Lasa Fusion Summer 2015

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

Why

ACFI GROWTH IS JUST A RIPPLE

compared to what’s ahead

WHAT 2016 WILL MEAN FOR AGE SERVICES – PAGE 4 WHY WE CAN AFFORD AN AGE CARE PENSION – PAGE 14 FINANCIAL PERFORMANCE SURVEYS – PAGE 63

CONTENTS The voice of aged care

4 NATIONAL CEO UPDATE

Summer 2015 | www.lasa.asn.au

7 CHAIR UPDATE

EDITOR

8 FOCUS ON... QUALITY

Katie McKeown

LASA NATIONAL

FEATURES 14 How we can afford a universal

Patrick Reid CEO PO Box 4774, Kingston ACT 2604 E: patrickr@lasa.asn.au

age pension

19 Codesign in practice:

LASA NSW/ACT

the Step Forward project

Loula Koutrodimos Acting CEO PO Box 7, Strawberry Hills NSW 2012 E: Loula.Koutrodimos@nswact.lasa.asn.au

23 What it takes to service rural and remote communities

LASA QLD

INNOVATION 31 ITAC 2015 award winners

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

FEATURES

LASA SA Paul Carberry CEO Unit 5, 259 Glen Osmond Road Frewville SA 5063

16: The butterfly effect of tinkering with ACFI

37 Culture, leadership and persistence at Webstercare

41 The latest in assistive technology

E: ceo@sa.lasa.asn.au

BUSINESS MANAGEMENT 50 Bentley’s national

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

aged care survey

55 Preparing your business

LASA WA

for sale

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

63 StewartBrown national aged care survey

71 Policy implications on housing decisions

ADBOURNE PUBLISHING PO Box 735, Belgrave, VIC 3160

Adbourne

DESIGN

HEALTH & WELLBEING 72 Hearing loss & dementia

43 : Where research meets reality: a new dementia care wing

74 The power of resistance

PUBLISHING

Advertising

Melbourne: Neil Muir (03) 9758 1433

Adelaide: Robert Spowart 0488 390 039

Production

Emily Wallis (03) 9758 1436

training

EVENTS 76 SAGE tour: independent living

Administration Robyn Fantin (03) 9758 1431 Susan Moore Marketing susanmoore@y7mail.com

in the US

78 OSCAR winners 81 LASA Congress 2015 wrap up

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

85 WHAT’S NEW

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

BUSINESS MANAGEMENT 67: Embracing deregulation to strengthen growth

NATIONAL UPDATE I

CEO

WHAT 2016 STANDS

TO LOOK LIKE FOR

AGE SERVICE PROVIDERS

As I’m sure is the case for you, the end of the year for me is always a time for reflecting on what has come to pass and what lies ahead.

O

ver recent months we have been working with members to redefine what LASA looks like and how best to provide services and advocacy for you into the future. The first half of 2016 will see LASA move towards a unified operational platform to derive synergies and benefits for members across Australia. Across our industry we are all finding ways to do more with less, and this is no different for the peak bodies operating on your behalf. LASA members in Victoria have already voted strongly in favour of this change and I encourage you to consider how LASA can better meet your needs through this process, informing and shaping the change from the grass roots.

As we look to the new year, foremost in my mind is the demographic shift that will continue with the first of the baby boomers turning 70. This will see a swell in numbers included in items such as the critical ration calculations to size demand for services. It is these unchartered waters where longevity – which we celebrate – poses challenges for an industry in flux.

The start of 2016 will see changes to the aged care complaints scheme with the transition to the Aged Care Commissioner.

As Commissioner, Rae Lamb will be directly responsible for managing complaints about the subsidised care and services people receive in their homes and in facilities. Statutory independence will provide a better outcome for providers but it is important that providers continue to work with clients to ensure complaints are predominantly dealt with at the service level.

During February it is likely that legislation required to confer fund holding capability to consumers will be introduced to

FOUNDATION PARTNERS

Patrick Reid Chief Executive Officer Leading Age Services Australia

parliament with a timeline of being operational by February 2017. Australians receiving home care packages will not only be able to choose their service provider but will also be able to change providers. This is a fundamental change to how the age service system will work in terms of entry, provision and transfer, requiring a re-think on how providers market to and engage with clients.

This is the leading edge of the transition to a market-based system where relevance of services, reputation, branding, quality and capacity will be somewhat determined by the customer choosing a product rather than being offered a service alone. LASA will keep a forensic eye on the related legislation to identify gaps, changes and omissions that may prove problematic for providers.

The Aged Care Sector Committee, on which I represent LASA as National CEO, has finalised a broad road map of the next steps required for age services to continue to evolve and support increasing numbers of clients. The roadmap is now with Minister Ley and with a federal election on the horizon we expect it will be given due consideration ahead of the next stage of reforms.

Caution is also needed given the roadmap process, quite apart from being an opportunity for stakeholders to own their destiny, has the potential to send us into cul-de-sacs and dead ends.

It is imperative the whole industry participates with strategic intent to capitalise on the opportunity before us.

Beyond the various committees and working groups on which the LASA team represents your interests, we will continue to push out submissions to government and other bodies at

CEO

every opportunity to ensure providers are front and centre of co-designing the systems and policies governing our industry.

Since the last election this activity has been significantly increased with over 100 submissions made on your behalf.

It is through this advocacy role that LASA facilitates providers to be active policy makers, which has never been more important than in this current environment.

| NATIONAL UPDATE

education and quality standards to support and bolster the age services workforce.

One certainty in 2016 will be the next federal election. Malcolm Turnbull’s honeymoon as a new Prime Minister has ended and the Christmas/new year parliamentary break is when members return home to gauge what issues constituents might expect to be raised in an election.

The new year will also see the continuing roll out of the Severe Historically, age services has not been a vote winner for Behaviour Response Teams (SBRT) to replace the dementia politicians but with the baby boomers increasing experiencing supplement activities. We remain concerned the SBRT process our industry this is beginning to change. We saw the will not build capacity and registration of a specific ‘grey capability within the workforce, power’ themed party during enabling your staff to deal the NSW state election and There is no reason why we cannot create a with severe behaviours when across the Tasman New quality framework that safeguards standards they occur, rather than have Zealand has had a strong discrete specific interventions ‘grey power’ advocacy for and innovation without unnecessary regulatory at a fixed level. In recognising some time. red tape and compliance. that the DBMAS program and LASA’s election lobbying some other dementia specific campaign will get under programs will be rolled into a single framework during 2016-17, way in the new year, and centres on supporting providers to the SBRT must be objectively assessed against the program proactively articulate issues that matter the most to you and intent. Successive Ministers have now acknowledged that your clients to your MPs. We will combine local, state and dementia is core business for age services of all types. federal activity to ensure your voice is heard loudly and clearly.

As such, it is incumbent on both government and providers This opportunity only comes around every three years so we to make substantive change to ensure that people living must consider what is ahead as well as what is in front of us with dementia receive services that align with their needs now. and expectations.

While this is not an exhaustive list of what 2016 stands to Debate about quality and what quality looks like will continue bring, these are some of the areas where we will need to throughout 2016 and remain a key pillar strategically and apply further focus and activity. operationally for government, providers and consumers. Along On behalf of the LASA team, I wish you, your families, staff with a revision of the standards against current practice there and clients happiness, good health and prosperity in 2016. ■ is the 2015 budget outcome for full cost recovery of $30.7M from providers, but with the additional opportunity for new providers of accreditation apart from the quality agency. There is no reason why we cannot create a quality framework that safeguards standards and innovation without unnecessary regulatory red tape and compliance.

Another key pillar that impacts across the industry is our workforce. The attraction, recruitment and retention of an available, inspired, skilled and valued workforce is critical.

There is significant debate over who should have carriage of a workforce strategy but pragmatically each stakeholder has levers they can pull to influence change. Government can use legislation, policy and funding, while providers can use flexible work hours, non-traditional salary incentives, technology and workplace culture to name a few levers. At a policy level LASA will continue to advocate on your behalf to strategically influence changes to industrial relations, immigration, LASA National Board with Assistant Health Minister, Ken Wyatt

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CHAIR

| NATIONAL UPDATE

LET’S TALK ABOUT

QUALITY

As we slip quietly into December I note there is a black mark against the Australian Aged Care Quality Agency’s unmet promise to have the result of its discussion paper “Let’s talk about quality” available in late November.

T

he premise of the paper and related fora were based on five themes:

• Putting consumers front and centre

• Safety is essential but not enough • Integration across the aged care experience • A quality culture that encourages excellence • Leadership and innovation

The agency received more than 130 responses to the discussion paper (none of which were publicly available), and ran three consultation forums attended by 140 people.

There is intense interest in the subject of quality, though in practice it is a very subjective word. From our perspective, quality is one of the five strategic pillars that form the foundation of a sustainable age services industry, and we must safeguard quality to enable innovation. Contrary to increasing rules and regulation we believe this requires eliminating unnecessary red tape and compliance measures.

In the 2015 Federal budget, government indicated it would seek savings of $30.7 million over four years through increased cost recovery arrangements for residential care accreditation services undertaken by the Aged Care Quality Agency from 1 July 2016.

What was also presented to the industry in a quieter way is that with full cost recovery comes the opportunity for the Quality Agency to have competition.

The reform process our industry is going through has been pitched as an opportunity to offer competitive, high quality services that meet the needs of Australia’s ageing population.

However, to do this we need to consider if our current standards are fit for purpose and meet current practice, and whether quality outcomes are the goal. In this context, innovation must be supported and enabled to work out how those outcomes are met.

Currently the Quality Agency is the sole provider of aged care accreditation services. It has existed in one form or another since 1997 and during that time we have seen accreditation

Dr Graeme Blackman OAM Chair I LASA

rates rise from 64% in 2000 to 95% in 2012. Many would say this is a stellar result that requires no change, but consumers and providers alike are looking for innovative measures of ‘quality’. This includes meaningful benchmarks that describe outcomes rather than compliance based met or unmet criteria.

We know that you are craving recognition for excellence that frees you from red tape and in turn gives consumers the chance to review and provide meaningful feedback on what quality looks like.

In Australia, residential aged care and at-home care are currently required to meet different standards. Having varying arrangements in residential care on the one hand, and at-home care on the other, increases the complexity and red tape for aged care providers delivering both types of care (let alone those that do NDIS or childcare services). In our minds, a single aged care quality scheme is therefore required across both community and residential aged care, possibly with consideration of disability services too.

Not only are residential aged care and community aged care facilities accredited against varying standards by differing providers, the accreditation for retirement villages also differs.

Harmonisation of the quality process across the age service industry is required to reduce regulatory burden and ultimately improve standards of care for all Australians.

While we consider what a contestable accreditation process might look like, we know that providers and consumers must work together to ensure the opportunity for an improved and more transparent system is realised. Active feedback loop from consumers and their families that contributes to reviewing the quality outcome is a big step but certainly attainable.

2016 is set to be another big year in aged care reforms, particularly in terms of how we as an industry, and our elected representatives in Parliament, think about quality. We are at cross roads right now and the chosen path will either set us free to grow and thrive, or keep us imprisoned by red tape.

We cannot allow innovation to suffocate at the hands of regulation. ■

7

FOCUS ON I

QUALITY

FOCUS ON... QUALITY Cost of care cannot be separated from quality Last month the Department of Health stated its intention to curb increasing ACFI expenditure following continued higher-thanprojected growth.

Paul Carberry Chief Executive Officer LASA SA

In the context of this knee-jerk reaction, it is timely to see reports by both StewartBrown and Bentleys that credit the increase to two primary factors: higher proportion of residents entering facilities with acute needs, and higher costs of care.

StewartBrown makes the point that while results from 2015 are better than the last two years, figures have not fully recovered from 2013 when ACFI rates were frozen. The result of $9.84 per bed day equates to a return of only 5% on care income, which in 2012 was a 7% return.

This is important given last year, then Minister for Social Services, Mitch Fifield, made a big deal out of returning the Workforce Supplement in the form of an additional 2.4% increase in ACFI on 1 July 2014. He actually used it as part of the justification for removing the Payroll Tax Supplement.

According to the StewartBrown report, even with this increase the “care results” (care income less care expenses) have still not returned to their pre-2013 levels. In fact, the average care result for 2015 was down 18% to $9.84 pbpd compared with $12.00 for 2012, even with the return of the Workforce Supplement.

The fall in profitability as a proportion of income has occurred during a period in which care income has increased by an average 17%, despite the 2013 freeze in subsidy rates.

StewartBrown notes that one of the reasons for declining margins is that care costs have increased by an average of 21% during that same three-year period.

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A key point made in the StewartBrown is that if the If the top quartile was excluded from the survey, the remaining 75% of facilities (597 facilities) had an average care result of just $2.11 per bed day. This does not make for a sustainable, quality driven age services industry.

While the Department remains focused more on the fact that subsidies have grown faster than it projected, rather than the issue that residents have higher care needs than it assumed, the longer term implications become an issue about quality.

In recent year we have seen funding for health care rise in line with population needs and growing costs, but the opposite is occurring for older Australians despite the changing demographics.

Far from growing too fast, ACFI payments are lagging the growth in care costs. And if this very real problem isn’t fixed, we will see a domino effect starting with a decline in quality and further workforce issues.

It is therefore important that we view ACFI and any proposed modification through a quality lens rather than purely a funding issue and address the real problem at hand. ■

QUALITY

Barry Ashcroft Chief Executive Officer LASA QLD

I FOCUS ON

One accreditation framework for age services

In September 2011, health ministers endorsed the NSQHS Standards and a national accreditation scheme; creating a national safety and quality accreditation system for health service organisations.

Age service quality reporting should involve a range of indicators, developed by industry and consumers that simply represent the key elements of what in reality is a complex ecosystem of care and environmental issues.

Citing this precedence, it would appear that we could universally adopt a core set of standards (such as NSQHS) across the three streams of age services that could be assessed by a certified authority independent of Government.

Selecting which indicators to focus on depends on which model or framework is used to examine issues or progress.

Many different approaches can be used to observe trends depending on the context and purpose.

There is no universal set of indicators currently available and the selection of different indicators may vary by location and by region.

Quality indicators could be broadly grouped into different types including: • state of care and environmental indicators, which reflect the quality of care delivery and the environment in which that care is delivered • sustainability indicators, which are long-term success measures • economic and accounting indicators, which evaluate income, delivery costs and benefits.

At present there are three frameworks in use across our industry: • Residential Care (the Australian Aged Care Quality Standards) • Community Care (Home Care Common Standards administered by the Australian Aged Care Quality Agency) • Retirement Villages and Supported Accommodation (the International Retirement Community Accreditation Scheme).

At the core of all of these frameworks is the assessment of risk and safety.

The National Safety and Quality Health Service (NSQHS) Standards were developed by the Australian Commission on Safety and Quality in Healthcare to drive the implementation of safety and quality systems and improve the quality of health care in Australia. The 10 NSQHS Standards provide a nationally consistent statement about the level of care consumers can expect from health service organisations…and at the end of the day, whether we like it or not, we are ultimately all in the healthcare business.

To cater for industry diversity we would need to co-design and develop a set of modules based on the profile of each provider/operator. A diverse but inclusive suite of performance indicators would enable providers to make informed decisions on which combination of indicators best suited their business model and supported successful consumer engagement.

This in turn would allow for the development of useful and accurate industry benchmarks.

Equally as important in developing one accreditation framework is the need for the age services industry to regain its enthusiasm for quality. The current system in residential and community care is largely compliance driven and does not encourage a quality focus, true continuous improvement or innovation.

If we consider the hospital system of accreditation – EQuIPNational, it is operated independently of government, depends almost entirely on peer review and encourages sharing of quality improvement suggestions (which a risk averse government operated agency is loath to do). It also celebrates quality achievement and is an essential component of a world class healthcare delivery system (in a human services environment equally as fraught as age services).

While work is underway on developing quality indicators and standardised measures for the information and use of government, surely it’s incumbent on the industry and consumers to advocate strongly for the co-design of a system and processes that will not only drive quality improvement but also engage strongly with consumer interests – independent of government.

Governments focus should be rightly on compliance – they are the largest funder and should indicate and identify the standards, but it is the industry in partnership with consumers (increasingly forced to pay their way) that should co-design an independent, collaborative and collegiate system to enthuse providers to go above and beyond the basics to achieve true consumer success. This ideal will ultimately deliver improved compliance – this should be of equal interest to government, consumers, their representatives and to industry participants. ■

9

FOCUS ON |

QUALITY

Will free trade agreements impact quality?

A common concern raised when it comes to the international expansion of aged care businesses is the perceived potential impact on quality. When it comes to ensuring quality is maintained in Australia – we all know the question is a nonsense. The Quality Agency don’t relax their requirements for Beth Cameron global companies; standards of care Chief Executive Officer within Australia remain exceptional.

LASA WA Indeed, this is one of the many reasons Australian aged care companies are of interest globally.

At a recent inquiry, Melissa Parke MP had her eye on this issue – where providers are coming in from outside of Australia to provide housing and care, is there a concern that the standard of care could be lower?

The provision of care in Australia by any approved service provider is required to meet the standards set and audited by the Australian Aged Care Quality Agency. There is nothing within any Free Trade Agreement that would allow standards of care to be lowered within Australia.

Senator Sue Lines acknowledged the standards, and the need for strong regulation around quality. She notes a different challenge – when Australian service providers are already stretched by local demand, do we have the resources to spare?

And can we afford to lose essential skills to expansion projects?

Maintaining quality when resources are stretched can be a challenge. One that you are aware of and manage carefully.

We see that in the pause in development in the past few years as aged care businesses managed the waves of change from Government. It is a wise approach to take.

Fast paced, under resourced, inadequately communicated regulatory change has historically resulted in errors occurring in the industries involved.

It is important to note though, that aged care providers have very high standards to maintain throughout the current time of change and, despite the lack of support, have done so to their absolute credit. Quality Agency statistics show accreditation rates remain high. Providers are demonstrating care, for example, not accepting clients when they are not confident that the quality of care can be maintained.

This is in the face of overwhelming pressure from Governments to care for more clients with fewer resources.

The best way for the government to ensure high quality services are maintained are to make any required changes thoughtfully, with planning, warning, thorough communication and ultimately

10

providing the information, financial support and packages to enable implementation.

We need to maintain the high quality that older Australians deserve. And with unprecedented global opportunity – we can’t risk the reputational damage. ■

Quality is a culture, not a process What is ‘quality’ when it comes to the provision of services to our ageing community? When we think of other consumer goods and services, we all bring an individual perspective to the evaluation of quality.

Do you consider a quality meal to be a burger that can be readily bought Trevor Carr from a fast food franchise, knowing Chief Executive Officer it will be consistently provided no LASA VIC matter where you are? Or do you see quality in a ‘bespoke’ offering from a high-end restaurant?

When you need accommodation, do you search for the cheapest offering with the highest rating from one of several search engines, or do you filter first by ‘star-rating’ and amenities?

These two simple examples demonstrate that to assess ‘quality’ from a consumer perspective requires you to meet their expectations of your service offering. Importantly for our industry, these examples also reflect that many levels of service are needed to satisfy the full spectrum of consumer expectation.

In my view, quality is a culture not a process. The way a service provider interacts with clients, their representatives, family, friends, and even their pets will contribute more to the assessment of ‘quality’ service provision than a process such as our accreditation system.

The furniture, fittings, food, and recreational activities all form an important part of this interaction and the customer’s subsequent emotional response.

Responsibility for culture in any organisation begins at the board level. The board is ultimately responsible for confirming the strategy of the business, and the strategy must consider how you wish to be judged for the services you provide.

The board is responsible for selecting and retaining a chief executive to implement the strategy, with processes for testing its successful implementation and the culture embedded therein.

The recent changes within our industry and the clear need for service providers to become adept at marketing their services

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I FOCUS ON

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FOCUS ON I

QUALITY

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in a deregulated, consumer-directed market, highlight the need for governing bodies to consider culture and quality.

While information on the My Aged Care website is perfunctory in nature, it does nonetheless provide a starting point for aged care providers to enter the ‘consumer’ market.

There can be no doubt that the utterances of Senator Mitch Fifield, and more recently Minister Sussan Ley, about ‘booking. com’ type rating sites for aged care services will become a reality for us all within the next few years.

The transition from ‘trial’ to ‘mainstream’ of the three outcome indicators recently assessed through KPMG – and the likely addition to the indicators set, which was the subject of this trial – will give further rigor to the accreditation process that is just one indicator of whether an organisation’s culture is aligned to its strategy.

This is an important change within our industry and I encourage the governing bodies of all of our members and the executives supporting them to consider the notion that quality is indeed a culture, not a process. ■

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QUALITY

Quality in home care systems The aged care reform process has led to unprecedented change across the industry over the past year, with many providers evolving their services to meet consumer expectations.

When ‘quality’ and ‘standards’ are mentioned, for many the immediate thought is toward the four standards Loula Koutrodimos in residential care, and the 44 expected outcomes. However, Acting CEO increasingly as providers innovate LASA NSW-ACT and implement new approaches to care, an understanding the Home Care Standards assumes far greater relevance than might previously have been the case.

There are three Home Care Standards, and each of these is supported by a principle and 18 expected outcomes.

The Standards are: 1. Effective Management 2. Appropriate access and service delivery, and

I FOCUS ON

to assist providers to prepare for visits and to demonstrate continuous improvement in their care and services for care recipients.

As consumers become more adept at controlling their own package, and as services become more flexible and person centred, the process of continuous improvement will determine quality for each individual consumer.

Key to continuous improvement is: • consumer focus • innovation • service enhancement • involvement and accountability of key stakeholders including service users, representatives and carers, staff and volunteers, committee and board members, and advocates • regular monitoring and evaluation of consumer satisfaction • linking evaluation to strategic planning.

Quality is a difficult thing to define. It is as unique and different as each consumer being cared for. So, what is quality in home care? Quality is what the consumer says it is. Services that can adopt early adaptive strategies, be flexible and innovative will be quality services. ■

3. Service user rights and responsibilities All services which operate under the Home Care Package Program (HCPP) and the Commonwealth Home Support Program (CHSP) will receive a quality review in accordance with the Home Care Standards. So how can providers best address areas of quality in home care? How can quality be maintained in an environment of an increasing range of models of home care and home support, including some delivered through fee for service arrangements?

Considerations to ensure quality in home care is best managed, include: • Having an effective approach to managing risk • Quality consumer outcomes understood and worked toward across the home care service • Effective processes and systems are in place, for instance, police checks of new staff • That the Standards are understood across key staff and the greater organisation • Access to appropriate clinical care • Effective engagement with a care recipient’s GP, and care nurses • Considered and appropriate preparation is made for a home care recipient to potentially enter residential aged care.

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FEATURES |

FUNDING

HOW AUSTRALIA CAN AFFORD

A UNIVERSAL AGE PENSION

Matt Grudnoff presented on funding retirement incomes at LASA National Congress 2015. In this article written exclusively for LASA and its members, Matt shares his thoughtprovoking ideas on alternate options for aged care.

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t is no secret that the retirement income system is dysfunctional. Take lots of disparate programs with different objectives, mix with lots of government tinkering and you end up with a big mess.

It’s not a mess that comes cheap either. According to the Budget papers this year the government will spend $44 billion on income support for seniors. It will also give $37 billion in super tax concessions.

Matt Grudnoff Senior Economist I The Australia Institute

Rather than being used as a way to save for a comfortable retirement, super tax concessions are increasingly being used as a means of avoiding tax and for estate planning. 60% of the benefit of super tax concessions go to the top 20% of income earners, while half of all those paying into a super account only get 11% of the benefit.

That’s the bad news. The good news is that there are solutions.

With so much money going into helping people with their retirement incomes the government has an opportunity to make significant changes and really improve the lives of older Australians.

Combined, the government is going to spend $81 billion on increasing retirement incomes this year. This is expected to rise to more than $100 billion in the next three years with most of the growth in super tax concessions. While the pension is expected to grow Those who are unable to contribute much to their at just over 4% a year, super superannuation fund are going to be increasingly tax concessions are expected at risk of falling into poverty when they retire… to grow over three times as this is especially the case for women. fast at 13% a year.

If the cost of the age pension is ‘ballooning’, then super tax concessions are the Hindenburg.

All this spending does not seem to be helping poorer retirees either, with recent OECD data showing Australia has the second highest rate of poverty in over 65s among 32 OECD nations.

Pension means-testing, which is designed to make the system fair, discourages older people from working part time by reducing their pension payments. The result is far less of the monetary benefits of work ends up in their pocket, which reduces the incentive to work.

Different age pension income and asset tests make the whole system complex and laid over all this is a superannuation system that overwhelmingly benefits the well off.

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One solution is to get rid of all super tax concessions and use the money to pay for a universal age pension.

That is a pension that is not means tested.

With the money saved from removing super tax concessions the age pension could not only be made universal but also increased to 37.5% of male total average weekly earnings. This would see the single pension increase to over $26,000 per year and the partnered pension increase to about $40,000 per year.

So large are super tax concessions that after all this there would still be almost $14 billion a year left over. This could help pay for other age services, increase the pension further or be used the help reduce the budget deficit.

There are a number of significant benefits to a universal age pension. It simplifies the system. The age pension becomes the base on which everyone’s retirement income is based.

The increase in the age pension would help lift many retirees

FUNDING

out of poverty. Superannuation then becomes a top up to the pension that people save through their working lives.

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Image courtesy of Diego Cervo/shutterstock.com

The current age pension is becoming increasingly difficult to live on and the current government seems more determined to reduce it than increase it. This means those who are unable to contribute much to their superannuation fund are going to be increasingly at risk of falling into poverty when they retire. This is especially the case for women who have significantly lower super balances than men.

A universal pension would also remove the disincentive for older people to continue to work. There would be no withdrawal of the pension as more was earned so the more of the benefit of the aged pension would flow to the worker. Work participation rates for older people are much higher in New Zealand, which has a universal age pension.

A universal age pension fixes many of the problems in our current retirement income system. It addresses aged poverty by substantially raising the rate, it increases the incentive for older people to continue to work if they wish and it fixes the inequality of superannuation tax concessions. ■

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FUNDING

TINKERING WITH ACFI

WILL RESULT IN A BUTTERFLY EFFECT Last month the Department of Health stated that ACFI expenditure has exceeded budget estimates for 2014-15 and therefore it needs to consider options to curb growth. Unfortunately the solution is not that simple.

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ASA has strongly advocated that constant manipulation of the instrument is neither efficient nor effective, and a long term solution is required for income stability and forward planning.

Seeking to slow inevitable growth in aged care expenditure is a bit like installing a sea wall because a tsunami is on the way.

Its overall effect will depend entirely on how big the wave and its after-currents are, and what triggered the tsunami in the first place.

The problem with ACFI is not that growth is continuing, but rather why growth is happening faster than the Department’s own projections, which have fallen short for several years running.

LASA identifies two primary reasons for this: the significant increase in costs of care and an increase in people with higher care needs. Together these are creating a double-whammy effect which have not been adequately factored into the Department’s forecast modelling.

In November LASA wrote to the Minister highlighting these issues, and it is likely that by the time you are reading this she will have given guidance on how the government intends on dealing with the situation.

But a whole-of-industry approach is needed to ensure the government understands the potential impact of tinkering with ACFI. Those who manage the inputs to forecasting have told us that acuity increase is a steady, stable log curve which has continued since the 1950s, but this assumption needs to be challenged.

People are living longer and with far more complex comorbidities. If we look at dementia alone, 60% of ACFI scores are ‘high’ in the behaviour domain, yet this is the lowest paying

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Patrick Reid CEO I LASA

of the domains. It is also the most labour intensive, accounting for some of the poor return on care investment by providers.

In its recent Aged Care Financial Performance Survey, StewartBrown analysts identified that care income increased by an average of 17%, while care costs increased by 21% during 2012-2014.

While the overall ACFI expenditure increase was 2% higher than projected (7.6% compared to 5.6%), care costs have increased by an average of 4% more than care income, resulting in an overall decline in profitability.

The report notes that, “care income continues to rise at rates much higher than CPI or COPE. This is due to the higher ACFI subsidies being received as a result of residents having higher care needs (acuity levels). To meet those care needs there has also been an increase in care costs that has been at a rate greater than CPI”.

Seeking to curb expenditure, without addressing the causative factors, is a knee-jerk reaction that stands to cause longlasting damage to our industry. Providers need stability, not volatile funding tides which only make delivery and planning of care harder than it already is.

It is sobering to consider the ramifications of continued decline for providers striving to improve quality, recruit and retain staff, and expand services to meet rapidly growing demand.

Government might have the right to determine what it pays for services but it is morally and ethically bound to ensure that care and accommodation for those who cannot provide for themselves is sufficient for wellbeing.

We do not have to cast our minds too far back to recall the impact of the ACFI freeze in 2013. While overall “care results”, defined by StewartBrown as care income less care expenses, have increased this year, they have still not returned to their

FUNDING

| FEATURES

pre-2013 levels. In fact, the average care result for 2015 was down 18% to $9.84 pbpd compared with $12.00 for 2012, even with the return of the Workforce Supplement.

next few years and providers must be able to bridge this shortfall through ensuring co-payment is factored into business models, irrespective of structure.

The change in guard on Parliament Hill since then is no excuse for a repeat of history, which unless managed through a codesign approach, will consign the industry to cyclical fiscal cliffs.

Our other challenge is to remove inefficiency from ACFI, such as the perverse incentive that sees providers paid more for taking longer to administer medications, rather than funding for the outcome of the right medicine at the right time for the right person, and allow providers to innovate systems (including safety and quality) to satisfy that outcome.

The findings by StewartBrown, which were mirrored by other firms including Bentleys, highlight that far from growing too fast, ACFI expenditure is lagging the growth in ‘true’ care costs.

We calculate that current funding indexation levels are one-third of what is needed for providers to keep up with rising costs, let alone expand their services. This year’s indexation rise was just 1.3%, despite healthcare costs rising by 4.4% in the last year.

These consequences of failing to address the real issues relating to ACFI are far greater than the ripples the Department is currently worried about. ■

Our industry also gets fixated with clinical care and costs, but we know infrastructure is costing more to build, maintain and operate. Aged care providers do not see any rebates for electricity usage or a fuel rebate for fleet logistics that other industries receive.

On the other hand, we must balance expectations on government with considering options for consumers who can afford to do so to remunerate you for good service. Means testing alone will remove $377M from ACFI payments in the

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CODESIGN IN PRACTICE:

THE STEP FORWARD PROJECT Earlier this year CommunityWest and COTA received funding from the Department of Social Services to launch a national project to support providers and communities codesign programs to innovate, solve problems or improve services with a wellness and enablement focus.

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here are now 10 pilot sites across Australia involved in the Step Forward – Together Project, which are trialing co-production principles and techniques and pooling the lessons learned into what will become a portfolio of guiding principles, tools and resources.

Each project is supported by a reference group of industry professionals, consumers, carers or their representatives, and deliver peer education sessions to support consumers to engage in the process.

Over the next year we will follow the pilot sites’ progress as part of a series showcasing codesign in practice.

Incorporating exercise into everyday life Uniting Communities is a for-purpose organisation operating and supporting people living in Adelaide both in their homes and residential facilities. Over time staff have become concerned people are at risk of becoming sedentary and dependant when they move into residential care or begin to receive more home care services.

People are at risk of becoming sedentary and dependent when they move into residential care or begin to receive more home care services.

When people enter residential care, their involvement in the daily household tasks they had undertaken for the last 50 years generally tends to cease. While most of us don’t enjoy housework, such tasks are an excellent source of exercise help maintain the normality of daily life. Uniting Communities wanted to encourage older people both in their own homes and in the residential facilities to keep active and saw an opportunity to engage residents in a different way.

Uniting Communities’ project as part of the Step Forward – Together initiative is to co-produce an exercise program based on activities of daily living. The project has two main purposes:

L-R: Lorraine, Sue and Mima

to improve the wellbeing of individuals with dementia through an exercise program based on daily life activities, and develop a visual resource to assist people to complete the exercises and understand the benefits.

The project will design basic task sheets outlining stepby-step activities to assist with promoting a range of movements. The types of daily tasks will include dusting, mopping, sweeping, hanging washing, washing dishes and gardening – all dependent on the abilities and interests of the older person.

Uniting Communities believes this project will encourage people with dementia to remain active, and promote a home-like environment for those people living in residential facilities.

Uniting Communities have formed a Steering Group to drive

Mel Ottaway, Executive Manager, Aged Care, Uniting Communities

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their project over the eight month period, consisting of five residents from the Felixstow Residential Facility, and five staff, including the lifestyle coordinator, site manager and clinical coordinator.

Mel Ottaway, Executive Manager Aged Care at Uniting Communities says they are already noticing changes in dynamics between staff and residents following staff training about the building collaborative relationships.

“The project has encouraged staff to look at residents differently, to do for, not with, which has been overlooked in residential aged care. It has challenged their thinking and done a role reversal by creating a more even relationship between staff and residents,” she said.

“We want people to view exercise as not something they have to go to the gym to do. It’s about changing mindsets and educating people exercise comes in different forms.”

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The group are currently meeting every six weeks, and are recruiting volunteers from residential facilities and the community to model the exercises. Although the original idea was to develop cue cards with pictures and step-by-step instructions, the group will decide the best way to display the exercises.

“Someone even suggested using YouTube,” Ms Ottaway said.

Kelly Gray, CommunityWest Training Consultant and Project Lead, says codesign is about changing relationships between people and breaking down traditional views and behaviours to facilitate true collaboration.

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A FRESH APPROACH TO GYMS AT

UNITING AGEWELL

The benefits of physical activity in ageing are well documented to reduce disability in later life and to maintain an independent lifestyle for as long as possible.

Uniting AgeWell, an organisation of the Uniting Church, offers many specialised options throughout Victoria and Tasmania to support health and wellbeing. These include residential care, independent and assisted living, home care, social support, therapy programs and respite.

Early in 2015, Uniting AgeWell’s Strathdon Day Therapy Centre purchased 10 pieces of the Helsinki University Research (HUR) gym exercise equipment, which use specially designed air resistance and smart card computer technology to support older people to regain and maintain fitness levels.

The Strathdon Day Centre wanted to create a gymnasium that addressed the barriers to physical activity among older people who felt they were insufficiently active. While ill health is the most common barrier to remaining active, social support is one barrier Uniting AgeWell believes it can significantly impact.

“The research showed us older people have a preference for group-based exercise and the company of peers while exercising,” Ana Mubaslat, Community Programs Manager said. “We wanted the HUR gym to be a strong motivator for older people in our local community to become involved in exercise. We decided a co-production approach would encompass these two elements.”

From this, an idea was formed to develop a peer buddy system in the HUR gym to provide people with the social benefit of exercising, as well as to support each other completing the exercises.

Uniting AgeWell’s Step Forward project is to identify and train peer buddies to specifically mentor those who identify as needing extra support on their exercise journey. The older people will then be involved in the co-design of their exercise program, as well as being mentor/buddy matched with a selected HUR gym member to address the positive and social enabling influence of exercising with a peer. If a consumer has an existing friendship with another HUR gym user, they are supported to mentor each other.

L-R (back row): B elinda Stewart, Clinical Care Manager; Bart Kelly, resident; Amanda Bennett, Site Manager; Josephine Markus, resident; Emma Calabro, Lifestyle Coordinator L-R (front row): Residents Athalae Deveth, John Casey and Pat Rassmussen.

Uniting AgeWell has formed a Steering Group to drive their project over the eight-month period, comprising four consumers and four staff including CDC project coordinator, volunteer coordinator and exercise physiologist.

“We want to use our experiences with this project to inform the sector in moving from professional-led models to innovative co-created approaches to wellness, health and enablement.

We, like many others, are a provider of packaged care, so we have to embrace co-production in this new environment,” Ms Mubaslat said.

Supporting staff a key to the success of a codesign approach.

“This is a new model for staff and it requires an adjustment in how they interact with consumers. It’s always been a professional-led model, so we will need to educate people about how to work in a co-production framework. But our staff are embracing the opportunity and fully supportive of it,” Ms Mubaslat said.

“We are trying to change the way we deliver a service; we want it to be in a co-production environment. Traditionally these are delivered by professionals; we want services to be delivered in the spirit of co-production. We also want the consumers to have a say in everything we do. If people have a say in their exercise program it will hopefully motivate them to participate in the gym program, according to what they want to achieve. ■

Ana Mubaslat, Community Programs Manager, Uniting AgeWell

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What it takes to service

RURAL AND REMOTE

communities

Whiddon has a long history of providing aged care services in rural and remote NSW. Our philosophy has always been to provide care where it is needed, which has led us into servicing remote communities such as Bourke and Walgett as well as entering into partnerships with community providers, when the challenges of providing quality care has surpassed capability.

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e know from long experience that the closer our services are connected to their local communities, usually the better the care and the more sustainable they are. We are a major employer in many of our more rural areas such as Casino, Kyogle and Narrabri. In some of our more engaged communities we have more volunteers than staff members, our Kyogle home for example has 40 staff members and is visited by 80 volunteers.

Chris Mamarelis Chief Executive Officer I Whiddon Group

to seek care up to six hours away and leave their home town, family and friends. This can add considerable stress to families already struggling with the scenario of admitting a parent into aged care. Being a major employer in many of our communities also adds to the sense of responsibility that we have to these communities, and the pressure to perform and commit to the long term.

Being at the heart of the community also means giving as well as taking. We hold community fairs to fundraise, we sponsor local sports teams and invest in community programs such as funding a local education grant for Temora Council to help students with further study. We try to use as many local suppliers and businesses as possible, we run creative ageing programs that are also designed to engage young people and school children and foster a greater sense of community.

We partner with organisations like Replay to offer training and employment opportunities to indigenous Australians in our communities. We spend millions of dollars annually on infrastructure renewal and refurbishment programs boosting the local economies and employment.

There is demand for aged care in remote areas within NSW but the challenge is scalability. We are looking at homes that may cater to as few as eight residents or as many as 40 but at this level it is extremely difficult to generate a viable business model due to the economic forces at play. In a commercial sense the development of new aged care services requires local demand drivers that result in building to scale and must also be supported by solid local median house prices (to facilitate acceptable RAD levels). Obviously this is not always the case in rural and remote NSW where higher supported ratios are also experienced. We need to find a way to drive sustainability through partnership with government or finding business models and a construction methodology that works within these challenging financial parameters.

Today, as we move into more of a demand-led market, the focus for all providers necessarily shifts to sustainability and staying competitive. While we remain committed to our rural and remote communities, a proactive approach to managing the mounting challenges remains a key to future success.

Compounding these challenges, and as any quantity surveyor will attest to, the cost of labour and material is generally higher in regional locations. Regional construction projects can attract locality indices of between 5-10% to cater for localised inflation.

The CEO perspective

The feasibility argument for these projects is further challenged by the ability to service, access debt and maintain an acceptable return on the investment given local economic conditions.

Our commitment to the more rural and remote communities means that older people living in the community are not forced

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Image courtesy of Darryl j Smith/shutterstock.com

Boosting local economies When we consider our annual payroll and the business we are generating for local suppliers, Whiddon is comfortably spending around $20M per annum across our more rural and remote sites. The investment in towns like Bourke, Walgett and Wee Waa is at around $0.5M-$1M per annum in the form of employment and local supplier spend. Larger rural areas such as Condobolin and Temora benefit from around $3M with Narrabri at approximately $4.5M. Our care homes use the services of local businesses such as the butcher, baker, pharmacy and many of the trades such as gardeners and electricians. Government also needs to consider our contribution beyond our role as provider of care and social services.

Maintaining high quality care Whiddon’s purpose is to deliver a consistently high quality of care and life enrichment to all its residents and clients, regardless of location. We have this ambition for even our most remote residential and community care services, which generally means that we subsidise services to enable them to offer the specialist care and positive ageing programs that we feel are important to supporting client wellbeing. For example, Whiddon offers a wide range of creative ageing programs, as the evidence is clear that creative expression and activities are very effective at improving quality of life for all our clients.

This includes AHI’s Play Up program, which is offered at every service, including the Far West Circuit. Cognitive Stimulation

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Therapy, arts programmes, singing and choirs, drama programs and pet therapy are other examples of programs that we offer in many of our services. We spend approximately $1M offering creative and positive ageing programs across the group annually that includes locations such as Bourke, Condobolin and Temora. The current funding instrument in residential aged care covers none of these programs.

Of course the remote services also need to maintain the same standard of accreditation, ACFI validations, food safety audits and other internal and external audits. While this can be a challenge for a service with minimal staff, we have found it to be an opportunity to showcase the varied and flexible roles that our staff perform in remote services. Some of the most positive remarks from assessors come from these small services as they talk to clients who truly feel “at home” and part of the family with us.

Employment and training Recruiting suitably qualified staff in remote areas can also pose significant challenges and costs. At times specific roles can only be filled by agency staff or by transferring individuals from other services, which is generally a short term solution that is costly. Whiddon invests in localised training, scholarships and recruitment strategies (such as tapping into the 457 Visa program).

The annual scholarships that Whiddon provides are available to all sites from Walgett to Kyogle. This provides local people

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with real education opportunities that they may not ordinarily have access to and includes tertiary education. We also participate in the Replay program, which offers training and employment opportunities to indigenous people in our communities. This has had some wonderful outcomes both for indigenous residents and the Replay graduates that we have working in our Whiddon services.

The tyranny of distance can be a particular challenge for providing community care services and require creative and practical solutions. We have managed to provide care services to the remote township of Elands, for example, by identifying staff members who live locally, and adapting their roster to enable the servicing of community care clients in Elands one day a week.

| FEATURES

Tweed Heads

Bourke

Casino Maclean Grafton

Walgett Wee Waa Narrabri

Wingham Largs Condobolin

Kelso

Kyogle Yamba

Laurieton Hamilton Adamstown Redhead

Belmont Hornsby Sydney Glenfield

Temora

Viability Supplements and other funding It is obvious that the viability supplements provided by the Commonwealth in regard to rural and remote aged care services need to be reviewed. The current supplement is restrictive, complicated and insufficient given the financial challenges we face in regional Australia. When we consider the financial challenges outlined such as localised inflation, recruitment, scalability and new construction opportunities the Government

needs to review the level of funding and also appreciate that operators are delivering much more than a care service to these locations. Often the largest employer in these rural and remote areas, our presence contributes significantly to the communities we serve both at a social and economic level. â–

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FEATURES |

WORKFORCE

SUPPORT AND GUIDANCE

HELPS SINGLE MUM SHINE IN AGED CARE ROLE Earlier this year, Rebecca Matheson found out she had won The Gordon’s Lifelong Learning Award, which is presented to an Ostara student who has demonstrated a willingness to include learning as part of their lifelong goals.

S

he was surprised to hear the news, and attributes it to finding the right support that helped her to get on track and achieve her dreams. “Winning this award just tells me that all the hard work and dedication over the past five years has been worth it. I’ve achieved something. It means everything!”

The journey to this point for Rebecca has been particularly tough. She has been diagnosed with borderline personality disorder and during her life has also battled with severe anxiety and other mental health related issues. As a single mother of three children, including a new baby, Rebecca was finding it very challenging to cope with everyday stresses and in addition, was experiencing financial strain due to long-term unemployment. Despite having no family support, she was eager to become a good role model for her expanding family.

Rebecca knew that she needed to study but didn’t know what she wanted to do.

The step that helped transform Rebecca’s life was registering with Ostara Australia, a national notprofit that assists people living with disabilities and mental health issues to transition into or back into the workforce while overcoming personal barriers. Ostara Australia provides specialist disability recruitment services to employers and places people disadvantaged through mental illness, disability, cultural background or age into sustainable employment. Over the last year Ostara has provided employment and vocational assistance to over 3000 Australians.

Employment is proven to benefit both physical and mental health; it provides a vital support network, social contact and a sense of belonging and engagement in the community.

“Research tells us that the high unemployment rate experienced by disadvantaged people is not due to

26

WORKFORCE

a lack of capacity or desire to work, but instead due to the perceived challenges employers believe they may face,” Ostara Australia CEO, Tom Baxter, said.

Ostara Australia works with employers to help them understand the many business and social benefits associated with employing disadvantaged job seekers within their organisation, together breaking down barriers and opening doors for everyone who wants to work.

In partnership with over 6000 businesses across Australia, Ostara Australia has placed candidates in sustainable positions across all industries, including aged care.

Ostara Australia is committed to strengthening its relationships with aged care service providers to assist with the growing need for enthusiastic staff in the future, and to assist disadvantaged people with achieving their employment dreams.

Blessed with a supportive teacher, who was aware of the additional challenges in her life, Rebecca thoroughly loved the course and proudly completed her certificate in September 2014.

As part of the course, students undertook a six-week placement with Uniting AgeWell at Kalkee Nangatta, Geelong.

Rebecca shone as a tenacious, hard working student who

| FEATURES

embraced every part of the job and was offered casual employment as a personal care worker at the end of the student placement. Her manager, Leonie Bray, says Rebecca is an inspiration to all the other students who come through.

Standing in front of a crowd of 300 people at the award ceremony, Rebecca thanked everyone who had supported her during her journey.

Ostara Australia Employment Consultant, Barbara, said that she was fighting back tears when she watched Rebecca stand on stage to receive her award. While Barbara supported Rebecca throughout her journey, she says, “all of Rebecca’s success has come from her own willingness and drive to achieve her goals. I’m so proud; she really deserves this recognition given what she’s had to overcome to get to this point.”

While Rebecca still has good and bad days related to her mental health issues, she says that being employed has had a huge impact on her overall wellbeing. “My first wage helped me get my car fixed and now I’ve been able to connect the internet. It was a huge deal not to have to rely on someone else to pay my bills for me. Having work feels like I’m really contributing to something now.” ■ For more information contact Ostara Australia on 1300 JOB SEEK or visit www.ostara.org.au

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How we work • Team approach, able to discuss processes to ensure the ultimate outcome is reached • Assist with implementation where required • Provide you with a sustainability plan Our experience includes • Operational reviews • Financial reviews • Regulatory requirements • Labour structures • Technology/equipment requirements Our clients include • Public Health and Emergency Services • Aged Care – public and private • Private health • Local government

WORKFORCE

| FEATURES

What a national code of conduct

FOR UNREGISTERED

HEALTH WORKERS

means for you

Dominique Egan Partner TressCox Lawyers

Zoe Hamilton Associate TressCox Lawyers

In its final report on the provision of a National Code of Conduct for unregistered health care workers, the Australian Health Ministers’ Advisory Council (AHMAC) has made a number of recommendations that will impact aged care.

T

he National Code is aimed at regulating the conduct of any person who provides a health care service but is not captured under the national regulatory system for registered health practitioners under the Health Practitioner Regulation National Law. The types of occupations which are likely be captured under the National Code include, inter alia, aromatherapists, assistants in nursing, dental assistants, dietitians, massage therapists, paramedics, sleep technologists, social workers and speech pathologists.

AHMAC’s final report was released following a national public consultation process, and discussion and revision of a draft code. It contains a recommendation that each state and territory give effect to the terms of the proposed National Code by enacting or amending legislation. This has not yet occurred in those jurisdictions that did not have existing regulatory codes for unregistered health care workers.

With respect to those jurisdictions that did have existing regulatory codes for unregistered health care workers, being New South Wales, South Australia and Queensland, the final report recommended that they undertake a comparison of the provisions in the National Code to their current regimes and make any amendments required to ensure consistency.

Queensland and New South Wales have already incorporated the terms of the National Code into their regulatory schemes, while South Australia anticipates that their amended code will be ready by late 2015/early 2016.

The key features of the National Code, as described by the CHC, are to provide: • A ‘negative licensing’ regulatory regime that does not restrict entry to practice, but allows effective action to be

taken against an unregistered health care worker who fails to comply with proper standards of conduct of practice; • A set of objective and clear standards against which to assess a health care worker’s conduct and practice in the event of a complaint or serious adverse event; • An independent investigator to receive and investigate complaints about an alleged breach of the National Code; • P ower for the independent investigator (or a tribunal) to issue prohibition orders and give public warnings about health care workers who have failed to abide by the required standard of conduct and practice; and • Offence provisions for any person who breaches a prohibition order to be prosecuted though the appropriate court.

The National Code contains 17 provisions, including in relation to obtaining informed consent, reporting unsatisfactory conduct of other health care workers, responding to adverse events, infection control, not practising under the influence of drugs or alcohol, not engaging in sexual misconduct, patient privacy and maintaining appropriate records.

The Australian Health Complaints Commissioners intend to implement a common framework for the collection and reporting of data and for annual performance reporting to the COAG Health Council. There will be an independent review of the National Code regulation regime after five years, or earlier if requested by the Health Ministers.

Unregistered health practitioners should familiarise themselves with the recommended terms of the National Code and adopt its principles as best practice, as it is expected that it will be given legislative effect in each Australian jurisdiction in the near future. ■

29

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30

INNOVATION

IMPROVING QUALITY A KEY FOCUS FOR ITAC AWARD WINNERS

A common theme of quality improvement featured in each of the winning entries of the 2015 ITAC awards, presented at the conference gala dinner in November. The annual conference, held at the Gold Coast, attracted over 250 delegates and saw the latest in aged care, assistive and business technology on display

J

udge and Chair of the ITAC organising committee, Rod Young, said the calibre of entries reflects the increasing role and influence of IT in aged care from clinical practice through to human resources and business management.

“We are delighted to announce the winners of the ITAC awards for 2015, all of whom have developed or implemented technology with an ultimate goal of improving the quality of their service delivery, and through that the experiences of older Australians,” Mr Young said.

“The adoption of IT across every area of age services, from clinical and wellness programs through to human resources and business management, is improving standards, experiences, efficiencies and outcomes.”

Innovation and quality go hand in hand, and with a review of quality standards underway it’s important we continue to showcase all types of innovation.

“The Aged Care IT Council is committed to recognising and showcasing innovative ideas that don’t always require big budgets or drastic change. As we have seen once again at tonight’s awards ceremony and the ITAC event, the possibilities really are endless for both IT vendors and age service providers,” he said.

LASA CEO, Patrick Reid, said the variety of innovations recognised shows providers are driving quality standards from the ground up.

“Each winning entry had an overall goal of quality improvement, and even when systems were developed for internal purposes there were clear linkages to improving services and outcomes for older Australians,” he said.

Suri Ramanathan and Rod Young

“We know that innovation and quality improvement go hand in hand, and with a review of quality standards underway it’s important that we continue to showcase all types of innovation, however small or large,” Mr Reid said.

In addition to the industry awards, two further accolades were presented to Rod Young and Suri Ramanathan who were inducted into the Hall of Fame for outstanding contributions to ICT in aged care.

“Both Rod and Suri have worked hard over many years to ensure ICT and aged care are considered by all industry stakeholders, particularly government. Their efforts in bringing together vendors, providers and government are helping to ensure aged care has the ability to build capacity and capability to meet the increasing demand from our ageing population,” Mr Reid said.

31

INNOVATION

Flexicare

Best Implementation of the Year (facilities with <$5m income) Winner: Flexicare Inc – Home Care Package Infrastructure Best Implementation of the Year (facilities with $5m-$30m income) Winner: Adssi Home Living – Quality Management System Best Implementation of the Year (facilities with > $30m income) Winner: Wesley Mission Brisbane – Clinical information made mobile Best Implementation of the Year for Infrastructure (hardware/software) Winner: Sundale’s Data Centre Move – NextDC ICT Innovative Company of the Year Winner: Webstercare – medication management chart for residential aged care homes (RxMedChart) ICT Innovative Entrepreneurial of the Year Winner: Community Care Smart Assistive Technology Collaborative

32

About the winners Flexicare Flexicare Inc needed a cost effective and intuitive IT solution so case managers and podiatrists could access client information remotely, and effectively and securely communicate important, relevant information about the client’s visit in real time. They developed new processes and purchased new technology including tablet devices for all case managers and podiatrists to enable this. Flexicare Inc says their innovative approach has enhanced client care outcomes, improved staff morale and efficiency, while enabling them to deliver more services to clients.

Adssi After finalising its new strategic plan which features five business goals, Adssi recognised that in order to meet these goals a new electronic Quality Management System was required that could integrate human resources activities. The new I.On.My Thoughtware system enables Adssi management of suppliers, feedback items, policies and procedures, quality improvement projects, incidents and human resources activities such as training and events. Using a number of tools

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| TECHNOLOGY

procurement

33

INNOVATION

Adssi

Wesley Mission Brisbane

they were able to implement the system remotely saving time and cost, while maintain strong communication with staff.

Adssi believes the system demonstrates what can be achieved by a small organisation with limited resources.

meant supporting care practices improvements, governance/ risk mitigation processes and invigorating staff. The system implementation included the rollout of a mobile touch screen tablet/device for every staff member to use the clinical system ‘on the go’; building works to embrace IT infrastructure requirements including the implementation of wifi at all WMB Aged Care facilities; creating a ‘software implementation team’ who could configure the software as requirements and best practice evolved; developing a purpose-built App with clinical software vendor, Leecare, that mirrored our working desktop

Wesley Mission Brisbane Wesley Mission Brisbane sought to improve holistic care to residents and clients by implementing a single system with various components that would ultimately support an efficient, quality and user-friendly electronic clinical system. This

34

INNOVATION

Sundale

Community Care Smart Assistive Technology Collaborative

system; integrating Active directory with other software; working with pharmacies to plan for an e-medication system in near future; and promoting and embracing a paperless system throughout every aged care business unit.

Webstercare

Sundale The moving of infrastructure from the local server based in Cooroy and hosting it all at the NextDC-managed service in Brisbane was a business critical decision that carried high risk for Sundale. A very precise project plan was developed using JIRA, with checks and balances occurring during the transition process. A trial run was initiated to ensure the dismantling of the equipment, packing, transport, reassembly and connection could take place within the critical time period between backups (12 hours). Sundale and their professional services vendor entag and other entities, developed the solution realising that every infrastructure system has its own unique design and you could not follow a plan carried out by any other companies.

The RxMedChart system is a unique solution to medication management in Residential Aged Care. It is the first computer-generated medication chart which is also valid as a prescription under the National Health (Pharmaceutical Benefits) Regulations 1960. As a computerised medication chart it provides a single sources of information for a resident’s medication profile to all members of the healthcare team.

The information integrates across all software used to manage medications by the prescriber taking the decision to prescribe, the pharmacist dispensing medications and the nursing staff ordering and administering medications to a resident.

It enables a medication chart to document a resident’s medication profile and it can be used by the pharmacist to dispense medications. ■

Community Care Smart Assistive Technology Collaborative The purpose of this collaborative is: • To promote the use of assistive technologies in service provision through knowledge sharing and collaboration • To raise awareness of the various roles of Smart Assistive Technology and its applicability in community care service provision • To provide practical information on how Smart Assistive Technology can be incorporated into service delivery and business models • To encourage collaboration and knowledge sharing • To gain an understanding of Service Providers and gauge their attitudes.

The Collaborative attributes its success to having a clear purpose and vision which was underpinned by an evidence base, as well as strong linkages and networks with international partners to provide content and connections around new products, research and development Webstercare

35

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INNOVATION

CULTURE, LEADERSHIP & PERSISTENCE KEY TO INNOVATION For more than 30 years Webstercare has been an innovation-led company at the vanguard of solving problems Australians have with managing their medication. Its latest design, the RxMedChart system, saw Webstercare named Innovative Company of the Year at the ITAC 2015 awards.

M

anaging Director Gerard Stevens AM, was credited with being the driving force behind a culture of achievement, providing the structure, leadership and resources to drive innovation.

This culture was recognised in 2013 when BRW magazine named Webstercare as Australia’s 6th Most Innovative Company.

The privately owned Australian company began its journey of innovation about 35 years ago with the invention of the Webster-pak – the world’s first multi-dose medication management packing system.

“Our focus then was the aged care sector, and it continues to be today, with more than 600 product lines devoted to solving medication issues, particularly for the elderly,” said Gerard Stevens.

“The aged care industry is asked to drive and lead innovation and change. After all, with funding pressures and an ageing population, we are continually asked to do more for less and the only way to do it is through innovation. That is, developing new ways to achieve better results with fewer resources.”

“Expectations from innovation are high but so are failure rates.

Just because an idea is good doesn’t mean that it will succeed through to implementation,” said Mr Stevens.

Collaboration In addition to supporting the safe use of medicine, Webstercare has also demonstrated how medication management can support deprescribing and improving judicious use.

A joint project with Southern Cross Care utilised the NPS MedicinesWise Quality Use of Medicines report Antipsychotics for behavioural and psychological symptoms for dementia and demonstrated how of electronic reporting resources could deliver patient improvements across a range of measures, and drive positive staff cultural change aged care facilities.

The QUM report was the result of another Webstercare collaboration with NPS. For Southern Cross Care’s 1,800 residents in NSW and ACT, the project resulted in effectively managed deprescribing, evidenced by increased function, decreased falls and disorientation/confusion, improved communication and appetite in individual residents, increased participation in assisted daily life, decreased extrapyramidal side effects, insomnia and the promotion of natural sleep patterns.

These outcomes help decrease the risk associated with frequent hospitalisations, directly improve quality of life for residents and have immediate cost benefits to the health care system as a whole.

The project also drove cultural improvements within Southern Cross, with staff reporting higher levels of empowerment in their roles, increased knowledge about the use of antipsychotics, increased confidence and an ability to manage behavioural and psychological symptoms of dementia with non-pharmacological intervention. This all facilitated an organisational culture change that has improved the quality use of psychotropic medicines in residential aged care.

INNOVATION

Stepping stones

medicine order/prescription by reviewing and confirming that the medication should be continued, ceased or dosage changed, before signing and dating each order, either at the aged care facility or at their surgery.

The RxMedChart system is an evolution from the National Residential Medication Chart (NRMC), a federal government initiative that was developed to streamline medication prescribing, dispensing and administration within aged care while also reducing risk at each stage of the medication cycle.

Mr Stevens said that in one state the doctor is still required to handwrite each item. â&#x20AC;&#x153;This is inconvenient, unnecessary and frustrating for doctors, especially considering that it goes against best industry practice.

We hope that this bureaucratic anomaly will soon be overcome.â&#x20AC;?

Previously, a prescriber had to write a medication chart, then duplicate the medication order on a prescription. The chart is necessary as a communication tool. The prescription is necessary to access PBS medicines. Duplication increases risk of error and adds considerable workload for everyone.

The Prescriberâ&#x20AC;&#x2122;s Order is interpreted and confirmed by the pharmacist, performing the usual checks required for the dispensing process, before entering the information into Webstercare medication management software system (MMS) for packing the medication in the usual way. Any changes to the residentâ&#x20AC;&#x2122;s profile in MMS is emailed to the prescriberâ&#x20AC;&#x2122;s software so they maintain a complete record of changes in their software.

Stevens had always thought combining the medications chart and the prescription for the term of the chart was a logical approach and began the lobbying for innovation in 2004. â&#x20AC;&#x153;We recognised that the adoption rate of computerised charting within aged care facilities was increasing and for good reason,â&#x20AC;? said Mr Stevens.

Following RxMedChart workflows, the pharmacist will audit and check the medication charts at the facility every four months, then print the Prescriberâ&#x20AC;&#x2122;s Order on the medication chart stationery. This computer-generated chart will be given to the prescriber to review and sign each individual medicine order.

â&#x20AC;&#x153;For consumers they reduced the chance of transcribing errors, not to mention errors due to the legibility of some doctorâ&#x20AC;&#x2122;s orders. They also improve process efficiencies for the prescriber, dispenser, and especially for the administration process within facilities.â&#x20AC;?

During the review process the prescriber will take the decision to continue, change or cease the medicine order depending on their assessment of the resident. During the medication dispensing and Webster-paking process the pharmacist will always refer back to the prescriberâ&#x20AC;&#x2122;s original handwritten order as the â&#x20AC;&#x2DC;source of truthâ&#x20AC;&#x2122;.

â&#x20AC;&#x153;So when we trialled RxMedChart in three states, we were delighted, but not necessarily surprised, to receive excellent feedback. In the months since it has gone to market, we continue to receive positive feedback,â&#x20AC;? said Mr Stevens.

Instead of handwriting every drug, as required by the NRMC, the doctor is presented with the RxMedChart folder which is printed by the pharmacy after the chart currently in use has been audited by a pharmacist.

This model allows all levels of aged care staff to be confident of the prescriberâ&#x20AC;&#x2122;s intentions before medications are administered.

Furthermore, the computer-generated medication chart is consistent with the principles of ACSQHC recommendations for legible terminology. â&#x2013;

The RxMedChart workflow (see flowchart below) demonstrates how, after reviewing the resident, the prescriber initiates every

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40

INNOVATION

THE LATEST IN ASSISTIVE TECHNOLOGY 2015 has seen a new wave of assistive technologies become available to consumers with FitBits and the Apple Watch taking the market by storm. Wearable technology is evolving quickly and over the next few years it is tipped to revolutionise aged care.

S

hara Evans, technology futurist, shared some of the types of assistive technology we can expect to see in the short term and how they will impact care delivery and health outcomes, with delegates at LASA National Congress. Here’s a snapshot of just some of what is heading our way.

Health monitoring devices Beyond the basic fitness stats, health monitoring devices are evolving to include every imaginable body function. Sleep and movement patterns, weight, heart rates, oxygen and temperature will all be trackable remotely before 2020 thanks to the latest innovations from Apple, Google and Microsoft and BlackBerry to name a few. The Apple Watch has a heart-rate sensor and quantifies when you move, exercise or stand. Apple has also filed a patent to upgrade its earbuds to measure blood oxygen and temperature. Google is working on a smart contact lens that can continuously measure a person’s glucose levels in their tears.

Smart clothes The next step to devices worn on the body is “smart” clothing.

This will include socks that can alert people remotely if someone has fallen over or goes for a walk – ideal for carers of people with dementia – and can include GPS tracking. Other clothing items are connected to smoke detectors. Shirts that measure heart rate, breathing rate, can tell how much sleep you are getting and workout intensity are already on the market.

Ingestible devices Ingestible devices will open a whole new world for measuring vitals and body function and fall into two categories: those that stay in your bloodstream and provide ongoing information and those which pass through the body. America’s FDA has already approved an ingestible sensor that monitors how much medicine is absorbed by the body through a bluetooth app, and PillCam COLON that gives you a colonoscopy by having a light and two colour video cameras within the pill.

Google is allegedly working on building a nano-size particle that will travel in the bloodstream and attach to particular types of

cells, such as cancer cells, or to enzymes given off by plaque in the arteries before they are about to rupture or cause a heart attack or stroke. If the particles found questionable cells or enzymes, they would send a signal to a device worn outside the body that would transmit the information to the patient or to a physician.

Hologram chef A great invention to help people living at home to cook or prepare healthy meals. Combined with smart appliances, this will bring a new level of safety for people living with disability or elderly people living on their own.

3D food printing 3D printing of food is here and it offers a great potential for personalized diets for people suffering from chewing and swallowing difficulties. In Germany, 1000 nursing homes serve a 3D-printed food product called Smoothfoods to elderly residents who have difficulty chewing. Said to be tastier than conventional purees, Smoothfoods are made of mashed carrots, peas, and broccoli, which 3D printers congealed with an edible glue. ■

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WHERE RESEARCH MEETS REALITY:

THE SCIENCE AND DESIGN BEHIND DEMENTIA CARE HOUSING Earlier this year Paynter Dixon completed a $4.9 million project for Cooinda, which saw three years of careful research and design culminate in an award-winning dementia care wing.

R

esearch conducted over the last 20 years indicates that a person’s sense of self supports their ability to act, even when they have dementia. The creation of an environment that assists a resident with dementia to make choices goes some way to meeting their unmet needs and any resulting agitation.

In planning for a new special care unit to replace its existing facility in Gympie, the team at Cooinda Aged Care determined they wanted a building design and model of care that embraced these research findings. “Our vision was to create an environment that supported residents to do the things they can still do,” said Cooinda CEO, Robyn Kross. “It’s important that we don’t try to fit the resident into the facility and its routine, rather we fit our routines around theirs, supporting their independence and ability to exercise choice.”

To enable this vision the company partnered with Paynter Dixon, utilising their aged care specialist team to explore ways to implement evidence-based design principles while maintaining the relaxed, rural ambiance integral to the rich tapestry of their 40-year history. Participation in Paynter Dixon Study Tours provided an opportunity to gather ideas on design features and business models from facilities in New Zealand and Germany that maintain resident’s dignity and sense of self, while supporting their independence.

The result is Cooinda’s new secure 24-bedroom special care unit, which was completed and opened in April 2015.

This unit has won both the Regional and State Queensland Master Builders Association (QMBA) awards for lifestyle accommodation for seniors, and has recently been awarded an Australasian Over 50s Housing Award for the Most Outstanding Rural Aged Care Facility.

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Early comparative assessment of existing Cooinda residents who moved into the new special care wing show an overall improvement in levels of agitation (utilising the CohenMansfield Agitation Inventory) and a movement towards increased independence (based on Modified Barthels Index Score results). These trends appear to support the positive impact of design and model of care on resident quality of life.

Cooinda is working with the University of Tasmania to further investigate and understand these initial results.

Facilitating Orientation Mobile people with dementia find their way around their environment using information that is familiar and readily accessible, moment by moment, as they move along a path.

The design of this special care unit ensures that circulation through the unit takes the form of short continuous loops that are interesting and familiar, easily connecting the bedrooms with social spaces and gardens. Readily accessible spaces offer a variety of choices depending on whether the resident wishes to engage, observe or withdraw.

The central dining, lounge and associated open verandah areas offer a feeling of openness, light and connection to the outdoors while preserving distinct spaces that support more intimate interactions. This is achieved through a combination of a glassed wall that runs along the full length of the room, incorporating two 4m sliding glass doors which open out onto

44

the outdoor living area, and considered placement of furniture both inside the building and on adjacent verandah areas.

Angled corridors leading towards this central area, combined with non-visual cues such as the smell of bread cooking in the servery or the sound of age appropriate music from the jukebox in the lounge area, mean that while there are points in the unit where residents can’t see where they are going, they can nevertheless sense it. Wayfinding is further enhanced through signage that combines words with pictures, a clear line of sight from the resident’s bed to their toilet, memory shelving at the entry to resident’s bedrooms and blending of storage cupboard doors with the unit wall colour to minimise confusing choices.

Careful Lighting Lighting is important to both the ageing eye and people with dementia. Good lighting can make the most of people’s capabilities and can assist them in making their way around new and familiar surroundings. For example, light uniformity reduces shadows that can be misinterpreted by people with dementia as obstacles. Access to natural daylight provides high levels of diffuse light over a wider area. In addition, the changes in lighting levels over the course of the day help residents’ awareness of the passing of time and thus support normal sleeping patterns. “Cooinda maximises the utilisation of natural light through the north east orientation

of the building and the use of large windows and outdoor living areas that increase light penetration into resident areas. This is further enhanced through clerestory windows in the central living area,” Paynter Dixon Design Manager Chris Jacobsen explained. From an operational perspective, an additional energy efficient benefit is the reduced requirement for artificial lighting during daylight hours.

Promoting Independence Cooinda provides opportunities for residents to move around the unit freely, including unrestricted access to landscaped garden areas offering features such as a men’s shed, a potting/ gardener’s shed, a car in a garage, and a windmill and tank.

Natural stone walls, picket fences, water features and a small bridge over a water course provide unique ‘stopping places’ that evoke reminiscence of an earlier time and to which residents are naturally drawn. Residents and their families access these areas throughout the day and enjoy al fresco dining on mild evenings.

The design purposefully faces the building and outdoor courtyard into a steep embankment on the eastern face, which acts as a natural security fence. This minimises the feeling of being ‘fenced in’, while the landscaping of the embankment provides a wonderful visual outlook from all areas of the building.

A variety of seating spaces with varying degrees of social connectedness provided throughout the unit and gardens allow residents to choose where they ‘want to be’ at particular times throughout their day, conveying a level of control back to the resident.

The design of the unit’s servery, which was inspired by examples seen in Germany, is open and accessible for residents and has a seating bench along the length of the joinery. Residents are able to actively participate in familiar kitchen activities or, if they choose, sit and engage less actively in this domestic setting. Cooinda’s staff team led by an Occupational Therapist, are focussed on supporting residents to make the most of their remaining abilities, and to exercise choice and independence.

A common finding that has become visible through review of many small, non-randomised researched projects over the past twenty years is that the desire for autonomy is of primary importance to residents of aged care facilities. With this in mind, Cooinda has focused on supporting resident autonomy and independence through applying research principles to building design, model of care and culture in their exceptional special care unit. ■ For more information contact Kerrie Storey or Erica Lambert at Paynter Dixon Queensland on 07 3368 5500.

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46

EAST MEETS WEST

AT JETA GARDENS

Jeta Gardens is regarded as Australia’s first retirement and aged care community to successfully blend the concept of eastern values and philosophies and western care into its design, services and management.

A

bout 30 minutes south of Brisbane in Bethania, Queensland, Jeta Gardens is a new 72-bed facility which combines tranquillity with convenience.

Situated in 60 acres of landscaped gardens and parklands which have been done in a traditional Eastern style, not only does Jeta Gardens set a new standard of integrated planned facilities for the aged care sector, but it adheres to the eastern philosophies of filial piety, compassion and respect for elders.

Driving this was the unique vision of Jeta Garden’s founder, Mr Choe Lam Tan, who wanted people to experience and celebrate cultural diversity within retirement and aged care communities, combining Eastern values with the latest in Western technology and aged care services.

Designed by leading international architectural firm and aged care specialists ThomsonAdsett, the design itself champions the idea of ‘the home’ and the small house model for planning.

Discrete and intimate households of 12 form the basis for the

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DESIGN

arrangement of the new building. The houses are designed to facilitate a scale of interaction not dissimilar to a large family.

All nursing functions within the house are minimised to three locations, with the ‘nurse station’ adjacent to the kitchen. Staff are trained to work on the floor, building relationships with residents rather than ‘nursing from a desk’. The nursing areas are also discrete, but well placed for passive observation.

Similarly, the way finding logic explored in the planning encapsulates the concept of empowering an individual to be part of the family within the house, the design encouraging the resident to do this without the assistance of staff.

This simple assumption is that if you can walk to your bedroom door you will be able to see activity and therefore be encouraged to socialise and participate.

This concept of purposeful wandering is also recognised in the built form. The design is focused on creating a clear and strong visual connectivity to activity opportunities. The main premise behind the planning and aesthetics, is that if you structure an environment in a way that people are able to understand and it is perceived as natural and normal, then they will respond to it and socialise in a natural and normal way.

Jeta Gardens, its staff, residents and visitors alike are excited about the new building, its facilities and surrounds. The result is a harmonious blending of Eastern and Western cultures, and importantly, a fresh approach to Australian aged care design and seniors living. ■ For more information contact Matthew Hutchinson, Sector Leader Seniors Living & Partner at ThomsonAdsett, on 07 3840 9999.

48

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49

BUSINESS MANAGEMENT

Bentleys’ National Aged Care Survey 2015:

HOW PROVIDERS ARE EVOLVING The Bentleys National Aged Care Survey is an industry benchmarking tool that has been monitoring and measuring financial performance across the aged care sector since 1994.

I

n 2015, data and feedback was again collated from a sample of aged care providers with not-for-profit, for-profit, urban, regional, large and small providers represented.

The insight from this data collection provides a snapshot of how providers in the industry are faring, with some interesting insights showing through.

Key amongst this year’s findings:

EBIT has increased Since the reforms introduced in July 2014 the average Earnings Before Interest and Tax (EBIT) for a provider participating in the Bentleys National Aged Care Survey has increased by around $2000 – to $6278 per resident per annum.

Drilling down into the data, we note that there are some clear areas where the top 25% of providers (based on EBIT) in the survey sample most contributed to this improvement.

Technology enablers

Kate Beckman Accountant I Bentleys Qld

gain efficiencies in these service expenses through economies of scale with costs are being shared within these groups.

While achieving these savings is more challenging for smaller operators, these findings should encourage ongoing discussion around collaboration with other providers/facilities to achieve buying power.

Accommodation pricing The survey snapshot shows an increase in the average lump sum (RAD) collected from consumers since the reforms were introduced. Providers appear to have been positively impacted by the removal of the demarcation of high and low care residents. The average RAD collected during the year was around $242,000, or an equivalent daily charge of $40.71, higher than the pre July 2014 maximum accommodation charge for high care residents set by the government.

Active management delivers better outcomes

As a whole, subsidies The top 25% of providers received by providers have show a higher level of increased. Drilling down understanding of the Care staff now provide a higher percentage of into the survey data, we can efficiencies that can be identify that this is owing to hours versus support staff than 10 years ago. captured in the area of a number of key factors – in administration. We have particular, active management seen evidence of providers of ACFI profiles by DON staff. rolling out various technology enablers to save their organisation time and money. Examples The requirements of aged care residents are changing. More include timesheets – providers who have moved their and more aged care clients are electing to remain in their own timesheets to a cloud based system can save around three to homes and access home and community care services. This four hours on a weekly basis across their workforce than those means the proportion of residents with acute needs at the time using manual timesheets. of entering a facility is higher.

Services seeking synergies The top 25% of providers recorded significantly lower expenses in cleaning, laundry and catering. Larger providers

50

In an acute care environment it’s not uncommon for a resident’s care needs to change dramatically in a short time frame. From a provider’s perspective, active management of

BUSINESS MANAGEMENT

resident profiles is critical to ensure that the appropriate levels of subsidies are accessed.

The benefits of this active management are evident. Last year a survey participant undertook a comparison of their performance against the top 25% of providers from last year’s survey, and as a result made strategic changes to focus on regular assessment of their residents. Within months they experienced a sharp increase in subsidy income, and they have recorded far stronger performance metrics in this year’s survey.

Activity based costing Aged care clients are becoming increasingly sophisticated in their requirements so there is opportunity to think outside the box as to different services over and above what providers have previously been offering. This generation is expecting retirement villages to provide a ‘lifestyle’ with extra services such as gyms, pools, theatres, hair salons and other activities.

Forward managing the aged care business model to deliver this level of service (and subsequent impacts on profitability) requires providers to understand both their costs through the Activity Based Costing (ABC) approach and the demand and capacity to pay from consumers.

This approach is has been used in many industries in recent years such as the airline sector where operators such as Jetstar have created a targeted pricing model using activity based costing. Starting at a base price that passengers are willing to absorb that covers the core service they seek (i.e. transport) – these operators then offer ‘extras’ such as catering and entertainment to give clients various option preferences to upgrade.

In the aged care key activity streams can be broken into accommodation, services and care.

To apply the ABC approach we need to firstly understand what consumers/the government are willing to pay for core services (accommodation and care) and then identify the non-core or customisable services where ‘extras’ pricing can be developed based on what consumers will pay. We then need to develop pricing around what the provision of these services would cost the organisation.

‘Extra services’ could be things such as complementary/ natural therapies (massage, osteopathy, aromatherapy), counselling and support, organic food options, room service, non-emergency patient transport, technology rental, leisure activities, entertainment (theatre subscriptions), or property management services.

51

Image courtesy of GBZero/shutterstock.com

There is growing evidence of residential aged care providers embracing this approach. Home care providers have recently undergone this shift to adopt an ABC approach in line with the Consumer Directed Care changes from 1 July 2015.

The learning curve is upon us and we will be charring this course with interest.

The ABC approach means identifying customisable services where ‘extras’ pricing can be developed based on what consumers will pay.

Staffing mixes have changed We are facing an environment where residents are increasingly absorbing more of the cost of their care (as opposed to government footing the bill). To remain competitive and sustainable in the industry, providers need to ensure that inputs going into the service delivery are balanced appropriately to get the best utilisation of resources.

52

Our comparison of staff hours data collated in 2005 to that collated in 2015 indicates a higher percentage of hours is provided now by care staff (per resident per fortnight) versus support staff than it was back then. So our ratios have improved for the better and more is going into care.

However, the staffing mix has changed. There has been a shift toward upskilling carers on the front line, such as aged care nurses, assistants in nursing and personal care workers.

This is due to the fact that care tasks are now being allocated based on level of qualification. Carers are taking on more of the rudimentary, everyday tasks allowing more qualified care staff (e.g. RNs and ENs) to be freed up to address the more acute needs of residents.

This follows the “arbitrage” pattern of other industries especially health services, where skills utilisation and defining different roles and responsibilities forms part of the efficiency dividend.

Overall, the 2015 Bentleys National Aged Care Survey has revealed providers are evolving in line with the changes occurring across the industry. ■ For more information about the survey visit www.agedcaresurvey.com.au

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COMPUTER SOFTWARE

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BUSINESS MANAGEMENT

Why you should

ALWAYS BE PREPARING

your business for sale

One topic discussed in a Masterclass at the recent LASA National Congress was the impact that changes in the relative proportion of RADs versus DAPs had on the EBITA per bed in nursing homes.

It was noted that this had potential to impact the value of a business.

L

et me explain why. A common basis for valuing a business that is a going concern is the capitalisation of future maintainable earnings method.

When using this method, a valuer first assesses what is the likely ongoing annual economic returns from an activity, or future maintainable earnings. This is usually based on the analysis of historic financial information and the assumption that current trading conditions will continue. EBITA per bed is a common industry measurement and importantly, closely related to future maintainable earnings.

Geoff Campbell Partner I Duesburys Nexia

However one strategy that may improve the bottom line, but not impact on the value of a business is the owners taking on more work, or being paid less than market rates of remuneration. This is because when determining future maintainable earnings a valuer makes a number of adjustments to historic financial information including adjustments to include the market value of the personal exertion of owners. Adjustments are also made in relation to nonarms length transactions such as rental payments made to related entities and non-business expenditure.

The Governmentâ&#x20AC;&#x2122;s higher accommodation supplement The overall value of a business and the ability to charge higher Care must be taken when seeking to drive is then calculated by a multiple fees for newer accommodation growth in EBITA through capital investment. being applied to future can be a strong investment maintainable earnings. This Over-investing while increasing EBITA can incentive. But care must be valuation is first allocated to the generate a lower overall return. taken when seeking to drive fair value of tangible net assets growth in EBITA through capital utilised in the business with the investment. Over-investing while increasing EBITA, can generate a remainder forming goodwill. Other assets included as part of a lower overall return on investment. potential sale are valued separately.

Business owners and managers are encouraged to seek advice Whilst rules of thumb are sometimes used, the determination from accountants and other advisors with knowledge of the aged of a multiple is very subjective and is a substantial component care industry when evaluating capital investment proposals. of many business valuation engagements. At very least, the Methods such as discounted cash flow analysis can be used to multiple warrants detailed analysis of risk, required rates of return determine whether or not projects meet required rates of return, and barriers to entry in the market. The multiple should reflect a as well as providing valuable information such as the timing of required rate of return i.e. a multiple of 4 equates to a 25% return peak borrowings and payback periods. on investment.

Improving the bottom line should be an ongoing activity, not But despite the subjectivity of valuations and the fact there just a priority when preparing a business for sale. Not only will may be other motivating factors behind an offer to purchase a business owners benefit from improvements to their income, any business, when preparing a business for sale it is in an ownerâ&#x20AC;&#x2122;s unexpected offer to purchase a business is likely to have greater best interest to improve the bottom line. potential, all other things being equal.

This can be done in a variety of ways including the tightening of Interestingly, not all business valuations are undertaken in expenditure, more effective marketing strategies and ensuring relation to the possible sale or purchase of a business. Many are the business is generating the most from its revenue base. Your undertaken for banks, for stamp duty purposes, to determine accountant can assist you in identifying opportunities through damages or the ability to access income tax concessions. â&#x2013; their knowledge of similar clients and industries, and through unit For further information visit www.nexia.com.au costing and benchmarking activities.

55

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BUSINESS MANAGEMENT

Operating performance trends

in Residential Aged Care In its recently released third annual report the Aged Care Financing Authority (ACFA) reported that industry financial performance in 2013-14 was relatively strong with average Earnings Before Interest Tax Depreciation and Amortisation (EBITDA) increasing by 6.5% from 2012-13 levels.

W

ith the aged care industry transitioning to a more consumer-focused model and the government continuing to manage the supply of places and much of the industry funding understanding the underlying trends in macro performance can provide early insight into the challenges at a provider level.

RSM’s analysis of the three-year trend in industry profitability, industry operating efficiency and performance by the quartile bands suggests that despite the relatively strong performance in 2014 there remains much to do to ensure the industry’s long term sustainability.

Industry Profitability As ACFA points out industry EBITDA and NPBT grew by 7.3% and 19.9% respective between 2013 and 2014.

Table 1 shows what this means when the 2012 results are included in the analysis.

Table 1

EBITDA

2012

2013

2014

$1,544bn

$1,473bn

$1,581bn

-4.6%

7.3%

$594M

$710M

-18.2%

19.5%

Year on year change NPBT Year on year change

$726M

3 year trend 2.4%

-2.2%

While profit as measured by EBITDA and NPBT increased in 2014 this has only restored these measures to their 2012 levels.

Bruce Bailey National lead of aged care and retirement living practice RSM Bird Cameron

To truly appreciate the level of profit within the industry these aggregate measures have to be related to the number of places in each of the relevant years. As can be seen from table 2 when this is done there hasn’t been any change in operating performance of the industry.

Table 2 2012

2013

2014

3 year trend

EBITDA per active place

$8,453

$7,908

$8,353

No change

NPBT per active place

$3,975

$3,189

$3,751

No change

Industry Operating Efficiency Just as a more forensic analysis of aggregate EBITDA and NPBT provides greater insight into the operational performance of the industry so too measuring operational efficiency provides greater understanding as to what is happening within the industry Aggregate EBITDA or NPBT are not measures of operational efficiency. At an industry level changes in EBITDA and NPBT relative to revenue over time show how operational efficiency is changing. These measure shows whether it is costing more or less of the available revenue to deliver the services over time.

In an industry where government controls approximately 65% of the income changes in the measure of operational efficiency is of interest to both government and providers.

Again, analysing the trend over three years provides interesting insights:

57

BUSINESS MANAGEMENT

2012

2013

2014

EBITDA to Gross revenue

11.8%

10.6%

10.7%

NPBT

5.6%

4.3%

4.8%

This clearly shows that operational efficiency declined between 2012 and 2014. The trend in the efficiency with which services are being delivered is consistent with the aggregate trend in industry profitability.

Performance of the quartile bands A third measure of industry performance used by ACFA is the change in quartile EBITDA. Table 3 below shows the trend in quartile performance over three years: 2012

2013

2014

3 year trend

Quartile 1

$21,081

$19,825

$21,889

4%

Quartile 2

$10,394

$9,884

$10,357

No change

Quartile 3

$5,654

$4,468

$5,067

-10%

Quartile 4

-$3,646

-$5,276

-$8,866

-242%

As the ACFA report notes the third quartile had the most significant improvement during 2014, however, this still leaves the average profitability of this quartile 10% below the level of 2012. Only the top quartile has seen an increase in average profitability as measured by EBITDA between 2012 and 2014.

While the industry has experienced very little operator failure to date, the dramatic decline in performance of the bottom quartile is significant. When the average performance of this quartile is aggregated it suggests that providers in the bottom quartile collectively lost $420,000,000 at the EBITDA line I 2014. The aggregate loss of this quartile has grown from $166,000,000 since 2012 and in 2014 represented a drag on industry EBITA of 31%.

In its 2012 and 2013 reports ACFA provided two other insightful measures of operating performance and the sustainability of the industry these measures are shown in table 4 (ACFA did not provide figures for this for 2014): Table 4 2012

2013

Percentage of providers with positive EBITDA

84%

80%

Percentage of providers with positive NPBT

70%

66%

2014

Understanding the percentage of providers not reporting positive EBITDA and NPBT would provide further insight into the risks of operator failure.

Conclusion 2014 was the last year under the previous operating model for the industry. The trend in operating performance between 2012 and 2014 reinforces the need for a change in the funding model. In 2015 the industry experienced deregulated accommodation pricing, the full impact of the changes to the complex care supplement, access to higher accommodation supplement through significant refurbishment and the removal of the payroll tax supplement. These changes will have a significant impact on EBITDA, NOPBT and other key measures of financial performance.

As we look to 2015 and 2016 three are a number of factors impacting operational performance. If the turnaround seen in 2014 continues then this will be positive for the industry. In addition to this there is the opportunity for providers to gain extra revenue through undertaking significant refurbishments.

Against this there is the impact of the removal of the complex care subsidy and in the for-profit sector the removal of the payroll tax supplement. In general though as we talk with clients and providers there is no doubt there is significant positive sentiment, which is a very good thing! â&#x2013; For more information contact Bruce at bruce.bailey@rsm.com.au

58

COMPUTER SOFTWARE

| TECHNOLOGY

HOW TO GET THE RETIREMENT YOU WANT WHAT HESTA MEMBERS say they WANT MOST

Free time, family and no deadlines

– the retirement we all want and can afford.

Super is one of the biggest investments most of us will make during our lifetime – what you do with your super today can really make a difference to your future.

Despite media claims you need $1 million to retire, the majority of Australians live well in retirement by supplementing the Age Pension with their super.

You can too.

For the majority of Australians the Age Pension is, and will continue to be, an important part of their income in retirement. Did you know, around 80% of Australians who’ve reached the age to qualify, receive a full or part Age Pension?*

“I want to do what I want, when I want.”

“I want to be able to catch up with family and friends.”

“I want to be off the clock.”

“I’d like to rediscover my hobbies and try new things.”

how you can make it happen

y $20 Your weekl er sup top up into

9.5%

compulsory super

$1 million in super not required.

While media stories can make us believe we need millions in retirement, if you’ve lived well on your current wage, living well in retirement is achievable – when you take simple steps to increase your super.

When combined with the Age Pension, even a modest super balance can help you enjoy the things you look forward to most – free time, no deadlines, fewer demands and less stress.

Age Pension safety net

Adding an extra $20 per week now, can make a huge difference later!

*Source: http://ncoa.gov.au/report/phase-one/part-b/7-1-age-pension.html

59

TECHNOLOGY |

COMPUTER SOFTWARE How to contribute?

How you can turn $20 per week into around $59,000 more in the future •

•

•

Sam and Pip are both 36 years old and earn a before-tax salary of $35,000 p.a. excluding super.

Sam makes no extra contributions – the only super going into his HESTA account is the compulsory 9.5% his employer pays on his behalf.

There are two options.

1. Contributions from your before-tax pay If you earn more than $50,000 p.a. this is usually the best way to build your super. The main benefit is tax – these contributions are generally taxed at 15% when they go into your super – so before-tax contributions make a lot of sense if you pay more than 15% income tax.

It’s also called ‘salary sacrifice’ – talk to your employer about setting up a regular contribution from your pay into your super account.

Keep in mind: •

Before-tax contributions may be subject to extra tax if you withdraw them from super before you turn 60.

Pip tops up her account with $20 extra each week from her takehome pay.

•

They’re included in the income test for co-contributions and other government benefits.

•

Keep track of your super contributions, if you exceed your contributions cap, excess contributions may be taxed at your marginal tax rate, plus incur an interest charge.

Excess contributions can be withdrawn.

Pip could end up with $59,000 more at age 67 for her future than Sam

•

If you haven’t provided your TFN, contributions will be taxed at the highest marginal tax rate.

•

If your taxable income exceeds $300,000 your contributions will be taxed at 30%.

$289,471 $230,188 SAM

PIP

2. Contributions from your after-tax pay After-tax super contributions are paid from your take-home pay. If you earn under $50,000 p.a. this is usually the best way to build your super, because you could also receive a bonus super top up from the government.

You may have heard of the government co-contribution. This is where, for every dollar you put in to your super (from your after-tax pay) the government will kick in another 50 cents. It can be as much as $500 worth of bonus super from the government! It all depends on what you earn and how much you put in.

If an eligible HESTA member puts $1,000 extra into their super account each year – together with the government’s $500 co-contribution – here’s what can happen^.

Age

No extra contributions made

$20 weekly contributions from age 36

*Assumptions based on: Age at start 36, opening account balance $30,000.Starting salary of $35,000 p.a. SG rate assumed at constant rate of 9.5%. Rate of return on investment of 6.5% after fees and taxes. Admin fee of $65 per annum not indexed. ICR of 0.82% as per Core Pool (2014/15). All figures are rounded to nearest dollar. $20 per week after tax contribution and Medicare Levy, assumes LISC and Gov. co-contribution payable to age 67. Contributions received quarterly. LISC received at the end of each year.

Tax on earnings and contributions applied at 15%. Salary indexed at 2.5%. Inflation applied at 2.5% to calculate Future Value, all figures in todays dollars. Life expectancy to age 91. This example is an illustration only and is not guaranteed. Actual outcomes may differ. Investments may go up or down.

60

Without co-contribution

With co-contribution

Difference at age 67

30

$415,613

$616,397

$200,784

40

$209,127

$327,129

$118,002

50

$89,577

$150,773

$61,196

It’s easy to set up regular payments into your super – using BPAY®, electronic funds transfer or direct deposit.

The ATO even deposits it into your super account, so you don’t need to fill out any forms to claim!

For more information on the government co-contribution scheme visit ato.gov.au/super or hesta.com.au/contributions ^Assumptions: Income $30,000 p.a. Account balance $0. Inflation 2.5% p.a. Growth rate after fees 6.5% p.a. (CPI+4%). Salary index 3.5% p.a. $1,000 non-concessional contribution made at end of each financial year from stated age to age 67 with $500 co-contribution received at end of the following financial year, except the year member turns 67. Contributions received monthly, at end of each period, contributions tax applied at the time of contribution. Net growth rate on monthly contributions at 2.53%. Interest on concessional contribution based on interest calculated in 2014/15 financial year and applied as a constant rate of return each year thereafter. This is a conservative rate of return, actual interest applied will increase in line with salary indexation. Retirement at age 67.

This example is an illustration only. It is not a guarantee in any way. Actual outcomes may vary.

COMPUTER SOFTWARE

| TECHNOLOGY

How much can I contribute?

Each year, you can contribute up to $180,000 of after-tax earnings to your super. If you’re under 65, you can bring forward three years’ contributions into one year, to allow a maximum of $540,000. Any contributions made over this amount will be taxed at the highest marginal tax rate.

Keep in mind: Your super fund needs your tax file number (TFN) or you can’t make after-tax super contributions.

Desperately seeking super Are you one of the millions of Australians with lost super?

If you’ve ever changed jobs you could have lost some of your super. You’ll be glad to know you can find your lost and unclaimed super by running a quick SuperSeeker search.

SuperSeeker lets you: •

check super accounts paid into for you in the last two financial years

•

find lost super held at the Australian Tax Office (ATO)

•

transfer your super to the super account you want to keep.

To access SuperSeeker, you need to register online with the ATO and create a myGov account. This is an important security measure to protect your personal information. It also helps to ensure any transactions are made by you.

Reclaim your lost super Visit ato.gov.au/superseeker to register today or search using HESTA’s SuperFinder tool at hesta.com.au/superfinder

Growing your super comes down to what you put in and earning interest over time.

Brought to you by HESTA – the super fund dedicated to health and community services.

Information issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No. 235249, the Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. This information is current as at 19/11/2015. While every attempt has been made to ensure the accuracy and reliability of the information, it is not guaranteed in any way. Investments may go up or down. Past performance is not a reliable indicator of future performance. This information is of a general nature. It does not take into account your objectives, financial situation or specific needs so you should look at your own financial position and requirements before making a decision. You may wish to consult an adviser when doing this. Before making a decision about HESTA products you should read the relevant Product Disclosure Statement (call 1800 813 327 or visit hesta.com.au for a copy), and consider any relevant risks (hesta.com.au/understandingrisk).

61

TECHNOLOGY |

COMPUTER SOFTWARE

Simavita and Health Metrics, working together to provide integrated software solutions. Improving quality of life, and efficiencies in care.

Queensland Dept. of Health to provide significant funding for deployment of SIM™ Under the New Technology Funding Evaluation Program (NTFEP), successful applications to use SIM™ were registered by two large Queensland hospitals who will deploy the technology throughout their rehabilitation wards.

It is well known that the Australian aging population is rapidly expanding which places significant strain on the government.

According to AIHW data, the Federal Government spent in excess of $14.8 billion on aged care services during 2013-14. It is therefore more important than ever before that technology companies collaborate effectively to ensure that improved care does not imply increased costs.

Simavita provides leading edge digital technology in the form of a digitized incontinence solution called SIMTM (Smart Incontinence Management). The SIMTM technology provides an instrumented, softwareenabled assessment which is evidence based. SIM creates person centered care plans to the healthcare sector wherever incontinence is prevalent and its analysis and management is necessary.

The use of SIM™ in this setting, as opposed to a traditional aged care setting, represents an outstanding new opportunity for the SIM™ to disrupt the “pathway of the elderly person” from their home to residential aged care. With improved continence the elderly person has the opportunity to return to their home again after a stay in hospital and the hospital itself has the potential to reduce hospital stay days.

This supports the global focus on the pathway disruption where clinical outcomes and cost of caring for the elderly is greatly improved for all stakeholders.

Simavita and Health Metrics have jointly collaborated to integrate Simavita’s SIMTM technology with Health Metrics’ eCase. The integration sees the SIMTM solution being hosted as a module on the eCase solution.

Simavita’s digitized incontinence solution, SIMTM, will seamlessly launch as part of the eCase generated work flow and log. eCase, an enterprise strength software solution for health and wellbeing, is a leading choice of aged care providers in Australia and New Zealand.

62

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BUSINESS MANAGEMENT

CHANGING NATURE OF AGED CARE:

StewartBrown

Financial Performance Survey 2015 Australiaâ&#x20AC;&#x2122;s largest Financial Performance Survey, conducted by StewartBrown, has identified significant change across residential aged care in the last year. The Aged Care Financial Performance Survey for the 2015 financial year comprised data from over 800 residential aged care facilities and 16,100 home care packages, representing close to 30% of facilities nationally.

I

t has been a year of both reflection on the past and planning for the future for many aged care providers as they deal with the reforms that have occurred to date and the reforms still to come.

On average, facilities spent $8.19 per bed day more on administration costs than they did on the catering costs to feed the residents.

with those care needs, and increasing compliance costs that reflect the significant cost of regulation and red tape. This 2015 survey showed that, on average, facilities spent $8.19 per bed day more on administration costs than they did on the catering costs to feed the residents.

Changing nature of aged care The 2015 survey included only 90 facilities with average ACFI income of less than $124 per day which represents just 11.3% of the total survey population. In the 2014 survey that group represented 27.4% of the all the facilities in the survey.

Over 800 facilities submitted data but ultimately they only used data from 797 of those facilities. This represents close to 30% of the residential aged care facilities nationally covering 62,280 operational places.

The survey data reflects the changing nature of residential aged care in Australia with continuing high occupancy rates, rising income reflecting increasing care needs of residents, rising costs reflecting increasing numbers of staff to deal

63

BUSINESS MANAGEMENT

Since ACFI was introduced (using 2007 as the base year), average care income (mainly basic daily care fee + ACFI subsidy) has risen cumulatively by 65%. During the same period CPI has risen by 23% and COPE by 20%. The significant increase in income levels that is directly related to the care needs of the residents reflects the significant rise in those care needs.

The reason that all that additional income is not reflected in significantly improved operating results is that care costs, the largest share of which is staff costs, have increased cumulatively by 65.4% during that same period, slightly more than the average increase in care income.

We have seen continuing high occupancy rates, increasing care needs of residents, increased staffing to manage those care needs, and increasing compliance costs.

This income has not all dropped to the bottom line. In 2007 average EBITDA was $3,653 per bed per annum and for the 2015 financial year it was $9,108. Some of that increase in profitability has also been derived from additional accommodation income through higher accommodation supplements, more people paying accommodation charges and now through daily accommodation payments. This accommodation income has contributed $2,850 to the increase in profitability during that period.

experts in providing At StewartBrown, we are solutions to the aged ting oun acc and business tor. sec and community care your business with Our guarantee is to provide l services, specific to ncia fina of e rang a complete your industry. nce in: We have significant experie • Due diligence • Audit and and feasibility assurance reviews services ng • Taxation Advice • Reviewi and managing • Accounting your business services systems and including processes outsourcing

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dge. At Our difference is our knowle relationship long a e hav we wn, StewartBro sector. This care ity mun com with the aged and tions that go solu ide prov knowledge allows us to . bers num ond bey survey is the largest Our financial benchmarking providers, over 170 in the industry. With over s and over 400 litie faci care d age tial den 800 resi icipate - it is part who s ram prog community care trends and stry indu e rmin a powerful tool to dete strengthen your business. customised graphs Join our survey to creative e against various anc comparing your perform top 25% of facilities! the g udin incl , arks chm ben

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BUSINESS MANAGEMENT

Image courtesy of Devrim PINAR/shutterstock.com

facilities that are at the lower end of the income scale is lower than those facilities that are meeting the demands of residents with much higher care needs. Again, this is a reflection of direction of the residential care sector.

While there has been some improvement in the average results of aged care providers in the 2015 financial year, there remains a great deal of room for improvement. If the results of the top quartile is removed from the survey, the average care result of the remaining 597 facilities is just $2.11 per bed day.

The survey also collected data on the financial performance of aged care operators and the following table shows some key high level results from that data. ■

Management practices and philosophies of an organisation play the major role in the profitability of that facility.

This is not to say that all residential aged care providers are not doing well. The top quartile representing 200 facilities in the survey achieved an average care surplus of $35.20 per bed day or average EBITDA of $17,072 per bed day. These facilities come from major cities, regional and remote areas and are of all different shapes and sizes. One of the common themes is that managers of these facilities are more financially accountable and understands the financial aspects and drivers of an aged care business as well as the clinical aspects. Other common characteristics include: • Using benchmarks to assist in setting targets and KPIs • Education of managers in financial management • Better systems and timelier reporting • Accountability for financial performance at lower management levels • Using benchmarks in contract negotiations Other factors will contribute to the ability to achieve higher levels of profitability, however, they are unlikely to be the defining factor. In the large majority of cases it is the management practices and philosophies of an organisation, in particular of facility management, that will play the major role in the profitability of that facility.

References 1. Aged Care Financing Authority Annual report on the Funding and Financing of the Aged Care Sector 2015

Other highlights from the survey • Care income averaged $204.51 per bed day compared to $189.46 in 2014 • The care result represents a return on care income of only 4.8%, up from 4.5% in 2014 • 69.9% of all facilities in the survey achieved a positive facility result (June 2014: 67.8%) • 73.5% of facilities in this survey (June 2014: 72.5%) made an overall surplus taking into account all sources of income and expenditure.

• 90 facilities (11.3%) in the survey had a negative EBITDA which is down from 15.4% of the facilities

If the results of the top quartile are removed, the average care result of the remaining 597 facilities is just $2.11 per bed day.

One of the interesting aspects relating to residential care is the continuing high occupancy levels of facilities. In each of our benchmark bands (based on care income), the top quartile has higher occupancy than the survey average for that group. It is also interesting to note that the occupancy levels for those

in the June 2014 survey.

• The average care result of the top 50% of facilities in the survey was $27.74 per bed day • In contrast, the average care result of the bottom 50% of facilities in the survey (398 facilities) was a loss of $5.18 per bed day • If the top quartile was excluded from the survey, the remaining 75% of facilities (597 facilities) had an average care result of just $2.11 per bed day

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BUSINESS MANAGEMENT

Embracing deregulation

to strengthen growth Over the last two issues of Fusion we have discussed workplace culture and leadership impact on culture. Today we look at alternate options for boards, executives and leaders to harness the effects of improved culture and the forces of deregulation to strengthen their financial position.

L

eadership, culture and the ability to grow are the three critical factors that will influence whether a business booms or busts.

To some, the governmentâ&#x20AC;&#x2122;s push to deregulate residential aged care is seen by some as a threat to the future of small and medium scale providers. However, this is not necessarily so. For Boards willing to embrace change, a new, pooled funding approach is available that can attract institutional equity investment to help transition providers into an enduring funding model that strengthens the profile and legacy of the organisation.

As is now well understood, the governmentâ&#x20AC;&#x2122;s challenge in supporting residential aged care in a fiscally sustainable manner is driving continued deregulation of the industry. Aware that an ageing population is, on one hand, driving up demand for care while on the other hand, worsening the ratio of working age taxpayers to retirees, the government is being forced to cap outlays through mechanisms such as means testing of benefits.

To make this palatable to voters, it is pursuing deregulation to allow the industry to adapt its services so that they are more attractive to residents. It is assumed residents will be more willing to pay out of their own pocket if the care product is attractive enough.

In countries that have deregulated aged care, such as New Zealand and the UK, we have seen a consolidation of the industry with large-scale private sector operators leading the way. Sadly for the community at large, this has seen many community and religious not-for-profits, as well as smaller for-profit brands, disappear as they are either absorbed into the larger for-profit groups or vanish entirely.

For Boards, particularly of not-for-profits or owners of smaller for-profit enterprises, the growth of the larger forprofit operators is challenging. The institutional investment

John Young Executive Director I Apollo Care

community has embraced aged care and is enthusiastically funding the expansion of these for-profit operators. ASX listed operators are able to access equity investment capital on very attractive terms. Effectively, these listed operators can source new capital at a cost of 4% of earnings, which is very cheap.

Hence, we are seeing an unprecedented wave of acquisitions, mergers, refurbishments and expansions emerge.

How can the smaller players compete with this cheap funding?

One tempting option is to increase bank borrowing to fund expansions and refurbishments. The current environment of record low interest rates is driving strong appetite by major lenders for new credits (loans).

However, bank borrowing is an option that carries risks that need to be well understood. First, itâ&#x20AC;&#x2122;s a loan, so it ultimately has to be repaid. The property assets that are being financed have working lives of 25 years or more, whilst banks seem generally unable for their own prudential reasons to provide facilities longer than five years or so. Unless the loan can be substantially repaid during that period (unlikely given the operating margins of residential aged care), at the end of that term there will be a refinancing risk. Most will remember that refinancing risk was very real during the GFC only seven years ago as bank lending dried up and contracted severely.

Second, with loans there is always an interest serviceability risk. Directors will be aware the current interest rate environment is, by historical standards, exceptionally benign.

There have been many periods in living memory where interest rates have been well above 10 per cent. How would the interest coverage look if we were to see those levels of rates again?

On top of these risks, in residential aged care there is the additional, finite risk of a net outflow of RADs occurring for whatever reason (such as by changes in government policy or fluctuations in the MPIR) and this would need to be financed.

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BUSINESS MANAGEMENT

Some quantum of RAD outflow needs to be factored into any risk analysis.

their branding and community profile and have their brand associated with leading levels of resident and employee satisfaction.

Of course, the ideal alternative is for Boards to access those same institutional funds that invest in the listed operators. As 2. Obtaining crucial economies of scale in administrative all Directors will understand, funding growth with equity rather systems, accounting, and compliance management. than debt carries essentially Residential aged care no risk for the provider requires substantial systems (borrower) because an equity to efficiently manage these An aggregated model allows providers to access investor neither has the right complexities efficiently. The to demand repayment, nor aggregation created by the the same institutional capital as larger operators is there any obligation to pooling allows best-practice for their residential aged care expansions, and pay interest. In an equity private sector standards to redeploy the dividends and investment proceeds investment mechanism, all be achieved by delivering into expansion. parties share in the risks and the scale required to make benefits equally. the necessary investments economic.

An appropriately structured pooled funding approach can create this mechanism for Boards to access institutional 3. Utilising an efficient corporate structure that preserves funding for residential aged care operations. Providers do this most of the tax benefits available to not-for-profit operators. by subcontracting out the management and operation of the This means both not-for-profit collaborators and investors residential aged care operation. By aggregating a number of enjoy essentially a straight pass-through of earnings from smaller operations into a pool, this achieves the scale needed a tax perspective. to make the operations investable from an institutional investor In an alternative pooled funding approach, both institutional viewpoint. Thus those smaller and not-for-profit operators are investors and the provider organisations remain invested able to access the same investors as the larger operators. (together) in the underlying residential operations. They This pooled funding innovation is made possible by the share in the equity and dividends of the combined group. following ways: The transformation of the financial position of the provider organisation can be dramatic, nearly doubling the value of the 1. Adopting a scientific approach to culture financial endowment under its Board’s control while avoiding management. Even not-for-profit operations can deliver the risks associated with high levels of debt. exceptional levels of resident satisfaction, coupled with a more harmonious and efficient employee environment, at Many residential operators have ambitions to expand their a consistent level of profitability (financial surplus) that is operations and move into other areas of age services such as fully comparable to the larger private sector operators. For retirement villages, transitional care or home or community institutional investors, this earnings consistency is an essential care. This aggregated model allows providers to access the part of an attractive investment. Linking the evidence from a same institutional capital as larger operators for their residential system such as Pulse’s culture management program with aged care expansions, and redeploy the dividends and a pooled funding approach can enable providers to retain investment proceeds into expansion of these other activities.

For not-for-profit operators to whom community impact and social benefit measures are of crucial significance, this aggregated pooled model gives the financial means to fund new initiatives while maintaining existing community profile and presence. This allows not-for-profit operators to embrace deregulation to create an enduring financial endowment that strengthens their community activities.

This new environment of deregulation challenges Boards and executives to exercise their fiduciary responsibilities, encourage new thinking and investigate all possible options to exercise and secure their organisation’s futures. Deregulation is an opportunity to make decisions that further the best interests of the organisation and our ageing population. ■ For more information on pooled institutional funding models contact John Young, Apollo Care on 02 9235 9937.

Image courtesy of TijanaM/shutterstock.com

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This workshop is designed to provide participants with the knowledge, practical skills and strategies they can use in their workplace.

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This can be done as a tailored course for your organisation or your staff can join one of our public courses.

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Policy implications

on people’s housing decisions The Productivity Commission has just released its latest research report examining the housing decisions of older Australians. Aged Care Gurus was delighted to be consulted and to have a seat at the roundtable discussions held in Sydney in September.

Rachel Lane Principal I Aged Care Gurus

T

he research focuses on the accommodation options available to older Australians, the significant equity tied up in the home, products available to unlock equity and the tax and social security impacts associated with a change in accommodation.

Of course, the housing decisions of older Australians have wider reaching implications than individual tax, pension entitlements and the provision of age appropriate housing.

The ability of families (and let’s face it, developers) to buy family homes in established suburbs relies in part on older Australians choosing to downsize.

Older Australian’s have a range of options when it comes to what is being referred to as “age appropriate housing” from granny flats and life interests with family to community living in a retirement village or manufactured home park and, for some, an aged care facility.

There are currently a number of impediments that older Australians face when considering a change in their accommodation, at least some of these can be removed by a change in government policy.

Family arrangements Granny flats and life interests have all of the issues of living with family combined with serious legal and financial implications (the house is likely the biggest asset of the future estate and in many cases it is transferred to only one child). But added to this are the restrictions imposed by local government on what can be built, who can occupy the unit and in some cases what needs to be done when that person is no longer living there. In some states you can spend over $100K and months obtaining permission to build a granny flat only to realise that when the older person leaves the unit cannot be rented out and there is a substantial bill to have it removed.

Removing such restrictions would alleviate at least some of the disincentives for these arrangements and may serve to provide more rental accommodation in the future.

Community living Retirement Communities often have financial arrangements where the resident pays a discounted amount upfront and an exit fee when they leave. The purchase price, often designed to give the resident some of the proceeds from their home to fund holidays and lifestyle expenses, frequently leads to a reduced pension entitlement and an increase in the cost of a home care package. The exit fee at the other end often encompasses a number of costs including refurbishment expenses and sales commissions in addition to a deferred management fee. In order for residents to accurately forecast their exit entitlement they often need to project the value of their unit for the period of their stay – not an easy task. The ability to compare costs and benefits across villages and manufactured home parks can be an almost impossible task. Greater transparency and choice in the financial arrangements would make moving to a retirement community a much more attractive proposition.

Access to equity is going to be key.

While downsizing often releases some of the equity in the family home, the majority is likely to be spent on the new accommodation. Equity release products that can accept the security of a granny flat, a unit in a retirement community or a Refundable Accommodation Deposit, while providing flexible payments, will ensure that older Australians can unlock the equity in their new home. If financial products are unable to be created with such flexibility then a government-backed scheme, similar the current Pension Loans Scheme (without the limit being the full pension) where people can draw a regular income or lump sum (or both) would enable to people to draw on their equity to fund their lifestyle.

Policies that remove disincentives and deliver greater choice and flexibility to the way people can fund their retirement will ensure people are less reliant on the pension, able to fund a longer retirement and, most importantly, can afford the lifestyle they desire. ■

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HEALTH & WELLBEING

HEARING LOSS & DEMENTIA:

WHY TREATMENT IS IMPORTANT IN THE ELDERLY Hearing loss is generally accepted as part and parcel of getting older. However, its link to dementia, increased social isolation and subsequent overall health decline means hearing loss should not be dismissed as normal, even in the very elderly. Studies show that in people aged over 80 treatment can lead to such improved quality of life that the minimal risk of surgical complication is outweighed.

H

earing loss affects over half the Australian population to be involved in the early stages of mild cognitive impairment aged between 60 and 70. This increases to more than and Alzheimer’s disease,” they said.

70 per cent of those over the age of 70, and 80 per cent Both studies point the importance of treating hearing loss rather of those over the age of 80. Long considered a normal than accepting it as normal, with the Hopkins researchers part of the ageing process, a study published in medical journal, concluding that, “if hearing loss is potentially contributing to JAMA Internal Medicine in 2013 found that hearing loss is these differences we’re seeing independently associated with on MRI, you want to treat it accelerated cognitive decline before these brain structural and impairment in older people The possibility that hearing loss is an early sign or changes take place.” who still live at home. even a cause of dementia means it can no longer With the prevalence of In the study involving 1984 simply be accepted as a normal part of ageing. dementia projected to double adults, 1162 with baseline every 20 years, identifying hearing loss had annual rate hearing loss as an early of decline in 3MS and Digit Symbol Substitution test scores that symptom – and treating it to slow or delay cognitive decline – were 41% and 32% greater, respectively, than those among could have a drastic effect on the provision of dementia care individuals with normal hearing. by age service providers. The implications are also significant In another study conducted over 10 years and published in for home and community care service providers, who may be 2014, researchers from Johns Hopkins and the National Institute amongst the first to notice or identify hearing decline in a client on Aging found that brain shrinkage appears to be fast-tracked and arrange early testing. in older adults with hearing loss.

“Those participants whose hearing was already impaired at the start of the sub-study had accelerated rates of brain atrophy compared to those with normal hearing,” the authors wrote.

Those with impaired hearing also had significantly more shrinkage in particular regions, including the superior, middle and inferior temporal gyri, brain structures responsible for processing sound and speech. While this was to be expected, the researchers noted these structures don’t work in isolation, and their responsibilities don’t end at sorting out sounds and language.

“The middle and inferior temporal gyri, for example, also play roles in memory and sensory integration and have been shown

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Treatment options

Devices such as the cochlear implant are increasingly being used in elderly people as research continues to favour the improvements in quality of life over the low risk of surgical complications.

In a study published in Published in Otology and Neurotology, 2013, “‘Outcomes of Cochlear Implant for the Octogenarians: Audiologic and Quality-of-Life’’, the authors assessed the impact on quality of life, hearing performance, and surgical complications among patients aged 80 years and older, at the time of cochlear implantation.

In what has been one of the most extensive studies on the impact of quality of life for patients aged 80 years and older

HEALTH & WELLBEING

who received a cochlear implant, the authors described the audiologic benefit as “undeniable”.

hearing loss, testing is important as a first step in identifying the extent of the problem and what options the individual has.

“The quality-of-life improvement is comparable to studies made on much younger patients. It is also well- tolerated surgery with relatively low risk but with possible delayed complications.

Given all these results, there should be no concerns regarding implantation in well-selected octogenarians,” they wrote.

The possibility that hearing loss is an early sign or even a cause of dementia means it can no longer simply be accepted as a normal part of ageing. ■

The researchers noted that fear of increased risks associated with surgery and anaesthesia, beliefs that implantation may not be beneficial because of age-related degeneration of the central and peripheral auditory systems, and the overall high costbenefit ratio have been barriers to elderly people considering cochlear implants.

However, recent literature indicates that surgery is safe and that even the elderly population perform quite well. Patients in the study with known chronic diseases including dyslipidemia, diabetes mellitus, hypertension, coronary artery disease, and chronic kidney disease did not require specific medical treatment before the surgery.

Two patients had intraoperative complications during the anaesthesia, without any repercussions. The first had respiratory problems postanaesthetic, which was probably caused by residual neuromuscular blocking medication. The second patient had intraoperative sinus bradycardia, but was released from the cardiology department the next day, when totally asymptomatic and with normal investigations (heart ultrasound, blood test).

All patients underwent successful placement of the internal component and device activation.

In concluding, the researchers noted, “Our results indicated that very aged patients did well with the cochlear implant.

More importantly, though, was that this benefit resulted in great improvement on quality of life, with a +37.5 on the GBI total scale, without any nonuser and with relatively low surgical and anaesthetic complications.”

How it works “Unlike hearing aids, cochlear implants don’t just amplify sounds,” Shaun Hand, Cochlear General Manager Australia & NZ, said.

“They mimic the natural hearing function of the inner ear through electronic stimulation. The system has two parts, an external sound processor and the actual cochlear implant.

Incoming sounds are processed into electronic signals and then transmitted directly to the hearing nerve, bypassing the damaged part of the inner ear.”

Signs of hearing loss • When you’re asked to repeat yourself, even in one-onone conversations in a quiet room • If someone appears to be lip-reading and concentrating hard on what you’re saying • If someone is avoiding social activities – they may fear not knowing what is being said or responding incorrectly • Extreme tiredness at the end of the day because listening takes so much concentration • Avoiding using the phone • If someone no longer enjoys listening to music

We can help you make your residents' lives easier by: • Supplying your staff with Bellman Audio Maxis (a personal amplifier) for important 1on1 conversations.

• Offering wireless headphones to help residents hear the TV more easily.

• Using our free onsite training for your staff on hearing aid maintenance and tips on how to best communicate with hearing impaired residents.

Funding options are available to older people who may benefit from a cochlear implant through private health insurance and government subsidies for people who receive pensions or veteran’s affairs benefits.

With multiple studies pointing to the social isolation and general decline in mental and physical health of elderly people with

Call us on (02) 9412 6790 hearing.com.au 73

HEALTH & WELLBEING

RESISTANCE TRAINING

A POWERFUL TOOL TO PREVENT LATER LIFE DISABILITY

We all know that exercise has incredible health and wellbeing benefits. However, all exercise is not created the same.

Evidence shows us the common low-intensity group-based activities where, for example, a balloon is beaten around Dr Tim Henwood the room, is only just better than usual sedentary behaviour.

If clients want gains and providers want results, programmes need to be targeted, balanced, progressive and of a moderate to higher intensity.

P

rogressive resistance training (PRT) is a powerful but underutilised tool in the battle against later life disability.

Evidence is strong that with regular and ongoing PRT older adults can reduce their decline into dependency and disability, and improve numerous health markers. Based on this evidence A new PRT exercise project for community-dwelling older adults with aged care packages is being run in Queensland and investigates the impact of participation on physical and mental health, quality of life and health service utilisations.

The project involves Burnie Brae Senior Citizens Centre in Brisbane, in partnership with AgeFIT Solutions, the University

74

of Queensland, Bond University, St Vincentâ&#x20AC;&#x2122;s Health Australia and HUR Australia with the support of the Department of Social Services.

Over the next two years approximately 300 people aged 65 years and older, residing in north Brisbane and receiving some form of government home care assistance, will be recruited to participate in the project.

While the project employs a wait-listed randomised control design, all participants enter the PRT programme eventually, even if randomised to the control group, for an initial 24week period.

HEALTH & WELLBEING

PRT participation upper and lower body resistance training using six pieces of HUR equipment and balance exercise programme, twice a week for 24 weeks. All training is done under the careful guidance of an experienced university qualified accredited exercise physiologist who also offer motivation, technique guidance and lifestyle education, such as discussing the important of diet to compliment the benefits of exercise.

Participation, however, is not for those wanting gentle exercise, with participant programmes progressed regularly in line with their improvements in muscle strength and balance. Following the PRT period, participants are then tracked for a further 24 weeks to investigate the residual impacts of training.

Two waves of recruitment have been undertaken, with a further two more planned for 2016 and over 100 clients have been enrolled to participate. Progress data and participant testimonial already demonstrate the value of being involved.

While statistically analysed of data will happen at the end of the project, to date PRT participants have achieved large improvements in lower-body strength, measured fortnightly, and talk regularly of “feeling and moving better”. In addition, those participating speak highly of the opportunity to be involved, and that now they are they feel more confident with their ability to continue living at home.

These gains in muscle strength, physical capacity and confidence are not uncommon with resistance training.

There has been positive research to this effect from the community aged care setting for about 45 years and from the residential aged care setting for about 35 years.

However, the value of this modality of exercise for older adults continues to be overlooked by individual, provider and government alike in preferences for lower-intensity activities such walking or balance exercise.

Of the many programmes that claim to employ resistance, large numbers are in fact low-intensity in nature and, most importantly for health benefits, lack any progression or challenge past the first few sessions. In contrast, machine based progressive resistance training that delivers a balanced programme in a supervised environment can significantly improve the health and wellbeing of an older individual.

For elderly people it can even reverse disability, sarcopenia and frailty.

While the muscling-up against disability study has a few more years to go before all the data is in, based on current evidence and knowing the benefits outweigh the risks, for participants an increase in health and wellbeing appears eminent. ■

25TH ANNUAL TRI-STATE CONFERENCE & EXHIBITION 21 – 23 February 2016

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TWILIGHT ON THE INSIDE Chris Puplick - Chair, Justice Health & Forensic Mental Health Network Board FACILITATOR Dr Sally Cockburn ‘Dr Feelgood’

RESOLVE, PROTECT, IMPROVE Rae Lamb - Aged Care Commissioner (Aged Care Complaints Commissioner as of 1 January 2016)

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75

EVENTS

SAGE TOUR

SHOWS WHOLE NEW APPROACH TO

INDEPENDENT LIVING IN THE US For Madeline Gall, the CEO of Lifeview Residential Care, the recent SAGE Tour to Boston and Massachusetts was all about inspiration, but from day one her expectations were exceeded.

L

ifeview are in the midst of designing a new urban multi-story development that is a combination of aged care and independent living units with what Madeline believes is a unique focus for Australia.

“We are in the middle of designing a new development site and an extension to an existing building so I am searching in the US because they have a reputation for excellence and innovation,” she said.

“This building will focus on the LGBTI community in Melbourne, that’s why we chose Prahan, it’s close to the hub of the city.

So I was looking for some high end design components.

Then on day one, when we went to visit the Leonard Florence Centre for Living in Boston I think almost everyone on the tour was blown away.”

The Leonard Florence Centre is the first of its type in the USA. In the heart of Boston, it is a purpose-built complex with ten 7,000 square foot condominium-style homes. Each house has 10 private bedrooms arranged around a common living room, dining area and open kitchen. There are no central nursing stations or typical long corridors.

SAGE Tour participants being taken around the specialist MND facility.

“I have a board member who is interested in the mix of disability and aged care and after seeing what this organisation has done I will be going back to him to say, I think we need to have another look at this concept.”

Along with serving the elderly and providing short-term rehabilitation, the Leonard For Helen Jones, General Florence Center has separate Manager of Strategy and high-tech residences to Service at Australian On day one when we visited the Leonard accommodate those living Unity, the tour was about Florence Centre for Living in Boston I think with ALS, (Lou Gehrig’s discovering innovation and almost everyone on the tour was blown away – Disease or Motor Neurone ideas to better measure

Madeleine Gall service delivery in multiDisease), Multiple Sclerosis or Alzheimer’s disease. site organisations. Halfway through the tour she said the group had visited four inventive For Madeline the ‘wow’ factor came when their tour guide and innovative organisations, that presented something that turned up in a wheelchair. “He was a young man in his was above and beyond customer expectations.

40s, suffering from advanced MND yet he lives relatively independently. Through the use of technology installed in “I wanted to see how different organisations approach his house and wheelchair, and the blinking of his eyes he quality and quality measurement, as well as consistency and can communicate, he can open doors, he can draw windows performance and I was also interested in visiting some of the and curtains. It was mind blowing stuff,” she said. organisations that I saw three or four years ago and seeing how they have matured. What I really need to know is how multi-site

76

EVENTS

organisations assess their level of service to customers, what software programs do they use to inform themselves on the quantity, quality and calibre of service, and whether or not that measures up to expectations,” she said.

The Boston and Massachusetts SAGE tour incorporated a focus on quality and leadership systems in Boston and Toronto (Canada), and how these regions have met the challenges of implementing quality systems and developing leadership in CEOs, senior executives and relations to Boards.

The tour included residential care facilities, community care organisations, academic overviews and IT innovation.

The tour participants also attended a day-long leadership program at the Massachusetts Institute of Technology (MIT).

“Not only do we see how other organisations do things well, but we also need reminding that as a country we have a very robust and effective aged care and seniors living industry and we do get a lot of things right,” Helen said.

“These tours are also great to meet and get to know other people who are really passionate about seniors living. It makes your job back home a lot easier and more productive when facing a problem you are having difficulty with, you have someone to ring and chat to. It’s a great network to build.” ■

The Harry and Janette Weinberg Building at the Johns Hopkins Kimmel Cancer Center, one of the research facilities visited

For more information on upcoming SAGE tours go to www.sagetours.com.au

SAVE

THE DATE LASA National Congress

2016

9–12 OCTOBER

GOLD COAST CONVENTION & EXHIBITION CENTRE

Call for Abstracts Open Late-January 2016

Submissions Close Late-March 2016

Enquiries LASA Events P: 02 6230 1676 | E: events@lasa.asn.au

Early Bird Close Early-September 2016

www.lasacongress.asn.au 77

EVENTS

2015

OSCAR HOSPITALITY

AGED CARE HOSPITALITY NATIONAL AWARDS LASA congratulates the national winners of the 2015 OSCAR Hospitality Aged Care Hospitality National Awards (ACHA) which were presented on 30 October.

A

fter an exhaustive selection process the esteemed independent judging panel awarded the national winners across all categories.

Facility Catering Service of the Year The Whiddon Group Easton Park NSW Catering Innovation of the Year (Joint Winners) BlueCross Chelsea Manor & Riverlea VIC Baptistcare Maranoa NSW Chef Manager of the Year Chris Mann, Bupa Care Narre Warren North VIC Chef/Cook of the Year June Ellem,The Whiddon Group Grafton NSW

BlueCross Chelsea Manor & Riverlea VIC; Baptistcare Maranoa NSW

Food Service Assistant of the Year Deepthi Domingo, BlueCross Taralla VIC Facility Cleaner of the Year Kymberley Meehl, RSL Care Adelaide SA Laundry Services Individual of the Year Narelle Lewry, Opal Aged Care Bossley Park NSW â&#x2013;

The Whiddon Group Easton Park NSW

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June Ellem,The Whiddon Group

Kymberley Meehl, RSL Care

Grafton NSW

Adelaide SA

Chris Mann, Bupa Care Narre Warren North VIC

Narelle Lewry, Opal Aged Care Bossley Park NSW with

Deepthi Domingo, BlueCross Taralla VIC

Jason Neville, OSCAR National Operations Manager

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NEWS

The Complete Management Solution for Aged Care.

Now Managing your Consumer Directed Care (CDC) Programs.

CDC ACCOUNT INCOME • Estimate and Reconcile Government Subsidy Income

FUTURE

• Calculate accurate Home Care contributions and IT fees

• Est 1984 • Aged Care Specific • Mature yet flexible

CDC ACCOUNT EXPENSES • Schedule and record service delivery • Allocate 3rd party purchases to CDC accounts • Automatically calculate admin fees & other charges

CLIENTS • Billing & Subsidies • Medicare Claiming • LLLB & CDC

REPORT WITH CONFIDENCE • Include all income & expense items on the client CDC statement • Automatic generation of CDC liability GL journals • Monitor performance of CDC programs & track unused client CDC budget

FINANCIALS • General Ledger • AP / Purchasing • Assets / Tax

HUMAN RESOURCES • Rostering • Payroll • Time & Attendance 80

Flexible Integrated Compliant

Sydney Melbourne Brisbane Cairns Perth

Call 1800 777 549

solutions@caresystems.com.au www.caresystems.com.au

EVENTS

RECORD NUMBERS MAKE

LASA NATIONAL CONGRESS 2015 BIGGEST AGE SERVICES EVENT IN ASIA PACIFIC

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The numbers speak for themselves. Over 1100 delegates. 150

opportunity today to put clearly on the record that the aged

exhibitors and sponsors. Over 100 speakers. LASA Congress

care changes announced in the 2015 budget will continue and

2015 was the biggest age services event of the year.

the day to day business of delivering quality aged care will also

Super Sunday kicked off with advice 2015 AFL premiership

continue as usual.”

winners’ coach, Alastair Clarkson, about building a winning

Over three days delegates heard how changes across our

team during tough times. His secrets? Aim for the moon –

industry, and in the broader context of the current economy,

and be clear about where you want to be, have the right people

may impact providers and how to minimise the effect. Mergers

on the bus and invest in nurturing a strong company culture.

and acquisitions came up frequently with practical advice

The newly appointed Assistant Minister for Health, Mr Ken Wyatt,

shared by experts for those looking to merge, sell or expand.

spoke about the government’s plans for aged care and promised

New ideas such as how Australia can fund a universal age

delegates that the cabinet changes would not mean a new

pension, what is needed to end elder abuse and the latest

policy direction.

in assistive technology were shared, while great connections

“The current reforms take us quite some way along that track but – as the industry agrees – there is still more to be done,” he said.

“When there is a change of minister, people inevitably wonder whether existing policies and initiatives will continue or be subject to change by the new broom. I want to take the

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were made at the Taste of Melbourne evening and Congress gala dinner.

Planning is already underway for Congress 2016 at the Gold Coast, which is shaping up to be everything you could imagine.

LASA EVENTS 2016 Tri-State Conference & Exhibition 21-23 February 2016 – Albury, NSW

LASA Q National Service Integrated Housing Conference 1-3 June 2016 – Surfers Paradise, QLD

LASA Q State Conference 13-15 April 2016 – Gold Coast, QLD

LASA Victoria State Congress 23-24 June 2016 – Melbourne, VIC

LASA NSW-ACT State Congress 26-27 May 2016 – Pyrmont, NSW

LASA National Congress 9-12 October 2016 – Gold Coast, QLD

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YOUR INDUSTRY’S REGISTERED TRAINING ORGANISATION

WHAT’S NEW

LASA Victoria’s nationally recognised RTO has become a leading provider of accredited qualifications and workshops for the aged and community care sector.

We offer accredited qualifications and short courses, workshops, CDC and SRS training.

Are you ready to take the next steps in your career? Our nationally accredited RTO will help develop your skills and qualifications, whether you’re seeking leadership and management positions, office administration roles, or want to become a more effective frontline staff member.

We are a leading provider of accredited qualifications, workshops, short courses and training in Consumer Directed Care and Supported Residential Services, and Occupational Health & Safety.

Our courses can be delivered as work-based training, face-to-face workshops, fully supported online learning, or in rural and regional areas via our simulation van.

LASA VICTORIA & TASMANIA

STATE CONGRESS

2016 Valued at over

$1,200

We can help employers to plan and take advantage of Commonwealth or State funding to access Aged Care qualifications.

BOOK NOW FOR OUR 2016 COURSES www.lasavictoria.asn.au/education-training E: training@lasavictoria.asn.au T: 03 9805 9412 RTO code 21826

Melbourne Park Function Centre Thursday 23 – Friday 24 June 2016

www.lasavictoria.asn.au/upcoming-events

The LASA Aged Care Health and Safety Manual is the first comprehensive set of peer reviewed template policies and procedures for residential and home care providers.

Templates that can be tailored to your individual needs.

Including: - policies - procedures - safe work practices - tools - checklists

“This manual is easy to use, practical & helpful” Purchase the LASA Victoria Aged Care Health and Safety Manual for $1,200 FREE TO MEMBERS 84

- residential and home care providers - 188 templates - can be tailored to your workplace - word and pdf (digital only)

This manual has been developed by the LASA Victoria OHS Committee and a working group of contributing members.

The Manual content is applicable to all Australian aged care employers irrespective of operational size, approach or jurisdiction.

The LASA Aged Care Health & Safety Manual is the industry’s first comprehensive Health and Safety Manual.

Available in digital and hard copy.

Please email membership@lasavictoria.asn.au or phone (03) 9805 9418 for further information.

WHAT’S NEW

WHAT’S NEW Has your Hotel Services had a recent Health Check?

5 Steps to Chemical-Free Cleaning in Aged Care

Aged care organisations face increasing challenges in light of higher expectations from stakeholders. With constant changes to regulations, the planning of a facility literally moves on a daily basis.

Technological changes have had a major impact on meal, cleaning and linen services affecting delivery, administration and a strong emphasis on ensuring they meet the clients’ requirements.

Now is the time to question the way your current work practices are operating – ask these questions: • Does your Facility provide the level of resident or customer service that you aspire to?

• Is the model you have chosen based on the optimum services that will meet the Clients needs?

• Does this model allow for staff to provide the services in the manner you are seeking?

• Have you provided staff with the necessary tools to undertake this service?

• Has the model being costed to ensure you are providing efficiencies as well as the customer and staff satisfaction?

For more information and a ‘health check’ assessment of your Facility, contact MAJ via: info@majconsulting.com.au Or Mary Whelan – 0408 039 964 John Patison – 0419 592 861

New White DoseAid Sachets – Listening to your needs At DoseAid we pride ourselves on our ability to adapt to meet our customers’ needs.

After receiving some feedback about the readability of our sachets, we have changed their look. The printed side now features black print on a white background, while the back is clear so medications can be easily identified.

DoseAid supplies dose administration aid sachets, or DAAs, to aged care facilities Australia-wide through a network of pharmacies. Using the latest packing and checking technology in a facility licensed by the Therapeutic Goods Administration, we provide consistency, reliability and peace of mind.

Director of Duplex, an aged care cleaning solutions company, Murray McDonald, is travelling throughout Australia in January, February and March 2016 presenting his workshop, 5 Step to Chemical-Free Cleaning Aged Care.

This training is free to attend for aged facilities and their staff.

Early bookings receive a free copy of Murray McDonald’s latest book, 5 Steps to Chemical-Free Cleaning in Healthcare (valued at $19.95).

Murray McDonald will be presenting on the “Duplex 5 Steps method” which is based on the following: 1. Identification: Pre-planning and cleaning product gaps 2. Assessment: Auditing and looking at your current cleaning processes 3. Planning: Developing goals, managing objections and formulating a cleaning program 4. Implementation: Practical touch point cleaning, training and consistent workflow 5. Evaluation: Auditing against benchmarks Early bookings are encouraged as there are limited spots available depending on your state.

DoseAid sachets reduce medication round times, decrease storage space and – most importantly – improve dose accuracy and medication compliance.

To register your interest, email info@duplexcleaning.com.au or call 1800 622 770 and be notified in early 2016 as to when Murray will be in your local area.

If you would like to learn more about how DoseAid sachets can provide a better solution for your aged care business, contact DoseAid Customer Service on 1300 306 748.

Email: customerservice@doseaid.com.au Website: www.doseaid.com.au

For more information on Duplex, steam cleaning equipment and aged care cleaning solutions, visit: www.duplexcleaning.com.au/infectioncontrol

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WHAT’S NEW

2nd Annual 2016 Aged Care Procurement Conference

SAFE T GUARD For over 80 years Jasol has a trusted reputation for providing best in class products (for value and effectiveness) on all our cleaning and hygiene solutions (chemical manufacture plus equipment supply) and in line with this tradition, we’re pleased to announce Safe T Guard; our new innovative instant hand sanitiser joining our Personal Care Range soon.

We understand the constant need for hygienically clean hands in the health & aged care industries. Where washing of hands is not always practical, the use of Sanitiser’s is now a quick, reliable sanitation method to eradicate and stop the spreading of harmful bacteria. Whilst in the past, the most traditional hand sanitisers contained up to 60% alcohol (which can be very efficient ingredient to reduce germs but leaves the skin dry, sticky with probable skin irritation problems and poor aroma) Jasol’s Image used for Safe T Guard is an alcohol free, instant hand promotional purposes sanitiser, containing unique ingredient’s that only reduces the spread of germs. Delivered via a touchless dispensing system as a foam (or via pump bottle) onto the surface of the skin and quickly evaporates when hands are rubbed together. This unique moisturising formula is also perfume free which also makes it ideal for use in food processing environments, leaving hands soft, smooth with no lasting stickiness, odour or residue.

The 2nd Annual 2016 Aged Care Procurement Conference will be held on the 24 & 25 May 2016 at Melbourne Olympic Park.

PASA will bring together the country’s leading Procurement, Financial, Operational and Clinical professionals, and aged care suppliers addressing the specific challenges of procurement for the aged care sector. The conference programme focuses on practical solutions and strategies to achieve best value in procurement and quality care outcomes.

In a time of margin pressures, the 2016 Aged Care Procurement Conference will assist you to overcome the dual challenges of delivering value and providing greater choice. The conference is for the entire aged care sector including the acute care, home care, community care, aged care facilities and retirement living industry, transition care, hospitals and health care.

The Aged Care sector is increasingly looking to procurement as a strategic way to improve an organisations performance.

The conference is for all levels of procurement expertise and addresses specific aged care procurement skills to improve outcomes for your organisation.

The conference features an extensive trade show providing delegates with the opportunity to interact with a wide range of suppliers of goods, services and procurement solutions for the sector.

If you are responsible for delivering cost savings, positioning your organisation for Aged Care reform, providing choice and ensuring quality service outcomes, then this conference should not be missed. www.agedcareprocurement.com

PASA are the leading providers of information, education and networking opportunities to the procurement profession in the region. www.procurementandsupply.com

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For more information visit our site www.jasol.com.au or call our Customer Service Team on: 1 800 334 679

Confoil The Pack and Seal System from Confoil has been tried and tested in the hospital, aged care, Meals On Wheels and prison systems.

Using a sealing machine, which creates an air-tight plastic seal over the tray (this lidding can also be frozen, microwaved and ovened to 220ºC), is beneficial for customers who may normally have food accessibility issues.

These machines are installed and serviced by Confoil and many organisations have found that being supplied the entire packaging solution from one source has led to increased packaging, warehousing & logistical savings. The machines themselves are easy to use and clean and can seal from 4 to 34 packs per minute. Another feature of the system is the availability of compartmentalised trays, which can segregate different foods. These trays are microwavable, ovenable to 220ºC and freezable to -40ºC. Other benefits of these trays include: recyclability, aesthetically pleasing and are also strong enough to cope with long transportation.

For more information visit www.confoil.com.au

COMPUTER SOFTWARE

| TECHNOLOGY

Put your hands together for the revolutionary dispenser range from Jasol.

You’ll applaud our stylish and durable, easy to operate dispenser range that suits every hygiene point.

NEW TOUCH FREE & MANUAL DISPENSERS LIQUID OR FOAM SOAP COMPATIBLE Jasol’s wall mounted soap dispenser comes in both a touch free and manual option and is the latest innovation with a 100% disposable inner mechanism for both, which ensures full hygiene integrity. Highly versatile, both units are made with the same unique mechanism with interchangeable pumps and soap pods that can be switched between both the touch free and manual models easily and hassle free. Once the soap pods are popped into the unit they will only need replacing when the container is empty. The chemical is never in contact with air or germs, hence its integrity is never compromised.

NEW Safe T Guard - why not combine your Jasol Dispenser with our new, innovative non alcohol, foam hand sanitiser.

Contains unique ingredients that reduce the spread of germs. Placed directly onto the skin it quickly evaporates when hands are rubbed together.

NEW WET WIPE DISPENSER Solid and clever, the modular dispenser has been designed to dispense one wet wipe at a time while keeping the remaining stock as fresh as new. Wall mounted, this static cleaning station also keeps the workplace tidy and locks away the stock of wet wipes.

NEW AUTOMATIC DRYER Jasol’s automatic hand dryer offers the highest level of performance.

Its small size helps to reduce the amount of water spread by the blast, resulting in a cleaner and more hygienic environment.

Speak to your Jasol Account Manager or contact our customer service team on 1 800 334 679. www.jasol.com.au

Providing hygiene service solutions since 1934 87

At Webstercare, we understand that residential aged care facilities need end-to-end visibility and accountability with medication management

Electronic signing with MedSig® ticks all the boxes Easy to read eye-level touch screen

A secure, robust medication management solution

Prompts medication administration

Reduces adverse incidents

Risk management and contingency processes

Improves medication outcomes for residents

Notes can be added to the screen

Auditable clinical governance

Prevents steps being skipped and flags missed medications

Supports compliance with Aged Care Standards

Efficient, time-saving and cost effective

Streamlines processes

Facilitates communication between pharmacy and RACF

Interactive and easy to use

The MedSig® system is part of the complete medication management solution from Webstercare. At Webstercare, we are proud of our range of products and services. If you would like more information, please call our friendly customer service team.

freecall 1800 244 358 I www.webstercare.com.au WINNER OF 2015 MOST INNOVATIVE COMPANY

INFORMATION TECHNOLOGY IN AGED CARE