receiving care in their homes. As the definition of ’home’, in line with both the Commonwealth Home and Community Care (HACC) Program and the Home Care Packages is inclusive of a retirement village, it is reasonable to expect that packages and programs designed to support and assist ageing Australians have relevance and a place in this segment of the age services sector. To date, the implementation of the government’s aged care reforms has failed to acknowledge that retirement villages are an important part of the Australian aged care environment. Retirement living must be included in aged care discussions to ensure that the future needs of older Australians, choosing retirement villages as part of their future housing plan, are not neglected nor under-resourced. Retirement villages must be considered a true consumer funded and consumer directed accommodation alternative that to-date has failed to leverage federally funded care packages to allow

people to stay in their own home. Information and access to Home Care Packages and the impending Commonwealth Home Support Programme should be better promoted within the retirement living sector. The benefits of care delivery as part of a suite of services offered by a retirement village operator are well documented, in terms of retention of residents and reduced cost to government as older Australians maintain greater independence and levels of health for longer; delaying a move to residential care, while also maintaining effective consumer choice and control. The next generation of older Australians will demand more flexibility and choice in selecting their accommodation and management of their care and support; this will be critical to the success of the rollout of new aged care sector reforms. Retirement villages already have the capacity to accommodate the traditional low care resident. Introducing funded care packages and programs to these well-established communities will only ensure better value for the consumer, provider and government.

LASA seeks: • Retirement living is considered within the context of the National Aged Care Reforms, and retirement living operators be considered as providers within the aged care sector, with potential application within the home care sector • The existing governance, expertise and care options of registered retirement living operators be considered in an application for Approved Provider status • The roll out of targeted Retirement Living Home Care Packages (and potentially Home Support Program) be expedited as a matter of urgency • The communications strategy involving the preparation and dissemination of relevant materials for consumers, families, carers, and retirement living operators who qualify as service providers be implemented as a matter of urgency • Future design of funding schemes include systems that allow Commonwealth funding to be tied to the consumer • Care to be separated from accommodation, consistent with the recommendation of the Productivity Commission

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Policy Statement: Consumer Directed Care (CDC) Outcomes: To provide an age services industry that is easy to understand and navigate. To provide age services that reflects population needs via facilities, accommodation and services that are fit for purpose. To provide a funding system that enables vulnerable, marginalised or disadvantaged Australians to access affordable care, accommodation and lifestyle choices as they age. LASA supports the continued Government policy of consumer direction across the age services continuum. The implementation of this policy direction requires refinement and further development, initially in the context of Home Care Packages, and within the future of the Commonwealth Home Support Program and the planned roll out of CDC in residential care. The benefits of CDC or self-directed care are well documented in international literature, both in terms of reduced cost (compared to residential accommodation) and consumer choice and control. The demographic bubble of the ageing baby boomers ensures demand for flexibility and choice in the parameters of care and a willingness to break away from the traditional ‘aged care’ paradigm. The expected cost benefits are a major attraction for Government and the flexibility of care at home ensures that bed based construction will increasingly be targeted at older Australians who are most frail, chronically ill, and/or experiencing cognitive decline and behaviours preventing them from receiving ongoing care at home. CDC is consistent with the self-directed care initiatives being piloted through the National Disability Insurance Scheme (NDIS), and together

they form a major social policy shift towards consumer rights and choice. Further work is required by Government to ensure that providers of age services are able to maintain viable, sustainable and successful businesses through efficient operational systems and reduced compliance costs, as the provider sector is critical to the success of the CDC policy. For providers, CDC will have possibly unintended administrative costs. One example of this impact is a provider who issues 30,000 invoices for 1,000 Home Care Packages. Industry needs solutions to streamline these systems, one option would be to allow the issuing of a statement (rather than a multiplicity of invoices) for each package rather than for the service provided. The complexity of CDC needs to be able to be managed as efficiently as possible from an administrative perspective. LASA is concerned that there may be unintended consequences from the roll out of CDC. These concerns include that the provider and client may be put at risk by the move away from a ‘global approach’ that the targeted nature of CDC may lead to ‘overservicing or underservicing’ of clients; special needs recipients are unlikely to see benefit from the CDC approach; and that there needs to be confidence that the new approach is adding value, especially for the client, above the old system.

LASA seeks: • The transition of existing Home Care Packages to CDC be undertaken at the discretion of existing providers of packages • The roll out of increased numbers of CDC Home Care Packages be expedited • The communications strategy involving the preparation and dissemination of relevant materials for consumers, families and carers, and service providers be implemented as a matter of urgency • The Government commitment to red tape reduction be actively applied to streamline the implementation and ongoing operation of CDC, including through quality and compliance processes • The evaluation parameters for CDC Home Care Packages be determined and disseminated • Block funding be made available for communities with diverse or additional needs • CDC should not be introduced for the residential care sector (including as a pilot) until a full evaluation of Home Care CDC has been undertaken to determine the impacts or benefits for both consumers and providers

56 | FUSION

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Whether you are a doctor, nurse or aged care provider, you can always turn to Australian Medicines Handbook to give you the information you are looking for. Recognised within the Australian health care sector as a key provider of drug information for professionals concerned with QUM, we publish a range of peer-reviewed resources. As well as being independent of both the government and pharmaceutical industry, AMH is the preferred source of drug information for thousands of health care professionals.

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Policy Statement: Cost of Care – Diversity and Special Needs Outcomes: An age services industry which supports and responds to the needs of all Australians regardless of their culture, background, location or entry point. Develop new funding measures to support service provision in disadvantaged, rural, regional, remote and indigenous communities enabling vulnerable, marginalised or disadvantaged Australians to access affordable care, accommodation and lifestyle choices as they age. LASA supports the continued government policy of defining groups or categories of consumers with special needs to address actual, perceived and potential discrimination across all levels of care. Some of these special needs are already being addressed through specific supplements and supports to providers, with supplements already in place for consumers with dementia and behaviours of concern, for veterans and for consumers who are financially and socially disadvantaged. This leaves potential inequities for those special needs consumers due to the higher costs of delivering care and services in a fixed funding and resourcing environment. The cost burden of special needs care has been well documented but not necessarily in the Australian context. In the context of residential care, cultural, ethnic and language diversity require additional cost elements such as dual kitchens, bilingual and multilingual staff, and dual or multiple provision of ethno-specific food choices and celebrations. For consumers at home, the need for interpreters and specific culturally relevant staff and care comes at an added cost to ‘standard’ care, and Consumer Directed Care (CDC) Packages are fixed, therefore allowing less hours of care or service. The National Ageing and Aged Care Strategy for People from Culturally and Linguistically Diverse (CALD) backgrounds recognises additional requirements for these consumers.

In rural, regional and remote areas of Australia, there are challenges for providers recruiting and retaining qualified staff in both residential and home care services. For Package Care providers, there is also an impost in the cost of travel for workers, especially in CDC, where the consumer has choice of staff and choice of timing of care delivery. This occurs at the expense of hours of care. For Aboriginal and Torres Strait Islander (ATSI) consumers, who are often but not always located in rural or remote communities, there is an identified need for culturally safe and sensitive care, as well as the travel and choice of worker implications noted above. For homeless consumers and those in insecure housing, there are additional access costs including a requirement for two workers in many circumstances. For care leavers, and for people separated from their children by forced adoption or removal, there are additional support requirements often allied with a need to support these consumers at home in preference to residential placement. For Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) consumers, the National LGBTI Ageing and Aged Care Strategy has been developed to define and recognise their special needs and circumstances, many of which cost more and therefore reduce funds for direct care.

LASA seeks: • The true costs of care be identified and assessed for all special needs groups listed in legislation as a matter of urgency • The additional costs of diverse care be recognised through equitable provision of supplements • The government commitment to reduce red tape be actively applied to streamline the implementation and ongoing provision of care for special needs consumers and residents • Effective measures for ensuring ongoing validity of special needs supplements be designed and implemented in consultation with industry • The care contribution be allocated to age care services funding and not consolidated revenue • Services that provide for additional needs, including those meeting the needs of diverse population, be appropriately funded • Government fully implements the CALD and LGBTI strategies

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Policy Statement: Innovation and Technology Outcomes: To ensure aged care services are enhanced through innovative Information and Communications Technology (ICT) in order to establish care and services that are accessible and sustainable. Enhanced Information and Communications Technology (ICT) is an essential component to the sustainable delivery of care and services for older Australians. Governments understand the desire for the majority of older Australians to stay in their home for as long as possible. Enhanced ICT capacity will not only enable the delivery of health care and essential services but also prevent social isolation. There is currently a variation in technical competency and capability across service providers, with many providers still using paper based records and struggling to keep pace with new ICT capabilities1. Aged care has not yet received the support that State Health Departments, Community Pharmacies and General Practitioners have been afforded to enhance their ICT capability. Industry is seeking a partnership with government with a goal of moderate investment in the short to medium term making long term gains for all key stakeholders. There are 5 key areas of ICT enhancement: eHealth: will ensure the right information is provided to the right person at the right place and time in a secure format. This is of considerable importance when older Australians transfer from home care to hospital or residential care, and the interface between primary and specialist care. Telehealth and Mobility: addresses distance challenges to ensure equity of access to healthcare and as a method to enable older Australians to remain in their own homes longer.

Management Information and Reporting: information management, data exchange, analytics and reporting functions are critical to the delivery of quality care and a culture of continuous improvement. Core Technology and Support: more robust systems to better manage the complicated interface of data storage, payroll and transaction management and reduce capital investment. The indicative benefits of ICT enhancement are substantial: Consumers: acute hospital admissions were reduced by between 30% and 60% for older Australians receiving telehealth enabled services2. Providers: with enhanced ICT capability have found a 20-30% improvement in workforce productivity. Across industry this translates to approximately 45,000 additional care workers3. Government: with industry productivity gains of 10-20% and a reduction in unnecessary hospital admissions of up to 60% benefits to government investment are clear.

References 1. Aged Care Industry Information Technology Council (ACIITC) Digital Care Services (2014) p7 2. A CIITC and Accenture Telehealth Pilots Program evaluation (2014) 3. d u Plessis D The Dollars and Sense: Quantified Benefits of Technology in Community Care, Healthcare Pty Ltd (2013)

Care Management: enables integration of care planning, personal health support and medications management to enhance quality and assist in managing chronic health conditions.

LASA seeks: • Government recognises ICT as a key enabler for sustainable age services and creates an incentive for the adoption of technologies that improve the quality and efficacy across industry • Industry taking a leading role to harness the power of technology with services and products that support the functions it provides • The Aged Care Industry I.T. Council’s (ACIITC) Digital Care Services be adopted as the implementation framework for ICT capacity building • Industry join with Government to create an ICT framework to enable age service providers to ‘Think Big, Start Small and Scale Rapidly’ • Government acknowledges that aged care providers interact with seniors more frequently than any other profession and that promotion of and investment in an age services ICT policy would yield profound social benefits

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Policy Statement: Newly Built or Significant Refurbishment Outcomes: To ensure providers have sufficient funding to deliver a fair and affordable system of care and accommodation. To ensure redevelopment and building of infrastructure, services and operations by attracting a funding stream and resources from investors who are attracted to the industry via sufficient return on investment. The residential aged care sector provides living options for aged residents that are geographically, culturally and religiously diverse and also offer a range of accommodation options. The sector is a comprehensive mix of public, private and not for profit organisations competing in an increasingly transparent marketplace to provide residential care services to an ever expanding cohort of aging Australians. As a component of the age care reforms1 the government have determined to continue providing financial support for refurbishment and expansion of aged care residential facilities. This capital co-investment is critical to ensure the ongoing upgrading of facilities as well as supporting the expansion of the available facilities. As 38.2% of residential aged care places are publicly supported (2011-2012)2 there is an imperative to ensure that government support is maintained. This investment should expand, at least by CPI, and aspire to the OECD average of 4.1% per annum3. Public consultations on the guidelines for newly built and significant refurbishment of aged care facilities highlighted a range of processes that are of concern to the residential aged care industry. They include: • Very complex guidelines that require unnecessary information (too much red tape); • The 40% supported resident threshold exceeds the national average and is therefore seen as a deliberate intervention to limit the number of organisations that qualify for the maximum accommodation subsidy; • Response timeframes for approvals from the department are too long and out of step with commercial practice; and

• No ongoing commitment to maintain, and incrementally increase, funding for refurbishment. The ongoing promises, from all sides of politics, to reduce red tape, make government more efficient and to be transparent must be put into action as part of these reforms. Complicated guidelines, demands for unnecessary information and approval timeframes that are too long are key examples that must be addressed by government, with industry advice, to ensure this program has successful outcomes. There is an overwhelming community demand for accommodation options and industry expects the government to play a significant role in the maintenance and expansion of the available infrastructure. Industry cannot fund these improvements and expansions alone, especially given the significant proportion of publicly supported residents and the pricing controls exerted by the Commonwealth across the aged care spectrum. Industry will maintain its commitment to improvement and expansion and co-invest with government where it provides a transparent and accessible model for application, approval and implementation of government support.

References 1. http://www.livinglongerlivingbetter.gov.au/ 2. http://www.livinglongerlivingbetter.gov.au/internet/living/publishing.nsf/Content/ acfa-inaugural-report-fund-financing-june2013 3. http://www.agedcare.org.au/campaigns/acsa-submissions/submission-onsignificant-refurbishment.pdf/view

LASA seeks: • The national 40% concessional rate be abolished and the regional concessional rate be adopted as the trigger to qualify for the maximum accommodation supplement • The Government commitment to reduce red tape be actively applied to streamline the application and compliance process for refurbishment • State and local Governments be encouraged to provide transparent, robust, planning and approval frameworks • All safety refurbishments be fully calculable for application to receive the higher accommodation supplement • The building code requirements continue to be administered by the states and be based on the Building Code of Australia

FUSION | 61

Policy Statement: Provision of Quality and Care Services Outcomes: An age services industry that safeguards quality and innovation, enjoying a high level of public confidence without unnecessary regulatory red tape and compliance. A high quality aged care industry whose focus should be on continuous improvement rather than regulation or compliance. Age services availability reflects population needs via facilities, accommodation and services that are fit for purpose. Quality, in the context of age services, includes access to care that is 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 manner. This therefore considers the rationing of age care places (both home and residential) the funding available to providers, the fees and charges for consumers and the delivery of contemporary, evidence based care and services through a competent, skilled and available workforce. Accreditation is an accepted core business activity for age services and should provide public recognition of achievement to peer developed standards that build on the safe provision of quality care and services. Some providers believe that for those organisations which have a robust quality improvement system in place, and have consistently met the standards over a prescribed period, should have less surveillance responsibilities than would otherwise be required. The new Australian Aged Care Quality Agency commenced operation on 1 January 2014, replacing the Aged Care Standards and Accreditation Agency. This new body has been described as “the sole agency that approved providers under the Aged Care Act 1997 will deal with in relation to the quality assurance of the aged care services that they deliver, whether those services are delivered in an aged care home or in the person’s own residence1”.

The explanation given for the change was that it would ‘create efficiencies, reduce costs and support the Government’s commitment to an end-toend aged care system’. LASA contends there should be a separation of powers between the standard setting, the accreditation process and any actions or sanctions for non-compliance. Standard setting (incorporating regular review), with a continuous quality improvement focus and the accreditation to those standards should be undertaken by an independent body/ies separate to the Department of Social Services (DSS) and Government. Regulatory compliance is an approved provider’s responsibility which should be administered by the DSS. The collection and reporting of valid, relevant and reliable performance indicators (including resident surveys) is currently under consideration for residential services and later for home care services. A two fold use of such data should be to provide the consumer with information pertinent to their needs and to assist service providers with continuous quality improvement.

References 1. http://www.livinglongerlivingbetter.gov.au/internet/living/publishing.nsf/Content/ CA257A4E001A603BCA257ABC00828E7A/$File/Overview%20of%20 proposed%20legislative%20changes.pdf

LASA seeks: • The provision of quality care and services across the spectrum of age services. This includes: -- Achieving accreditation for residential, home care and retirement living services -- The provision of specified care and services in residential and home care services (as per the Quality of Care Principles) -- Benchmarking performance indicators • Voluntary accreditation through an independent accreditation body • The development of a suite of performance indicators that are relevant to service provision and in concert with a continuous quality improvement framework

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Policy Statement: Residential Accommodation Pricing Outcomes: To ensure a range of options for financing care and accommodation that meets the changing needs of older Australians. To deliver an age services industry that safeguards quality and innovation enjoying a high level of public confidence without unnecessary regulatory red tape and compliance. A key component of the transition towards implementation of the age care reforms has been to broaden the capital base available for industry by allowing Refundable Accommodation Deposits (RAD) to be charged to all residents who are of sufficient means to pay them. An understandable consequence of the age care reforms is to provide a ‘one stop shop’ – My Aged Care – for intending residents, their families and supporters access to a comprehensive, searchable and comparative dataset of information on pricing and companion information. An unacceptable component of this reform has been the introduction of an Aged Care Pricing Commission (the Commission). The Commission is charged with approving RAD prices above the arbitrary Ministerial threshold of $550,000 and approving extra service fees. The intent seems to be to provide some level of consumer protection, the effect however serves only to introduce an unnecessary level of compliance burden with no evidence of any consumer protection. The activities of the Commission also run significant risk of distorting the market by intervening in price setting which is both unacceptable and contrary to the stated intent of Government. LASA therefore seeks the immediate abolition of the Commission with any savings applied to enhancing residential subsidies. Such abolition would naturally and coincidentally also remove the threshold for accommodation pricing approval with all RADs listed in equal manner on the My Aged Care website and other company based promotional platforms.

Significant uncertainty is also created via the provision of the 28 day decision period for a resident to determine how they wish to fund their accommodation, i.e. whether by RAD or Daily Accommodation Payment (DAP) or both. This compromises the decision making process for a provider as to whether they offer a place, as they cannot be certain of the ‘terms’ of the residency, and thus adds an unnecessary layer of risk to capital planning. Despite consistent representations from LASA there remains difficulty with the way the Maximum Permissible Interest Rate (MPIR) operates. There are two concerns, firstly that the rate operates as a set application of a formula, not, as the name would suggest, as a maximum. This means that a provider cannot choose to calculate a DAP under the formula using a lower rate than the MPIR, despite this being to the favour of the consumer, there is no logical explanation as to why this is so. This exacerbates the second problem which is the compulsion to vary the DAP when the three month moving average interest rate changes, even if the variation is minuscule. While LASA do not propose that any adjustment should be made to the MPIR that will apply additional cost to the consumer it does propose that a threshold for recalculation of the MPIR apply. This will prevent to need to recalculate the DAP where it is otherwise not material nor therefore viable.

LASA seeks: • • • • •

The Aged Care Pricing Commission should be abolished Providers should have a clear understanding of the methods by which they are paid by consumers prior to admission The ‘threshold amount’ for Accommodation Pricing should be abolished The My Aged Care website remain as a public search portal including pricing and other promotional detail In the event that the Commission is not abolished that, for residential accommodation pricing above the threshold: -- The cost of lending and other financial and capitalisation information not be required -- The amount used prior to 1 July 2014 be deemed approved -- An applicant must be able to have any claim of comparative advantage considered equally with other assessment criteria • The MPIR is regarded only as a maximum and that a Provider may choose a lower interest rate than the maximum when converting a Refundable Accommodation Deposit (RAD) to a Daily Accommodation Payment (DAP) • The 28 day rule for a decision to pay a RAD or DAP be abolished

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Policy Statement: Specialist Funding (Supplements) Outcomes: To enable all Australians who have specialist needs to have access and choice of high quality aged services. An age service industry that supports and responds to the needs of all Australians, and specifically those that require care and service that is not met within the boundaries of existing funding levels. To ensure that specific funding allocations reach those for whom it is identified. It is widely accepted that the subsidies paid via the Aged Care Funding Instrument (ACFI) do not fully capture the cost of care needs of residents exhibiting severe and complex behaviours1. Similarly, the viability supplement aims to improve the capacity of small, rural aged care services to offer quality care to residents and is paid automatically to those providers who demonstrate a history in providing access for people who are homeless or at risk of homelessness and/ or Indigenous Australians, a continuing commitment to target and predominantly focus on the needs of one or both of these groups, the capacity to provide high quality care that meets the specific needs of these groups, the capacity to promote access to the broad range of services relevant to the needs of these groups; and the capacity to link with relevant local services and communities, including agencies which may provide sources of client referrals2. Additionally, the Homeless Supplement, has been implemented to better support aged care homes that specialise in caring for people with a history of, or at risk of, homelessness. The Supplement provides $15 per day for each resident of eligible aged care homes. This funding is in addition to the funding provided under the Viability Supplement3. In recent times the Dementia and Severe Behaviours Supplement in residential services was ceased4 with no industry consultation, despite expertise within the sector to assist in developing an appropriate policy strategy to address the budget allocation problems. LASA has consistently sought from the Department of Social Services, information on what level of modelling has been undertaken when recent supplements have been introduced. This information has not been forthcoming and requests from the National Aged Care Alliance have also proven to be futile. With significantly more than 50% of residents in residential aged care having dementia (90,000+ people) and with almost half those with dementia also having a diagnosis of mental illness5, it is obvious that

dementia services are no longer ‘niche’ but a core component of care and service delivery for residential age services. However for those people with severe Behavioural and Psychological Symptoms of Dementia (BPSD), their families and carers, additional support is required. In the current budget framework it is obvious that there are insufficient monies allocated to support those people suffering severe BPSD. $11.7 million a year will not reach all people, however a co-design of policy and processes needs to be implemented immediately to reinstate the funding to meet the needs of those with severe BPSD. Options currently under discussion include a grants programme, special care units, increased access to specialist support, enhanced staff capability or capping the previous system. There is a substantial body of research into areas such as dementia which now requires investment into translating this research into practice, through enhancing staff capacity, knowledge and capability. Whichever mechanism is in place to disperse supplementary funding, LASA believes it needs to be developed based on knowledge gained from shared data, it should follow the resident (where applicable), and demonstrate measurable outcomes.

References 1. http://www.dss.gov.au/sites/default/files/documents/07_2014/ eligibility_ guidelines_february_2014.pdf 2. http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-ruralviability-supplement.htm 3. http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-homelesssupplement.htm 4. http://mitchfifield.dss.gov.au/media-releases/121 5. http://www.fightdementia.org.au/media/key-facts-and-statistics-for-media.aspx

LASA seeks: • • • •

The true cost of care be identified for those people requiring specialist care and services Any funding initiative should be based on a full disclosure of available data analysis Funding initiatives should be person focused, based on measurable outcomes The government commitment to reduce red tape be actively applied to streamline the identification of people requiring specialist care and services • Collaborative approach with LASA to provide efficient and effective funding programme design, delivery and evaluation

64 | FUSION

YOUR CHOICE, YOUR CONTROL FUSION | 65

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13-14 May 2015 Grand Pavilion, Rosehill Racecourse, Sydney On display will be the latest in aids, equipment and assistive technology, as well as options for mobility, services and lifestyles. The event is open to visitors of all ages, including those with a disability, seniors and their families, friends and carers.

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Increasingly, the effective use of reliable information and technology is depended on to deliver quality health care to the aged. Australian Medicines Handbook’s mission is to support health care professionals working with the elderly in any setting to do so easily and cost-effectively with up-to-date information. The AMH Aged Care Companion which is available in online and print formats contains peer-reviewed and evidence-based information on more than 70 specific conditions common in older people. These include dementia, delirium, cardiovascular diseases, stroke prevention, falls prevention, osteoporosis, insomnia, Parkinson’s disease, urinary incontinence, type 2 diabetes, COPD, immunisation, wounds and caring for ageing skin.

Therapeutic information emphasises issues relevant to older people, who often use multiple medicines. Importantly, non-drug treatment advice is also included. Many of the topics in the AMH Aged Care Companion direct the reader to additional resources, useful tools and standards of care, augmenting the information provided. To find out more about the online and print versions of the AMH Aged Care Companion and pick which format suits your work, go to AMH Aged Care Companion (online); AMH Aged Care Companion (print) www.amh.net.au

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Policy Statement: Workforce Outcomes: To have sufficient people and resources that meets industry demand via a workforce that is available, inspired, skilled and valued. To have an aged care workforce which is equipped to best meet the changing needs of all older Australians regardless of their circumstance or background. To have an industry that is funded and structured to perform highly in the areas of worker skills, health, safety and positive work life balance via consistent and appropriate training delivery which ensures worker capability. By 2050 the aged services workforce (workforce) is expected to grow from an estimated 352,100 (2012 estimate) to 827,100 employees1. Over a similar time period (2010 to 2050) the number of Australians age 85 and over is projected to more than quadruple from 400,000 to 1.8 million2. This projected increase in demand for age services cannot be overlooked. Actions and strategies need to be developed to ensure the age services industry has the resources necessary to meet the needs and demands of all older Australians. An available, accessible and appropriately skilled workforce is a fundamental requirement of the growing age services industry. Sourcing and maintaining a sustainable workforce is a significant issue for the age services industry. Residential, home and community care providers continue to struggle to access appropriately skilled and available staff. All providers need support, funding and new initiatives so as to adequately fulfil current and future staffing needs. Research indicates three quarters of residential facilities and half of the community outlets report skill shortages in one or more occupations. It is anticipated that the increasing demand for nursing and allied health professionals in the age services industry will be further exacerbated by increased competition for staff with the staged introduction and upscaling of the National Disability Insurance Scheme (NDIS).

LASA has identified three pathways that can assist in meeting the identified expanding requirements of the workforce. Firstly, the Commonwealth must invest in enhanced training opportunities and initiatives, including mandatory clinical placements in aged services facilities, and offer financial incentives and funding for placement and employment opportunities in the age services industry. Secondly, the industry calls for a review of workforce constraints and improved access opportunities with respect to Australian immigration laws. Sensible adjustments and amendments to immigration laws that provide greater access for overseas workers to join the age services industry and opportunities for age service providers to increase their labour pool must be considered. Lastly, transitional funding for displaced workers to encourage and target opportunities within the age services industry must become a priority focus. All pathways and workforce considerations must ensure sufficient training is available to bridge any language, cultural or other barriers to attracting and retaining a workforce and initiatives need to take into account that the age services workforce needs to be mobile and resourced to meet age service needs in rural, remote and other special needs areas.

References 1. http://www.myagedcare.gov.au/ 2. http://www.pc.gov.au/__data/assets/pdf_file/0004/110929/aged-care-volume1.pdf

LASA seeks: A qualified and skilled age services workforce with adequate numbers to address the growing and diverse needs of Australia’s ageing population delivering: • The development of a mandatory clinical placement in age services as part of the undergraduate education or an age services clinical stream • Sufficient government financial support that ensures competitive wages are offered for similarly skilled workers in similar sectors • Creation of new graduate programs (similar to the LASA Aged Care Nurse Graduate program) • Government funded financial incentives to attract a workforce to areas and occupations of need • Age Services be considered a priority area for displaced workers and recipients of Government funded and led transitional industry re-training programs The removal of barriers that inhibit access, attraction and retention of an age services workforce including: • A review of, and variation to, Australian immigration laws which: -- include age services positions in the skill shortage list -- remove Temporary Skilled Migration Income Threshold for occupations listed on the skill shortage list -- remove labour market testing requirements for occupations listed on the skills shortage list • The creation of a workforce website where employers can list current vacancies and potential workers can upload their work profile, and the development of locum service • A targeted review of rural and remote workforce issues • Strategies to enhance age services as a profession and the image of the age services workforce -- a National Code of Conduct for health care workers be supported and administered through a body such as the Australian Health Practitioners Regulation Agency (AHPRA) -- government issued financial incentives for innovative workforce practices -- government assistance for the development and introduction of new and improved technology

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Stewart Brown Aged Care Financial Performance Survey June 2014 â&#x20AC;&#x201C; Summary

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Figure 2

Facility Result ‐ All Facilities $14 $12 $10 $8 $6 $4 $2 Jun‐14

Dec‐13

Jun‐13

Dec‐12

Jun‐12

Dec‐11

Jun‐11

Dec‐10

Jun‐10

Dec‐09

Jun‐09

Dec‐08

($4)

Jun‐08

($2)

Dec‐07

$0 Jun‐07

Dollars per bed day

Given the size of the sample and the including the distribution of the sample across State borders, as well as the rigorous data cleansing process undertaken, we can be confident of the representative nature of the survey, particularly in the not‐for‐profit sector. The results for the current financial year are better on average across the board. This was expected given the results from our earlier surveys this year as well as the fact that there were normal increases in subsidy rates during the year after a freeze on ACFI rates in the previous financial year. The average facility result of $8.28 per bed day for the full year to June 2014 was better than the result for the 2013 financial year ($5.51 per bed day). However, it is not as high as it was at the same time in 2012 when the average facility result was $8.53 per bed day. The result is also $3.41 per bed day less than its 2014 financial year peak recorded in the September 2013 survey. It is also $1.28 per bed day less than the March 2014 survey. These declines are relatively seasonal as Figure 2 shows and somewhat expected. A significant gap between the survey averages and the performance of the facilities that are performing well remains. Of course included in the average for the full survey are all those facilities in the top quartile whom on average achieved a facility result of $36.15 per bed day. However, if we exclude the benchmark group from the rest of the participants, the average result of the remaining facilities is only $0.37 per bed day. This is a difference of $35.78 per bed day. For a 60 bed residential aged care facility with an occupancy of 95% this could mean an additional profit of nearly $750K per annum.

ACFPS | Summary of Survey Outcomes | June 2014

($6)

Some of the other highlights from this survey are:  Average facility result was $8.28 per bed day (June 2013: $5.29 per bed day)  Average Facility EBITDA was $7,784 per bed per annum (June 2013: $6,573 per bed per annum)  Facility income averaged $212.66 per bed day (June 2013: $201.48 per bed day)  The facility result represents a return on income of only 3.9% (June 2013: 2.7%)  67.8% of all facilities in the survey achieved a positive facility result (June 2013: 63.2%)  72.5% of facilities in this survey (June 2013: 69.0%) made an overall surplus taking into account all sources of income and expenditure. This is higher than it has been for some time. The ratio was 77.8% at June 2012, 73.4% at June 2011, 65.0% at June 2010 and 63.5% at June 2009  Of continuing industry concern were the 116 facilities (15.4%) in the survey that had a negative EBITDA which is down from 16.9% of the facilities in the June 2013 survey.  The average result of the top 50% of facilities in the survey was $24.50 per bed day  In contrast, the average facility result of the bottom 50% of facilities in the survey (377 facilities) was a loss of $7.03 per bed day In the recently released ACFA Report on Funding and Financing of the Aged Care Industry the average EBITDA for the Top Quartile of Facilities in high care facilities in 2013 was $19,612 per resident per annum. This includes both for profit and not for profit facilities but is comparable with the top quartile results for the StewartBrown survey

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70 | FUSION

ACFPS | Summary of Survey Outcomes | June 2014

Table 2 – Summary of survey results Extract from StewartBrown Aged Care Financial Performance Survey for the year ended 30 June 2014. All amounts shown are measured in $ Per Bed Day.

June 2014

June 2013

June 2012

June 2011

June 2010

June 2009

755 facilities

710 facilities

607 facilities

545 facilities

432 facilities

333 facilities

Resident fees Government care subsidies

48.42

46.65

44.97

43.32

39.75

37.90

140.02

132.48

128.29

117.79

105.64

98.78

Other resident revenue

12.32

12.23

11.77

10.36

8.33

7.11

Other government revenue

11.91

10.12

8.62

6.97

7.38

5.28

212.66

201.48

193.65

178.43

161.09

149.07

Total revenue Expenditure Care

110.54

105.07

97.94

90.06

81.70

77.88

Hotel services

34.65

33.75

31.90

31.49

29.69

28.70

Accommodation services

29.15

28.30

27.65

25.79

22.99

20.66

Administration & support services

30.05

28.85

27.64

25.41

25.88

25.84

204.38

195.97

185.21

172.76

160.27

153.08

Facility result

$ 8.28

$ 5.51

$ 8.53

$ 5.68

$ 0.82

$ (4.01)

Provider result

$ 2.21

$ 3.03

$ 4.05

$ 3.11

$ 3.07

$ 3.66

Total result

$10.49

$ 8.54

$ 12.57

$ 8.79

$ 3.89

$ (0.35)

Total expenditure

Facility EBITDA per bed per annum

$ 7,784

$ 6,573

$ 7,621

$ 6,046

$ 3,977

$ 1,707

Overall EBITDA per bed per annum

$ 7,944

$ 6,884

$ 7,994

$ 6,435

$ 4,427

$ 2,171

Care cost as % of resident fees & government subsidies

58.7%

58.5%

56.5%

55.9%

56.2%

57.0%

As the data in Table 2 (above) highlights, after an initial improvement in profitability in 2010 through to 2012, average profit levels have only been maintained at the 2012 levels this year. Figure 3

Total Expenditure vs Total Income ‐ All Facilities $220 Dollars per bed day

$200 $180 $160 $140 $120

Total Expenditure

Total Income

Jun‐14

Dec‐13

Jun‐13

Dec‐12

Jun‐12

Dec‐11

Jun‐11

Dec‐10

Jun‐10

Dec‐09

Jun‐09

Dec‐08

Jun‐08

Dec‐07

$100 Jun‐07

The improvement in the average result since the end of the previous financial year was due to income increasing by $11.18 per bed day and expenses only increasing by $8.19 per bed day. Specific highlights include:  An average increase of $11.18 per bed day in income  An average increase of $5.47 per bed day in care costs  An average increase of $0.90 per bed day in hotel services  An average increase of $1.20 per day in administration and other support costs As shown in Figure 3 (opposite) income has increased at a slightly higher rate than expenditure since 2010 resulting in improved profitability on average. However, the differences are marginal at best.

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FUSION | 71

Care Income & Wages ‐ Cumulative Change All Facilities 60% 50% 40% 30% 20% 10%

2013/14

2012/13

2011/12

2010/11

2009/10

2008/09

2007/08

0% 2006/07

There have been a number of factors that have influenced income levels since the funding stream has transitioned from the RCS model to the ACFI model. The graph opposite looks at a number of things that have happened over that period.  The overall rate of increase in income has been significant since the introduction of ACFI in 2008. This is partly due to the higher subsidy rates being initially capped and that cap being eased by $10 per day over the three years to 2011.  There were still 2 years at the beginning of that period in which there were increases in the Conditional Adjustment Payment which is why the overall subsidy rate increase (including CAP) is higher than the COPE line and was higher than or in line with CPI until 2010.  Since the 2009/10 financial year the overall subsidy rate increase has been running below CPI.  COPE consistently runs below CPI meaning that for providers to maintain profit levels it has to continually achieve productivity or efficiency savings.  The overall increase in income beyond the subsidy rate increases clearly demonstrates the significant role that the increased care needs of residents have played in the overall increase in income levels.  The increased care needs of residents entering residential aged care also has the knock‐on effect of increased wage costs and increased overall care staff hours.

Figure 4

Average All Facilities CPI Subsidy rate increases (including CAP) COPE increases Average All facilities ‐ Care Wages

Table 3 – Year on year rates of increase to care income (daily care fee + care subsidies) and care staff costs

Year on Year rate of increase in care income Year on Year rate of increase in care staff costs

2009

2010

2011

2012

2013

2014

5.7%

6.4%

10.8%

7.5%

3.4%

5.2%

4.7%

10.8%

8.5%

7.6%

5.2%

Figure 5 – Hours worked per resident per day movement over time

Hours worked per resident per day Hours worked per resident per day

Income and Expenditure

ACFPS | Summary of Survey Outcomes | June 2014

4.00 3.50 3.00 2.50 2.00 1.50 1.00 0.50 ‐

2007

2008 Band 1

2009

2010 Band 5

2011

2012

2013

2014

All facilities

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72 | FUSION

The main profit measurement that we use in this analysis is the facility result, which excludes those sources of income that might be considered to be attached to an organisation rather than a specific facility including interest on invested funds, other investment income, fundraising income, capital grants, fair value adjustments and profits on sale of assets. The other main measure that we use is the facility EBITDA which excludes, depreciation, amortisation, interest and taxation expenses from the facility result. When we benchmark we group facilities based on their care income (resident daily fee plus ACFI subsidies (including respite fees and subsidies). Of course the results of the facilities in the top quartile are always generally impressive and the survey average far less so. What happens when we stratify the data a little further? What happens when we isolate the top quartile from the rest of the survey? Of course the results of the top survey are not affected, but when we examine the performance of the rest of the participants the results are less than impressive as shown in Figure 6 (opposite). The results of the vast majority of the facilities in the survey should be of concern to both aged care operators and industry leaders. When the results of the top quartile of the survey are excluded, the average facility result for the remaining facilities is $0.37 per bed day. That is a little better than break even. The average result of the bottom 50% of facilities is a deficit of $7.03 per bed day. Of the 377 facilities in the bottom 50%, 243 had a negative facility result.

Figure 6 – Stratification of results by benchmark band

Average Facility Result ‐ By Band 50 40 Dollars per resident per day

Performance by benchmark groups

30 20 10 ‐ (10) (20) Band 1

Band 2

Band 3

Band 4

Band 5

All Facilitie s

Top Quartile

39.71

36.97

29.93

41.34

30.93

36.15

Top 50%

27.06

25.46

18.99

28.88

22.86

24.50

Survey Average

10.79

9.94

4.82

8.83

7.05

8.28

Bottom 75%

2.09

1.98

(1.65)

0.37

(1.33)

0.37

Bottom 50%

(6.54)

(6.89)

(8.47)

(5.27)

(7.53)

(7.03)

Top Quartile

Top 50%

Survey Average

Bottom 75%

Bottom 50%

CMY

Figure 7 – Gap to average of top quartile

Gap to Result of Average of Top Quartile ‐ By Band 50 45

Dollars per resident per day

ACFPS | Summary of Survey Outcomes | June 2014

40 35 30 25 20 15 10 5 ‐

Band 1 Top 50%

Band 2

Band 3

Survey Average

Band 4 Bottom 75%

Band 5

All Facilities

Bottom 50%

Page | 5

FUSION | 73

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Band 4 $ pbd

Band 5 $ pbd

(0.66)

0.39

0.55

6.71

14.14 3.11 4.09

15.74 2.36 3.44

13.53 2.76 5.69

20.16 2.78 4.71

7.67 1.41 4.70

5.14 26.47 $ 28.92

6.66 28.20 $ 27.53

2.74 24.72 $ 25.11

4.31 31.96 $ 32.51

3.40 17.18 $ 23.89

So what might a perfect facility look like? It is more likely to:      

Have a majority of single rooms Be around 68 places Not cater for Dementia residents Be built over more than one level Be located in a major city Be a high care facility

Of course this is unlikely to be the sort of facility that is built in today’s aged care environment. Most modern facilities will cater for dementia care. The issue here is that the funding being received for residents suﬀering from dementia does not meet the costs of providing the necessary care. Similarly facilities are likely to be built of a size greater than 68 places. Figure 10

99%

Occupancy - 2014 Financial Year

98% 97% 96% 95%

90% 89%

Band 5 Top 25%

91%

Band 5 Average

92%

Band 4 Top 25%

93%

All facilities Average

94%

Band 4 Average

One of the questions that is always asked is “what does a good performing facility look like. The answer is both varied and complex.

Band3 $ pbd

2.45

Band 3 Top 25%

Top Quartile facilities

Revenue Expenditure Care costs Hotel services Accommodation services Administration/Other Total expenditure Facility result (diﬀerence)

Band 2 $ pbd

Band 3`Average

Of course in the case of a number of facilities their care costs are higher because they should be in a higher band. The care needs of their residents the higher level of expenditure, but they are not receiving the ACFI income that they probably should be claiming. For these facilities it is possible, if not probable that they need to review their ACFI claiming model to ensure that they are receiving the income that is properly matching the care needs of the residents. It will not be a “one-answer-ﬁts-all” solution. The higher income levels will push them into a higher band and their costs will be more comparable.

Band 1 $ pbd

Band 2 Top 25%

Table 4 (opposite) shows what the diﬀerences are, particularly in the costs of facilities that are grouped together by income. It shows that there are cost savings to be made across all areas, particularly care costs.

Benchmark v Average

Band 2 Average

While the gaps between the top performers and the bottom performers is signiﬁcant, they are not insurmountable. There are 189 facilities in the top quartile and they are all achieving a facility result in excess of $22.92 per bed day and averaging $36.15 per bed day. If those facilities can achieve these results there should be no reason that other facilities can’t aim to at least aim to be part of the group.

Table 4 – Composition of gap in results – Survey average to Top Quartile

Band 1 Top 25%

Make facility managers more accountable. Give them the tools and help them understand what drives ﬁnancial performance. Use the benchmarking to set goals and measure performance. Don’t just look at costs but also look at the way in which income is derived.

What is clear is that there is representation in the top quartile from all major groups and from all States and from major cities and from regions, from all sizes and multi-story, single storey with and without dementia wings. While some of these factors will have an inﬂuence on the proﬁtability of a facility none are absolute barriers to achieving a benchmark result.

Band 1 Average

The upside to all of this is that results can be improved by taking appropriate action.

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76 | FUSION

One of the other major influences on profitability is occupancy. As the graph in Figure 10 shows the occupancy levels of those in the top quartile are significantly better on average than for the survey as a whole. While this might be a result of a number of things, it does indicate that the levels of care provided by these facilities are equal to or if not better than those poorer performing facilities. If levels of care in the facilities in the top quartile were sub-standard it would be expected that their occupancy levels would not be as high because people would be voting with their feet and going to another facility. One of the reasons that we hear from aged care operators or facility managers for poor financial performance is that it costs more to provide a higher standard of care and that is what they are doing – the problem with this is that they more often than not cannot quantify how much that extra care is costing and these occupancy statistics would indicate that the care being provided by the facilities in the top quartile meeting the needs of the residents and the expectations of their families. What operators and facility managers must realise is that if a facility is more profitable there is more to spend on additional services to residents or to improve accommodation standards. The danger for Boards and management in the future will be to be given a false sense of security from obtaining higher accommodation prices than is currently the case. If these are received in the form of a DAP or part DAP then it could increase the levels of profit. However, income from the recently implemented changes to accommodation pricing should not be seen as the solution to the problem of low profit levels. If the income from accommodation is used to effectively subsidise the care of residents then providers will not have the capital to refurbish and replace facilities when it becomes necessary to do so.

Figure 13

Comparison of Bonds taken in 2014 to Average RAD Prices by State 2014

Average RAD

$450,000 $400,000 $350,000 $300,000 $250,000 $200,000 $150,000 $100,000 $50,000 $0 NSW & ACT

QLD

SA & NT

TAS

VIC

National Average

Average RAD Price Sourced from ACFA Report on Aged Care Funding and Financing of the Aged Care Industry – 31 July 2014

Accommodation pricing With the changes to the accommodation pricing regime from 1 July 2014 StewartBrown undertook some research to establish what factors might be influencing the prices including existing bond prices, competition and median house prices in catchment areas. We undertook this research from the following viewpoints: A comparison of the prices set by providers for accommodation in relation to the bond prices that had been received in the previous financial year A comparison of RADs set when they were first published and the prices four months later A comparison of current RADs and the median house prices in the suburbs in which the residential service was located. This was done by looking at several major city areas and also several regional and remote areas to ascertain whether the location has influenced price. We already knew a number of things about accommodation bond patterns. The bond levels being achieved differed between States and also a lower average bond was received in regional areas compared to the levels received in the major cities. What the graph in Figure 13 highlights is that many providers did not increase their RAD prices by significant amounts, particularly in NSW, QLD and SA. In contract the average differences in the other states between the values of bonds taken during the 2014 financial year and the average RAD for that State was well in excess of $100,000. So the first thing is that it would appear that the uplift from existing bond prices to RADs was not as high as some expected it would be to compensate for the loss of retentions. The second thing is that it would appear that on average those in the regions increased their accommodation prices by a greater margin on existing bond prices than their major city counterparts. Again this is something that was not entirely expected. Our research covered several government planning regions in three different States and in each State we selected an area in a major city and one or more in a regional and remote area. In all 242 facilities were included in the analysis.

CMY

FUSION | 77

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The ﬁrst aspect we looked at was whether there had been much movement in accommodation process between 19th May and end of September. Had operators looked at the prices of their competitors and adjusted their own prices downwards to maintain competitiveness or adjusted them upwards to take advantage of where others had set their prices?

Table 7 Survey Average Hours worked per resident per day for the twelve months ended 30 June 2014

Band 1

Band 2

Band 3

Band 4

Band 5

Care management

0.08

0.09

Registered nurses

0.44

0.37

0.32

0.22

0.10

Other care staﬀ

2.55

2.29

2.15

1.97

1.48

Therapists

0.12

0.10

0.09

0.10

0.11

Total care hours

3.19

2.85

2.65

2.38

1.78

Of the 242 facilities in our initial analysis:

Hotel services

0.64

0.66

0.62

0.59

Accommodation services

0.06

0.08

0.09

0.07

14 (5.8%) have increased their minimum RAD  14 (5.8%) have decreased their minimum RAD  16 (6.6%) have increased their maximum RAD  13 (5.4%) have decreased their maximum RAD

Administration

0.16

0.17

0.13

Total hours

4.05

3.73

3.55

3.26

2.57

June 2013

3.94

3.71

3.43

2.70

2.44

June 2012

3.71

3.47

3.00

2.63

2.19

2014 Top Quartile Care Hours

2.87

2.59

2.55

1.85

1.48

2014 Top Quartile Total Hours

3.74

3.46

3.41

2.42

2.11

While it is only early days, it appears that at this stage competition may not have had a great deal of eﬀect on providers. We may have expected a greater movement in prices once everyone published their prices initially but that does not appear to be the case. One of the aspects that we did see was that a large proportion of facilities had set a variety of accommodation prices for diﬀerent accommodation groups within each of the facilities. For that reason we have taken the minimum and maximum RAD for each facility for the purpose of this analysis.

Figure 18 Care Hours Worked 3.50

Hrs worked per resident per day



3.00 2.50 2.00 1.50 1.00 0.50 Band 1

Survey Average

Staff costs One of the first observations to be made is that there appears to be a general increase in staffing levels in a number of bands at both the survey average level and the benchmark level. However, this is more than likely due to the realignment of the band parameters which have shifted facilities downwards along the bands and caused the average hours worked to be higher in each of those bands. In the case of Band 1, the facilities remaining in that band are those with residents with very high acuity.

Band 2

Band 3

Band 4

Band 5

Top Quartile

What is clear is that there is a distinct difference in the total hours worked per resident per day between the survey average and the benchmark group. This is illustrated in figure 18. The other difference that occurs between the benchmark group and the survey average is the mix of staff.

Utlity Costs Since 2007 both electricity and rates (mainly water rates) have outstripped CPI increases by significant margins. The cumulative average increase in electricity costs since 2007 is 116% and for rates it is 168%. The increase in CPI during the same period is 21%. Unfortunately there does not appear to be any major relief on the horizon. Even with the removal of the carbon tax it is unlikely that electricty rates will decrease significantly and it will have no effect on water rates. In addition it is forecast that gas prices will be rising substantially in the near future so we can expect utility costs to continue to rise at rates in excess of CPL.

80 | FUSION

However these factors do play into investment decisions of aged care providers. These type of increases may make it commercially viable to look at supplementing traditional sources of electricity with solar energy, or the installation of water tanks to help minimise excess water usage, particularly when looking at new buildings or major refurbishments.

Administration and support services

other

This cost mainly represents administration expenses but includes education and quality assurance costs and workers compensation premiums for all wage costs. The cost of administration has risen signiďŹ cantly over recent years as the cost of compliance with an everincreasing level of regulation.

We have mentioned earlier how food is a focus for both providers and residents. In that context, in this survey the average amount spent on administration and other support services was $30.05 per bed day which was $5.75 per bed day more than was spent on catering costs. Since 2007, administration and other support services costs have increased by 56.3%.

When we speak with providers around the country it is evident that one of the reasons for the level of administration costs continuing to rise at a rate in excess of CPI is the level of regulation and compliance that they and their managers have to deal with on a daily basis. This includes documentation necessary to meet accreditation standards, dealing with planned and unplanned

Interestingly, one cost that does appear to have been reduced over a number of years is the workers compensation premiums. The average premium across all facilities has decreased by 17.5% since 2007.

We understand that reducing red tape is a focus of the Government â&#x20AC;&#x201C; this initiative is to be supported and put into practice as soon as possible. However, from what we have seen to date there has been little progress made.

FUSION | 81

ACFPS | Summary of Survey Outcomes | June 2014

HOME CARE The 2014 financial year has been the first in the two year transition period to consumer directed care (CDC) in the delivery of home care services. It is still early days with the Department of Social Services (DSS) indicating recently that only 11% of home care packages had been transitioned to CDC by the end of the financial year. We will have some observations on some of the CDC data that has started to filter through. The June survey contains data from a total of 417 programs representing 14,912 packages which is 22.5% of the packages nationally at June 2014.

Home Care Packages Level 2 (formerly CACP) The survey has received data from 214 Level 2 programs representing 10,646 packages. Proﬁts for the year to June 2014 quarter of $3.34 per client day is higher than the $2.18 per client day for the year to June 2013 and are also an improvement on the December half year results of $3.06 per client day.

average proﬁt of $3.38 per client per day compared with $3.34 average for the full survey. Expenditure also increases slightly to $40.13 which is still $0.10 per client day lower than it was for the full year to June 2013. Table 8 – Survey participation by various measures

Funding from Client •Total for industry $1.24 billion Fees and Government •Total represented in 2014 Survey $337.6 million (27%) Subsidies Number of Level 2 Home Care Packages

•Nationally in 2012/13 – 47,158 •2014 StewartBrown survey - 10,646 (23%)

Number of Level 4 Home Care Packages

•Nationally in 2012/13 – 13,150 (EACH & EACHD) •2014 StewartBrown survey - 4,167 (32%)

Number of Providers

•Nationally in 2012/13 – 504 •2014 StewartBrown survey – 51 (10%)

Table 9 – Summary of results Extract from StewartBrown Aged Care Financial Performance Survey for the year ended 30 June 2014.

Home Care Packages – Level 2 Survey Average Year ended 30 June 2014 $ 214 Programs

Survey Average Year ended 30 June 2013 $ 236 Programs

43.18

42.41

Client care costs

28.95

29.66

Operating costs

All amounts shown are measured in Dollars per Actual Client Day.

Table 9 shows that while income increased marginally, expenditure was slightly lower than it was for the 2013 ﬁnancial year which is something that was not expected.

Revenue

2.36

2.29

Administration

8.08

7.83

Early indications are that this level of proﬁtability may not be able to be maintained as packages are transitioned to CDC. The average proﬁt for a CDC Level 2 program was $2.61 per client per day. As stated these are only early days and this is based on the average across only 20 programs representing 506 packages.

Depreciation – non building

0.45

39.84

40.23

$ 3.34

$ 2.18

Of the 214 programs in the survey, 194 (91%) do not appear to have started the transition to CDC in any signiﬁcant way.

Expenditure

Total expenditure Net operating result Result as % of revenue EBITDA per package per annum

7.7% $ 1,385

5.1% $ 960

Average Staﬀ Hours per available package per week Client care staﬀ

4.39

4.66

Coordinators/Case Managers

0.85

0.78

Administration

0.72

0.45

5.96

5.90

Total staﬀ hours

Despite the overall decline in costs, administration expenses increased by $0.25 per client per day on average across the survey as shown in Table 9.

When we examine these 194 programs in isolation, the overall result improves marginally to an Page | 14

82 | FUSION

Figure 22 opposite shows a comparison of the wage hours worked per client per week between CDC and Non-CDC packages and it highlights a number of things.  The CDC programs employed less care staff  Coordinator hours are higher for CDC programs  Administration hours for CDC programs are significantly higher than for non-CDC programs  Total staff hours are significantly higher for CDC packages There could be a number of reasons for these differences. Administration hours are likely to be higher for CDC because in all likelihood the administration is now being more accurately allocated. In addition there is no doubt that at present the administrative burden of a CDC package is greater than a non-CDC package. It would be hoped that this would improve as systems are improved including through the use of technology.

Home Care Packages Level 4 (formerly EACH and EACHD packages) The 2014 survey includes data from 187 level 4 programs representing 4,167 packages (2013: 4,240 packages). The average result of $22.43 per client day for the 2014 financial year were a little better than the average result of $21.58 per client day for the 2013 financial year. This was mainly attributable to a decline in expenditure by an average of $0.76 per client day. Despite the reductions in overall expenditure, the cost of administration rose by $0.33 per client day during the year. Figure 23 (opposite) shows that the results are continuing to trend upwards from the results of previous financial years.

The average results of $46.48 for the benchmark (Top Quartile) group remain higher than the results for the year to June 2013 by $2.02 per client per day (4.5%). The difference in average results between the survey average and the benchmark is $24.05 per client per day. The difference in costs contributes $22.61 per client day to the overall difference and of that care costs contribute $18.39 per client day or 76% of the total difference in the average results of the two groups. When we look at CDC packages in isolation there is a significant difference in costs in general and in staff costs and hours worked in particular. Of the Level 4 187 programs it appears that 23 (12%) programs are either specifically identified as being CDC or have shown indications that they have begun to transition existing packages to CDC. This ratio and that of the Level 2 programs (9%) is in line with what has happened in the industry generally in regards to transitioning to CDC.

As shown in Figure 24 opposite, the CDC packages appear to have higher care costs and administration costs. This is a little different to the Level 2 packages where there was a lower amount of care costs and a higher level of administration expense. As previously stated it is early days and there are only a small number of programs in the data set so it is difficult to make any firm conclusions at this stage. However, the wage data appears to reaffirm the financial data for Level 4 packages in that the CDC packages do demonstrate higher levels of care staff hours and administration hours per client per week than non-CDC packages. These figures, particularly in relation to the administration costs and hours, do appear to confirm what we are seeing from providers who clearly have to spend significantly more time on administrative tasks for CDC packages.

Table 10 Extract from StewartBrown Aged Care Financial Performance Survey for the year ended 30 June 2014. All amounts shown are measured in Dollars per Actual Client Day. Revenue

Home Care Packages – Level 4 Survey Average Year ended 30 June 2014 $ 187 Programs

Survey Average Year ended 30 June 2013 $ 279 Programs

135.21

135.12

Client care costs

80.16

82.91

Operating costs

6.55

5.51

Administration

25.19

24.27

0.88

0.85

112.78

113.54

$ 22.43

$ 21.58

Expenditure

Depreciation – non building Total expenditure Net operating result Result as % of revenue EBITDA per package per annum

16.5% $ 8,509

16.0% $ 8,188

Average Staﬀ Hours per available package per week Client care staﬀ

10.30

10.59

Coordinators/Case Managers

1.72

1.75

Administration

1.57

1.02

13.60

13.36

Total staﬀ hours

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Some Early CDC Observations The early data for CDC packages is highlighting a number of areas of difference from the non-CDC packages: Average result for CDC programs for Level 2 packages was $2.61 per client per day compared to $3.38 per client day for non-CDC packages Average result for CDC programs for Level 4 packages was $8.56 per client day compared to $23.26 for nonCDC packages Based on data from 7 programs (50 packages) the average result for Level 1 packages was a deficit of $4.08 per client day A average of 1.82 hours per client per week (care hours: 1.01 hours) were worked for Level 1 packages Based on data from 9 Level 3 programs (49 packages) the average result was a profit of $11.53 per client day The average number of hours worked for Level 3 packages was 7.45 hours per client per week including 5.48 care hours

For the Level 1 packages the cost of Case managers and coordinators ($5.32 per client day) was greater than the cost of care staﬀ ($2.29 per client day) The proportion of providers who provided wage hours data was signiﬁcantly higher for CDC packages (Level 2: 90%, Level 4: 91%) packages than for non CDC packages (Level 2: 66%, Level 4: 64%). This may be an indication of better information systems by necessity

For those Level 2 packages that reported unspent funds they averaged 12% of gross revenue although there were a signiﬁcant number of programs where unspent funds were between 15% and 25% For those Level 4 packages that reported unspent funds they averaged 9% of gross revenue although there were a signiﬁcant number of programs where unspent funds were between 15% and 25%

These will be continue to be interesting and somewhat challenging times for providers as well as in this benchmarking space as not only methods of service delivery change but also the ways in which income and expenditure is accounted for. One of the problems that many providers are having at present is identifying what the costs of providing individual services are. Current systems are often not designed to record and report the information that is required to undertake this exercise. This transition requires not only a change in culture with respect to service delivery but also a change in culture around collecting, recording, reporting and analysing business input costs and the selling prices of services. This change management process will be critical and many providers, particularly the smaller providers, are ﬁnding it a diﬃcult process to navigate. Condensed report reprinted with permission. Full reports available at www.stewartbrown.com.au

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84 | ADVERTORIAL FUSION

Bock beds By Luke Craddock, Aged Care Specialist

f there’s one piece of equipment in the healthcare industry that doesn’t get enough recognition, it’s beds. Beds in the healthcare market often, quite literally, just become part of the furniture, but without them we wouldn’t be able to offer the care we can now. We spend approximately 33% of our lives asleep (Better Sleep Council 2014), and hardly think about the equipment we sleep on. Rest and recovery in healthcare play an even more important role than life outside of the industry. Care facilities including hospitals, nursing homes and retirement villages need beds not only with exceptional comfort, but extra features for safety and accessibility, in order to provide maximum wellbeing with dignified living. A high quality healthcare bed adds to the overall comfort of the patient, making care easier to give and receive, and decreases issues that can occur due to stress, discomfort and lack of proper rest. Healthcare beds need to comply with stringent Australian quality and safety standards. A key aspect is the ability to apply safety and therapeutic devices when necessary. These additions include electronic adjusting devices, and side rails. It is particularly imperative that side rails comply to standards, as they play an important role in not only securing the patient, but in the ability for staff to access the person in care when necessary. Side rails are seen as a restrictive device and need to be able to be removed at the patient’s request, or with consent from a guardian or relative. Australian side rails on healthcare beds must comply with set standards, (Muller C J. 2008) including: • The height and spacing of side rails in raised and locked positions • Spacing between the side rail and fixed parts of the bed • The height of the side rail in relation to mattress height • The distance between the segmented side rail and the mattress support platform • Set standard of the smallest dimensions of any accessible opening between the side rail and mattress support system

• The total length of the side rail, or sum of the length of segmented side rails on one side of the bed. There is also more need for high quality beds than ever before. A downstream effect of hospital overcrowding has led to a lack of aged care beds in the community (Australian Government Department of Health and Ageing 2012). Bock beds (© 2014 Hermann Bock GmbH) comply with Australia’s safety standards, and uphold the highest in safety, luxury and comfort. Bock beds new side rail system allows for the option of either no side rails at all, an option which is important for creating a non restrictive environment, or a split rail system. The Bock bed range has delivered not only a range of beds with high quality and comfort, but a range of important accessories. The split rail system assists in entry and exit of the bed without the use of a bedstick. They have been designed to look less institutional than current aged care beds on the market and slide neatly out of the way when not in use. The Bock Bed range comes in a range of customisable wood grains and collateral fabric options that create a comforting hotel atmosphere that the patients in care will appreciate. Next time you need a bed with superior safety, quality, design and comfort, choose the Bock Bed range. ■

References Australian Government Department of Health and Ageing. The state of our public hospitals. June 2006 report. http://www.health.gov.au/internet/main/publishing.nsf/ Content/state-ofpublic-hospitals-report.htm(accessed Dec 2014) Government of South Australia Department for Communities and Social Inclusion (2013) Assessing, Planning and Using Restrictive Practices Guideline p. 9 Muller C J., (2008) Examples (only) of BEDS with segmented SIDE RAILS and single-piece SIDE RAILS Better Sleep Council (2014) The Science of Sleep, accessed the 9th December 2014 from < http://bettersleep.org/better-sleep/the-science-of-sleep/>

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Palm Springs dementia think-tank

n the first week of December 2014 a team of representatives from Australia, England, Canada, France and America met in Palm Springs to talk about what might be possible for the future of dementia care. The focus was on what good care and service provision looks like, and also on the creation of a multimedia, visually guided offering presenting some of the best thinking and exemplars in this area. The think-tank was organised by Sociologist and photographer Cathy Greenblat, who has spent more than 10 years capturing photographs, films and stories that showcase innovative dementia care settings around the world. “Currently the focus of attention and financial support is on finding a cure, this gathering is focused on how the lives of those living with dementia might be improved” explains Cathy Greenblat. Two representatives from the Australian Aged Care Industry – Daniella Greenwood, from Arcare, and Colin McDonnell, from UnitingCare, formed part of the team of 14 who attended the 7-day think-tank. The team consisted of geriatricians, aged care providers, researchers, authors, Alzheimer’s peak body representatives, and film-makers such as Corinne Maunder and Jimmy Harmsworth, from Fire Films, Australia. Other participants were invited to contribute and participate via telephone and internet, including an online Alzheimer’s support group who offered first-hand advice and recommendations based on their personal experiences living with dementia. Greenwood and McDonnell recently featured in two short films produced by Greenblat and Maunder: It Takes a Community and Finding the Why. The films will form part of the larger multimedia

project highlighting the best of dementia support approaches internationally. “We need to look closely at the innovations in residential care – such as those highlighted in the two Australian films – and then work out how these approaches might inform services beyond a residential setting – from diagnosis to end of life”, said geriatrician, Soo Borsen. The group will continue to meet and work together over the next 12 months to develop an interactive multimedia product that looks at the best of what is and of what might be possible in terms of services and support offered to people living with dementia. This will include an exploration of what dementia means and how it is viewed in different cultural contexts throughout the world. “It was a fantastic experience to meet and work with a group of such amazing and creative people. I am excited about what we are developing together and am really looking forward to continuing the conversation in our first online meeting next week” said Daniella Greenwood, Arcare, Australia. The two Australian films “It takes a Community” and “Finding the Why” are available on YouTube. ■ https://www.youtube.com/watch?v=IUJWFWXz-wY&app=desktop https://www.youtube.com/watch?v=hZN1CyEiFNM

The Eden AlternativeTM ...a place to call Home One day you might need to receive care support in your home or move into Residential Care. How will you know which place to call home or that the service provider understands You? Homes and organisations that adopt the Eden Alternative model of person directed care are committed to creating an environment that focuses upon the individual, empowering staff, residents, clients to live a life with meaning. We offer a range of training and workshops that enable organisations to create a culture of home and not an institution.

Forthcoming Training and Workshop Events Dementia Beyond Drugs Workshop - G.A. Power facilitator WA 20th - 21st April 2015 - bookings now open VIC 27th - 28th April 2015 Implementing the Eden Alternative in Aged Care NSW 25th - 27th February 2015 VIC 18th - 20th March 2015 NSW 25th - 27th March 2015 Sth Aust. 20th - 22nd May 2015

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Product News Aged Care Facilities of Australia Compliance Testing – Radiation Guidelines AS60336.2.25 This articles outlines how Aged Care Facilities can take the necessary steps to ensure that the radiation levels being emitted from microwave ovens on their premises are compliant with Australian Standard AS60335.2.25 radiation guidelines.

The most practical and accurate way to ensure that the microwave ovens used by Staff & Residents are compliant with the above guidelines is to have them tested by an accredited organisation.

“The purpose of Australian Standards is to avoid all known adverse health effects by limiting exposures to levels below those at which heating occurs.” SO : ARPANSA Australian Radiation & Nuclear Safety Agency – Australian Government

Testing can be arranged by contacting Microwave Safety Systems which an ISO 9001 Accredited & Quality Endorsed organisation is servicing over 800 Aged Care Facilities.

Tests undertaken in workplaces have discovered microwave ovens leaking radiation 10 x (times) above the recommended limit.

To arrange inspections or for further information contact Microwave Safety Systems on ph:1300 305 303, admin@microwavesafe.net or visit www.microwavesafe.net

Hot Mumuz Hot Mumuz is an online clothing retailer dedicated to selling stylish affordable Men & Women’s Split Back Clothing, with prices ranging from $22.00 to $32.50. “Split back clothing allows for easy dressing, and even the most constricted residents can be quickly and comfortably dressed into our clothing” says business owner Rosalyn Evans. Hot Mumuz Split Back clothing includes Women’s Printed T-Shirts and Nightshirts and the Men’s lines include Nightshirts, Sleep Tees, and an assortment of T-Shirts, all with their X-over Split Back. These are available at www.hotmumuz.com.au and further details can be viewed on page 26 In addition Hot Mumuz can add a Wrap Over Split back as shown , or Tie back to their Traditional Day Dress. Rosalyn says the dresses remain popular with her customers as they wash n wear extremely well in the industrial laundries, are affordable, and our ladies love the variety of prints available. “We are continually humbled by the feedback we receive. Our customers continually thank us for providing affordable clothing for their mums and dads, which they say is not only comfortable but also stylish in prints and colours”, explained Rosalyn. “Our focus is ensuring our garments are comfortable, look good, durable and AFFORDABLE FOR ALL” Hot Mumuz is always available by phone including AH, to discuss possible solutions to your needs.

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88 | FUSION

Diploma of Dementia Care Leadership McCarthy Learning’s accredited Diploma of Dementia Care Leadership is an online learning experience with two days of face to face learning. “The point of difference with this qualification is that it is not just another academic experience,” said Bernie McCarthy CEO of McCarthy Learning and qualification designer. “We take participants through a dementia experience where they walk in the shoes of a person living with the disease; feeling out of control of their surroundings and invisible to those around them, as this, unfortunately, can be the experience of people within care. “It is from this point, participants are shown how to be leaders within their workplace with increased knowledge and skills specific to best practice contemporary dementia care; to enable the necessary management and leadership skills to lead teams; guide development of policy and shape organisational direction to ensure excellence of dementia care,” said McCarthy.

• Assessing, planning and supporting the person with dementia • Relationships in dementia care • Practical leadership • Leading the future of dementia care Benefits for students include: • Specialised knowledge and skills relevant to the care of people living with dementia and provision of leadership to staff and carers under their authority • Improved dementia knowledge and skills • Improved leadership skills for more effective decision making, problem resolution and staff management.

For more information, contact Karen Carver karen@mccarthylearning.com I 03 9431 0311

Participants need to be employed in an aged care environment as assessment will be project based. The course is delivered in six blocks of online learning and workplace projects. The six blocks of training are: • Foundations for dementia care leadership • Dementia building blocks

Hospitality Services Boards of Aged care organisations face increasing challenges in light of higher expectations from stakeholders. Technological changes have had a major impact on meal services, delivery, and administration ensuring they meet the clients’ requirements. An operational review of these services will provide the knowledge and, detail required in the decision making process, for the design of services when building new or upgrading current facilities. MAJ management consultants have many years of operational experience providing a team approach through input from staff and management at the Facility. MAJ will review and provide solutions – not only the meal services that best suit the Client; but will also provide the approach to cleaning and a review of the laundry processes that will provide the Organisation with both the ‘home like’ environment, happy staff and a financial check. Training of staff is also seen as a key to ensuring Clients and staff are able to provide the required level of service. Menu development, production planning, written job descriptions, food safety programs, new technology, kitchen planning, cleaning

programs, quality & financial control, risk management are some of the areas where MAJ can provide the ‘one stop’ solution. MAJ provide independent advice to the Hotel Services Departments within the Health and Aged Care sectors.

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FUSION | 89

2 Key ways to prepare for the shift to chemical free cleaning in aged care The 3000 year old mop, chemical and bucket method is fast becoming a process of the past for the aged care sector. Over the last 15 years, the push for chemical free cleaning has increased dramatically in the aged care sector due to its infection control benefits. Here are 2 key ways aged care facilities can prepare for the shift in going chemical free and increase their standard of hygiene and infection control.

Create a green team A green team involves senior managers and support staff who have a common goal and understanding of what the new chemical free cleaning process will involve. This group will be the team championing the shift and the implementation. The green team is responsible for identifying what current cleaning processes are being used, and what are the current gaps. For example, is every touch point being cleaned, the same way, 100 per cent of the time?

It’s important that each person in the team is involved in understanding the reasons of why the change is happening, what new equipment or process will be used, and how often the cleaning is to be carried out and by whom. Having everyone on the same page from the very beginning of the new cleaning program will minimise the risk of objections and confusion later on.

Equipment planning High temperature steam is a chemical free cleaning technology which is leading the chemical free cleaning movement in aged care. Be on the look out for high temperature steam technology equipment which provides +165 degrees Celsius combined with 94% dry steam. Due to steam being a vapour, it is able to get into crevices that chemical and detergents can’t, and is a powerful disinfector of aged care bacteria. It’s also crucial that any steam machines purchased come with versatile tools and attachments for aged care cleaning applications, specifically for touch point cleaning. Critical areas to ensure you have the right tools for are resident rooms and bathrooms.

Murray McDonald has over 20 years experience in aged care cleaning solutions and infection control, and is Director of Duplex. Duplex is an expert in healthcare and aged care cleaning products in Australia and New Zealand. Murray is also author of the book ‘5 Steps to Chemical Free Cleaning in Healthcare’. Visit www.duplexcleaning.com.au/infectioncontrol

Confoil’s Pack and Seal systems Confoil’s Pack and Seal systems are designed for busy kitchens and are ideal for Aged Care and Meals on Wheels organisations. Comprising of custom packaging, lidding and machinery solutions, the options can be tailored specifically to your kitchen layout, staff ratios, cooking methods and the packaging requirements of your clientele. Meals are packed using aesthetically pleasing paperboard or pulp trays, and act as a natural insulator, meaning the packaged meals are pleasant to handle after heating. The trays are never brittle and can withstand temperatures of –40°C to 210°C Importantly, the transparent heat sealable lids allow the meal to be viewed, and the generous film overhang allows for simple removal of the lidding.

Packaging options within the range are varied, from large and smaller portion single serve meal sizes, to pulp containers with 2 or 3 separate compartments. Dessert and soup specific packaging are also available. Many of the trays can also be custom printed with your company logo, corporate colours or message. To complete the system, a choice of cost effective heat sealing machinery is available, from ergonomic benchtop sealers to inline automatic models.

Contact Confoil for more information or to arrange a consultation to discuss your unique requirements. Ph: 1800 786 340 or http://ad.confoil.com.au/packandseal

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Australian Medicines Handbook – concise, independent, comparative drug information AMH is the indispensable drug reference for Australian healthcare professionals, with a reputation for independence and accuracy. It is continuously reviewed by an expert editorial team of pharmacists: every edition involves hundreds of changes. In addition to routine updating, such as new drugs, indications and safety information, AMH also incorporates advice to reflect shifts in evidence and practice. For example, if respiratory topics inspire you, AMH 2015 (available in January) contains updated advice on asthma treatment (including information from the latest Asthma Management Handbook), tables succinctly summarising asthma management in adults and children, and a new table enabling quick comparison of the increasing number of inhalers available for asthma and COPD.

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The Country Care Group The Country Care Group is made up of a national group of service providers that carry the full range of products required to meet the clinical needs of its clients. The group has a proven track record in delivering equipment solutions within tight timeframes to the DVA, Hospital, Occupational Therapists, Health Care Centres and other service providers. The Country Care Group consortium is primarily made up of independently owned and operated businesses where the owners

usually work within the business. Currently the group has over 60 showrooms and warehouses in various locations across Australia, and operates in excess of 200 delivery vehicles. The group’s experienced team members have a vast wealth of knowledge within the rehabilitation products field and fully understand the needs of their clients.

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Because your staff need to concentrate on patient care Hills Health Solutions brings together the patient care expertise of Merlon, Questek and HTR. By integrating them into a single health-technology platform, we allow health care managers at hospitals and aged care facilities to focus on patients. We bundle leading edge solutions for patient entertainment, phone service, nurse call, radio pendant systems and security. Weâ&#x20AC;&#x2122;re applying ingenuity, not just to make life easier for patients, but also for the healthcare professionals who take care of them.

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