Lasa winter 2013

Winter 2013 | www.lasa.asn.au

LLLB legislation passes:

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HESTA Aged Care Awards:

31

STEWART BROWN:

58

Where to from here

WINNERS ANNOUNCED

Aged Care Financial Performance Report

L E C

NATIONA EDITION CONFEREN

The voice of all aged services

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

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National Update 5 7 8 10 12 14 15

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

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31 Winners of the 2013 HESTA Aged Care Awards announced

SPONSORS

Workforce 17 Legislative Wrap Up 21 Care Entitlement, What Does It Really Mean?

23 Reducing the risk of innovation 26 Heed the Lessons 29 Governance Trends, Issues and Solutions

35 Telehealth Multimedia DVD Resource 36 The Engaging Jon Dee 40 See me, Hear me 43 Introducing ME Bank 44 Acquisitions in Aged Care

Technology 48 Activities of the Aged Care Industry Information Technology Council (ACIITC) 51 National Aged Care Sector CIO Forum

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

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

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

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

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

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

51 Serving Older Australians 52 To Boldly Go Where No Software Has Gone Before 55 IT Governance – whose responsibility is it?

general 58 Stewart Brown Aged Care Financial Performance Survey – Summary 67 Sage 2013 US Study Tour Report 76 Hearing Services Program 77 The New Frontier 81 SummitCare Strikes Gold 85 Aged Care Reforms – Determining a Price 87 Calendar of Events 88 Product News

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Production Emily Wallis

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

material. Opinions expressed in Fusion are not necessarily those of LASA and no responsibility is accepted by the Association for statements of fact or opinions expressed in signed contributions.

Fusion may be copied in whole for distributed amongst an organisation’s staff. No part of Fusion may be reproduced in any other form without written permission from the article’s author.

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National Update | 5

Report from the CEO LASA Advocacy Continues: Pragmatic and Positive Industry Support to achieve total Reform Patrick Reid Chief Executive Officer | Leading Age Services Australia

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ore than two years in the making and a huge effort from all stakeholders late June saw the Aged Care bills pass through the Senate and the lower house, essentially clearing the way for LLLB to continue.

The Senate committee process where LASA was an active participant highlighted that the legislation overall was marred with poor process. Despite acknowledging that bills should not pass through without related subordinate legislation, both government and the Greens enabled the passage of the aged care bills, before tabling 18 pieces of subordinate legislation that contain much of the operational detail of the reform.

Despite this poor process LASA had a number of wins on behalf of the members with the contents of the bills. LASA’s amendment that the Aged Care Pricing Commissioner be a Statutory Authority was accepted as was the removal of DOHA management of ACFA. Accommodation price setting was another area LASA impacted positively with the RAD now setting the DAP rather than the proposed reverse. The Government also decided to leave the insurance of bonds process in place a position LASA advocated strongly for.

LASA’s position stands that the reform did not go far enough and we must move quickly towards full adoption of the Productivity Commission’s recommendations in their 2011 report, Caring for Older Australians. We will advocate strongly for providers from now until the election (and beyond) to secure appropriate forward thinking policy and appropriate policy commitments.

Despite Minister Butler’s assurances, LASA’s concern about the ‘flight of capital’ that underpins sustainability of the industry has been proven a reality in a report undertaken by KPMG on behalf of ACFA. LASA’s position was confirmed by ANZ in evidence they made to the Senate inquiry.

Our one major qualification, though, that we want to raise today is the proposed changes to the legislation which will adversely affect what we refer to as refundable accommodation bonds, or RADs, in the draft legislation. There appears to be a major bias in favour of daily payment bonds, which are referred to as DAPs. Refundable bonds could reduce as the principal source of capital funding for the industry, with serious financial consequences. The key driver to this bias seems to be a new means test that is proposed as it applies to the new care co-contribution to be paid by residents in residential care. The family home will now be treated differently to the refundable bond. The family home will be included in the assets test but capped

at $145,000, whereas the refundable bond will be fully included and not capped. This could see a significant shift from refundable bonds to daily charge bonds.

Despite concessional pensioners being considerably disadvantaged over those with greater assets, the Greens and Government refused to adopt LASA amendments that would deal with assets equally, preventing DAP’s being more attractive than RAD’s and thus threaten the industry’s capital base.

Where to from here? With a change in Prime Minister and subsequently Aged Care Minister the political landscape has become a little more interesting, especially with a new election date. Whilst we may have an even longer election campaign, LASA’s strategy is well grounded to support the interests of our members. LASA will continue to advocate strongly on the draft subordinate legislation as it comes to hand, making sure it is practical, pragmatic and enhances sustainability of industry. LASA will fight against more complexity and red tape, and strongly supporting sustainability of the industry overall.

LASA developed a multi-faceted strategy early in the year. This included key advocacy in Canberra conducted by national office, with our state office CEO’s backing that up visiting federal MP’s in their home electorates, often accompanied by LASA members.

The 3 Million Reasons campaign was established as a broad public education and industry building campaign aimed to come alive during the later stages of the election campaign, capitalising on the activity and interest of the legislative process. LASA has developed this to support you and your workforce but now we need you to support us. Successful election campaigns resulting in positive policy and funding announcements rely on large numbers of public support; please encourage your organisation to implement a ‘sign-up’ campaign for 3 Million Reasons (3millionreasons.com.au).

There are many other activities LASA can support you with, why not invite your local federal MP or candidate to join you as an ‘Age service worker for a day’. LASA is also confidentially collecting financial data to demonstrate the effects of the reform process http://bit.ly/17iLINV This will assist us providing cogent arguments to policy makers regarding future funding. I look forward to meeting and re-connecting with many members at Congress in Sydney. I am proud of the program we have developed. Importantly we have been able to address the immediate concerns and needs of members as they face reform with a lens that takes into account future demands, challenges and indeed great opportunities. ■

National Update | 7

Message from the Chair Working Now and Planning Beyond: Using Our Age Service Network to Develop Stronger Communities and Sustainable Services.

General Peter Cosgrove AM MC (Ret’d), Chair, LASA

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s LASA Chair, I have developed a strong understanding of the needs of age service providers, the challenges you face and the opportunities now and into the future. As part of our member advocacy strategy we addressed your immediate concerns, particularly regarding the legislation and will continue to make strong representations that related subordinate legislation is crafted to ensure industry can meet the growing needs of older Australians.

There is a real need to enable industry to function efficiently and effectively on a day to day basis and yet we also need to put real thought into the services and facilities of the future and establish a plan in order to meet growing demand. I understand this is difficult for many, as the vast majority of time and energy available is exhausted with operational tasks. I believe that industry should be supported with policies researched and developed to assist us to meet the needs of the future. In some cases this may include ‘left-field’ thinking, however older Australians and those working hard within age services deserve a ‘whole of community’ approach. In fact this is what I believe will be necessary to achieve our goals.

There are 2773 residential aged care facilities in all corners of Australia. They provide a holistic daily service to the residents that live in those facilities with essential health care, meals, social and cultural activities. In order to promote healthy ageing and incorporate age services as an integral part of our community we need to assess how our industry can value add which can be as simple as extending the services currently provided outward into the communities that they are located. Why are we not utilising residential aged care facilities’ kitchens and logistics as the commissary to provide a base for the ‘meals on wheels’ services?

How can we expand upon the formal social and cultural links between communities and age services? There are no doubt a number of creative and innovative programs that forward thinking people have already implemented. I want to advance this thinking globally so we see it applied as practice across the board.

Part of our challenge when we think about ageing is the negative connotation of becoming less mobile, losing vitality and

ultimately facing death. Is it possible, even subconsciously, that the general perception of services and facilities that support older Australians is the same? Other areas such as disability services face a similar challenge. If we are able to integrate age services with other parts of our community I believe the flow-on benefits will be considerable. Greater visibility of what we do creates greater interest and understanding. This ‘virtuous circle’ can only assist in the recruitment and retention of staff but also intergenerational awareness and engagement.

The challenge heading into the future is to create seamless integration of age services, allowing individuals to stay in their own home longer, and interact with a variety of services based on their current need. To do this we need to shift our thinking and assist industry to move with it. We need to establish dialogue with the Australian public helping them to understand that the wellbeing of older Australians also relies significantly on younger generations, now to provide practical assistance and in the future as a funding base. While LASA continues to support our members in the challenges of daily operation both myself and others will work at longer term strategy to educate politicians and bureaucrats about the capability and capacity that age services can contribute to ensure we rise above election cycle thinking. As LASA members, I invite you to join us through engagement with your state office.

In May I launched LASA’s workforce and community awareness campaign, 3 Million Reasons. Part of the launch took place at Christadelphian Aged Care in Gladesville in Sydney.

I am grateful to CEO Ross Peden and Managers, Barbara Walsh and Jane Burns for welcoming myself and LASA staff. I also met a great number of age service workers and this experience reinforced my resolve to make 3 Million Reasons a successful campaign highlighting the dedication, skill and empathy of our workforce. If you haven’t signed up on the website please do so today www.3millionreasons.com.au The action we take today determines the care and services of tomorrow, something we are all responsible for. ■

8 | National Update

Queensland Report LASA Q – Time to take care…seriously Barry Ashcroft Chief Executive Officer | LASA Queensland

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or some time now community care, or home care as it is to be known under the Living Longer Living Better reform agenda, has been evolving to meet the ever increasing demands of an ageing population.

With more and more older Australian’s seeking to age in place; in their own homes, amongst family and friends, and in familiar and/or comfortable surrounds, demand for community age services in the home will need to grow accordingly.

Last month, I had the pleasure of opening the LASA Q Community Care Conference before some 200 community care professionals, all eager to engage in the dynamic and highly relevant conference program.

Themed Learning, Leading, Living – Through Change, expert guest speakers delivered informative and interactive presentations, exploring the learnings and experiences of leaders in community age service provision, and focusing on the many opportunities and challenges of delivering age services at home to a rapidly increasingly ageing population.

Delegates were engaged on topics ranging from Consumer Directed Care, the Gateway, NDIS, LGBTI and Medicare Locals, through to active ageing and reablement, squalor and hoarding and mental health. An interactive master class on the new Home Care Package framework and current design discussions on the Home Support Program also contributed to the conference experience.

Whilst much of the program centred on the leadership and innovation required in meeting future opportunities and challenges, the Living Longer Living Better reform agenda and the likely future Australian Government approach, regardless of political persuasion, was also a key discussion point.

We already know that there are challenges, now and into the future, in meeting the home care needs of older Australians, particularly around issues including: • Department of Health and Ageing imposed restrictions on the number of home care packages available in each planning region – with allocations continuing to fall well short of demand and still being locked to each level, • Potential for older Australians living at home on low incomes to pay considerably more than they currently pay for care provided in the home… and at the other end of the scale – couples with an income of $50,000 or more potentially paying

up to 20% of their income in care fees as a result of the proposed means testing policy, • Home care indexation for 2013/14 largely being redirected toward the Dementia and Veteran’s supplements, • Potential financial and compliance impacts on employers seeking to access additional funding as a result of workforce supplement conditions.

Balancing these challenges however, are some possible opportunities for the home care sector including, the potential for The Gateway to better inform consumers and match services to needs, and for the new four level home care package system to simplify and better provide a continuum of care for older Australians.

In a recent discussion paper Living Alone With Dementia, Alzheimer’s Australia NSW noted that there are currently more than 321,000 Australians living with dementia, and that this is expected to grow (without a significant medical breakthrough) to more than 900,000 by 2050. Of these numbers, research indicates that up to one third of people with dementia living in the community, live alone.

The paper makes several recommendations to federal, state and local governments around ensuring community services are ‘targeted and funded’ to respond to the support requirements of those living alone (in the community and outside of residential care) with dementia.

And it is this message (around ensuring community services are ‘targeted and funded’ by government) that LASA will continue to pursue in the home care space, be it for dementia, respite care, day-therapy, home care package allocations or industry education and training.

Here in Queensland, through the leadership and determination demonstrated by our members, we have a strong home care industry. Our members are supported by LASA Q’s abiding commitment to the sector through the application of our talented resources to service and support them.

With the many challenges and opportunities ahead...

I’m glad we do.

Alzheimer’s Australia NSW June 2013, Living Alone With Dementia, Discussion Paper #7, Alzheimer’s Australia NSW, 24 June 2012, http://www.fightdementia.org.au/content/new-south-wales ■

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10 | National Update

South Australia Report LASA SA – The LLLB Reforms, Now to the Job of Getting on with Them Paul Carberry Chief Executive Officer | LASA South Australia

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he main event for aged care this year has been the Living Longer, Living Better Reforms which, at the time of writing, are in the final stages of debate in the Federal Parliament.

Understandably, busy aged care providers have found it difficult to keep up with the relentless flow of discussion papers and announcements which began in 2012 and have continued through the first half of 2013.

Trying to absorb and distil the vast detail has been a challenge for all of us, and I commend Patrick Reid and his team at LASA National for their great efforts in representing LASA members on the many advisory groups established by the government, and in lobbying hard for improvements to various aspects of the policies.

The National office’s efforts have been fully-supported by each of the state CEOs, who have conducted dozens of meetings with MPs and Senators, explaining LASA’s position.

LASA has made a difference, with withdrawal of the requirement for providers to insure their refundable deposits, and changing the basis for accommodation price setting to be based on the refundable deposit, being two important changes resulting from our lobbying.

With the passage of the Bills there is still plenty of opportunity to influence much of the final outcome, with 18

pieces of subordinate legislation (Principles and Ministerial determinations) still to be tabled in the Parliament.

One of our challenges as an industry association is helping aged care providers know what the reforms are likely to mean to them, in practical, down-to-earth terms, and what strategies they need to be considering for the future. In talking to providers from all sectors of aged care in South Australia, it’s clear that the financial and operational implications of the reforms loom as major areas of interest and concern to them.

It is precisely for this reason that we will be running a seminar on 12 July which will give providers information, expert opinion and ideas on what it all means.

Called At The Financial Crossroad – Considerations and Options for Home and Community Care the seminar will bring together some of Australia’s best-known and respected consultants, advisors and practitioners, to present their interpretations of the changes and consider the strategies providers should be weighing up.

The timing couldn’t be better, just two weeks after Parliament will have dealt with the LLLB Bills.

The idea seems to have struck a strong chord, with numbers exceeding our expectations, including broad representation from across the whole sector. It would appear that this seminar is meeting an important demand in the South Australian marketplace. ■

12 | National Update

victoria Report LASA VIC – Industry excellence recognised at LASA Victoria Awards John Begg Chief Executive Officer | Victoria

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n late June Leading Age Services Australia – Victoria (LASA Victoria) held its annual Awards for Excellence at an elegant cocktail reception, held at Flemington Racecourse overlooking the magnificent Melbourne city skyline.

The Awards recognise excellence across all fields of the aged care industry and celebrate significant contributions to the quality of life of older Victorians.

Individuals and organisations from across Victoria were rewarded for their outstanding contributions to the aged and community care sector across four Awards categories; Employee, Organisation, Volunteer and Trainee.

The winners, judged by a panel of industry representatives, were Graham Custance from Care Connect Ltd (Employee Award), Royal District Nursing Service (RDNS) (Organisation Award), Barry Fenton from mecwacare (Volunteer Award) and Paula Clarke from CaSPA Care (Trainee Award).

RDNS has a long history of pursuing innovation and change for the benefit of its many thousands of clients and was recognised as a leader in the provision of community based nursing and home care services, pioneering innovative practices such as a hand held, field based real-time client management system that ensures staff have access to up to the minute client data.

Volunteer of 29 years Barry Fenton, was recognised for his dedication, professionalism and leadership. In his nomination he was described as having a hands-on approach to volunteering which is both effective and contagious, making the quality of his work shine.

Paula Clarke, 2013 Trainee Award Winner, was a Personal Care Worker with CaSPA care before embarking on a career change through studying a Certificate IV in Leisure and Health – one she has since excelled in, proving the value of her training in its application to her new role and demonstrating that her passion for resident care is paramount in her thinking and approach.

L-R David Aberdeen, Executive General Manager – People and Culture representing RDNS (Organisation Award Winner); Paula Clarke, CaSPA Care (Trainee Award Winner); Barry Fenton, mecwacare (Volunteer Award Winner) and Graham Custance, Care Connect Ltd (Employee Award Winner).

Graham Custance, Community Development Manager at Care Connect Ltd is responsible for promoting and supporting the development of community services for Aboriginal Elders.

In his nomination Graham was described by colleagues as dedicated to his role and is recognised as a voice for the Aboriginal community, advocating on its behalf so that appropriate programs can be developed and delivered in a way that are culturally-sensitive and right-fit.

Trainee Award Finalists & Winner support the 3 Million Reasons Campaign L-R: Lauren Parkinson, BlueCross; Jack Bremner, Southern Cross Care (Vic); Paula Clarke, CaSPA Care (Winner) and Helena Higginbottom, representing Trainee Award Sponsor – HESTA (Finalist Lily Simcic, Arcare was absent)

The Awards winners and finalists also showed their support for Leading Age Services Australia’s national public campaign 3 Million Reasons. The campaign is raising support and awareness for much needed workforce growth, funding that matches care needs and a secure age services industry. ■

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14 | National Update

NEW SOUTH WALES – ACT Report LASA NSW-ACT – Clarity needed in the second half of 2013 Charles Wurf Chief Executive Officer | LASA NSW-ACT

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rustrated and impatient. These are two words which best sum up the attitude of the age services industry in 2013.

After months of delay, in March 2013 the industry was at last able to review the legislation that the Government intends to structure and shape our industry for years to come.

Moreover, we then had to wait until the final Parliamentary sitting week in June to know if the legislation would be amended, or even pass the Parliament.

From workforce to funding, from delivery of care, to capital expenditure, so many aspects crucial to the delivery of age services have been in limbo. There is a clear desire within the industry to get on with making decisions, and to get on with

business, and to best provide the care older Australians deserve.

With the passage of the legislation many providers are now in a position to make the decisions that circumstances and process have delayed.

In the last issue of the Fusion I commented on the fickleness of confidence, and confidence in the age services industry. History will judge the impact the legislative delay of the Living Longer, Living Better package will have to the viability of some providers.

At the LASA NSW-ACT Congress in late May, with the passage of legislation through Parliament still pending, the program was deliberately developed to address many of the issues and concerns that have been on-hold. The program was titled, “Let’s get it done...”, and focussed on providing clarity in the legislative vacuum.

Sessions at the Congress included, “Residential aged care: beyond 2013”, “The currency of tomorrow,” and “understanding where I fit: Home Care – beyond 2013.” Other sessions at the 2013 Congress addressed future workforce factors, social media in aged care, and also gaining and maintaining the respect of a local community.

Information at the Congress had a focus for those who work in and manage age services, this was particularly through sessions including, “Consent, care, tenure”, and “The complaints system.”

Each session at Congress 2013 was extremely well-attended.

The LASA NSW-ACT Congress, like those Congresses and events held by other LASA states, has been one of the means the industry has striven to communicate to providers this year. The strong attendances have clearly shown that right around Australia the industry has been starved of clarity.

In the second half of 2013 government must provide better communication and must provide more information than has been the case.

With the Living Longer, Living Better legislation through the Parliament, provider concerns are now questions needing consideration and answers. Effort and availability to address providers’ questions must be a priority.

Government would also be encouraged to realise that, for the age services industry, the work did not finish with the legislation passing through the Parliament. In many ways, and for many providers of age services, the work of government is only now beginning. In the second half of 2013 clarity and communication must rule. ■

National Update | 15

WESTERN Australia Report LASA WA – Holding on to your vision Beth Cameron Chief Executive Officer | LASA Western Australia

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n a past life, I came to know of a Western Australian guy named Keith who had a really big vision. He was concerned about the challenges facing the environment in the south-western corner of Australia; an area recognised as one of only 25 biological ‘hotspots’ in the world and the only one in Australia.

His vision was to build a corridor of vegetation connecting the scattered reserves around Margaret River, to the south-western end of the Great Western Woodlands – over near Kalgoorlie.

About 1000kms of reserve.

Now, Keith had this idea before connected reserves were seen as important, in the days before climate change. The area he has his eye on is a combination of bush, government owned, private property, farms, and crown land. Every owner has their own ideas about how to manage their patch of Australia, and he understands that. He is very creative about finding ways to make small gains in ways that landholders are comfortable with, and working collaboratively.

Keith has spent over a decade talking to all kinds of people about his vision.

Politically in that time, Governments have come and gone.

There have been a revolving series of Ministers, some supportive, some not. Some provide funding and streamline regulation, some withdraw funding and throw up new regulatory barriers. Keith holds onto his vision.

An old colleague of mine recently headed to the Southwest to see how the project was progressing, and even though there is still a lot of work to do, real progress has been made. There are hundreds of hectares now more protected than they were. It takes hundreds of years for bushland to completely restore, but if you head down to the area you can see real change in the vegetation already. And the wildlife are returning. Keith and his growing team have received support from government, but also the public, trusts and philanthropists, and even donations from Hollywood!

I know that Western Australian members have been engaging with government for decades, advocating for important reforms needed in the industry. Last week, one of our WA Board members shared a story about being in Canberra to meet with the then Minister, on the day that the Whitlam Government fell. Her meeting was postponed.

So many of you keep working and engaging in the mad and often harsh world of politics to try and make a difference, to try and be heard, to try to shore up better care, and better regulation

for this essential industry. Your endurance and tenacity are so important and so inspiring.

Like Keith, hold onto your vision: for proper support and resourcing; for the public to join you in understanding the importance of this sector; for the provision of great care for every older Australian.

Let the Ministers churn and the politics play out. Sometimes governments will help, sometimes they will hinder. Support will come and go from all kinds of places. If you hold onto your vision you can effect change. And if you can improve the conditions in your ‘hotspot’ that change will improve the surrounding environment; inspire your colleagues within the sector; inspire people in other sectors; inspire change in the world.

If you have read Fusion this far, you know that you have LASA teams in each state and at national level that are passionate and working hard to support you in your endeavours. We all do it because your vision is inspiring.

One way that LASA is increasing support for our vision is through an industry building and community raising campaign to promote you and your workforce, 3 Million Reasons. Please sign up at the website (www.3millionreasons.com.au) today if you haven’t already.

It will take time and persistence, but we will get there together.

Find out more about Keith’s work at www.gondwanalink.org. ■

Workforce | 17

Legislative Wrap Up Living Longer Living Better Bills Pass into Legislation: What Now?

By Justine Caines, Government Relations & Communications Manager, LASA

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he legislative framework known as the Living Longer Living Better Bills passed the Senate on June 26.

It did so without 18 pieces of subordinate legislation, also known as Principles and Determinations. This subordinate legislation is supported by guidelines developed by the Department of Health and Ageing. Most of the substance of the reform is found in this legislation and guidelines. They cover a raft of subsidies and supplements including the workforce supplement and issues relating to sanctions, complaints and quality of care.

The subordinate legislation was signed off by the Minister on June 28 and now await 15 parliamentary sitting days where they can be either passed through (allowed) or disallowed.

Subordinate legislation such as this is also referred to as a ‘disallowable instrument’. It is important to note that these cannot be amended so they will either pass in entirety or be excluded in entirety. Politicians are often loathed to do this because often positive aspects are lost within the instrument.

This is why LASA’s advocacy was so strong in relation to politicians, particularly those representing the Senate Committee adopted appropriate parliamentary process and assess subordinate legislation alongside the bills.

Unfortunately, despite In relation to the precedent with the National Workforce Supplement Disability Insurance Scheme it is legally operational (NDIS) and the Greens and therefore until it is penchant for process repealed, if in fact it is, appropriate process was there is capacity to draw rejected. So where to from on the supplement for here? At the time of writing funding. the election date is unknown The same applies for and also if politicians will the Dementia and return to Parliament. LASA Cognitive Supplement understands however that in Home Care, preparations are being made Dementia and Severe for Parliament to resume Behaviours Supplement on August 20. Subordinate in Residential and the legislation however once Veteran’s Supplement registered becomes operational. If a particular instrument is disallowed it is treated like repealed legislation.

So until Parliament (both houses) sits for 15 days from when the subordinate legislation was registered they are considered law. It is virtually impossible that there will be 15 clear sitting days before an election and therefore it is

very likely that the instruments will be considered law until the new Parliament resumes and the 15 days expire.

The composition of both houses in the next Parliament is obviously unknown. If there is a change of government the Senate is likely to remain hostile (to a Coalition Government) with only a half Senate election the Greens are likely to retain balance of power (even if they exist in reduced numbers).

Changes Proposed for January 1 2014 There are two main changes to delegated legislation that are proposed to take effect From 1 January 2014: Drafts of the proposed new Principles and amendments to the User Rights Principles will be released on the Living Longer Living Better website by the end of October 2013.

The creation of new Quality Agency Principles and Quality Agency Reporting Principles.

The content of these Principles will be drawn from the existing Accreditation Grant Principles. As there are no substantive changes to the content of the Principles (merely re-making them in a different format and, in the case of the Quality Agency Principles, under a new Act), no consultation is proposed in relation to these changes.

Amending the User Rights Principles by inserting new provisions relating to the new Aged Care Pricing Commissioner.

The amendments will set out details regarding the application processes (for approved providers to apply to Charge accommodation payments that are higher than the threshold set by the Minister) and advertising requirements in relation to accommodation prices.

Proposed Changes: July 1 2014 The Department of Health and Ageing (DOHA) released an overview document in May suggesting that the changes to be made for 1 July 2014 will be ‘substantial’. Regrettably, this document failed to provide any specifics as to the content of the changes, other than promises of ‘consultation’, with the document saying:

18 | Workforce

Prior to the drafting of these Principles and Determinations, significant further consultation will be undertaken with working groups and the public. The Department in its initial phase of consultation on the proposed amendments to the Principles and Determinations will consult directly with the National Aged Care Alliance. Following direct consultation with the National Aged Care Alliance, the Department will undertake public consultation on the proposed amendments including consulting with industry, aged care consumers, their families and other relevant stakeholders. As these Principles are drafted, it is anticipated that they will be progressively released as exposure drafts from March 2014 on the Living Longer Living Better website. Subject to passage of the Bills by Parliament, it is proposed that the amendments to Principles and Determinations that take effect from 1 July 2014 will be made by the Minister in late May or early June 2014, following this further consultation on the substantive issues addressed in those Principles and Determinations.

This is an overview of the type of documentation that can be expected to be developed, drawn from the March Aged Care Principles Navigation Overview. ■

Consolidation of Advocacy Grant Principles, Community Visitors Grant Principles and Residential Care Grant Principles into a new document called Grants Principles

Consolidation of Home Care Subsidy Principles, Flexible Care Subsidy Principles and Residential Care Subsidy Principles into a new document called Subsidy Principles (which will also create new provisions to deal with all matters dealing with residential care, home care and flexible care subsidy and requirements, provide for leave arrangements from care and to ensure ratios are operating effectively).

Creation of a new instrument called Fees and Payments Principles. (which will include the creation of new arrangements relating to residential care, home care and flexible care fees and accommodation payments and will include detailing approved provider responsibilities relating to fees and payments, providing detail regarding residential care, home care and flexible care agreements, describing eligibility for hardship determinations for home care and residential care and prescribing types of flexible care services that may change accommodation payments.)

Amending the new (1/1/13) Quality Agency Principles (to add procedures for quality review of home care services).

Amending the new (1/1/13) Quality Agency Reporting Principles

RISK MANAGEMENT & COMPLIANCE Services and products to ensure regulatory compliance in any facility

(to describe information to be provided to the Secretary regarding quality review of home services).

Amending Accountability Principles (to make consequential amendments relating to accommodation bonds and charges and ‘minor technical changes’).

Amending Allocation Principles (to ensure the allocation process takes account of newly created classes of care recipient resulting from the 1 July 2014 change to subsidy and fees).

Amending Approval of Care Recipient and Classification Principles (to reflect the removal of high level and low level residential care).

Amending Extra Service Principles

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(to reflect amendments to the Act and to reflect that the Aged Care Pricing Commissioner will (sic) make decisions on extra service fees).

The Work Health & Safety Act and Regulations 2011 has prescribed actions that are now mandatory within any workplace.

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Amending Quality of Care Principles

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(following review).

Amending Sanctions Principles (to ensure the instrument covers non-compliance under both the Aged Care Act 1997 and the Aged Care (Transitional Provisions) Act 1997).

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Workforce | 19

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Workforce | 21

Care Entitlement, What Does It Really Mean?

By Susanne Macri AM, Senior Aged Care Advisor, RSM Bird Cameron

M

uch is written and talked about in relation to consumer directed care and care entitlement, whilst consumer directed care has been enshrined in legislation through Living Longer, Living Better, care entitlement for older Australians remains in the “too hard basket”.

We are all entitled to care through the current universal Medicare system, however, for older Australians needing to access care services this remains a rationed system, that is the entitlement continues to remain with the provider and the care recipient can only access that care if and when a package or bed becomes available. As outlined in the Productivity Commission’s Report, Caring for Older Australians (No. 53, 28th June 2011) the supply of aged care services is not matched to the level of demand or the geographic incidence of that demand.

In consequence consumer directed care, whilst going some way to ensuring greater consumer choice around actual care and services to be provided; it continues to restrict consumers in terms of who actually provides the service. There are many arguments around the affordability of doing away with the current ACAR system and moving to a more open market entitlement based system, and of course these are legitimate concerns to be raised in the current political and economic climate.

However, I have long argued that if we broke down the silos in funding between the acute health and aged care sectors and had a more integrated system, we would then not have the financial divide of what is the responsibility of the Federal Government and what comes under State Government funding for older Australians. The journey for the care recipient would firstly ensure that care and services would be able to be accessed in a timely manner, the process would be less complicated and we would not have the people being assessed and approved for care sitting on waiting lists waiting for either a package or a bed.

This of course in turn means that older people will not require admission or re-admission to acute care services whilst waiting for a placement. This has savings for acute care services, avoids premature and early admission to residential aged care and older

people are able to remain in their home supported by a range of services and care as required and in a timely manner.

There are some excellent examples of programs currently operating out of acute care hospitals such as St. George and Sutherland Hospitals in NSW where they have a Geriatrician Flying Squad which visits older people both in the community as well as residential aged care facilities and in a three month period they; • Had fewer admissions of elderly people through the emergency department.

• In Sutherland 120 older people were treated and only one quarter required hospital admission, avoiding 180 hospital bed days.

• At St. George Hospital three quarters of the people seen in that period did not require ambulance transport or presentation to the emergency department.

The cost savings are self evident, for the older person the interfacing of aged care services (within the community as well as residential aged care facilities) with the acute care system ensures that more cost effective and appropriate care is provided and the avoidance of unnecessary admission to hospital is managed more effectively. So moving into an Entitlement based system, ensuring timely access to care and services is good for both State and Commonwealth funded programs as well as being in the best interest of the older person in terms of continuity of care.

For Providers in the aged care industry this will create more competition in the market place for aged care services, drive innovation and ensure operational efficiencies in terms of diversity and growth of service delivery. This issue must and should be on the agenda of all stakeholders (Providers, Consumers and Unions) involved in the future negotiations around Caring for Older Australians. ■

Be sure to see Sue present on Monday 5 August 2013 at 11.45 am within the Poseidon adventure concurrent session at the National Congress.

22 | Workforce

Workforce | 23

Reducing the risk of innovation: the role of alignment and engagement in organisational change

By Malcolm Johnson, General Manager of Professional Development and Research, Australian Institute of Management

Don’t miss the Australian Institute of Management Partnered Session at the LASA National Congress on Monday 5 August 2013, at 11.45 am.

C

hange management sounds like a great idea – after all, in life and business, change is inevitable.

Why shouldn’t organisations decide to change and then work towards achieving that objective?

The value of any innovation initiative is only realised if it is implemented. With upwards of 75 per cent of change efforts failing, the cost to organisations and stakeholders is significant.

Dr Malcolm Johnson, General Manager of Professional Development and Research at AIM says change management programs often fail because organisations do not sufficiently involve employees.

A recent study revealed that only 19 per cent of employees in Australia are engaged at work. Of the balance, 61 per cent are emotionally detached and likely to do little more than is necessary to keep their jobs – these constitute the ‘unengaged’.

The remaining 20 per cent of employees are actively disengaged, indicating they view their workplaces negatively and are liable to spread that negativity to others both inside and outside of the organisation.

Dr Charmine Härtel, Professor of Human Resource Management and Organisational Development at The University of Queensland Business School, says “The cost of having unengaged and disengaged workers is extremely high. Not only does the organisation lose productivity, it loses adaptability. Only engaged workers seek to ensure the organisation’s values and objectives are enacted, including delivering high quality products and services, finding better ways of doing things and ensuring organisational change is effective.”

Professor Härtel, says “workers will welcome change if it is properly managed. It’s often said that people don’t like change but this is simply not true. The evidence is very clear – as long as people see something positive for themselves in a change and they feel they can cope with it, they are more than happy to do it. But they certainly don’t want to be pushed through a change process that they feel is unbeneficial and one they don’t feel able to handle. This is when you’ll get pushback”.

Dr Johnson highlights that “people work in organisations to achieve personal outcomes. Helping them clarify how the

proposed change supports achievement of their personal aspirations is a positive tipping point”.

“Engaging people is an ongoing process, however.

Even organisations with high levels of worker engagement cannot take for granted this competitive advantage”.

Organisations implementing innovation will likely confront a paradox: engaged workers are most able to effectively implement change but, implementing change carries the risk of reducing worker engagement. In other words, even seemingly successful change can make the organisation more vulnerable.

This raises two important questions for organisations: • How can change be managed so that engaged workers remain engaged?

• For workers with low engagement, how can senior management engage people to implement change initiatives?

Professor Charmine Härtel (UQ) and Dr Malcolm Johnson’s (AIM) presentation at the LASA Congress will reveal preliminary findings from collaborative research that addresses both questions. In so doing, they challenge current understanding on engaging people for implementing change initiatives and open a new pathway to value creation.

Their work identifies how engagement is fostered or undermined in organisations undergoing change. Sophisticated approaches to change management also involve aligning the values of the organisation with people’s values so they can say, “Being in this organisation is also helping me get some of the things that I want out of life”.

Using an appropriate mix of employee and organisational assessment tools, boards and senior management can obtain the information necessary to measure the risk of proposed change initiatives before significant organisation resources are committed.

Such a diagnostic also provides the foundation for developing a robust change implementation process. ■

Continued on next page >>

24 | Workforce

Dr Malcolm Johnson FAIM is General Manager of Professional Development and Research at the Australian Institute of ManagementQld NSW ACT NT and Adjunct Professor at Griffith University. He completed his MBA and thesis on corporate strategy while working at Shell Australia, subsequently contributing to preparation of the country business plan submitted to the Shell Board in London.

Through the prism of behavioural finance, Malcolm’s doctoral research identified key decision drivers that have specific application to change management. Understanding this complexity he has guided a number of strategic transformations across the public and private sectors.

Contribution to enhanced management practices has been recognised through coverage in publications ranging from BRW, Asset, InFinance, and Money Management through to the Australian Financial Review and The Australian.

Professor Charmine Härtel PhD FAIM is Professor of Human Resource Management and Organisational Development and Head of Management at The University of Queensland Business School. She is Fellow of the Australian Institute of Management, the New Zealand Academy of Management, the Australian Human Resources Institute and immediate past-president of the Australian and New Zealand Academy of Management.

Professor Härtel is recognised internationally as a leading expert in change management, organisational and employee development, diversity management and social inclusion, leadership development, employee engagement, and worker and community wellbeing.

Her thought leadership has been recognised by numerous awards internationally, including five awards for innovation in organisational practice.

As a practitioner, Professor Härtel has a long history of successful consulting activities. These have included performing organisational culture audits, design and implementation of change initiatives, and development of workforce solutions such as leadership profiling and development and work process redesign. Australian clients include DOT (VIC), SES (VIC), DSTO, AirServices, APS, Office of Fair Trading (QLD), IBM, GE, ANZ, and Rio Tinto Iron Ore.

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26 | Workforce

Heed the Lessons

By Adjunct Professor Debra Thoms FACN (DLF), CEO, Australian College of Nursing.

Don’t miss the Australian College of Nursing Partnered Session at the LASA National Congress on Tuesday 6 August 2013, at 2 pm.

T

he recently released Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis 2013) contains a number of lessons that nursing as a profession and the broader health community would do well to note. This Report, which follows on from an earlier Report, highlights a number of failings that led to patient care standards that many would say were not possible, but in looking at our own health systems are we sure that we do not already have some of the early warning signs?

Francis (2013) talks about the number of incidents and issues that were occurring but the system failed to consider in-full or see as representative of a larger problem. The answer, Francis argues, does not lie in ‘top down’ pronouncements or reorganisation of the system but by “engagement of every single person serving patients in contributing to a safer, committed and compassionate and caring service” ( 2013 p18). He further says that patient safety and requirements are obligations that “need to transcend particular policies and permeate all consideration within the system of fundamental standards” (2013 p38). Francis did not find that there were one or two poor managers or clinicians but rather a combination of factors and deficiencies within a complex health system (2013 p36).

In several places Francis refers to the focus on financial outcomes and targets. While he does not argue that having such requirements is inappropriate, it is the concentration on them to the detriment of care that is questioned. Measurement is critical for the feedback it provides on how our system is operating and in identifying opportunities to improve the delivery of care within an efficient and effective framework. There is though a need for balance and for a number of the measures to be seen to connect directly to care and patient outcomes. The measures that we use need to have meaning for clinicians and managers and provide feedback that supports and enables them to truly improve care.

Margaret Wheatley, in her article with Myron Kellner-Rogers on measurement in 1999 noted the following:

“But in too many organisations, just the reverse happens. The measures define what is meaningful rather than letting the greater meaning of the work define the measures. As the focus narrows, people disconnect from any larger purpose, and only do what is required of them. They become focused on meeting the petty requirements of measurement, and eventually, they die on the job.

They have been cut off from the deep well-springs of purpose which are the source of the motivation to do good work.”

A number of the comments within this latest Report would seem to reflect, at some level, this potential disconnection as identified

by Wheatley and Kellner-Rogers. Specifically for nursing Francis notes the issues of poor leadership and staffing policies and the delay in addressing the shortage of skilled nursing staff (2013 p45). A number of other recommendations are specific to nursing and are encapsulated in the need to have a culture that is one of ‘compassion and caring’ and that goes through the recruitment, training and education of nurses. He highlights the need for the ward nurse managers to not be office bound but to be out on the floor and aware of the plans and care of patients (2013 p76).

Francis argues that there is no need to “radically reorganise” but to re-emphasis what is truly important. He emphasises the importance of the patient being at the centre of care and of there being no tolerance for poor or substandard care. He lists eight (8) items that he sees as being important (2013 p66).

• “Emphasis on and commitment to common values throughout the system by all within it • Readily accessible fundamental standards and means of compliance • No tolerance of non-compliance and the rigorous policing of fundamental standards • Openness, transparency and candour in all the system’s business • Strong leadership in nursing and other professional values • Strong support for leadership roles

Workforce | 27

• A level playing field of accountability • Information accessible and useable by allowing effective comparison of performance by individuals, services and organisations”.

Some reading this may think that this will never happen in Australia, that we do not have these issues …but is that really the case? Can we really be confident that some of the problems of Mid Staffordshire could not be found in our health system? Our system too is increasingly focussed on meeting targets and financial outcomes and it is not unusual to hear clinicians commenting that the interest in the patient seems to be at times over-ridden by the need to meet a target. Nurses talk about the focus on targets, how the measures do not reflect care outcomes and the frustrations they feel at the emphasis on the targets to the exclusion of other important care issues. In thinking about this further I would argue that they are, in Wheatley’s words, in danger of becoming ‘cut off from the deep well-springs of purpose’ that not only motivates but sustains people in what are increasingly challenging and complex systems. We also hear of the workload of ward nurse managers – that they find it difficult to ‘get out of their offices’ and spend time on the ward not only knowing what is happening with patients and their care but also providing the support and mentoring that is needed to grow and support the workforce and contribute to the longer term retention of nurses.

All is not lost though!! Several health services in Australia have either undertaken or are undertaking work to both build the skills and capabilities of those in the critical role of ward nurse manager and also to ensure that they are not bound in offices. I am aware of a number of programs of work around Australia that are seeking

to redress some of the balance in terms of the focus on care – a number of these have Transformational Practice Development as an underpinning foundation and they are having some success.

Critically important in these programs are the examination of values that underpin the care that staff seek to provide and enabling them to implement strategies to deliver that care. A system developed in the USA, known there as Transforming Care at the Bedside, is also I understand being trialled in Australia. Both of these systems are based in more humanistic systems and approaches to care rather than some of the more mechanistic systems that have been prevalent in recent years. They do not bring about fast changes or improvements as they seek to bring about true cultural change and that takes time however, as Francis says it is critical that the culture and values that underpin our health systems are focussed on compassionate care for patients.

I would suggest that all nurses and managers take the time to read this latest Report on Mid Staffordshire and reflect on their own work and practice and identify what can be learnt both from an individual and system point of view. Ask ourselves are we satisfied that compassionate care is the overriding driver of our work each and every day or are we only doing something because it is to meet a target? ■ Francis R 2013 Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry London Available at www.midstaffspublicinquiry.com Wheatley M and Kellner-Rogers M 1999 What Do We Measure and Why? Questions About the Use of Measurement Journal for Strategic Performance Measurement June 1999. Available at www.margaretwheatley.com Republished from Nursing Review, 2 April 2013.

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Workforce | 29

Governance Trends, Issues and Solutions

By Michael Goldsworthy, Principal Consultant, Australian Strategic Services

Don’t miss the Better Boards Partnered Session at the LASA National Congress on Tuesday 6 August 2013, at 11.45 am.

“

Boards Govern, Managers Manage” is a catch cry that was coined by Michael Goldsworthy in 1998. It is something that many boards/directors and chief executive officers throughout Australia have, or are still, coming to grips with as they acknowledge that governance is not just about legislation and compliance, but more importantly a partnership in the leadership and management of their organisation.

For boards, directors and chief executive officers of private, public and community (NFP) aged and community care organisations, the “New World Order” is framed by Caring For Older Australians, A Healthier Future For All Australians and the Contribution of the Not For Profit Sector reports (for those organisations who are NFP).

Consequently, the announced or emerging Commonwealth Government policies, legislation and regulations are driving an increasing number of boards/directors to quickly and thoroughly come to grips with the realities and practicalities of governing in this new environment.

Whilst there are many legislative, regulatory and technical changes, be they focussed on such areas as funding, accreditation or service delivery, many of these changes have direct and profound governance implications and impacts for not only directors, but chief executive officers and executives/ senior managers, who are legally deemed to be “officers of the company”.

So how should these leaders come to grips with all these changes, in a timely and efficient way? Here’s a three step process to consider actioning:

Step One: Collate & Document Requirements Identify, collate and document the various legislative, regulatory and policy requirements in a spreadsheet/schedule or through the use of your organisation’s quality management system.

In turn, either of these approaches can be used as a basis for the actioning of steps two and three which follow on below.

Step Two: Determine & Document Focus on determining and documenting the existing and new governance policies, procedures and tools that will be required,

in essence mapping and aligning the content of step one against the content of step two.

Step Three: Review The Way The Board Works With more and more being asked of boards/directors by both State and Commonwealth governments, there is a real need to review the way your board actually works and behaves; continuing with your board’s current governance framework, processes and documentation will not guarantee any success in the “New World Order”. Therefore it is critical that a board can truly reflect on itself, its way of working and its actual attitudes and behaviours, by asking hard questions and determining the real “state of the nation”.

Aside from the increasing legislative and compliance requirements, a board also needs to consider the introduction and use of an e-boardroom, moving from monthly board meetings to quarterly/bi-monthly meetings, with board committee meetings, tours and guest speakers in between board meetings and similar such practical strategies and approaches.

At the forthcoming LASA National Congress, Michael Goldsworthy, Chairman of Better Boards, Victor Harcourt, Principal of Russell Kennedy Pty Ltd and Sallie Saunders, Director and Principal Consultant of Building Better Boards will present and discuss: • powerful governance perspectives on the various industry/ sector reforms as well as, in part, focus on the three aforementioned steps and the other practicalities and realities that boards/directors and chief executive officers could consider • the human face of boards, therein the interplay of human dynamics, power, politics and personalities and how classic board room cultural challenges are being addressed • a range of governance and organisational case studies, strategies, processes and tools that have been and/or are being put in place by boards and chief executive officers across Australia, to move beyond a standard governance framework and approach.

Join Michael, Victor and Sallie for a thought provoking and practical session that will assist your board of directors and chief executive officer to strengthen their partnership in the leadership and management of their boards and organisations. ■

30 | Workforce

2010 winners, left to right: 2012 winners, left to right: Chris McGowan Jan Wright and Raeline George representing Silver Chain, Rhonda Sawtell, Abby Dunnicliff and Shirley Nelson.

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Workforce | 31

Winners of the 2013 HESTA Aged Care Awards announced

All images from HESTA 2012 awards

T

he 2013 HESTA Aged Care Awards have highlighted the remarkable dedication and professionalism of Australia’s aged care sector, at an awards dinner in Sydney on 4 August 2013.

The winners were recognised for their outstanding contribution to aged care, in the categories of Individual Distinction, Outstanding Organisation and Team Innovation.

HESTA CEO, Anne-Marie Corboy said in choosing the finalists and winners, the judges had come up with a shortlist of outstanding individuals and organisations, demonstrating a high level of care, innovation and excellence in aged care.

“Our winners were selected from a significant number of nominations for their exceptional commitment to improving aged care in Australia,” Ms Corboy said.

“We are proud to give these professionals the acknowledgement they deserve.”

32 | Workforce

Workforce | 33

The 2013 winners are: Individual Distinction Award: Helen Williamson – of Bankstown City Aged Care in New South Wales – for her 40 years of service at the facility, including fundraising, managing the kiosk and serving on its Board of Management.

Mrs Williamson, aged 78, has raised more than $100,000 for the Bankstown City Aged Care facility since 1995 and continues to bake, sew and knit to provide additional comforts for the aged care residents. She has been recognised for her enduring commitment to improving the lives of residents at the facility.

Mrs Williamson oversees the running of the kiosk at the facility, which sells food and goods to residents and visitors, with the funds going back into the centre to buy extra equipment and improve the amenities.

She cooks some of the food for the kiosk at home, making special order cakes and treats for residents. One resident received homemade chocolate crackles every week and Mrs Williamson believes she has ‘made millions of fish cakes and rissoles’ over the years. She even takes charge of the barbeque every Friday, cooking her homemade hamburgers for residents, their families and staff.

Mrs Williamson also knits beautiful clothes, blankets and toys to sell at the kiosk, with many residents proudly displaying knitted football boots in club colours in their rooms.

The funds raised by Mrs Williams and her team of volunteers have provided plants, outdoor furniture, garden water features, gazebos, bird aviaries, barbecues and shade umbrellas for the outdoor areas. Other items such as special clocks for vision impaired residents, shower chairs, TVs and whiteboards have also been purchased with these funds, greatly improving the quality of life of residents.

Mrs Williamson was appointed to the centre’s Board of Directors this year and is also helping shape the future of the centre – all as an unpaid volunteer.

Outstanding Organisation Award: RSL Care, Queensland, for its work maintaining services and high-level care in the aftermath of this year’s devastating flood emergency.

Fifteen of the network’s 29 retirement and residential care communities were impacted by the January storm and flood event – precipitated by ex-cyclone Oswald – but most of its centres were operational again within hours or days, as a result of the high level organisational preparedness of staff.

At the worst hit RSL Care Fairways community in Bundaberg, 108 residents were evacuated in a mass operation to four temporary accommodation sites, while continuing to receive the best of care.

More than 40 RSL Care staff from 12 other centres then travelled by car, bus and plane to support and relieve fellow team members who had been relocating residents since the flood crisis began.

RSL Care’s Chief Executive Officer, Craig Mills, said staff also had help from the local community and fire officers, as well as defence force personnel who moved in to help with the clean up.

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34 | Workforce

appeal across our organisation to raise funds for them and also made a one-off payment of one thousand dollars to affected staff under a new grant scheme,” Mr Mills said.

“While there was a lot of heartache and loss as a result of the flood, there was also a lot of goodwill and generosity of spirit. In many ways, what tore a small community apart, brought a bigger community together.

“From the evacuation to the repatriation of residents, staff did what they were trained and compelled to do, with the safety and wellbeing of residents always first and foremost in mind.”

The judges praised the great achievements of RSL Care staff in a time of adversity.

Team Innovation Award: Better Together Services Model Team, of Wahroonga Aged Care in Glen Waverley, Victoria.

The Facility has been recognised for its innovative pilot program that involved residents moving out of the traditional long-term care facilities into a designated wing that was remodelled into a self-sufficient cottage.

Under a new Better Together service model, residents were given more say in how the centre was run, while staff in the role of housekeepers, undertook personal care, support and engaged in resident activities.

Wahroonga representative, Mary Fromberger, said clinical nursing expertise was provided by visiting nursing staff, while residents who wanted to, took over some aspects of the cooking and laundry work.

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“We first re-modelled the area so a new smaller environment – with a domestic style kitchen, laundry, dining and lounge room – was created to encourage residents’ long-term mobility and independence,” Ms Fromberger said.

“One positive result to emerge from the trial has been that many residents who previously spent the majority of their time on their own in their bedrooms, now spend more of the day in the cottage lounge room, enjoying conversations with staff and other residents,” she said.

“Another benefit has been giving aged care professionals more opportunity to genuinely engage with residents, resulting in higher staff satisfaction and residents enjoying having someone with them for longer periods each day.”

The judges praised the pilot as a great initiative, providing better outcomes for residents and noted the operator’s plan to extend the model into other new residential aged care facilities within the group.

A $30,000 prize pool was shared among the three winners, courtesy of long-term HESTA awards sponsor ME Bank.

The Individual Distinction winner received a $5,000 ME Bank EveryDay Transaction account and $5,000 towards further education. The Outstanding Organisation and Team Innovation winners each received a $10,000 development grant to put towards their program or initiative.

ME Bank CEO Jamie McPhee said, “We’re proud to continue our support of the HESTA Awards program, recognising the tireless contribution of individuals and organisations in the health and community services sector.”

To read more about the 2013 finalists and winners, visit hestaagedcareawards.com.au HESTA is the leading super fund for health and community services, with more than 750,000 members and $23 billion in assets. More people in health and community services choose HESTA for their super. ■ @HESTAACawards

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Telehealth Multimedia DVD Resource

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he Rural Health Education Foundation has produced a Telehealth: The New Bush Telegraph DVD that is aimed primarily at people who are contemplating using telehealth to increase demand and willingness to participate when offered telehealth. It is packed full of videos and printable resources that have been developed with the help of a wide range of professional organisations.

The DVD contains a one hour recording of a live panel discussion where the panel discusses the impact this technology is having for patients in rural and remote Australia accessing treatment; what it means for the primary healthcare teams involved; and the resources available to help get started.

Specifically relevant are the steps towards successful implementation: clinical workflow processes, myths and misconceptions; MBS items; and what they wish someone had told them. The panelists share their experiences of setting up their practices for telehealth consultations and supporting their patients through the process.

The DVD also contains a 30 minute documentary Stories from the New Bush Telegraph: The Impact of Telehealth showcasing clinicians and patients who are regularly using telehealth. Four short video clips illustrating the breadth of ways telehealth is being implemented all over Australia are also included.

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36 | Sponsors

The Engaging Jon Dee –

L

ASA’s Government Relations and Communications Manager, Justine Caines got to know Congress key note speaker Jon Dee a little better; finding out what makes him tick, and what we can learn from his inspirational achievements as we face considerable change and growth in age services.

Why do you think you are where you are today?

Has someone stood out as an influence on your career? Could be someone you know or a famous person.

My Grandfather was a major influence on me.

He always told me to stick to what I believed in and to always do what I thought was right. That kept me going through the early stages of my campaigning work and still inspires me today.

My Mum and Dad also set a very positive example for me with their lifelong community service. My Dad was a firefighter and although in her seventies, my Mum is still a very active local elected Councillor who has brought about lots of positive change in her community. They’ve been wonderful role models for me.

My boss at my first full time environmental job back in 1986 was also a wonderful mentor for me. I learnt a lot from him and it’s one of the reasons why I like to mentor young people starting out on their careers. He helped me to develop really useful skills and I’ve applied much of what I learnt from him into the way that I run my campaigns.

What is the most rewarding and enjoyable aspect of your work?

For me, the most satisfying thing is getting measurable results. My campaign to get the Government to phase out incandescent globes was successful and it’s now saving Australians hundreds of millions of dollars a year in their energy bills. It’s also making a real difference in cutting greenhouse emissions from power stations.

My campaign to ban phosphates in laundry detergents is going to ensure that the 1.9 billion laundry washes a year in Australia are going to be phosphate free. That is a big result for the environment but it won’t cost consumers anything extra.

Setting up case studies and role models like this that bring about measurable change is really rewarding, particularly where those campaigns are brought about at the very local level. The

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Changing Attitudes and Behaviours

ban on plastic bags that I co-organised in the small Tasmanian town of Coles Bay ten years ago has now become a plastic bag ban in 4 Australian States and Territories. That has made a big difference for marine life and it all began with a small community in Tasmania.

I have also had the benefit of establishing long term relationships through my charity work. Pat Cash first worked with me on my Rock Aid Armenia project in 1990. Pat and I then started Planet Ark together back in 1991 and we worked on that for 15 years. We left that to start our DoSomething! charity and our http://DoSomethingNearYou.com.au project.

So we’ve now been working together with our charity work for 22 years.

Back in 1993, Olivia Newton-John and I came up with the idea for National Tree Day over a cup of tea in LA and we fronted the event until 10 million trees got planted. Olivia and

38 | Sponsors

I have also recently started a new international initiative called ‘One Tree Per Child’.

Having long term relationships like the ones that I have with Pat and Olivia make it easier to get things done as people know that when you announce a campaign, you will be in it for the long haul and you won’t stop until you get a result.

What lessons would you like to pass on to age service leaders, whether or not as a result of your work influencing environmental awareness and social change?

I’m going to show how I’ve brought about change through my various campaigns. I’ll be talking about the different rules that I apply to my campaigns and the ways that I go about getting people involved and onboard in bringing about that change.

The other key thing I’ll be talking about is how to keep that change going. It doesn’t matter whether that change is in the age services sector or any other sector. There are certain rules for change management that are common to all organisations and I’ll be sharing my experience on that in a way that I hope will be useful to the people who come along to the speech.

What can leaders in age services learn from your work?

I guess the key thing is that to bring about change you have to be positive in how you go about getting people on board.

You also have to be resilient and engaging. Not just with your staff but with local communities.

When they’re properly motivated and given good direction, staff and volunteers can unite in ways that can achieve extraordinary results.

I want to show that you can achieve a lot even when the available budget is not there. Good team management, positive engagement and strong frameworks for change can unify people in ways that significantly improve results.

What are you going to focus on in your Keynote Address at the 2013 Congress?

With regards to my presentation there are a number of key issues that I’m interested in.

Firstly I’m passionate about how society treats its elders, so I have strong views on the need to reduce age stigma and to treat our seniors with the respect that they deserve.

Secondly, as someone who volunteered as a kid in a local aged care facility, I believe that local communities need to get more engaged in helping senior Australians.

I also believe that our society will improve when it better utilises the experience and contribution of older Australians.

As an example, senior Australians are more computer savvy than ever before, so I want to see what can be done to engage them in virtual volunteering. Over time these IT savvy seniors could be a very potent force for change.

Finally, on the commercial front, I’ll also be talking about case studies where organisations have achieved financial savings by becoming more sustainable and energy efficient.

There’s a lot of money that can be saved in aged care facilities, so I’ll talk about some of the basic rules for becoming more energy efficient.

What can audiences expect to gain from your Keynote Address?

I’m hoping to inspire the people who come along.

I’ve given hundreds of speeches over the years and the one thing I’ve learnt is that community and corporate change can be confronting for many people. But I know from experience that when change is implemented in innovative ways, it can create very positive outcomes.

And to me positive outcomes is what it’s all about. ■ Jon Dee Australian of the Year 2010 (NSW) Founder and Managing Director, DoSomething!

Web: http://DoSomethingNearYou.com.au Web: http://JonDee.com

40 | Sponsors

See me, Hear me: care through cultural awareness

By Sarah Burnell, Marketing & Communications Officer – Hall & Prior

CEO Graeme Prior (Hall & Prior), General Manager Jennifer Grieve (Hall & Prior), Executive Manager Sharyn McDavitt (Windsor Park), Ron Gidgup (artist), Professor Barbara Horner (WADTSC), Heather Freegard (WADTSC).

W

hat would happen if we could engage an Aboriginal artist to connect with Aboriginal residents with dementia in an aged care setting and document what happens?

It was this simple idea that set in motion a 15 month-long collaboration between the WA Dementia Training Study Centre (WADTSC), renowned Noongar artist Ron Gidgup, film maker Arun Raj, and the residents and staff of Hall & Prior’s Windsor Park Aged Care Home. The documentary that resulted – entitled Nungoo ngich Dunga ngich or “See me, Hear me” in Noongar language – was launched on 19 June, and offers an insight into the experience of Aboriginal people with dementia living in residential aged care.

“For the WADTSC, the project will form the basis for developing training materials and processes for health professionals working with Aboriginal people with dementia in mainstream services,” explains the project’s coordinator, Heather

Freegard. “For the residents, it has demonstrated that how a person spends their time and the relationships they share are the most important aspects of living, and far outweigh the disease they have in determining their quality of life.”

With a cluster of 18 Aboriginal residents, a group of staff dedicated to improving their capacity to care for those residents, and an established Indigenous Program that has been in place since 2006, Windsor Park was the ideal choice for the WADTSC to approach to become involved in the project. The residents and their families were invited to share their experiences through yarning (storytelling), music and art with the project’s artist, Ron Gidgup, who then translated the stories into three artworks that are displayed in Windsor Park’s Coolibah House. “Ron and Heather’s respectful approach have brought healing and recognition to our residents, helping to strengthen our community,” says Hall & Prior’s Chief Executive Officer, Graeme Prior, who hopes to work with both parties again in the future.

Sponsors | 41

“It has been a privilege to get to know these stories from our residents’ lives,” adds the home’s Executive Manager, Sharyn McDavitt. “We love having the artwork in the home, and the residents have a strong connection to it because it represents their stories.”

residents became increasingly interested by the stories in the artwork as the murals emerged. They asked him to explain the works and learnt to understand their fellow residents’ stories: a testament to the universal language of art and human stories.

The power of storytelling

The collaboration has been immensely successful so far, but the real strengths of the project are yet to emerge. For Hall & Prior and the staff of Windsor Park Aged Care Home, the project has provided a deeper insight into Aboriginal culture and will influence the evolution of its Indigenous Program. A planned new wing of the home will provide the opportunity to employ more Aboriginal staff and provide culturally-appropriate dementia care to a larger community of Aboriginal residents.

For Freegard and the WADTSC, it has enabled them to learn how to make stronger connections with the Aboriginal community, and helped to define areas of caring for their Elders. Nungoo ngich Dunga ngich will form the basis of a professional development package for people who care for Aboriginal people with dementia in aged care homes, as well as facility managers and health professionals who have an interest in Aboriginal art and culture.

The package will be available through the WADTSC, and is expected to be completed later this year.

For information about the project please contact Heather Freegard h.freegard@curtin.edu.au ■

What started out as a desire to engage with elderly Aboriginal residents through art became a moving journey for everyone involved in the project as the residents began to rediscover their confidence and reconnect with their spirituality.

Gidgup describes the profound effect that working with the residents had on him. “The most emotional highlights for me were seeing the Elders laughing, yarning, singing, playing musical instruments and opening up in the art project; hearing them tell me about their childhoods and family members; seeing them light up each time they saw me,” he says.

“For both the residents and myself it has been a very spiritual process, with those that could respond connecting visually and orally with the project, as well as by touch. We spent time yarning about family, culture, country, art and music. I know the residents were really excited to see me, to engage with me, to identify with me and just to have me around as a reminder of their spiritual connections to themselves as Aboriginal people.”

Although the project was intended for the home’s Aboriginal residents, Gidgup also noticed the way that non-aboriginal

The project continues

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Introducing ME Bank

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E Bank is a 100% Australian-owned, APRA regulated bank, created in 1994 by industry super funds, like HESTA, to provide low-cost home loans for members of industry super funds.

In 2001 ME Bank was awarded a full banking licence and today provides more than 270,000 industry super fund members with a range of transparent, straightforward and low-cost products combined with real service.

In addition to a range of personal and business banking products, we offer a range of institutional deposit products supported by a dedicated team of deposit experts directly within ME Bank’s Treasury department.

These products have proven very attractive for the Age Care sector particularly in relation to cash flow management.

ME Bank deposits are covered by the government guarantee up to $250,000. Our cash deposit rates are genuinely competitive for the wealth management market. We keep our term deposit rates consistent across terms so investors can choose what is the most appropriate for their circumstances, with confidence it will be competitive. We also keep term deposit rates consistent over time as evidenced by the graph below.

Our team of deposit experts will be available during LASA’s National Congress and would be pleased to discuss our product and service options.

Please visit booths 41 – 43 which will be shared by ME Bank and HESTA, to meet some of our team. ■

*The above graph refers to the ME Bank Business Term Deposit (BTD). The graph compares the BTD interest rates of the 1 to 12 Month Terms from ME Bank compared to the Retail Term Deposit interest rates of the same terms from CBA, NAB, ANZ and Westpac. The information in the graph has been sourced from InfoChoice and current as at 27/05/13. Other financial institutions may offer higher rates on Term Deposits. Every attempt has been made to compare the ME Bank Term Deposit with the most similar product from selected institutions; however the exact features of these accounts may vary. Your total deposits with ME Bank up to $250,000 are guaranteed under the Australian Government Financial Claims Scheme. Fees and charges may apply. Terms and conditions available on request. This is general information only and you should consider if this product is appropriate for you. Members Equity Bank Pty Ltd ABN 56 070 887 679. AFSL 229500.

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44 | Sponsors

Acquisitions in aged care – buying the box or what is in it?

By Julie McStay, Director, Hynes Legal

T

he threshold issue that needs to be considered when you are thinking of buying or selling an aged care facility is how you actually structure the transaction.

You need to consider whether you buy the box, or what is in the box. What do we mean by that?

Consider the aged care facility you are buying as a box for the purposes of this very simple example. If you buy what is ‘in’ the box you are purchasing in the traditional manner – you enter into contracts with the vendor for the purchase of the freehold facility and the operating business from the vendor entity. Those contracts include a due diligence over the assets themselves, and when it is completed the vendor entity walks away from you, and you own the asset. In effect you pluck the assets out of the box and walk away with them.

If you buy the vendor entity itself, as opposed to just what the vendor entity owns, you are in effect buying the box. You are purchasing the vendor. The vendor doesn’t walk away from you after settlement – their shareholders do because you have purchased the entity that is the box itself and all that is in it (including the freehold, the business and the assets and liabilities of the business).

What do you want to purchase?

An aged care facility will include some (or all) of the following:the allocated places (bed licences); the accommodation bonds; land, buildings, equipment, machinery; contracts or licences which support or underpin those assets – IT and other service contracts, financing arrangements, licences or permits issued by a government body; • contracts under which revenue is generated from those assets – lease agreements, service agreements, resident agreements; • intellectual property – trade marks, licences; and • employee and staffing arrangements.

A preliminary question is whether it is only some of the assets of the aged care facility that are to be sold. Depending on your answer, buying some of the things in the box might be your preferred option. However, that is not to say you cannot buy the • • • •

box and sell some of the assets in the box out to the vendors (or another third party).

The next issue – as with any commercial transaction – is consideration of risk. The biggest risk in buying the box is that the purchaser inherits the liabilities of the box. A typical transaction of this nature includes copious warranties on the part of the share vendors about the liabilities of the company itself – whether known or unknown. These are usually one of the most intensive legal aspects of the transaction – and for good reason – as the purchaser will bear the risk of those known and unknown liabilities after purchase.

Indemnities and the contractual right to claim for breach of warranty under any sale agreement are only as good as the willingness and financial position of the person who is bound by it.

Other considerations There are many things to take into account in either form of transaction and unique issues will arise in every case. Some of the issues you will need to consider in every transaction include: • Who is the approved provider? This might not necessarily be the owner of the underlying assets of the facility.

• Do the places need to be transferred from the seller to the buyer? If so, you will need to obtain the Department of Health and Ageing’s approval for the transfer and any sale should be made conditional on obtaining that approval. Careful consideration needs to be given to any conditions placed on any allocations which may need to be met.

• Adjustments – What adjustments need to be made in terms of tax, GST and related adjustments (including an adjustment for any accommodation bonds) on settlement.

• Restraints of trade – Unless a contractual provision is built in during the sale or pre-existing in employment contracts, any outgoing director or executive employee of the company is not restrained from opening a competing business following the transfer of the shares.

• Whether there any tax benefits or government subsidies or programs that will expire over time?

Sponsors | 45

• A re there any tax benefits or government subsidies or programs that will change with a change in ownership of the business?

• Due diligence – Who is doing the due diligence? If you intend to brief experts to undertake all or some of the due diligence what is the scope of their brief? It is vital in an aged care transaction to obtain assistance from experts who understand how an aged care business operates. We can certainly assist you from a legal perspective and we can recommend other experts such as accountants to you.

• The transferability of any service or other contracts and whether there are deemed assignment / change in control provisions in any of those.

• Employees – No matter what structure you choose, dealing with employees and their entitlements can be complex, depending on the nature of the employment arrangements in place but particularly if employees are subject to an award.

• Materiality – Protection against any material change between the time of signing the sale agreement and the transfer of the assets

TA R G E T I N G

YO U R

M A N A G E M E N T

N E E D S

Tax and stamp duty Stamp duty – An asset purchase (buying what is in the box) will almost always attract some duty due to the nature and definition of dutiable property, unless an exemption is available.

Buying the box may reduce stamp duty (subject to land rich duty requirements).

Tax – Deductibility of money borrowed to purchase shares needs to be handled carefully. Buying the box also means you may inherit the vendor’s cost base for CGT purposes.

GST – You need to compare purchasing as a going concern (buying what is in the box) as against buying the box, which may well be a financial supply which then becomes input taxed.

This article is only intended to highlight some of the issues you need to consider in the purchase of an aged care facility.

The matters listed above are by no means an exhaustive list of issues to be considered, but they are the first things you should consider in any transaction in the aged care industry.

If you need advice, whether as seller or buyer, Hynes Legal can help. ■

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48 | Technology

Activities of the Aged Care Industry Information Technology Council (ACIITC) Supporting Smart Services that deliver efficient quality care

By Rod Young & Suri Ramanathan, ACIITC

T

he Aged Care Industry IT Council (ACIITC) is a joint vehicle of LASA and ACSA that has a prime objective of supporting the industry to develop their IT capability.

As well as working with government to ensure system changes deliver improved performance and enhanced industry capacity to deliver the most efficient services; and as a consequence to underpin the delivery of services that will ensure our customers are able to maximise their choice of services and thereby ensure the best possible care outcomes.

ACIITC has been working with a number of organisations to ensure the objectives above are, as far as is possible, achieved.

Some of the activities in recent times have been:

Aged Care Industry IT Roadmap ACIITC convened a full day workshop earlier in the year with the intention of developing a Roadmap that could be used for the following purposes:

• Produce a plan that will provide a clear vision for providers as to the likely future direction for IT in the aged care industry, with a core objective firmly rooted in ensuring a wider business solution in the delivery of services by Aged Care Providers; • Produce a plan which will support individual providers to synchronise their strategic plans with the future directions of the broader industry; • Produce a plan that will support industry discussions with government for a long term investment in IT deployment; ACIITC is working closely with LASA and ACSA to ensure that the Aged Care Industry IT Roadmap can be finalised shortly.

It will then be made available to providers to assist with decisions around strategic directions and support government advocacy work of LASA and ACSA to ensure the industry work towards agreed objectives supporting the development of aged care IT capacity.

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Personal Alarm, TeleHealth & Home Automation

… all right at your fingertips!

ITAC2013 ACIITC has arranged a variety of industry conferences and seminars over a number of years, with a specific focus on the development of IT capability.

One of these activities has been an annual aged care industry IT Conference.

Known as ITAC the annual conference has become known as a major event with a specialist focus around the full range of IT deployment issues especially home based care, assistive devices, systems integration, clinical software solutions, medication administration and integration with the Personally Controlled electronic Health Record (PCeHR).

ITAC2013 was conducted at the beginning of May in Melbourne and attracted over four hundred participants all of whom exhibited high level interest in the future use of technology across the length and breadth of the aged care system.

International speakers Brian Prince, Microsoft,.Gaming Enthusiast, spoke about gaming theory and the lessons that could be deployed in other industries and circumstances.

Kevin Doughty spoke about the fundamental change being experienced in the UK aged care system through the significant uptake of home based devices, remote monitoring and telehealth.

The result being a much greater preparedness by individual households to contribute towards their own cost of service access and ongoing maintenance.

Based on participant feedback ACIITC has already decided that there will an ITAC2014 and has commenced planning next year’s event. ACIITC is always looking for interested participants in helping plan these conferences so if anyone would like to join the organising committee for ITAC2014 please contact the Chair, Rod Young through the LASA or ACSA national offices.

NBN Telehealth Pilot Project From among a field of two hundred and fifty eight applicants ACIITC was awarded a grant that would see a consortium led by LASA to pilot a number of diagnostic devices in people’s homes and have the daily information uploaded to a server which has been set up to send an alert if the recordings are outside set parameters. The system is supported by a Telehealth Nurse who instructs each participant, monitors the daily input and following-up on any alerts via a video conference.

The provider partners in the consortium are Silverchain in WA and IRT in NSW. Part of the project deliverables, in addition to demonstrating the projects capability to expand to national scalability, is to demonstrate how the system can operate on a country-wide basis.

The project intends to attract one hundred and eighty participants, each of whom will participate in the program for a period of approximately four months.

Accenture another member of the consortium will undertake an evaluation of the project as well as completing an analysis of the possible integration of the monitoring system with the PCeHR. ■

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Personal Response System / Medical Alarm TeleHealth System including Nursing Reviews Home Automation Features Cordless Phone and access to your contacts Social Media (such as Facebook and Skype), email, YouTube, and listen to your favourite music, all via the LifeGuard SmartHome.

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Technology | 51

National Aged Care Sector CIO Forum

A

ged Care Industry Information Technology Council has created a new committee called the National Aged Care Sector CIO Forum. The purpose of this forum is to bring together IT Professionals working in the sector to pursue the following initial objectives: 1. Create a forum of IT Professionals in Aged Care to share, converse and learn while interacting with peers.

2.

To support the implementation of the IT Roadmap for the sector that is currently being developed.

The Forum of 26 members has met for a full day in late February 2013 and subsequently met again during ITAC 2013 in Melbourne.

There have been further meetings developing the agreed action items.

Council anticipates that the Forum will evolve rapidly and the sector will be continually appraised of its activities. ■

Serving Older Australians – a National Approach to NBN enabled Telehealth Project

By Ashwath Sudaresan, Accenture Management Consulting

E

arly this year, the Commonwealth Government announced a series of pilots aimed at trialling new models of care involving Telehealth. A number of these address aged care, including the “Serving Older Australians” project put forward by Leading Age Services Australia (LASA). The LASA consortium comprises the Aged Care Industry IT Council (which includes ACSA), two leading Aged Care Providers with services in National Broadband Network (NBN) enabled areas, Silver Chain and IRT, and strategic partner Accenture. The focus of this trial is two-fold: first to conduct trials in early NBN-connected areas and assess the impact on patient care, and secondly to consider how new Telehealth models of care can support the wider aged care sector as NBN is rolled out nationally.

says 75 year old Maurie Earls, a trial participant in Kiama. By July 2014, it is anticipated that 180 clients from SilverChain and IRT will have participated in this trial.

The trial will also look at how telehealth can link to Australia’s eHealth infrastructure including the Personally Controlled Electronic Health Record (PCEHR) system. This is another major Federal Government health initiative aimed at joining up care between GPs, hospitals, aged care services and allied health. Launched in July 2013, more than 400,000 Australians have already ‘opted in’ and created an electronic health record2. Accenture, who help the Department of Health & Ageing run this service, will work with LASA and the ACIITC Council to explore how Telehealth could link to the PCEHR and further enhance care delivery within the sector.

What is Telehealth?

Telehealth and the future of Aged Care

Telehealth is a way of delivering healthcare through video and telecommunications which includes remotely monitoring people’s vital signs by a nurse using equipment that is installed in the person’s home. This enables clients to receive higher quality care in their own home and care providers to support a much larger number of clients.

At the same time, telehealth can change the way care is provided by enabling clients to play a more active and participatory role in their own healthcare. Combined with faster broadband, telehealth promises to better connect people with their providers and drive better clinical outcomes while improving productivity of the aged care workforce. The funded trials will test this.

Information and communication technologies have the potential to transform the aged care sector. Telehealth will be a key part of this. As Mr Earls says “We have an ageing population and anything that can help keep people in their homes and relieve the pressure on aged-care services is important”.

Given day-to-day demands, it can be difficult for provider organisations to understand the implications and opportunities associated with such technologies. Some providers, like SilverChain, are very advanced from an IT standpoint. Other organisations, like IRT, are service innovators but just underway in terms of adopting clinical IT solutions. Working together with the Aged Care IT Industry Council, this telehealth trial is expected to provide fresh insight to inform the ACIITC IT Roadmap, and assist Aged Care providers as they develop their future IT plans.

The major beneficiary of this will be Older Australians. ■

Trial overview The aged care telehealth trials are underway. They are being conducted by IRT in Kiama, NSW, and SilverChain in Geraldton, WA, in line with the NBN rollout. With 18 clients currently signed up, registered nurses remotely monitor people and if any vital signs move outside agreed parameters, nurses follow up with the client.

“This lets me monitor my health…. anything that allows me to stay in my home as long as possible is something I’m in favour of1”

References 1) Kiama Independent – 12th June 2013 2) http://www.ehealth.gov.au

52 | Technology

To Boldly Go Where No Software Has Gone Before

By Sonja Bernhardt OAM, CEO ThoughtWare

I

n 2008 the aged care software scene was dominated by traditional clinical care solutions. Then along came ThoughtWare with its ‘i.on my care’ Governance, Risk Management and Compliance new breed solution. Not only did i.on my care encompass broader areas of risk management; it was also designed around leading, true cloud-based technology.

It was a first and on reflection brave and potentially disruptive step for a newcomer to take.

“The going was tough in those early years,” says Sonja Bernhardt OAM, CEO of ThoughtWare. “We knew we had a fascinating product and were sitting right on the leading edge of technology, but convincing the market that there were broader issues to consider in conjunction with traditional clinical care was

Technology | 53

a hard slog. We invested heavily and attended many trade shows and our community of members started to build, but it was slow going.”

It wasn’t until the Aged Care Council instigated the Aged Care Cloud Initiative in 2010 that traction increased for i.on my care. Council understood well the technology trends, but mostly those trends were neither understood by the sector nor supported by its then dominant Microsoft software platform. It was a bold leadership decision for Council to undertake. It wanted to reduce costs to aged care providers by accelerating adoption of mobile technology, but to do so required software vendors to rearchitecture their software. To assist the vendors, Council offered a new Cloud Platform hosted and managed by NEC Australia for free, with the hosted software services at emerging pricing. ion my’s original design was cloud ready, so no re-architecture was required. That in turn meant ThoughtWare was able to swiftly leverage the thought leadership and facilitation by the Council, and i.on my care became a foundation application offered on the NEC platform. Since then i.on my clients on the NEC platform have consisted of remote, regional, indigenous and the very small – the target audience the Council wanted to reach. Small sites stand to benefit the most, as true cloud architecture results in genuine reduction in total cost of ownership and increased efficiencies, thus making access to solutions more affordable and accessible.

All sites require is internet access: as the software is accessed via web browsers, special investment in hardware or technology skills on site is not required. Between the Council initiative, the cloud platform and the applications, each site was well catered for.

In addition to Council’s cloud initiative, ThoughtWare was fortunate enough to have strong government support in the early days from the Queensland State Government and the Gold Coast City Council. As the company started to grow, media interest picked up and the company profile grew, accompanied by continued heavy R&D investment into the software. During this time the company CEO (Sonja Bernhardt) was recognised as an outstanding leader in technology by being honoured with a Medal of the Order of Australia (OAM) for services to the IT industry.

However it is exposure and success from ITAC (IT in Aged Care) trade shows and conferences that Bernhardt claims is the game changer, stating, “ITAC is a fantastic initiative. It continues to be our primary source of networking and contacts into Community and Aged Care. Each award we’ve won has raised our clients’ and our own profile and demonstrated once again to the community that our software is innovative and cost effective. We are now multi award winning with clients finding strong, measurable returns and improvements.” Evidence of this comes from clients having taken out awards across all ITAC implementation categories: Alphington Aged Care (2010) < 150 beds 150-650 beds St Luke’s Care (2013) > 650 beds McKenzie Aged Care Group (2012) In addition there has been increased interest at the trade stand each year, resulting in what the i.on my team called a “piranha frenzy” at their trade stand in 2013, with prospects lining up to talk and view the system through demonstrations. Such interest has been fuelled by ITAC conference presentations by clients keen to share their i.on my successes with their colleagues. For example, the 2013 conference featured a presentation by Amanda Seymour

(McKenzie Aged Care Group) on “Measuring IT”: a case study on the benefits the group has measured in education, compliance and incident management after implementing i.on my care.

From its early start as a newcomer in aged care through to today, ThoughtWare has proved it is not afraid to poke its head out of the crowd to offer and deliver something creatively different.

Innovation did not stop with the creation of their unique product and even today there are three main releases a year. In 2009 they held the industry’s first virtual conference, connecting clients via video conferencing to share best practice knowledge and discuss common challenges, with 100% positive feedback. In 2013 they held a two-day conference on the Gold Coast at the top of Q1, Australia’s tallest building. User and prospect communities were able to network, exchange best practice knowledge, share challenges and risks faced and learn from 5-minute quick training sessions. All attendees valued the experience and new clients signed up after attending.

The i.on my care Governance, Risk, Compliance, Accreditation, Quality Improvement and HR software (www.ionmycare.com) connects remote users, works in existing environments and is flexible, scalable and robust to meet changes in legislation, management or processes. Forms are accessible over the internet from any connected device including tablets, iPads, laptops, smartphones and traditional PCs. “Our clients, requiring little support from us, are embracing the latest technology. Over the next 90 days we have projects rolling out tablets for Aged & Community Care staff to simplify recording and alerting. Our company lives and breathes technology and it is exciting to start to see a sector shift towards greater understanding of technology trends and consequently increased uptake,” said Bernhardt.

ThoughtWare is constantly looking for new ways to simplify, automate and govern risk management and care provision. They have a firm footing as a software solution that serves the needs of providers now while highlighting that innovation continues to have a place in Aged Care. It all starts with people who make bold leadership decisions – whether it is Vendors, Providers or Council.

When asked what’s ahead technology wise, Bernhardt outlines that they are in R&D with some very exciting areas of visualisations, graphical maps, and voice activation: all areas designed to keep simplifying the workload. It may mean they need to restart the hard slog of convincing people of the advantages of taking up changing technologies, but she states that they are firmly committed to the aged care, community care, indigenous care, disability care and hospitals industries and believe that boldly striding ahead will ultimately benefit all.

Sonja Bernhardt believes that Council has done well in its focus on facilitating change for the better of the industry. She adds that, “We’re proud and delighted to be part of that change now and in the future. It is vital for a boutique software company like us to partner and actively collaborate with council and vendors on projects. It just makes good business sense to do so. We continue to partner with other innovators in many ways such as campaigns, trade shows, website promos and newsletter articles. I am involved in many community projects and boards, collaboration is part of my DNA and I see it as a key path to our companies’ continued success.” ■

A World Leader in Nurse Call & Dementia Monitoring Solutions Selecting a Nursecall system is a daunting task, with so many technologies involved how do you choose the right product and the right supplier?

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Aged Care Journal Half Page July 2013 Final.indd 1

4/07/2013 2:16:58 PM

AGED CARE NURSING SCHOLARSHIPS Open 1 July 2013 – Close 30 August 2013 Aged Care Nursing Scholarships are available for: Undergraduate > For those with a demonstrated commitment to aged care wanting to become a registered nurse.

Postgraduate > For registered nurses working in aged care wishing to further their studies.

Nurse Practitioner > For registered nurses working in aged care wishing to undertake studies leading to endorsement as a nurse practitioner.

Continuing professional development > For registered and enrolled nurses working in aged care wishing to attend a short course, workshop or conference relating to the care of older people.

Nurse re-entry > For formerly registered or enrolled nurses whose registration has lapsed wishing to re-enter the nursing profession with a focus on aged care.

DEVELOP AND SHAPE YOUR AGED CARE CAREER

freecall 1800 116 696 scholarships@acn.edu.au www.acn.edu.au

Aged Care Nursing Scholarships (ACNS) are funded by the Australian Government.

ACN, Australia’s professional organisation for all nurses, is proud to work with the Department of Health and Ageing as the fund administrator for this program.

Technology | 55

“Whaddya mean, it’s three times over budget and used by only four per cent of users?”

IT Governance – whose responsibility is it?

By Graeme Wickenden, Chief Financial Officer, Villa Maria

O

n 19 June 2013, The Age reported the Victorian State Government’s UltraNet project was looking to be scrapped three years after it’s rather tenuous launch; the servers crashed and teachers who had been given a pupil-free day to have training on the system were left floundering. Since that rather shaky start, the project has gone on to cost $180m – three times its original $60m budget with only four per cent utilisation by its intended users: the 1.5 million teachers, students and parents it was designed to assist by being a portal for students to submit work, teachers to share curriculum information and parents to monitor their child’s attendance records and track their academic progress.

The experience of the Victorian Government’s UltraNet project is a salutary reminder about how information technology (IT) projects can quickly go off the rails and escalate costs while failing to ensure users’ needs will be met. What’s particularly interesting is that despite all the advances and achievements the IT world has delivered, the UltraNet experience isn’t an uncommon one.

Project management, and what should be its watchful parent – IT governance – continue to produce stories of this nature.

Some immediate questions come to mind regarding the UltraNet project, which could be applied to any project: 1. What structure was in place to manage the project?

2. At what point did overruns of this magnitude start to raise alarm?

3. What was the escalation process in place to approve the budget increases?

4. Was there appropriate governance across the project?

It may well have been a considered and conscious decision to let the project continue while incurring overruns to this extent, knowing the user base was diminishing significantly. While good governance may indeed have existed, it was not visibly apparent.

Realising the full potential of IT and leveraging it for strategic benefit, is a critical success factor for most organisations. By way of definition, IT governance is an inclusive term for the elements that interact to provide an organisation’s IT services. These include abstract issues of communication and legality, as well as general management, IT users, IT staff and auditors. As this brief list suggests, IT governance is a holistic practice that relies on the involvement of all stakeholders.

Yet the approach many senior executives take today is to defer key IT decisions to the IT department. Whether this is due to ignorance or lack of interest (perhaps shrouded under the veil of already full agendas), the result is decisions are made that do not reflect the best interests of the unconsulted stakeholders. It falls to

senior management to act as the link between corporate strategy and IT and to ensure appropriate visibility and consultation occurs so the IT decision-making is aligned to strategy and reflective of organisational needs.

Like other areas of governance in an organisation, IT governance is a detailed and ongoing process. Good IT governance is characterised by a sophisticated and futurelooking understanding of IT issues. Training and communication is supported by leading-edge concepts and techniques. The risks and returns of the IT processes are outlined, balanced, and communicated across the organisation. External experts are leveraged when needed, and benchmarks are used for guidance. Monitoring, self-assessment, and communication about governance expectations are pervasive within the organisation and there is optimal use of technology to support measurement, analysis, communication and training. Corporate governance and IT governance are strategically linked, leveraging technology and human and financial resources to increase the competitive advantage of the organisation.1 At Villa Maria, a Victorian not-for-profit disability, specialist education and senior services organisation, IT governance is a developing process – and it always will be, as we constantly monitor the organisation’s requirements and emerging opportunities. We attempt to respond at both the operational and strategic level; but always within a framework of established governance processes to ensure user engagement, consultation, accountability and visibility.

IT governance sits within an established framework for Villa Maria’s strategic planning. Now approaching the end of its second three-year strategic planning cycle, Villa Maria’s strategic planning is based on a comprehensive engagement process, with management and the Board working collaboratively to create a plan that is strategic in focus, measurable in outcomes and responsive to client expectations. Underpinning the strategic plan are annual business plans setting out the objectives for each area of the organisation and the annual financial budgets that provide the resourcing for those plans. It’s an integrated and successful framework we continue to evolve and enhance based on our learnings.

Within the strategic plan are a number of organisational-wide plans (OWP). These act as key planks that support the overall strategic framework. The ICT & Assistive Technology OWP is one of these. It documents the framework for the provision of computer-based systems and related hardware to support Villa Maria to achieve its operational and strategic objectives. It is a

56 | Technology

detailed document giving management and Board full insight into the provision of Information Communication Technology (ICT) services to ensure IT is an agile and responsive service area.

In order to gauge how well ICT is serving the Villa Maria user community, an annual ICT User Survey is conducted and results analysed for areas where ICT would appear to be falling short of expectations. This allows greater focus on those areas to be made, particularly from an ICT Help Desk perspective.

Villa Maria also engages an external ICT audit firm to further assess its ICT platform and systems, providing an independent and expert review of ICT across the organisation and identifying gaps to be addressed.

IT governance at Villa Maria operates in a bottom-up approach.

There are two base-line committees with ICT management oversight. These committees report through to the Villa Maria Executive team, with each operating under agreed Terms of Reference which are reviewed annually.

1. ICT Projects Steering Committee – provides governance over major project implementations. The Committee has representation from areas across the organisation participating in, or impacted by, the systems being implemented.

2. ICT Committee – provides a general ICT forum for representatives across Villa Maria to contribute to the development of ICT services. The Committee is an open forum and can explore directions and issues as they arise.

Villa Maria’s Board has established a Finance & IT Committee which has primary oversight of ICT related matters. The Committee receives a monthly report providing an update on key ICT issues. The full Board of Directors then receives the Finance & IT Committee’s reports and again, key issues are dealt with.

Over the past five years, Villa Maria has invested significantly in its ICT infrastructure and supporting systems. Comprehensive requirements documentation was developed and moved through the various layers of ICT governance. Decisions were made in an environment of extensive consultation and supported by detailed business cases. But even with this level of planning and engagement, it hasn’t been an easy process.

Recently, we reviewed some of those early key decisions about some specific choices of software. In some cases, the software supplier couldn’t deliver the solution according to expected timeframes. In an environment of legislative reform, Villa Maria needed solutions that responded to these changes and couldn’t wait for software suppliers to catch-up. In other cases, user requirements had changed and the early choices no longer provided an optimal solution.

It was within the context of these challenges that our governance model was tested. Faced with the prospect of investing further in these systems to salvage a solution, or making the tough decision to cut our losses for those particular systems and learn from the experience, we chose the latter. Perhaps this is where good governance is most apparent. When things are going well, governance is easy. It’s in times of stress and challenging decisions, that governance rises to the occasion and provides the clarity that aids good decision making.

At Villa Maria, we reflected back on our vision and mission and the overarching strategic plan in which we operate. In this context, our direction was clear and we are now moving on with solutions that provide the functionality and efficiencies we require. Through our governance model we have considered the impacts and the costs, worked with stakeholders and documented decisions up through the committee structure to Villa Maria’s Board.

None of this was an easy process. Reviewing past decisions in the clarity that hindsight provides can be challenging. While most of our ICT investments delivered what was planned, for those few that didn’t the decision to step back from them was difficult – and at the time of making those decisions, they weren’t necessarily wrong. It’s more that circumstances had changed. This is where Villa Maria’s governance model provided a framework for the review to happen and the decisions to be developed with a considered and sensible approach. Emotion was removed and accountability was paramount. The alternative would be for further investment to try and keep alive the earlier decisions, despite obvious indicators to the contrary. Our framework avoided this and Villa Maria now has a much clearer vision for its ICT platform.

For Villa Maria, IT governance has become part of the organisation’s overall governance landscape – defined in our strategic plan and delivered in our normal operating framework.

Its importance has been recently tested and validated through that process. Those fundamental principles that George Bodnar espoused in 2003 remain constant today: IT governance is interwoven with good corporate governance. It may present unique challenges management and boards find uncomfortable, but it will only be through facing those challenges and embracing ICT as an integral part of an organisation’s strategic and operational environment, that real progress will be made and major ICT project failures avoided. ■

References 1. Bodnar, George H. Internal Auditing 18.3 (May/Jun 2003): 27. IT GOVERNANCE

58 | General

Aged Care Financial Performance Survey â&#x20AC;&#x201C; March 2013 Executive Summary Report

Aged Care Financial Performance Survey March 2013 â&#x20AC;&#x201C; Summary RESIDENTIAL AGED CARE Results

Across the survey the average facility result was $5.95 per bed day which is less than the $8.24 per bed day average result for the year to June 2012. The average facility EBITDA was $6,817 per bed per annum compared to $7,621 for the year to June 2012. The overall EBITDA was $7,378 per bed per annum compared to $7,994 per bed per annum. These results were achieved on an average income of $200.50 per bed day. The facility result represents a return on income of only 3.0% per annum which is down from 4.25% at June 2012.

The graphic below shows the trend in residential aged care results averaged across all facilities since 2007.

Figure 1

$ per bed day

Facility Result 14 12 10 8 6 4 2 (2) (4) (6) All Facilities

Trendline - All Facilities

The graph shows that in the early stages of ACFI the average results were in sharp decline. Since June 2009 until September 2011 results generally trended upwards. Unfortunately, since the peak in results in the September 2011 quarter, the average facility result across all facilities in the survey has been trending downwards. The graph also shows the seasonal trends with results peaking in the September quarter and declining over the remainder of the year. However, in this yearâ&#x20AC;&#x2122;s surveys this trend has not been repeated.

Instead of the seasonal recovery in results in the September quarter there has been a continual decline in average results since September 2011.

Given that there were no increases to ACFI subsidy rates, and that the increase to resident fees did not take effect until 20 September 2012, there were only minimal increases to income levels. As the historic trend has always been declining results after the September quarter, it does cause concern for the remainder of the year. The results for the March quarter are now approaching the facility result of $5.09 per bed day achieved in the June 2011 quarter.

Aged Care Financial Performance Survey – March 2013 General | 59 Executive Summary Report

Table 1 – This year’s results compared to prior year Extracts from StewartBrown Aged Care Financial Performance Survey for the nine months ended 31 March 2013. All amounts shown are measured in $ Per Bed Day.

All Facilities (585 facilities in Survey) Year to Date 31 March 2013 $

Year Ended 30 June 2012 $

Change Fav/ (UnFav) $

Income

200.50

193.65

6.85

Care costs

103.76

97.94

(5.82)

Care costs as % of resident fees and care subsidies

58.5%

56.5%

Hotel services

33.46

31.90

(1.56)

Accommodation services

28.70

27.93

(0.77)

Other services

28.63

27.64

(0.99)

194.55

185.41

(9.14)

Facility result

$ 5.95

$ 8.24

(2.29)

Provider result

$ 3.65

$ 4.33

(0.68)

EBITDA (facility) $ per bed per annum

$ 6,817

$ 7,621

$ (804)

EBITDA (overall) $ per bed per annum

$ 7,378

$ 7,994

$ (616)

Average bond held

$ 199,867

$ 199,295

Average bond received past 12 months

$ 227,343

$ 233,710

Total expenditure

The above table highlights a number of specific areas contributing to the movement in average facility results during the year including:   

An average increase of $6.85 per bed day in income from June 2012 (March 2012: $14.33 increase) An average increase of $5.82 per bed day in care costs (March 2012: $5.56 increase) An average increase of $3.33 per bed day in other operating costs (March 2012: $2.86 increase)

Other results from the March survey include: 62.6% of all facilities in the survey achieved a positive facility result (June 2012: 70.5%) 69.7% of facilities in this survey (June 2012: 77.8%) made an overall surplus taking into account all sources of income and expenditure. This is higher than the ratio of 65.0% at June 2010 and 63.5% at June 2009, but lower than June 2011 being 73.4% Of continuing industry concern are the 92 facilities (15.7%) in the survey that had a negative EBITDA which is up from 14.3% of the facilities in the June 2012 survey.

So whereas in the previous financial year there was a significant lift in average income and only a moderate lift in expenditure, in this latest survey total expenditure has actually risen by more than income.

The average results of residential care facilities have varied depending on where they sit in the survey and where they sit with their resident mix. As displayed in Figure 2, while the results for Bands 1 and 4 have improved since June 2012 the other bands have seen their results decline. Band 4 is the only group where the results are better on average than at December 2011.

Page 2

Aged Care Financial Performance Survey â&#x20AC;&#x201C; March 2013 Executive Summary Report

60 | General

Figure 2

Facility Result Comparisons 16 14 $ per bed day

12 10 Mar-12

8

Jun-12

6

Mar-13

4 2 Band 1

Band 2

Band 3

Band 4

Band 5

Survey Average

When breaking down the data by benchmark band, and then comparing the average results for each band with the benchmark for each band, there are significant differences between the benchmark result and the average result of facilities. The concerning aspect to this is that the gap between the benchmark and the average is continuing to grow as shown in the graph below (Figure 3).

Figure 3 â&#x20AC;&#x201C; Comparison of benchmark result to survey average result by band

Gap in facility result between survey average and benchmark 35 Dollars per bed day

30 25

2009

20

2010

15

2011 2012

10

2013

5 Band 1

Band 2

Band 3

Band 4

Band 5

The gap is greater than $30 per bed day for four of the five bands and over $27 per bed day for the fifth. On the face of it, income has not played a major role in these differences. The main reason for this is that facilities is sorted into bands by their income so you would expect income levels to be similar within that band albeit there is a $20 per bed day increment in income in each band. The main contributor in all cases is cost as the table below shows. In all cases care costs make up a large proportion in the overall difference in expenditure. This is not to say that a facility is obtaining the income levels that it should. It is important that managers monitor both income and expenditure levels.

Page 3

Aged Care Financial Performance Survey – March 2013 General | 61 Executive Summary Report

The table below shows the high level breakdown in the contributing factors to the gap between the benchmark average and survey average for each band for the nine months to March 2013.

Table 2

Income Care costs Hotel services Accommodation services Administration and other support services Total expenses Facility result

Band 1 $ pbd 4.45

Band 2 $ pbd 0.96

Band3 $ pbd 1.03

Band 4 $ pbd 1.58

5.43

5.16

4.55

5.11

2.02

26.61 $ 31.07

26.49 $ 27.45

29.71 $ 30.74

31.40 $ 32.98

26.84 $ 32.40

12.31 4.02 4.86

11.22 4.29 5.82

15.61 7.26 2.28

16.18 5.43 4.67

Band 5 $ pbd 5.55

13.76 4.45 6.62

Income and care costs

As might be expected income has been increasing in aged care facilities for a number of years. These increases have been driven by two main influences – increasing subsidy rates and resident fees and the average increase in the frailty of residents in residential facilities. It is difficult to measure the exact effect of each of these influences on income given the information available to us. However, given that COPO increases in subsidy rates have hovered around 2% per annum for a number of years as has CPI in relation to resident fees. Based on this we could say that the price influence is around 2% per annum. The 2013 financial year should give us a good indication of the overall influence on income of the increase in the frailty of residents due to the fact that the only price increase will be in relation to resident fees. Due to ACFI rates being frozen for this current financial year, it is an opportunity to see how dominant an effect on income the increasing frailty of residents plays on overall increases in income levels.

The table below shows the year on year increases in care subsidies and resident fees income across all facilities in our survey since 2007.

Table 3

2007 / 2008 4.7%

2008 / 2009 5.7%

2009 / 2010 6.4%

2010 / 2011 10.8%

2011 / 2012 7.5%

2012 / 2013 2.8%

The total average increase in resident daily fees and government care subsidies have risen by 2.8% since June 2012. Given that there was a 2.4% rise in the resident basic daily fee it would indicate that ACFI income has still increased in real terms on average for the nine months to March 2013. Note that we have not factored in the resident fee increase on 20 March 2013 as it will have had a negligible effect on the income in this survey period. However, the increases in income in this financial year is significantly less than in the previous five years and the only reason for this will have been the freezing of the ACFI subsidy rates.

This would strongly indicate that the measures taken by the Department of Health and Ageing to “claw-back” ACFI income are having a detrimental effect on the average incomes of the aged care facilities in our survey.

For a number of years there has been a gap between the cumulative increases in income and expenditure, in this latest survey the cumulative increases in expenditure has overtaken the cumulative increases in income. This gap previously existed peaked at 4.4% at June 2011 and was 3.2% at June 2012. This means that as at this March 2011 survey on average there are less funds available after accounting for care costs than there was five years ago. This is on the back of an upward trend in the care cost to income ratio since the September 2011 survey.

Band 1 and Band 2 facilities have seen their income rise at a much higher rate than their care costs. This has been helped by the relaxing of the $30 subsidy cap over the three years to 2011. Since the cap was removed in 2011 the gap has started to narrow as shown in Figure 10 below for facilities in Band 1. It must also be remembered that these facilities were also performing far worse than their low care counterparts before the introduction of ACFI. A facility in Band 4 in 2009 had a facility result that was averaging $5 per bed day more than a Band 1 facility.

Page 4

62 | General

General | 63

Aged Care Financial Performance Survey â&#x20AC;&#x201C; March 2013 Executive Summary Report

64 | General

COMMUNITY CARE CACP Results

The March quarter has seen some further improvement in the results since the December quarter, after the initial dip in results that we saw in the September quarter. The average CACP results for the March quarter was $2.45 per client day compared to $2.14 for the year to June 2012 and $2.47 per client day in 2011.

Income has increased by $0.45 per client day and costs increased by an average of $0.14 per client day or 0.4% since June 2012 which is on top of an increase of 3.9% for the year to June 2012. At first glance it appears that staff costs have increased significantly, however on a closer examination there appears to be a shift from the use of brokered services to direct wage costs. For the year to June 2012 the average cost of brokered services across all programs was $2.13 per client day and this has declined to $0.57 per client day for the nine months to March 2013.

Table 6 Extracts from StewartBrown Aged Care Financial Performance Survey for the nine months ended 31 March 2013. All amounts shown are measured in Dollars per Actual Client Day.

Community Aged Care Packages Average March 2013 $ 175 Programs

Income

Average Top Quartile March 2013 $ 43 Programs

Average Year Ended 30 June 2012 $ 177 Programs

42.52

42.53

42.07

Client care costs

29.78

26.49

29.34

Operating costs

2.18

1.28

2.60

Administration

7.73

6.50

7.50

Depreciation â&#x20AC;&#x201C; non building

0.38

0.33

0.49

Total expenditure

40.07

34.61

39.93

Net operating result

$ 2.45

$ 7.92

$ 2.14

5.8%

18.6%

5.09%

$ 1,034

$ 3,014

$ 960

Expenditure

Result as % of income EBITDA per package per annum

Average Staff Hours per available package per week Client care staff

4.10

3.49

4.70

Coordinators/Case Managers

0.65

0.50

0.87

Administration

0.34

0.24

0.41

5.09

4.23

5.98

Total staff hours

Figure 8

Dec-12

Jun-12

Dec-11

Jun-11

Dec-10

Jun-10

Dec-09

Jun-09

Dec-08

Jun-08

Dec-07

Jun-07

Dec-06

4.50 4.00 3.50 3.00 2.50 2.00 1.50 1.00 0.50 Jun-06

$ per available client day

CACP Results per client day

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Aged Care Financial Performance Survey â&#x20AC;&#x201C; March 2013 General | 65 Executive Summary Report

EACH Packages

The average result for EACH programs is $19.99 per client day and this is a small increase of $0.47 per client day on the 2012 average result of $19.52 per client day. This has seen a reversal of the decline of results in the December survey where the average result had been $18.80 per client day. The average result also leads to an EBITDA of $7,500 per package per annum. Given that residential care saw their average results decline in this quarter, the average facility EBITDA across the 585 residential aged care facilities in the March survey was only $6,817 per bed per annum. Given the amount of capital investment required in a residential facility, the return for the EACH packages appears even better.

Table 7 Extracts from StewartBrown Aged Care Financial Performance Survey for nine months ended 31 March 2013.

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

Extended Aged Care at Home Packages Average March 2013 $ 104 Programs

Income

Average Top Quartile March 2013 $ 26 Programs

Average Year Ended 30 June 2012 $ 120 Programs

131.66

131.84

130.86

Client care costs

82.57

67.04

83.56

Operating costs

5.04

5.40

6.90

23.50

17.72

19.98

0.56

0.33

0.90

Total expenditure

111.67

90.49

111.34

Net operating result

$ 19.99

$ 41.34

$ 19.52

Result as % of income

15.2%

31.3%

14.91%

$ 7,500

$ 15,210

$ 7,450

Expenditure

Administration Depreciation â&#x20AC;&#x201C; non building

EBITDA per package per annum

2013

Average Staff Hours per available package per week Client care staff

9.79

9.31

10.59

Coordinators/Case Managers

1.27

0.86

2.00

Administration

0.76

0.54

0.93

11.81

10.72

13.52

Total staff hours

2013

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Page 9

Aged Care Financial Performance Survey – March 2013 Executive Summary Report

66 | General

EACH Dementia (EACHD)

EACHD results have followed a similar pattern to the EACH programs. The average result for this financial year is a profit of $26.88 per client per day, which represents an increase of $3.73 per client per day on the result of $23.15 per client per day for the 2012 financial year. The main driver of this increased level of profitability is a reduction in staff costs. Average staff hours again declined this quarter. There has been very little change in the overall staff costs over the past two and one half years and indeed there has been a decrease of $2.44 per client per day since 2011 despite increases in rates of pay over that period. This is another sign that this is due to declining hours.

Table 8 Extracts from StewartBrown Aged Care Financial Performance Survey for the nine months ended 31 March 2013. All amounts shown are measured in Dollars per Actual Client Day.

Income

EACH Dementia Packages Average March 2013 $ 87 Programs

Average Top Quartile March 2013 $ 21 Programs

Average Year Ended 30 June 2012 $ 97 Programs

142.33

143.49

140.76

Client care costs

83.21

65.30

85.23

Operating costs

5.58

4.78

9.17

26.41

20.79

22.35

0.47

0.11

0.86

Total expenditure

115.67

90.98

117.62

Net operating result

$ 26.88

$ 52.51

$ 23.15

18.7%

36.6%

16.44%

$ 9,904

$ 19,207

$ 8,763

Expenditure

Administration Depreciation – non building

Result as % of income EBITDA per package per annum

Average Staff Hours per available package per week Client care staff Coordinators/Case Managers Administration Total staff hours

8.21

6.59

9.59

Aged1.05 Care Financial0.68 Performance Survey – March 2013 2.33 Executive Summary Report 0.77 0.37 0.98 10.02

7.63

12.90

We are currently working on a number of projects across these changes and will be providing updates on those as they become available. In the first instance we will be transitioning our benchmarking to cater for the new package levels from 1 July 2013. This will mean re-indexing our current data so that we have some trend data for package level 2 (CACP) and level 4 (EACH and EACHD). One of the side effects of having a dementia supplement available for all of the package levels is that there is likely to be a greater spread of income within a package level. At the moment the only real influence on the spread of income is the level of client fees received however there will now be variations on the subsidy line as well depending on how many packages within a program attract a dementia supplement.

With respect to CDC, we will be looking to benchmark unit costs of some individual service types in addition to the program wide costs. This is a work in progress and we will be consulting with survey participants in the formulation of which services will be benchmarked, what the components will be included in the unit cost and what unit will be used for comparative purposes ($ per hour, $ per service etc). We will keep everyone updated as we progress through these issues.

Reprinted with permission.

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General | 67

68 | General

SAGE UK 2013 Study Tour Bishop Gadsden Episcopal Home, South Carolina Olaf Zalmstra, DutchCare Ltd cfo@dutchcare.com.au

Bishop Gadsden has more than 450 residents and 300 employees that shape the vibrant character and active lifestyle on their 70-acre campus. They are located on James Island, just 10 minutes from downtown Charleston.

Bishop Gadsden offers an array of accommodations and services. As an accredited continuing care retirement community (CCRC), they provide the highest quality assisted living and health services on-site with an excellent staff-to-resident ratio. Bishop Gadsden’s comprehensive wellness program and holistic approach to care assures individualized attention, maximised independence and respect for the individual.

On arrival at Bishop Gadsden the first thing you notice is the grandeur and opulence of the overall site, lakes and fountains, huge portico and magnificent entrance foyer.

The service provides for a Continuing Care Retirement Community, CCDC, as its model with retirement living, assisted and skilled nursing care as well as service packages included. An ingoing of between $250,000 and $500,000 is expected along with monthly fees of around $4,000, these fees include a weekly clean, laundry service and use of all facilities, nursing care is provided if required. The crowning jewel at Bishop Gadsden is its dining program, with all residents as part of their package given “free” dining and drinks services in the complex’s numerous cafes, bars and fine dining restaurants.

Catering at this facility has been taken to a new level and by all indications is a major reason for moving in here. Residents will move through the continuum of care as the needs increase typically with no change to service charges or ingoings along the way. If a resident finds themself in financial difficulty the service provides for them through a resident working fund paid for by “voluntary” contributions.

General | 69

SAGE US 2013 Study Tour Bishop Gadsden Episcopal Home, South Carolina Olaf Zalmstra, DutchCare Ltd cfo@dutchcare.com.au

Bishop Gadsden has embarked on a large expansion program with the original buildings dating back to the 1990’s. Due to parts showing signs of age, lack of natural light and limited storage, some buildings will be demolished and replaced with 12-15 bed homely units in skilled and assisted care, providing a higher care open plan style and each room with a bathroom and maximum natural light. ILUs or flats would be developed on new grounds again taking advantage of natural light and providing vast amounts of inbuilt storage.

The service prides itself on its catering and hospitality service with several fine dining restaurants, a bistro café and a pub. These are used widely and frequently by all.

From an IT perspective, the facility uses several unrelated and unconnected programs to provide outcomes suitable to their environment. They employ two dedicated IT staff who manage hardware and software internally.

SAGE US 2013 Study Tour Vinson Hall Retirement Community, Washington Olaf Zalmstra, DutchCare Ltd cfo@dutchcare.com.au

The use of real time monitoring aids was demonstrated by way of a wearable time piece which also uses motion sensing for falls, proximity/GPS for monitoring both movement of person to ensure they are ok and location in the event they are “lost”.

BGL’s and cardio measurements can be taken with the aid of Bluetooth peripherals as well as weight and weight loss.

These aids are currently being used in Australia by Freedom Aged Care in Toowoomba, Qld. More info: www.aframedigital.com

70 | General

SAGE US 2013 Study Tour Lutheran Homes of South Carolina & Palmetto Senior Care Olaf Zalmstra, DutchCare Ltd cfo@dutchcare.com.au In the heart of the Midlands, scenic Upstate and coastal Low country, Lutheran Homes offers five communities with choices for living with a wellness-based lifestyle that emphasises comfort and convenience. Their continuing care retirement communities allow independent adults to choose to live in single-family patio homes, cottages and apartments with amenities for a chore-free and active lifestyle. When more help is needed, Assisted Living provides support with activities of daily living while encouraging independence. Memory Support Programs are more than secure, offering innovative care for people with Alzheimer’s disease and related memory concerns.

Skilled Nursing and Rehabilitation Centres provide person-centered care to meet short-term recovery and long-term health needs.

Palmetto Senior Care (PSC) is a program of Palmetto Health which provides frail senior citizens in Richland and Lexington counties with healthcare options that allow them to receive daily medical care at an adult day health centre. This allows the patient an opportunity to remain at home with family. The primary goal of Palmetto Senior Care is to help participants remain active in their families and community, as long as it is socially, medically and economically feasible. Palmetto Senior Primary Care Practice received the National Committee for Quality Assurance (NCQA) Level III for physician practice.

These organisations partner to provide a variety of services to primarily Medicade and Medicare clients, whilst their Assisted and Skilled Nursing facilities are aging they have built a significant wellness and day centre to accommodate both their retirement community and the local communities participating in their PACE program.

SAGE US 2013 Study Tour Visiting Nurse Service of New York (VNSNY) Olaf Zalmstra, DutchCare Ltd cfo@dutchcare.com.au The Visiting Nurse Service of New York offers a wide range of services in the greater New York area. From paediatrics to senior care, short-term interventions to long-term management, VNSNY’s skilled nurses, other clinical professionals and home health aides they have a long tradition serving the community.

They served more than 31,000 patients in Manhattan in 2007. In Manhattan, VNSNY offers post-hospital care, rehabilitation therapies, long term home health care, AIDS programs, end-of-life care, and help with all activities of daily living. Through an affiliate company, VNSNY CHOICE, they also offer two health plans – a managed long-term care plan for nursing home eligible Medicaid patients and a Medicare Advantage health plan for residents who are eligible for both Medicare and Medicaid.

This service claims to have changed the model of care and the way in which they communicate with providers by using technology, thus assisting in managing episodes rather than ongoing interventions. Additionally, its processes avoid rehospitalisation, a real issue under the new “Obama” care program, and allows the targeting of high risk rehospitalisation clients.

A large amount of data is collected by the service and regurgitated as meaningful and useful reports via a web portal to ensure the service is providing optimum care for its 31000+ clients per day. This data manipulation also allows for Fun Facts, evaluations, predictive modelling and program evaluation.

The service also maintains a Congregate Care Program (Home Care) where it identifies and works with building owners to supply services in a way in which their Nurses become part of that site providing integral services in a consistent, competent and compassionate way. This service is often located in a NORC, Naturally Occurring Retirement Community, and gives VNSNY a “foot in the door” for future fee for service works and ultimately facilitates aging in place in the home.

General | 71

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72 | General

SAGE US 2013 Study Tour Vinson Hall Retirement Community, Washington Olaf Zalmstra, DutchCare Ltd cfo@dutchcare.com.au Vinson Hall Retirement Community is a non-pro.t Continuing Care Retirement Community supported by Navy Marine Coast Guard Residence Foundation. Located on 20 pastoral acres in Northern Virginia, Vinson Hall’s vibrant community features independent living, assisted living, nursing and memory care, allowing our residents and their family members to enjoy peace of mind knowing that our continuum of care can accommodate changing needs.

Vinson Hall provides apartments for independent seniors who are commissioned military officers and their immediate family, as well as government workers of an equal rank from select agencies. Arleigh Burke Pavilion provides assisted living and healthcare, and The Sylvestery offers memory support assisted living residences.

Vinson Hall is currently undergoing major refurbishment/upgrade and construction works and the first thing that stands out here is their marketing focus. As an “upmarket” provider for retired officers of the armed forces, the properties have an air of providing just that little bit extra. The dementia specific building is designed to provide continuous movement around a rectangular passage way, with points of reference along the way. Once inside it is difficult to locate the main exit as it blends in so well and residents are therefore not tempted to “abscond”.

The organisation has set up a sales and marketing suite and spends considerable time and effort to provide information to its potential clients. Monthly fees for independent living range from $1,400 to $4,000 per month depending on the services provided. Again there is a real emphasis in the dining experience and residents pay up front for a minimum of 1 full meal per day with restaurant, café and take out services being available. The service has invested substantially in menu planning to ensure optimisation of resources and also reduce wastage using a software package called Sure Quest Inc.

General | 73

SAGE US 2013 Study Tour Selfhelp Community Services Inc., New York Olaf Zalmstra, DutchCare Ltd cfo@dutchcare.com.au Selfhelp is a not-for-pro.t organization dedicated to maintaining the independence and dignity of seniors and at-risk populations through a spectrum of housing, home health care and social services, and will lead in applying new methods and technologies to address changing needs of its community. Selfhelp will continue to serve as the “last surviving relative” to its historic constituency, victims of Nazi persecution.

Selfhelp’s commitment to secure independent living for seniors is evident in their six, award-winning housing complexes serving more than 1,000 low and moderate-income seniors. Their six senior centres provide programs that enrich the lives of over 6,000 older New Yorkers and four Naturally Occurring Retirement Communities (NORCs) offer residents extensive on-site care services.

As Selfhelp C.S. only service clients in “their own home” the focus is on maintaining wellbeing in that home by providing a myriad of technical and non-technical aids and services to achieve that result. Clients can attend central day care services which provide arts, computer learning, games and many other social functions giving a sense of community feel throughout the service. They utilise a form of “It’s Never 2 Late” software, IN2L, to open up communication with home bound clients allowing them to dial in and participate in various activities including sing along sessions, quizzes etc.

The service is also operating a program to train clients to self-monitor a variety of medical issues such as blood pressure, weight and BGL’s thus alleviating staff call outs etc. whilst the service is still in its infancy it has already proved popular, with this telehealth program they see an increase in clients self-managing chronic illness in the community thus staying in their own homes longer. Selfhelp has reference to IT included in its mission statement to ensure they do not lose sight of where they wish to head.

Like most services in the USA, Selfhelp receives considerable funding through philanthropy and this allows them to become more creative with the use of those funds as they do not have the same care restrictions placed on them, partnering with others to achieve mutually beneficial results.

The service also provides a Skype booth to all residents in its homes, giving them access to visual communication with loved ones around the world.

SAGE US 2013 Study Tour Lutheran Homes of South Carolina & Palmetto Senior Care Olaf Zalmstra, DutchCare Ltd cfo@dutchcare.com.au The PACE program is a signi.cant initiative in care for those who still remain in their own homes but are transported to the facility for anything up to 8 hours per day 5 days a week, and is primarily a day care program with added medical and ancillary services provided. This program is government funded at around $100 per day and in appropriate settings with appropriate service program delivery can assist in maintaining independence to many “high care” clients without the need for residential nursing accommodation. The organisation concentrates on turning the tables on care by promoting a wellness model rather than a “sickness” model.

The services are supported by an array of both interconnected and standalone IT services, significantly their Care solution integrates with billing and MDS data reducing the need for duplication of data across the service however move across the disciplines still requires some repeat entry. Most staff training is done via software operated across the “cloud” or online allowing staff to complete a variety of standardised training in their own time. Data on completed training is maintained and allows evaluation of progress and records of staff skill levels.

The services have also adopted forms of in-home technology with medication dispensing leading this charge.

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General | 75

SAGE US 2013 Study Tour Jewish Home Lifecare, New York Olaf Zalmstra, DutchCare Ltd cfo@dutchcare.com.au

Jewish Home Lifecare provides healthcare services and assistance for elders.

With more than 160 years of experience as a not-for-profit elder care system, Jewish Home Lifecare provides a broad spectrum of care and serves as a resource on concerns of aging for elders and caregivers. Its Research Institute on Aging works to expand knowledge of the aging experience and models of service, to contribute to the quality of care and quality of life afforded older adults and their families.

The Sarah Neuman Centre is the Westchester campus of Jewish Home Lifecare.

It offers nursing home care, a full range of post-surgical disease recovery and short-stay rehabilitation, an adult day program and respite care.

The service currently has a new Greenhouse facility under construction providing small clusters of home areas for 10-15 residents in each high care “home” but has already acknowledged that the USA is moving away from Nursing Homes to more of a rehabilitation model with ultimate return to the home care program.

Whilst moving along with technology the service still provides most dissemination of information via the Plain Old Telephone System (POTS) which works well especially considering their return to the home program, clients use self-monitoring devices to feed back information for review and evaluation by trained nursing staff reducing the need for staff to “be on the road”.

Jewish Homes, again like many US providers, partner with technology organisations to assist in developing both software and hardware to suit the services provided. Their technology partner, Panasonic, provides a large slice of their hardware requirement and demonstrated some of their equipment including toughpads.

76 | General

Hearing Services Program

By Tracey Duffy, National Manager, Office of Hearing Services Consultative Committee

H

earing loss can have far reaching effects on you and those around you. Currently one in six Australians is affected by hearing loss, and with an ageing population, the proportion of the population with hearing loss is projected to increase to one in every four Australians by 20501 Hearing loss affects many older Australians and this can have a significant impact on quality of life. Dealing with hearing loss can lead to a better quality of life through better communication, greater independence, improved wellbeing and stronger relationships within the community.

The Australian Government Hearing Services Program (the program) aims to improve access to quality hearing services for eligible clients, provide better targeted hearing services and support research into hearing loss prevention and management.

If you or someone you know is experiencing hearing loss, help is available through the program. In 2011-12, the program provided 616,639 people with hearing services performed by qualified hearing practitioners, at 2,344 sites around Australia.

For residential aged care facilities, accessing hearing services for eligible clients can assist in ensuring that residents’ sensory losses are identified and managed effectively.

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To be eligible for the program, you need to be an Australian Citizen or permanent resident 21 years or older who is: • a Pensioner Concession Card Holder or receiving a Sickness Allowance from Centrelink; • the holder of a Gold Repatriation Health Card issued for all conditions, or of a • White Repatriation Health Card issued for conditions that include hearing loss; • a dependent of a person in one of the above categories; • a member of the Australian Defence Force; or • undergoing an Australian Government funded employment services disability management services and referred to the program by a case manager.

Services under the program include: • comprehensive hearing assessments; • support and hearing rehabilitation services; • access to a wide range of quality free hearing devices; and • ongoing maintenance services for hearing devices.

Additional specialist hearing services are available for those who have severe to profound hearing loss, significant visual impairment in addition to hearing loss, or other disabilities which complicate management of a hearing loss. These services are provided through the Community Service Obligation component of the program.

The Australian Government is in the process of extending the way it conducts business with hearing services providers, clients and carers. The Hearing Services Online (HSO) project will provide a portal for online interaction between the department, clients and hearing services providers, it will include: • online services for near real time client eligibility checking; • the ability to securely lodge client applications online; and • an interactive hearing services provider directory.

Hearing services are provided by over 220 public and private hearing services providers throughout Australia. To find a provider in your area visit the program website at www.health.gov.au/hear and search the Local Provider Directory.

For further information about the program visit www.health. gov.au/hear or call 1800 500 726. The website provides easy to understand eligibility requirements and a step by step guide to assist you to apply for the program. ■

References 1. Access Economics & Cooperative Research Centre for Cochlear Implant and Hearing Aid Innovation (Australia) & Victorian Deaf Society, 2006. Listen hear! The economic impact and cost of hearing loss in Australia: a report by Access Economics Pty Ltd CRC for Cochlear Implant and Hearing Aid Innovation: Vicdeaf, East Melbourne.

General | 77

The new frontier: Designing for better cultural environments

By Dr Maggie Haertsch (PhD), CEO, Arts Health Institute and Cynthia Payne, CEO, Summitcare and Chairman, Arts Health Institute

D

escriptions of aged care services from websites include “wellbeing”, “independence”, “enjoying life”, “excellence”, “attention to detail”, “caring and respect”, “making every day the best it can be,” “resort living”, and “a haven of peace and good living”. Images of aged care services show designs of five-star hotel-like rooms, with descriptions of hotel services, entertainment, lifestyle activities and care options. Yet how closely does the marketing match the real experience?

Aged care services are all about people, the older person, the staff and all the communities that form by bringing strangers together just because of ageing and their physical needs that require attention. The older person needs this support because they are older, frailer, more vulnerable, and the challenges of living make it impossible to maintain a high degree of independence.

Most people have a fear of aged care outside of their own home yet aged care can improve quality of life. This delicate dance of providing the right support at the right time in the right amount is like following the lead in a waltz. While many aged care providers have aspirations of getting this dance right, it often doesn’t translate to the actual experience. We only need to see the alarmingly high rates of depression in residential aged care to understand that there is a lot more that needs to be done.

Aged care services have come a long way and continue to respond to societal pressures such as the growing rate of people living with dementia needing 24 hour care and changes to government funding. We delegate the care to nurses to manage primarily the physical needs and divide the lifestyle responsibilities to diversional therapists or recreation officers. In some aged care environments this lifestyle position is an all-in-one role with a carer rostered on the shift to provide both the physical daily care functions as well as activities. This may overcome the divide that develops between lifestyle and those providing direct daily care bringing together a more holistic approach to the individual’s needs. We know that bus trips are important and bingo can be a prized regular social slot in the calendar. Small budgets are allocated for the “entertainer” and recreation or lifestyle officers live with the hope they will provide services for free. Is the “activity” enriching and does it nourish the emotional and psychological self? Has the bar been set too low? Maslow’s hierarchy of needs helps to explain that in the last years of a person’s life, quality aged care services should encompass not only the physiological and safety needs of an older person but also a sense of belonging and love, an environment that promotes selfesteem and fosters creativity leading to self-actualisation. Having the right person for the right job so an artist with special skills in aged care working alongside diversional therapists, allied health

78 | General

professionals, nurses, recreation officers and managers will add to the rich experience and aged care provider offering. The artist is essential in cultural redesign. Designing for a better cultural environment presents an untapped opportunity.

Bringing the arts into aged care services de-institutionalises institutions. The arts connect life experiences to self-expression and embraces individuality. The arts allow for difference and foster feelings of being worthwhile and respected in both the expression and appreciation of the arts. It fills a void when people are removed from their own familiar environment. There a number of evidence-based arts programs designed for aged care environments. Participatory arts programs include: • bibliotherapy (reading specially selected literature); • choir programs particularly intergenerational singing; • comedy and theatre for people living with dementia, who are depressed or self-isolating; • visual arts • live music particularly in palliative care; • photography; and, • dance.

Aged care physical environments, like some hospitals, can be registered art galleries with walls adored with beautiful artworks and gardens a place to find sculptures. The use of theatre designers to create the interior of dementia units that foster staff engagement is taking the design of the physical environment to another dimension. It can create an imaginary environment that promotes playfulness and creativity.

Bringing artists into the environment can transform entire workplaces for staff and the quality of life for the older person however artists need to understand the special needs of older

people or people living with dementia. Just as there is outsourcing for any range of services, arts organisations such as the Arts Health Institute work specifically in aged care and is able to help with strategy and leadership to make an impact through the arts.

It requires a different set of lens, it is a new area of work with a growing research base.

It is time to change the thinking of arts as a “nice to have” but as a “must have” in aged care services. Best practice in dementia care shows that the Play Up Program using the results of a world first study (The SMILE Study) conducted by University of NSW’s Dementia Collaborative Research Centre (DCRC) has made a notable impact. The randomised controlled trial looked into the effects of humour therapy on 400 residents in 36 Australian aged care facilities between 2008 and 2011. The study showed humour therapy was as effective as widely used anti-psychotic drugs in managing agitation experienced by people living with dementia, but without the side effects. Agitation levels decreased by an average of 20 percent during the 12-week intervention at each facility during the study and remained lower at the 26 week follow up. Happiness and positive behaviour levels rose while the humour therapy was in place but decreased again after it ceased.

The study also found that the more humour therapy a person had the greater social engagement and reduction in depression.

Organisations that have introduced the Play Up Program have seen a reduction in the use of anti-psychotic medications, significant reduction incidents and falls rates, an increase in staff morale and a decrease in staff sick leave.

Programs such as Sing Out Loud, a choir program that becomes intergenerational during school term is showing improved mood and self-esteem. The choir fosters new-found

General | 79

funding programs such as the Dementia and Severe Behaviour Supplement to support aged care providers to introduce arts programs given the exciting evidence now available of their impact. It is time to raise the bar on what was traditionally seen as an activities role and support diversional therapists, allied health professionals and recreation officer to work with artists to deliver cultural change and redesign aged care services for an exciting cultural revolution. ■

friendships both with the child singing buddy but also in the aged care community. People living around a corridor are meeting in a social setting for the first time.

The investment in evidence-based arts programs can generate significant returns. They can cost between $17 – $32 per person each week and builds the capacity of staff to adopt the artists’ approaches and continue these in between sessions. It is good for the older person, good for their families and staff. The Department of Health and Ageing have the opportunity through additional

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General | 81

SummitCare Strikes Gold

S

ummitCare has achieved national and global recognition for its business excellence processes, taking out the Australian Business Excellence Gold Award 2012.

In doing so, it has become the first aged care provider in Australia – and one of the first aged care providers in the world – to achieve this level of recognition.

Winning an Australian Business Excellence Award requires a rigorous analysis of the processes of organisations that successfully apply the Australian Business Excellence Framework (ABEF). The ABEF is an integrated leadership and management system that helps organisations sustain high levels of performance.

It is part of a global community of 80 excellence awards programs, including the Baldrige Criteria for Performance Excellence in the US, the EFQM Excellence Model in Europe and the Singapore Quality Award.

The Australian Business Excellence Gold Award 2012 was officially presented to SummitCare at a luncheon on June 27, 2013, at Crowne Plaza Norwest in Baulkham Hills. More than 100 people, including senior industry representatives and SummitCare suppliers and staff, were in attendance.

SummitCare Chief Executive Officer Cynthia Payne spoke at the event about the importance of suppliers, management and staff in achieving such an accolade.

“I have the absolute pleasure of working with the most talented leadership group – and the results from today are

David Sikorski (centre) from SAI GLOBAL presents the GOLD AWARD to Peter Wohl and Cynthia Payne

The Advisory Committee. From left: Tom Loewy, Peter Wohl, Cynthia Payne, Julie Hough

directly attributed to the important work that this team does, and our staff as well.”

SummitCare previously took out a Silver Award in 2009, and Cynthia said the organisation had worked within the ABEF and been committed to business excellence for more than eight years.

“This effort culminated in an achievement as the only aged care company in Australia to reach gold level and to gain this level it meant achieving a scoring matrix higher than 650 out of a possible 1000,” she said.

“Our result was a magnificent 681. Through using the framework from 2007 and more recently the updated 2011 model, we strengthened every part of the organisation.”

STRONG FOUNDATIONS In the 1960s, Emerich Wohl created the Wohl Management Group, which has evolved into the SummitCare organisation of today. SummitCare owner Peter Wohl addressed the award luncheon, recalling the way in which he learned from his father about the importance of strong relationships in aged care.

“I’ve been honoured through my life to be in a position to provide care to so many people who have been placed in our charge,” he said.

He said he owed a debt of gratitude to residents, families, staff and suppliers, and felt a responsibility to each group.

“It’s this responsibility that I hold supreme and that motivates me each and every day.”

82 | General

The SummitCare Management Team. From left: Amit Malhotra, John Engeler, Ann Oâ&#x20AC;&#x2122;Loughlin, Peter Wohl, Cynthia Payne, Sue Smith, Judith Leacock, Carla Beheram, Kerri Hartney, Barry Cowling, Irene Stein, Caroline Collins, Joan Fernando.

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General | 83

Peter told the audience the gold standard of SummitCare meant that Cynthia, her leadership team and everyone who worked or partnered with SummitCare were continuing a very high level of care that his father had begun.

“I know that without you all the success we enjoy today would not have been a reality.”

Peter and Cynthia were presented with the Gold Award

by David Sikorski, Practice Leader – Capability Development Services of SAI Global, which is the custodian of the ABEF. David said he was struck by the fact that the award evaluation team wrote that SummitCare had a strong valuesbased culture, with a high level of relationships from the board through to the staff, including stakeholders.

“I couldn’t get over that statement – I’ve never seen it before. Congratulations.”

GLOBAL EXCELLENCE Business excellence is about “sustaining superior organisational performance through a systems approach, a customer and stakeholder focus and a culture of continuous improvement”, David told the audience.

“The ABEF is the premium model of excellence in Australia and is recognised by other associations that administer models of excellence around the globe,” he said.

He outlined the rigorous assessment process leading to the Gold Award. It involves self-assessment of the application of the ABEF via an initial submission, which is analysed by an independent team, followed by site visits and further organisational analysis before allocation of awards.

“It’s just an amazing thing for SummitCare to have got where they’re at, and they should keep it up,” David said.

The ABEF is recognised by the Global Excellence Models (GEM) Council. GEM Council representative Ravi Fernando said this meant SummitCare was now being acknowledged on the international stage for its achievements.

He said winning an Australian Business Excellence Gold Award required some key elements.

“It’s leadership to start with – leadership and passion,” he said.

“But it’s also very much about leadership empowering staff – that’s the only way anyone can win the Gold Award.”

Ravi congratulated SummitCare on receiving the Gold Award and for the work it does for the aged in Australia.

“I believe the services you provide are exceptional within the sector,” he said. ■

Baldrige Award Conference SummitCare had the honour of being invited to present at the Quest For Excellence Conference in the United States in April this year.

Held in Baltimore, the event marked the 25th anniversary of the Baldrige Award, the premier US award for performance excellence management. SummitCare’s Australian Business Excellence Gold Award win led to our CEO Cynthia Payne speaking at the event, in a program that included congratulatory video messages from President Barack Obama and former President Bill Clinton.

In her presentation, Cynthia spoke about the aims of the Australian Business Excellence Framework and outlined the characteristics of an excellent organisation.

“The ABEF has proven relevance to all types and size of organisation – multinational, small and medium such as SummitCare,” she told the conference, before describing the scope of SummitCare’s activities in Australia.

Cynthia also detailed the key strengths of SummitCare that were highlighted by evaluators and led to the Gold Award: a clear direction in the organisation through strong leadership and forward planning; leadership by the CEO and senior management, fully supported by Board; enthusiasm and engagement of people in their work and their involvement through teams in ways to improve their work practices; and a strong organisational culture based on a supportive work environment.

Global Excellence Models (GEM) Council representative Ravi Fernando said he had received “tremendous feedback” on Cynthia’s presentation from international representatives who were proud to see an aged care organisation as part of the global excellence community.

“They absolutely loved the presentation from SummitCare,” he said.

“They had never seen an aged care organisation win such an award.”

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General | 85

Aged Care Reforms â&#x20AC;&#x201C; Determining a Price

By Rachel Lane, Aged Care Gurus

A

fter two years of enquiries, reports, commissions, focus groups and debate the Aged Care Reforms have now received Royal Assent.

While the accommodation payments have been confirmed as a lump sum (RAD) to daily charge (DAP) calculation, rather than the DAP to RAD formula, we are still awaiting details of the lump sum amount for Tiers 1 and 2. The importance of timing and base point for the calculations cannot be underestimated for operators and residents alike.

Option 1 â&#x20AC;&#x201C; Use the existing Tier 1 and Tier 2 RAD and apply the current MPIR If we calculate the DAP from the original RAD at the current MPIR Tier 1

Tier 2

RAD $238,845

RAD $406,037

MPIR 6.82%

MPIR 6.82%

DAP $44.75p.d

DAP $76.08

If we simply convert the previous lump sums to a daily charge we can see that there is some discrepancy, partly due to the change in the calculation and partly because the MPIR has reduced to 6.82% from 1 July.

The Tier 1 bond cap when the conversion was a daily charge (DAP) to lump sum (RAD) equation was $238,845. If we apply the current MPIR (6.82%) to this amount it would give a DAP of $44.75 per day, this is $5.25p.d./$1,911p.a. less than the original DAP of $50 per day. The Tier 2 bond cap of $406,037 at the current MPIR would give a DAP of $76.08 per day, which is around $8.92p.d./$3,247p.a. This figure is less than the original DAP at $85 per day.

Option 2 Use the existing Tier 1 and Tier 2 DAP and apply the current MPIR If we use the original formula for calculating the lump sum from the daily charge at the current MPIR (6.82%), the Lump Sum for Tier 1 would be $266,862 and for Tier 2 would be $453,665. The increase in the lump sum amount is due to the decrease in the MPIR. As I pointed out in my previous article in the last edition of Fusion (Autumn 2013), a daily charge to lump sum equation will mean that any change in the MPIR would have the opposite effect

on the lump sum amount. Using this as our baseline will mean that the RAD and the DAP are equal to each other at the current MPIR. If we calculate the RAD from the DAP at the current MPIR Tier 1

Tier 2

DAP $50p.d

DAP $85p.d

MPIR 6.82%

MPIR 6.82%

RAD $266,862

RAD $453,666

86 | General

What happens if the MPIR changes?

If the MPIR was 6.5% when the price was set Tier 1 DAP to RAD

Tier 2 DAP to RAD

Tier 1 RAD to DAP

Tier 2 RAD to DAP

DAP $50p.d

DAP $85p.d

$238,845

$406,037

MPIR 6.5%

MPIR 6.5%

MPIR 6.5%

MPIR 6.5%

$280,000

$476,000

$42.65p.d

$72.51p.d

If the MPIR was 8% when the price was set Tier 1 DAP to RAD

Tier 2 DAP to RAD

Tier 1 RAD to DAP

Tier 2 RAD to DAP

DAP $50p.d

DAP $85p.d

$238,845

$406,037

MPIR 8%

MPIR 8%

MPIR 8%

MPIR 8%

$227,500

$386,750

$52.49p.d

$89.23p.d

From the operator’s perspective, any price that is set needs to reflect the value of capital with regular indexing to ensure that

the value is maintained. If we assume that all residents, with the exception of those that are supported, pay the market price then operators won’t need to cross-subsidise residents to achieve the set price.

From the resident’s perspective the decision to pay for their accommodation by DAP or RAD (or a combination) is a much more complicated decision than price. For a number of residents, price may be an issue as their assets and income may mean that they are not eligible to be supported but are not able to afford the market price. While the RAD will be exempt from the resident’s assets for pension purposes, it will be assessable for determining the amount of care contribution they need to pay.

Similarly, paying a high level of DAP may lead a resident to receive less pension and contribute more towards the care contribution under the income test. Currently income in excess of $156pfn, with the exception of rent from the former home under certain circumstances, leads to a reduction in Age Pension of 50c per dollar. A resident will need to determine their pension, cash flow, tax and cost of care outcomes before making a decision about which amount and method of payment will best suit them. ■

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2013

General | 87

2013 Calendar of Events 22 August 2013

19 September 2013

17 – 20 November 2013

LASA Victoria Retirement Living Seminar

LASA Victoria Residential Care Seminar

IAHSA 10th International Conference

The Westin, Sydney Caulfield Racecourse, VIC vic.lasa.asn.au/event/lasa-victoriaretirement-living-seminar

Caulfield Racecourse, VIC vic.lasa.asn.au/event/residential-careseminar

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

23 – 25 February 2014

20 – 22 October 2014

23rd Annual Tri-State Conference & Exhibition Albury Entertainment Centre, NSW http://vic.lasa.asn.au/event/tristate2014

LASA National Congress 2014 Adelaide Convention Centre, SA www.lasa.asn.au

Hosted by

8 November 2013 Aged Care Hospitality National Awards Gala Dinner 2013 – Hilton on the Park, Melbourne – oscarhospitality.com.au The Aged Care Hospitality Awards (ACHA), now in its 3rd year, aim to create a five star culture in the hospitality industry within Aged Care. The ACHA recognises and rewards outstanding staff members, initiatives and facilities in the betterment of Aged Care Catering, Cleaning and Laundry services.

For the first time the awards are being offered nationally. The award categories for 2013 are: - Facility Catering Service of the Year

- Food Service Assistant of the Year

- Catering Innovation of the Year

- Facility Cleaner of the Year

- Chef Manager of the Year

- Laundry Services Individual of the Year

- Chef/Cook of the Year

Submit your nominations today! More information available at oscarhospitality.com.au

88 88 || General Product News

At Catering Industries – RESIDENT SATISFACTION IS OUR BUSINESS! We, at Catering Industries, have long recognised that any successful organisation is only as good as the combination of employee talents – just like any good recipe is dependent on the combination of its ingredients.

Our success, therefore, depends on the level of client and resident satisfaction we generate. To achieve this, we have the following clearly defined objectives: • • •

To select and retain highly qualified and experienced personnel at all levels.

To provide a personalised and tailored service at both resident and client level.

To provide professional performance of all duties and responsibilities.

By aiming to achieve these objectives, over the years we have developed: • • •

A highly seasoned and experienced senior management team, specialising in aged care catering.

A broad client base featuring some of Australia’s most recognised aged care service providers.

A strong commitment to providing competitive pricing and value for money.

We are the largest, privately owned contract caterer to the industry – servicing all sectors of the market. Our growth in the industry is not co-incidental, but rather resultant on our deliberate approach to satisfy the requirements of the market.

Our vast experience translates in specific terms to include: • • •

Expertise in menu planning, focusing on a highly balanced and nutritional diet.

Our industry leading systems and procedures, backed by our ISO accredited Quality Management System.

Full accreditation support.

Currently managing the catering services at over 75 aged care facilities across Australia where we proudly boast an unblemished audit history across local, state and federal government authorities.

In 36 years, we have NEVER failed an accreditation audit.

Explore how Catering Industries can partner you in the provision of a high quality, cost effective catering service by calling 1300 364 092. or visit www.cateringindustries.com.au We guarantee a superior food service at a competitive price.

A Quick, Permanent Fix for Damaged or Leaking Pipes The demands on Hospitals can be a challenge at the best of times.

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So when a pipe becomes damaged, either through an accident or general wear and tear, the fallout from any leakage can be massive. A burst high pressure pipe pumping out litres of water can lead to damage, closure of facilities and high costs for repair or replacement. Keeping this disruption to a minimum is a high priority!

The Fernco Pow-R Wrap can help in this situation. It is supplied as a kit which contains all you need to stop a high flow or a slow leak from any pipe – quickly and permanently. Activate the resin by simply pouring water into the foil pouch which contains the wrap, wrap it around the damaged area of pipe, and hold for up to 15 minutes. An advanced putty is also supplied for additional strength.

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A NEW WAY TO MANAGE RESIDENTIAL AGED CARE SITES Building on it’s expertise in the out-of-hospital care services market, technology solutions provider Belgravia Health & Care is providing the retirement and aged care industry with a new way to manage sites from development, through operations and into the future.

With the CareSys solution, Belgravia Health & Care delivers a proven business specific application including financial, operational and management features encapsulated into a single integrated system.

CareSys provides some powerful features across key areas of site management. Enquiries and sales management in CareSys provides a single view of prospects to ensure a seamless experience for all enquiries. Asset and equipment management means village & facility design can be mapped to equipment allowing it to be tracked, ensuring equipment can be actively managed to reduce cost and increase performance.

CareSys client invoicing provides a very comprehensive billing system that also integrates with third party accounting systems. The person centred assessments and care module is a highly flexible care delivery system with user defined and DOHA recognised predefined care and lifestyle templates.

Time and attendance functionality captures staff working hours, as well as staff rostering and work requirements including attendance and skills tracking Importantly, CareSys includes dedicated management reporting for customisable, real-time reporting.

For more information on CareSys call Belgravia Health & Care on (03) 9941 3149 or visit belgraviahc.com.au

Product General News || 89

Q-Pulse Powered by HCI – A Compliance Solution for Aged Care Facilities Q-Pulse powered by HCI, is cloud based software that will allow aged care facilities to monitor the status and utilisation of policies and procedures, audits and related quality improvements. It is currently used by the Aged Care Standards and Accreditation Agency who are utilising it as their internal quality management compliance system.

The solution includes:

Document Control A framework for defining, developing, controlling and maintaining policies and procedures and regulatory requirement documentation.

Audit Management Customised internal audit scheduling, comprehensive audit tool kits for each audit type and detailed report methods.

Opportunities for Improvement (OFI’s) OFI management arising from audit reports and other internal and external sources.

The service focus is on reducing the administration workload for procedures, audit, and risk, to allow an enhanced focus on care improvement.

This includes: • •

140+ Evidence Based Care & Support Procedures 1000+ Audit Tools

• • • • • •

Annual Onsite Compliance Reviews Ongoing Access to Quality & Regulatory Experts Cloud Based – Quality Software System Remote Performance Monitoring Onsite Training ACSAA and DoHA Compliance

Health Care Informed (HCI) are international providers of regulatory, risk and quality improvement services to the aged care sector. HCI have been based in Australia since 2007, working with Pathology, Acute Care, Medical Imaging and Aged Care organisations to develop and improve their quality systems. Our clients include: the Australian Council on Healthcare Standards, the International Society for Quality in healthcare (ISQua), SA Pathology, Pathology One, Western Diagnostic Pathology and Eastern Health Medical Imaging HCI are delighted to be involved in the Leading Aged Services Australian (LASA) Congress 2013. Paul Marley, Operations Manager at HCI will give a presentation on “Supporting Effective Governance through a Quality Management Information System” at the LASA Congress on Monday 5th August. HCI are also exhibiting and will be giving regular demonstrations of Q-Pulse at stand 72.

For more information drop by our stand or contact us at: t 03 9606 0420 e info@healthcareinformed.com w www.healthcareinformed.com

An Industry first for Aged Care Catering Software OSCAR Hospitality has developed an industry first – Resident Dietary Information and menu Management software designed by aged care professional, for aged care professional.

A one-stop-solution for aged care facilities catering services management, the cloud-based OSCAR Hospitality Complete Catering Care Program (3CP) software integrates residents’ dietary information/ preferences with 30+ operational reports and tailored dietetically assessed menus supported by over 1000 dietetic suitable/cultural recipes designed specifically for Aged Care.

The 3CP provides a holistic business solution that considerably reduces workload, optimises operational efficiencies and productivity, saves money, meets legislative and industry requirements and enables nutritious and delicious food and beverages.

With a combination of over 60 years in the Hospitality and Aged Care Industries, OSCAR Hospitality offers Operational Support, Catering Consultancy, Auditing and Recruitment for Aged Care Catering, Cleaning & Laundry Services.

Contact: Diane Buettel (03) 98061090 or diane@oscarhospitality.com.au

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90 | Product News

Continence aid provider TENA launches multilingual communications To coincide with the Continence Foundation of Australia’s national campaign on raising awareness of continence issues within Australia’s numerous multicultural communities during World Continence Week, TENA is launching a series of brochures for non‐English speaking communities.

TENA launches Bladder Weakness brochures for men and women in various languages.

The new TENA brochure range includes both female and male versions.

They have been translated into five non‐English languages commonly spoken in Australia including Chinese‐Traditional, Chinese‐Simplified, Vietnamese, Greek and Italian. The brochures which deal with bladder weakness issues will be distributed to key Healthcare Professionals such as Continence Nurse Advisors, Continence Physiotherapists, General Practitioners, Practice Nurses, Urology Nurses, Occupational Therapists, Pharmacists, Pharmacy Assistants and Aged Care Nurses and Care Staff. TENA anticipates these will become a widely used resource for professionals working with clients with bladder weakness issues.

TENA encourages more individuals to access advice and services for bladder weakness.

The brochure range ensures that individuals know they are not alone and that the prevalence of bladder weakness is widespread. Various types of incontinence are covered and steps are provided to address bladder weakness such as: • Visiting a Healthcare Professional for advice and clarification • Protection options in order to continue to live a full and active life whilst commencing a professionally prescribed treatment and management program • Healthy bladder tips covering advice on fluids, diet, general health and good toileting habits • Contact details for further advice including the National Continence Helpline and the TENA free product sampling service.

Of particular focus for TENA is the section on pelvic floor exercises.

While TENA believes in superior protection for continence management, we also know that in many cases bladder weakness can be treated or even cured through pelvic floor exercises. As Nash Teelow, Head of Marketing, TENA Healthcare says, “at TENA we strive for quality of life. While healthcare professional advice should always be sought, it is important to protect against leakage at any stage of your treatment journey. We aim to develop products and services that help to give people the confidence to go about their daily activities, because without this, risks such as falls, social isolation and depression can heighten. We want everyone to be aware of this information, regardless of the language they speak, and launching these brochures is an important first step to breaking down such barriers.”

Samsung Advance Care System Samsung Communication Centre/VODA Communications saw a need in the market place for a quality Nurse Call product that would interface successfully to the Samsung telephone systems.

The Advance Care System is an Australian designed system that has purposely been tailored to meet the ever increasing demands for quality care in the Aged Care market.

The system has been designed to be very easy to use with excellent reporting and administration features.

The brochures couldn’t be launched at a better time.

The ageing of the culturally and linguistically diverse (CALD) population in Australia is increasing at a significantly faster rate than that of the Australian population overall.1 Older persons from a CALD background are estimated to comprise 23% of Australians aged 65 and over in 2011 and 30% in 2021.2 This fact, coupled with the Deloitte Access Economics findings that nearly 4.8 million Australians were living with incontinence3, shows that it is more important than ever that all Australians have equal access to information and services.

TENA to embark on a multi media campaign to promote multilingual brochures.

TENA will be rolling out the new language materials to Healthcare Professionals during World Continence Week with the view of adding more languages to the brochure range over the coming weeks. Advice for care givers will also be available, with a Carer brochure soon to be launched. A range of communication mediums will be used to assist the launch such as e‐communication, websites, face‐to‐face communication and there will be opportunities for feedback and review. The brochures are available free of charge for download and free hard copy orders can be made at

www.TENA.com.au/brochures References 1. F ECCA, FACT SHEET Caring for Older Australians Productivity Commission Inquiry Report: A Culturally and Linguistically Diverse Perspective, accessed 24 June 2013, http://www.fecca.org.au/resources/fact‐sheets 2. Ibid.

3. D eloitte Access Economics. (2011). The economic impact of incontinence in Australia. Independently prepared for the Continence Foundation of Australia.

With the requirement of DECT, Paging and Audible Annunciators the system interfaces simply and effectively with the telephone system.

Advance Care were one of the first companies to have an IP compatible system using structured cabling and IP networking the system is on the leading edge of technology. Advance Care also has a “Long Range RF” system which enables a system to be installed with minimal cabling, and labour content. The RF system enables an easy transition from an existing Nurse Call system to the new Advance Care product.

The flexibility of the Advance Care system means that any of the systems protocols “hardwired”, “IP” or “Wireless” can be implemented either as a complete system or as hybrid were one or more components can be installed to make up the complete solution for a particular site.

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Itâ&#x20AC;&#x2122;s all between the legs.

Contoured to fit your body shape.

Another leading competitor pant*

TENA Pants

Itâ&#x20AC;&#x2122;s simple really. The pad shape between your legs determines comfort levels. TENA Pants are naturally shaped between the legs for total comfort. So when next recommending continence care, make sure you take a closer look. Go for TENA Pants with a contoured fit between the legs and patented Body-Close Fit technology.

Available now. Order your free sample now at TENA.com.au/freesamples Improving the quality of everyday life.

TENA.com.au TENA Customer Service Australia 1800 623 347 *The image above represents the closest matching pant in size and absorbency to the equivalent TENA Pants Plus.

Products photographed are represented at equal scale.

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LLO A W CT M IN G ATT IN RE TE SS NS O IV F C EC H LIN OIC ICA E LS

Clinically shown to better support patients and your bottom line.

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Using the Maxi Glide mattress Canberra Hospital demonstrated 14% reduction in pressure injuries.

Fewer pressure injuries mean fewer days stay in hospital, less cost.

The Softform Maxi-Glide significantly eases the burden of pressure ulcers on patients and carers as well as providing significant cost savings.

Visit www.invacare.com.au/softform or call 1800 460 460 for more information

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