INsite September 2015 by NZME. Educational Media

September – November 2015 | $10.95

AGED care & retirement

We’ve got your industry covered I www.insitemagazine.co.nz

Aged Care

The pay fray that won't go away EDUCATION AND TRAINING

The cook, the cleaner, the carer and the quals dementia

Dementia –

looking beyond a cure

Technology

The rise of technology in aged care –

are we ready?

Respecting lives. Restoring independence. At RDNS NZ, (Royal District Nursing Service) quality care is not just about what we do in a client’s home. It’s the values our support is based on, and the services we have in place to ensure our clients can live the life they choose.

Our services include: Personal care – Assistance with showering, dressing, and meal preparation. Domestic help – Including housework, laundry and shopping. Restorative activities – From exercise programmes to socialisation activities, allowing people to lead more fulfilling lives. Respite in the home – Enabling full time carers to have a break. Nursing – Generalised and specialised home nursing including wound care, medicine management, stomal care and more.

0800 RDNS NZ (0800 736 769) www.rdns.org.nz

Ed’s LETTER

Here I am, at my fourth New Zealand Aged Care Association (NZACA) conference gala dinner. I’m positively a veteran. That’s not an award I’m holding, but a table centrepiece emblazoned with the words ‘Achieving excellence is a team game’ – a nod to this year’s dinner’s theme. As usual, people had made a real effort with their themed costumes. Sporting and super heroes, the royal family, all four ninja turtles, and even the cast of MASH were there. I thought the theme, ‘a team game’, was rather clever; not only was the dinner held at Eden Park where the greatest team I can think of achieved excellence four years ago (c’mon ABs!), but it clearly promoted the importance of working collaboratively to achieve the sector’s goals. In INsite last year, I wrote an article entitled ‘United we stand, divided we fall?’ In this I speculated about the sector’s possible division in a number of areas: signing the variation on the ARRC contract which specified a one per cent funding increase, the roll-out of interRAI, and support for the Bartlett v TerraNova pay equity case. It seemed to me that the interests of the big corporate players in aged care, many of which have the ability to cross-subsidise from their retirement village operations, were not wholly aligned with the interests of the smaller aged care providers. One year on, I’m still not convinced there is agreement on these issues. The possibility of any merger between the NZACA and the Retirement Villages Association (RVA), despite earlier suggestions, appears unlikely. While increasingly the retirement village industry has a vested interest in aged care, the two organisations ultimately have differing expectations of the Government. On the other hand, Bupa’s decision to join the NZACA is significant. As the largest aged care provider in the country, it will no doubt lend some clout to the association in future lobbying efforts. With the pay equity case moving up a few spaces on the Government’s agenda, particularly as the midwives and teacher aides jump on the bandwagon, it will be important for the aged care sector to maintain a united front. A team game indeed. I wonder what next year’s NZACA conference dinner theme will be? I have yet to come in fancy dress attire. One day I will surprise you all. Maybe next year. We’ll see.

Editor, Jude Barback editor@insitemagazine.co.nz

In this issue... FOCUS: Clinical focus in aged care

Tablets and tablets: when technology intersects with aged care

The pay fray that won’t go away

Wound champions

No-touch cleaning technology – the future of cleaning?

The burden of responsibility

Dementia: looking beyond the cure

The cook, the cleaner, the carer... and the quals

Are you all right? Earthquakes’ effects on older people

On the soapbox... Dick Williams

Conference updates

Up close and personal with... Gabi Hollows

Spotlight on... sexual health: over the hill or still rock ‘n’ rollin’?

A day in the life of... a health social worker

Let’s snoop around... Summerset by the Sea

Last Word... Graham Wilkinson

Editor: Jude Barback 07 575 8493 editor@insitemagazine.co.nz

For aged care news, views, trends and analysis visit: www.insitemagazine.co.nz Connect with INsite magazine on Twitter Follow INsite for breaking news, the latest innovations, and conversations with editor Jude Barback on the professional issues close to your heart. Find us on Twitter@INsite_NZ

INsite is distributed to key decision makers in the aged care sector and its distribution is audited by New Zealand Audit Bureau of Circulation (ABC).

Advertising: Belle Hanrahan 04 915 9783 belle.hanrahan@nzme-ed.co.nz General Manager & Publisher: Bronwen Wilkins Production: Aaron Morey Subscriptions: Gunvor Carlson 04 471 1600 gunvor.carlson@nzme-ed.co.nz

September – November 2015 Volume 9/Issue 4 NZME. Educational Media, Level 2, NZME. House, 190 Taranaki Street, Wellington 6141, New Zealand PO Box 200, Wellington 6140 Tel: 04 471 1600

© 2015. All rights reserved. No part of this publication may be copied or reproduced, stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopy, recording or otherwise without the prior written permission of the publisher. ISSN: 2324-4755

Errors and omissions: Whilst the publisher has attempted to ensure the accuracy and completeness of the information, no responsibility can be accepted by the publisher for any errors or omissions. www.insitemagazine.co.nz | September – November 2015 1

Technology

Tablets and tablets:

when technology intersects with aged care JUDE BARBACK reflects on the difficulties and benefits of incorporating technology into aged care.

ometimes it seems hard to believe that we’ve reached the point in aged care in which we talk about tablets (as in medication) and tablets (as in iPads) in the same sentence. Yet this is becoming a reality as digital technology becomes an integral part of aged care. The conversation has moved swiftly. One moment we are marvelling at our ability to gather and store information, the next we are working out the best way to collect this data and what to do with it so that it best serves the interests of the resident at the centre.

Technology and personcentred care

Person-centred care is a phrase that is used all the time, but in reality it is difficult to truly put the person and all their conditions at the heart of care delivery. Dr Jenny Basran, a keynote speaker at this year’s New Zealand Aged Care Association (NZACA) conference, talked about how technology can assist in delivering personcentred care. Basran, a gerontologist from Canada, believes healthcare with all its disciplines – GPs, nurses, pharmacists, physiotherapists and so on – still struggles to shake off the propensity for creating silos of information around a person’s care. There is a tendency for health professionals to look at each of a person’s conditions separately, and to naturally place more emphasis on that which falls within their area of expertise. There is no problem with this approach for a person with a single chronic disease; however, the “new normal” as Basran describes it, is that people are now living longer with multiple conditions. To understand and treat one condition in the context of the other conditions, Basran argues we need to shift from this multidisciplinary approach to an interdisciplinary approach, where an assessment carried out by one discipline populates the same single care plan used by another. She says there is currently a tendency for separate disciplines to carry out similar assessments and collect the same data, because they mistrust the assessments and data of other disciplines. By using a single interdisciplinary assessment tool, a single care plan can be populated by the contributing disciplines, without the need for each discipline to reinvent the wheel. The technology can include ‘what if’ scenarios to see how one area of care might affect another. While there is little doubt about the efficiency of such an integrated approach, 2 September – November 2015 | www.insitemagazine.co.nz

some questions still emerge. How is an assessment error rectified if it is part of the care plan and unchallenged by other disciplines? And how do you implement a tool that replaces or incorporates existing IT systems?

A centralised approach

Technology is ubiquitous and ever-changing, which makes it difficult to bring existing tools and systems together. Ideally there needs to be some collaboration or centralisation of systems to bring some consistency to the fore. Centralising IT systems is no easy task. The Government’s $3 million patient portal exercise is a good example of this, with takeup proving much slower than expected. Even so, the National Health IT Board remains hopeful of achieving the vision of a patient portal for every New Zealander. As things stand, 75,000 patients are now using a portal, with this number expected to exceed 100,000 by the end of the year. The National Health IT Plan aims for more eHealth records and collaborative sharing of information between healthcare professionals. Director of the National Health IT Board Graeme Osborne says the strategy envisages patient portals, community and hospital ePrescribing, and data from interRAI and other systems feeding into a single shared care plan for each person. A child born today will have a digital health footprint, says Osborne. The $6.5 million hospital ePharmacy system is the first shared regional hospital pharmacy software implemented in New Zealand and is a good example of what can be achieved with a centralised approach. The system has been successfully rolled out across all five Midland DHBs – Lakes, Taranaki, Tairawhiti, Bay of Plenty and Waikato. Health Minister Jonathan Coleman said that prior to the ePharmacy system the five Midland region DHBs each had their own

hospital pharmacy management system with different functions and costs. Now the Midland DHBs are using the same terminology for medicines and they know what medications are available. “The rollout of the ePharmacy system shows what can be achieved with strong regional leadership and close engagement with clinicians and IT vendors,” said Coleman.

The Medi-Map success story

ePrescribing is a hot topic. The national New Zealand ePrescription Service (NZePS) was one of the initial phases of the National Health IT Plan, allowing medical information, including medications and prescription data, to be collected and stored in one complete record, making it easier for health professionals to deal with patients. The launch of electronic medication platform Medi-Map demonstrates how a system can work with national programmes and strategies. Four years ago, Invercargill pharmacist Greg Garratt experienced a “serious near miss” at his pharmacy due to the misinterpretation of a prescription, which may have resulted in the death of the patient had it not been rectified in time. The experience prompted Garratt to establish – with the help of software developer Chris Parmenter – MediMap, a cloud-based medication platform that aims to join the dots between pharmacists, GPs and aged care providers. In place of bulky folders filled with illegible faxes, a rest home’s medication round can now utilise a tablet computer. This allows a caregiver or nurse to select a resident, verify that resident with a photo on screen, and administer their medication outlined on screen, with the reassurance that it is the most up-to-date and correct medication list. The electronic system allows any change in a resident’s medicine to be automatically stored in a shared web portal, effectively connecting aged care facilities with pharmacies and general practices. The system has many benefits: it increases residents’ safety; it is faster and it reduces wastage. However, the understated beauty of Medi-Map is its ability to work with national platforms and other consumer care management systems, like VCare and Momentum. Medi-Map has built New Zealand ePrescription Service integration into the system, which allows a ‘conversation’ between the prescriber and the pharmacy to take place

Technology through the system before the electronic script is given. Medi-Map received a waiver from the Ministry of Health that removed the need for a doctor’s signature on medicines charts. The tool has already been embraced by many aged care facilities around the country, with more jumping on board. MidCentral DHB made the decision to provide funding towards the set-up for every one of the district’s facilities and their associated pharmacies. Garratt and his team are working closely with the National Health IT Board to ensure Medi-Map is part of the longer term National Health IT strategy.

Meeting the clinical and business need

The take-up of Medi-Map and other new tools, systems and platforms now available to the health sector tends to flourish as organisations became convinced of the technology’s ability to assist their practice without damaging their bottom line. The thing about adding technology into the health equation is that it has to contribute to achieving both clinical and business objectives. Organisations generally want to know that the systems they will invest in will serve the interests of their clients and their business. The reluctance of GPs to take on patient portals, for example, has not been so much to do with how the portals will impact on the clinical solution, but more to do with how they might affect general practice costs and revenues. To this end, not-for-profit health IT organisation Patients First commissioned consulting firm Sapere Research Group to conduct financial modelling on behalf of the National Health IT Board to look at how patient portals might affect general practice time and the bottom line. In this example, the research found that patient portals have the potential to provide a net gain to general practice. InterRAI, on the other hand, needs to convince practitioners of its worth as a clinical tool. There is a degree of weariness on the subject of interRAI, even though it is early days for the assessment tool in New Zealand. Many clinical staff feel they’ve invested a lot of time and effort into the tool without seeing any benefit or outcome yet. According to interRAI’s Vij Kooyela, there is light at the end of the data tunnel. A new Data Analysis and Reporting Centre established by Technical Advisory Services (TAS) is currently in its establishment phase, which will run from July 2015 until June 2016. The collection and analysis of data from clients in home-based and community care, long-term care facilities and hospitals will provide information to serve NASC agencies, the Ministry of Health, DHBs, and aged care facilities, as well as contributing to a global

picture of interRAI trends. Kooyela says the information will assist planning and decisionmaking at the client, facility and DHB level.

Collaborative technology

InterRAI is one part of the jigsaw – albeit a major part. But it needs to be integrated with other platforms and consumer care management systems. It is no use having systems and tools that work in isolation – health technology needs to be collaborative. Health IT organisation SimplHealth – which drove the aforementioned national ePrescription service – released a white paper earlier this year that suggests that by harnessing information through collaborative technology, it might be possible to bring greater consistency and efficiency to the way aged care is managed in New Zealand. The paper, titled ‘Will you still need me, will you still feed me, when I’m 65?’, points to

“

growing older population: access to more information so that an overall view of demand can be developed; more consistent and better quality data; and a business process to hinge it all together. Mitchell points to the disability exercise as an example of what can be achieved with this sort of approach. “These types of systems already exist and could be adapted for aged care,” she says. “More sharing of information and collaboration through a business process would save time, support better decisions, and improve healthcare outcomes.”

Not a substitute

Indeed, data is important. We have become adept at collecting data. But is it the right data? And how should we put it to good use? Dr Basran says we need to establish what we’re trying to achieve rather than collecting

The thing about adding technology into the health equation is that it has to contribute to achieving both clinical and business objectives.”

an overhaul in the way the disability support services sector was run as an example of what can be achieved by taking this sort of approach. Previously disability support services were managed inconsistently, with the various Needs Assessment and Service Coordination (NASC) agencies storing assorted information in different systems. The inconsistencies – aside from creating inefficiencies and room for error – meant it was difficult for the Disability Services Directorate to forecast future demand. To address this, the Ministry of Health funded a major programme of work, led by Hague Consulting, which culminated in the development of a web-based National NASC Information System, named ‘Socrates’. The system collects information from the NASCs and stores it securely in a central database. It interfaces with a Geo-coding application, the National Health Index database, and Government funding and payment systems. Jodi Mitchell, chief executive of SimplHealth, the IT vendor behind Socrates, says the system enables a better understanding of New Zealand’s disability service requirements. After implementing the Socrates system, Mitchell said it was discovered that $3 million in payments had been made to deceased clients. It also disproved the assumption that adults with disabilities needed more money than children with disabilities. Mitchell believes it is possible to replicate the way technology and business systems were used to build efficiency and consistency into the disability sector in other areas of our healthcare system, namely aged care. The white paper identifies three things needed to better manage the health of the

data for data’s sake. She says we’re good at gathering data on health and safety, but we could be better at monitoring other aspects of care, such as a resident’s quality of life. Technology is there to assist care, not to replace it. The incorporation of technology into aged care should ideally make life easier for residents and aged care staff, not harder. By simplifying and automating the administrative aspects of aged care, technology can help free up time for delivering quality care to residents. It should also help reduce the possibility of errors. As with anything new, there is always likely to be resistance to the introduction of new technologies, especially from staff who have had only minimal exposure to technology in the past. However, the implementation of new technologies and the associated training can be seen as a way of engaging with staff, empowering them with new skills, and building a sense of teamwork. Ultimately, it should be presented to staff as a means of enhancing care delivery. There is a risk that we become so caught up in the technology at our disposal that we lose sight of the true origins and meaning of care. Professor Dan Levitt, a keynote speaker at the NZACA conference, sang the praises of sensor technology for older people in the home, but was quick to point out that they were not a substitute for social interaction. While technology will continue to play an increasing role in aged care, let’s hope it doesn’t completely replace the kind smile and the warm hand of the person helping to ensure a resident’s wellbeing and quality of life. www.insitemagazine.co.nz | September – November 2015 3

Aged care

The pay fray that won’t go away Will the pay equity case rocking the aged care sector be resolved in or out of court? JUDE BARBACK looks at the momentum building within government circles, the aged care sector, and other industries.

he long-rumbling Kristine Bartlett pay equity case has sprung back into life in recent months, although progress remains slow as the true complexity of the case begins to show. An Employment Court hearing date has been set for late November – but an adjournment has been sought due to a lack of guidance from the court. The Government has also begun a negotiation process with the industries and unions to settle the case out of court – but this too appears to have reached a hiatus. With midwives recently filing for court action over pay discrimination and education support workers signalling their intention to do the same, it would seem aged care workers are far from alone in their quest for equal pay. Regardless of whether the case is settled in or out of court, the Government will need to be prepared for the wider implications of any solution achieved for caregivers. However, some aged care providers aren’t prepared to wait for an outcome to the case, with retirement village operator Metlifecare signing a union agreement to increase staff pay rates by an average of 7.7 per cent. Yet, increasing pay rates is not as easily achieved for all providers. The sector remains hopeful of a solution to emerge from the pay equity case that will see any pay rate increase accompanied by an increase in government funding to providers.

Metlifecare’s move

The agreement between Metlifecare and the Service and Food Workers’ Union (SFWU) and New Zealand Nurses’ Organisation (NZNO) will see many Metlifecare carers’ pay rates increase by around 12–14 per cent. SFWU’s Alastair Duncan says the move “sets a new and impressive benchmark”. “Metlifecare have essentially said we’re not going to wait until the pay equity case is resolved and the Government sorts this out. Instead, they’ve reached deep into their own pockets to fund the shortfall,” says Duncan. However, Metlifecare chief executive Alan Edwards says their decision to lift pay rates wasn’t influenced by the Kristine Bartlett case. “At the point the courts make a decision on the appropriate pay rate, Metlifecare will either be equal to, below or above. If we’re below, we’ll raise our rates accordingly. If we’re above, then that’s fine. We’re happy today with the choice we’ve made. We’re very proud of the fact that we’ve got these rates.” Edwards says the decision to increase pay rates was more about doing what was best for the future of Metlifecare. He does not have any expectation or desire to see other operators follow suit. 4 September – November 2015 | www.insitemagazine.co.nz

The pay agreement came after Metlifecare held a strategic review of its employee value proposition. “We looked at the entire process of recruiting people, providing meaningful career paths, learning frameworks and reward mechanisms that are associated with learning and development. We saw that retention and loyalty produce quality outcomes,” says Edwards. “At the end of the day our employee value proposition needed to seamlessly integrate with our customer value proposition. “One thing residents value most is the consistency of care provided. This is solved by improving retention, which in turn is solved by offering a meaningful rate of pay.” He says the reaction from staff has been positive. “They’re saying ‘fantastic’ – that’s step 1. Step 2 is how to access learning to support what we’re doing.”

Not all providers can pull a Metlifecare

Other large listed operators also pay staff above average. Ryman Healthcare has increased their pay rates by 16 per cent over three years and introduced new incentives to train. Summerset chief executive Julian Cook said Summerset increased wages by around seven per cent last year. He says Summerset pays above average and links pay with training and qualifications. However Cook says the size of the operator is irrelevant and the Government has a responsibility to increase funding to the sector to allow operators to pay their staff fairly. He is hopeful that the Kristine Bartlett case will result in such an outcome. “Our position is clear – the Government should fund the sector properly. It’s not right that DHB healthcare assistants should be paid more than caregivers in residential facilities, who arguably do a harder job. It’s not an issue for the larger operators, but for the whole sector.” Smaller operators that are not in a position to increase funding are also hoping the Bartlett case will result in an increase to government funding. New Zealand Aged Care Association (NZACA) chief executive Simon Wallace says while Metlifecare should be commended for what they’re doing, it isn’t a move that can be easily replicated by other providers. He says Metlifecare has a small proportion of care beds and has the ability to cross-subsidise from its retirement village operation.

Aged care It can’t be easily compared with operators like Bupa or Oceania, which have significantly more care beds. Yet the SFWU has confirmed that both Bupa’s and Oceania’s bargaining agreements concluded with good progress on equal pay engagement – although not to the same degree as Metlifecare.

Will the case be resolved in or out of court?

Meanwhile the pay equity case continues to rumble on. The Employment Court is set to hear the case the week starting Monday 23 November: however, the NZACA’s legal defence has sought an adjournment due to the lack of any interlocutory judgement from the court that would define the principles and scope of the case. Wallace says without this information, the NZACA can’t adequately prepare its defence. “We can only surmise that the delay is due to the complexity of the case,” he says. When the court does meet – in November or later if an adjournment is granted – it will establish the principles to be used to decide what Kristine Bartlett should be paid. It will also look beyond Bartlett’s situation to what precedent should be set – not only for other workers in the aged care sector, but other sectors that are similarly dominated by women. Government officials are continuing to work with unions and aged care sector leaders in an attempt to resolve the case out of court. Negotiations are yet to start, with the brief for negotiations currently being prepared. It will look at the parameters around caregiver wages in the aged care, home-based care and disability sectors. Negotiations are expected to take a similar format to the recent in-between travel time case. The negotiation process is expected to run until the end of the year, with a view to reaching a settlement by March next year. Any settlement is likely to impact on the 2016 Budget. So the negotiation process will run parallel to the court proceedings, although the negotiation process now appears to have stalled as well. Simon Wallace says while he is hopeful the issue can be settled out of court, the NZACA must participate in both processes. The Association is continuing to raise money from its membership to meet the legal costs of the case. While donations are voluntary, the recommended amount is $10 per bed for the financial year. “Some members are asking why they need to contribute when the government negotiation process is happening – which is a valid question. However we need to prepare for both. A solution may emerge from the negotiation process or the court process,” says Wallace. “The NZACA takes the same line as it did in its 2014 election campaign. Caregivers are undervalued and should be paid more. However, any increase must be matched with an increased subsidy from government. “The difficulty is that no one knows how much money is available from government.”

A problem of precedent

“

One thing residents value most is the consistency of care provided. This is solved by improving retention, which in turn is solved by offering a meaningful rate of pay.”

How much money the Government has to resolve this problem, is a very real concern. The outcome of the Kristine Bartlett case is likely to set a far-reaching precedent. Both the negotiation and court processes are looking beyond residential aged care to include caregivers from home-based care and disability sectors, but the precedent is likely to stretch further still.

With midwives recently filing for court action over pay discrimination and education support workers intending to do the same, the “me too” effect of this issue is potentially huge. Primary school teachers’ union NZEI national secretary Paul Goulter said the union has been watching the Kristine Bartlett case and the midwives’ legal action with interest. “There has been no real movement, and in fact what we’re seeing across the workforce in New Zealand is growing inequity and femaledominated workforces are suffering the most. We have given the Government plenty of time to tackle this issue and we will now follow the path of the midwives and Kristine Bartlett, and seek redress through the legal system,” said Goulter. Any decision made in determining what Kristine Bartlett should be fairly paid will therefore need to take into consideration the ramifications it will have for many other industries.

Dementia Care Training Fickling Convention Centre – Auckland COGS Facilitator Training 2 days COGS is a lunch club programme which run for 5 hours per day. It is based on cognitive stimulation therapy (CST). 22nd and 24th March 2016 Train the Trainer in Dementia Care 3 days All participants will receive a training pack in dementia awareness, communication skills and positive interventions. 23rd, 25th and 31st March 2016 Person Centred Approaches in Dementia Care 1 day. 1st March 2016 Either book on line here: http://3spiritnz.com/new/workshop-dates Or email: caroline@3spirituk.com

www.insitemagazine.co.nz | September – November 2015 5

FOCUS

Wound champions As a clinical nurse specialist in wound care for the Southern District Health Board, MANDY PAGAN provides a consultation role in residential aged care (RAC) facilities in Southland. To complete her clinical masters, she conducted a systematic review investigating wound programmes in RAC facilities. Here is an overview and summary of this review.

esidential aged care facilities are faced with significant challenges when caring for the frail older person. These can include high patient dependency, inadequate funding and resources, care provided mostly by unregulated workers, high staff turnover, and reduced opportunities for staff education and training. Wound prevention and management practice demands ongoing knowledge and education to ensure best practice treatment and cost-effective care is delivered. Healthcare professionals require knowledge and skill to prevent and manage wounds and reduce the risk of chronic wounds developing. A systematic review was conducted to determine the effect of wound prevention and/or management programmes in RAC facilities. Objectives included establishing the composition of wound-related programmes, implementation strategies, and resident and clinical staff outcome measures. Of the 51 appraised studies, 11 observational or descriptive studies met the grading process. Due to methodological heterogeneity across studies, statistical pooling of data could not be performed. The data was then analysed to identify recurring findings. From this process, three key syntheses and nine categories were developed (Figure 1). Ten studies implemented pressure injury programmes. In addition, education was included for leg and diabetic foot ulcers in two studies and skin tears in one study. A single study implemented a skin care programme and regime solely for residents with incontinence to prevent incontinenceassociated dermatitis and pressure injuries. The available evidence indicated that pressure injury programmes based on practice deficits can improve staff knowledge and care processes to reduce pressure injury rates. The data is limited to providing conclusions for wound programmes rather than for pressure injuries and is an area for future research. The review included observational or descriptive studies that provide lower levels of evidence for intervention effectiveness and were of low methodological quality; hence caution when generalising findings must be taken. The use of randomised controlled trials applying process evaluations using qualitative and quantitative approaches would provide more rigorous study data and is appropriate for evaluating quality improvement interventions.

6 September – November 2015 | www.insitemagazine.co.nz

»» Project teams and/or champions are recommended to build staff confidence and skills, leadership and facilitate selfRecommendations included: sufficiency and programme ownership. »» Increase programme success, pre-assess Enrolled nurses and healthcare assistants facilities to determine the readiness for should be considered in these roles to change, the organisation’s culture, and potential programme barriers and facilitators. work alongside registered nurses. These roles need to be supported by managers »» Evidence-based pressure injury programmes and staff alike. in RAC are recommended in order to increase staff knowledge and skills and »» Use expert external mentors to assist thereby improve residents’ care and reduce facilities and staff to identify practice pressure injury rates. issues, develop programmes and model and guide best practice. »» Continuous quality improvement methods provide an adjustable and effective process »» Programmes implemented into to plan, implement, evaluate and sustain compulsory staff training schedules ensure programmes in RAC facilities. Audit and evidence-based updates are routinely feedback is an essential element to motivate provided for current and new staff. staff and monitor adherence. »» Allow a sufficient period of time for Applying research to practice programmes to be implemented, measured Within my clinical nurse specialist role and evaluated. I have begun working with nurses and »» Engage, involve and update relevant RAC managers to develop the ‘wound champion’ key stakeholders, including administrators, role in one RAC facility. An important part managers, nurses, healthcare assistants, of this role has been to help the facility to doctors, residents and family before, during identify their practice deficits. One of these and after implementing programmes. deficits included the under-reporting of stage »» The use of multiple programme interventions 1 pressure injuries and the need to better is recommended to increase the success of educate healthcare assistants on reporting programme implementation and outcomes. these. My role included providing and/or »» Increase staff engagement, use staff developing resources, including a 10-minute incentives when developing, implementing PowerPoint presentation to help the ‘wound and evaluating programmes. champions’ to provide this training to all the healthcare assistants. »» Plan flexible, realistic and achievable programmes in anticipation of staff turnover, The next identified issue is to investigate a and resident and administrative work skin moisturising regime to reduce the risk of demands. skin tears. I am now in discussion with other

Recommendations for practice from the studies analysed

Meet wound champion Bianca Bianca Lawrence graduated as a registered enrolled nurse in 2012. She has worked in aged care since graduation, and more recently, has become the wound champion at Bupa’s Ascot Care Home, which has 104 beds over three levels of care: hospital, residential and D3. In her role Bianca sees multiple wounds in the elderly, some due to the usual causes like falls, skin tears and so on. With the assistance of wound care specialist Mandy Pagan, the facility has a very high recovery and healing rate. Bianca says she is passionate about finding the path to increasing the healing rate. “Being able to access great products in conjunction with ongoing education shows we can heal and add to each resident’s quality of life,” she says. “Without a chronic wound everything is easier for the resident and it is much easier to achieve the best possible quality of life.”

FOCUS RAC facilities to provide the same support and resources. My objective is to provide a mentoring role and to empower the ‘wound champions’ to administer programmes in their facilities.

Acknowledgments: Thank you to my clinical supervisors Beverley Burrell, Henrietta Trip and Deborah Gillon for their guidance and support. Special thanks to the hard-working managers, nurses and healthcare assistants working in aged care who continually embrace new learning to improve outcomes for their residents. For further information of the review process, data synthesis, and for references, the full article can be accessed: Pagan, M., Trip, H., Burrell, B., & Gillon, D. (2015). Wound programmes in residential aged care: A systematic review. Wound Practice & Research, 23(2), 52-60.

Figure 1: Synthesised findings Syntheses

Categories

Findings

Educational outcomes:

Pressure injury prevention and management

n=15

Knowledge transfer

n=8

The delivery of education to clinical staff increases knowledge and when measured in practice can demonstrate improved resident outcomes.

Implementation strategies:

Evidence-based practice guidelines provide a programme foundation, which when implemented permits RAC facilities to drive changes according to practice gaps. This can be achieved through empowering staff and using a range of support resources, including collaboration, which enables the greater uptake of evidence-based strategies.

Organisational culture:

An organisation that presents barriers can impair programme implementation and reduce outcome benefits, whereas a proactive organisation that leads and supports staff to embrace change can work towards achieving the full potential of programmes.

Evidence-based practice Staff empowerment Support resources

n=15 n=16 n=19

Collaboration

n=8

Workplace barriers Workplace facilitators

n=17

Programme sustainability

n=17 n=5

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www.insitemagazine.co.nz | September – November 2015 7

Technology

No-touch cleaning technology –

the future of cleaning?

JULIE SPARKS of Bug Control New Zealand looks at the evidence behind ‘no-touch’ cleaning techniques and whether they provide a viable alternative to traditional cleaning methods.

resident with an MRSA leaves one of your facility’s rooms and it’s time to send in the cleaners. Would you like to be the next person in that room? Do you feel you can rely on the cleaner to do a good job, and that you wouldn’t pick up MRSA if you were there next? Another option is to bring in one of the new no-touch disinfectants and, as if by magic, 10 minutes later the room is clean and ready for the next resident. Wishful thinking or reality? These claims are being made by the manufacturers but how much evidence is there? Traditional cleaning methods have proved inconsistent so is this new technology worthwhile?

What is no-touch disinfection?

No-touch disinfection is a means of disinfecting an enclosed space without the usual cleaning staff, chemicals or other cleaning equipment. There are two major categories of no-touch techniques: an aerosolised-vapour generating system or ultraviolet light. In both cases a device is placed in an unoccupied room, the device is turned on, and after a specified time the room is deemed to be clean. This can take between eight and 240 minutes. The vapour systems are based on generating and spreading small, disinfectant-containing particles throughout a room. These particles land on the surfaces in the room, establish contact with micro-organisms on these surfaces and deactivate them. There are two main types of vapour systems: aerosolised hydrogen peroxide (aHP) and vaporised hydrogen peroxide (HPV).

Aerosolised hydrogen peroxide (aHP)

This system automatically produces pressuregenerated aerosol that contains a mixture of hydrogen peroxide and silver. The disinfectant 8 September – November 2015 | www.insitemagazine.co.nz

is spread into the room through a machine that creates droplets which then land on the surfaces and deactivate the micro-organisms. The room must be sealed, including vents and doors. Cycle times start at two hours and can be longer.

Vaporised hydrogen peroxide (HPV)

This system uses chemical reactions to produce a vapour of heat-generated hydrogen peroxide that is dispersed throughout the area to be disinfected. The oxygen in the hydrogen peroxide vapour reacts with the cell walls of micro-organisms leading to cell death. HPV has been previously used for sterilising instruments. The room must be sealed, including air vents and doors. Safety monitors are also required. Cycle times start at 1.5 hours and can take up to eight hours.

Ultraviolet light (UVC)

This is sometimes referred to as UVD (ultraviolet environmental disinfection). Using a variety of methods, high-energy ultraviolet light is produced by either mercury or xenon gas lamps. These six-foot-high devices emit UVC, which has a shorter wavelength than UVA (as used in tanning beds) but it wreaks havoc on harmful microbes, including those with antibiotic resistance. There are no chemicals used in this process although bulbs can need to be replaced. UVC passes through the cell walls of bacteria, viruses and bacterial spores. Once this has occurred the organism can no longer replicate and therefore is no longer infectious. The machine’s cycle must be run in several locations in each room to ensure all hightouch surfaces are covered. However the benefit of the UV light system is that the room does not need to be sealed for the lamps to work.

Pulsed xenon ultraviolet (PX-UV)

This lamp produces a flash of light (like a camera flash) delivered in millisecond pulses. The broad spectrum nature (meaning more UVC wavelengths are produced) combined with the high intensity of the pulses gives PXUV disinfection efficacy several times faster than the Mercury UV. Cycle times are short, between 5 and 10 minutes.

Other factors to consider

Other considerations, aside from which disinfection system to use, include: »» Operator training: As in all things, the effectiveness of the services can depend

on the person using them. Training is required. »» Room turnover: While not as urgent for a rest home as it might be in a hospital setting, this can be a factor. »» Cost: These machines cost between $40,000 and $120,000, so it may be some time before they are used routinely in an aged care setting. »» Environmental friendliness: Hydrogen peroxide regrades into H2O. The xenon pulsed UV light is certified “green” by Practice Greenhealth. The most important consideration is how effective these systems are. Significant evidence has shown that traditional room cleaning does not always clean residents’ rooms effectively. A recent study by the American Journal of Infection Control showed that UVD decreased VRE, MRSA, and C. diff by 20 per cent. The study discovered that the rate of infection was significantly lower during the 22 months of use of UVD, compared with the 30-month period before using UVD. The authors state that “although there were many other simultaneous infection control interventions occurring at our hospital that could have contributed to the reduction in VRE acquisition, the rates experienced during UVD are the lowest incidence rates of VRE at our institution for the past 10 years and were sustained for 22 months”. While the results from the vapour methods are unconfirmed, another study showed that there was an 82 per cent reduction in C. diff. MRSA reduced to zero in half of instances. Aged care is generally the last cab off the rank when new technology is being acquired and used on a day-to-day basis, which is not always a bad thing. Several US hospitals have purchased this technology and are having good success. Most of these places are using conventional cleaning methods in conjunction with the new technology. While it appears that these new systems, in particular the UVC devices, are making a significant difference, it would seem that the evidence is not yet conclusive. However, it must be said that any technique that reduces existing infection rates is worth pursuing. We await further evidence-based studies with interest.

For references to this article, please contact the editor at editor@insitemagazine.co.nz.

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Education and training

The burden of

responsibility Caregivers are ultimately responsible for people’s lives when carrying out their day-to-day jobs. Are we equipping them with adequate skills, expectations and remuneration to handle this level of responsibility? By JUDE BARBACK.

n 10 January 2014, 15-year-old Nathan Booker drowned in a bath at a family support centre in Palmerston North. The judge cited deficiencies in staff training and uncertainty around procedures and policies as the root causes of Nathan’s death, which she described as “totally preventable”. The caregiver who was responsible for the care of the high-needs teen at the time has been charged with manslaughter, a charge to which she has pleaded not guilty. It’s not the first time New Zealand has seen a case like this. In 2006, Kathleen Hesse, who was severely disabled, died as a result of drowning after being left alone in the bath for five minutes by her caregiver; actions the judge described as “criminal negligence”. In this case, the caregiver pleaded guilty to manslaughter and was sentenced to 400 hours’ community service. Both cases serve as stark reminders of what is ultimately at stake with caregiving. At the end of the day, caregivers are responsible for people’s lives and there can be no room for uncertainty around what is expected of them at work. If a workforce is to be entrusted with this level of responsibility, the people in that workforce – the caregivers – deserve to be equipped with the level of skills, knowledge and expectations required to do their job. Their clients deserve this. Considering the enormous responsibility caregivers shoulder in carrying out their job, it should follow that their employment conditions should reflect this. Education and training; job expectations and requirements; consistency; integration; appropriate remuneration – a half-hearted approach appears to be taken in addressing all these aspects of the caregiver’s role. Alastair Duncan from the Service and Food Workers Union (SFWU) agrees. “At the heart of the union concerns are three issues: training and staffing levels; the need to understand that this is an unregulated workforce; and that underfunding in aged care and disability support is as much a contributory factor to such tragedies as any ‘fault’ of the individuals under investigation.”

“If something goes wrong, nurses are covered, but caregivers are not. Caregivers have lost their jobs over incidents. The finger gets pointed and the higher-ups run for cover.” She points out that at her facility there are many procedures in place to protect both staff and residents from things going wrong. She says the caregivers have the full support of their site manager. “As long as you follow procedures you’re pretty safe, but there are a lot of distractions.” She gives the example of being distracted during a medications round by a resident’s bell or alarm, which requires her to leave what she’s doing and attend to the resident requesting help. “You’ve then got to clear your head and get back to what you’re doing with the medications. You’ve got to have your wits about you the whole time,” she says. Sue works a 3–11pm shift, which encompasses a range of activities, from washing dishes, to doing laundry, to giving residents approved medications, to delivering personal care, to assisting with meal times, to preparing residents for bed. On top of this, she listens to residents’ emotional concerns. She will have up to 13 residents under her care during a shift. Sue is responsible for these residents’ physical and emotional wellbeing. She has support from colleagues, including her

Realities of the job

SFWU delegate Sue Dolden, who works as a healthcare assistant in a rest home, says caregivers are in a “very vulnerable position”. 10 September – November 2015 | www.insitemagazine.co.nz

site manager, so she doesn’t shoulder the responsibility alone, but it is still a defining aspect of her role as caregiver. And for this, Sue is paid $16 an hour. Caregivers who work in residential aged care or in the community are typically paid around $15–$17 an hour. This is on a par with supermarket checkout operators and fast food workers, who arguably have far less responsibility for the same pay.

Kaiāwhina Workforce Action Plan

Much of the problem has to do with the fact that caregivers are part of an unregulated workforce. Registered nurses, by contrast, are part of a regulated workforce, which ensures that nurses have the appropriate preparation, knowledge and skills to do their job. In recent years there has undoubtedly been an improvement in terms of rolling out better training and expectations for caregivers. Yet the problem persists where some caregivers lack the knowledge, skills and expectations of their work, and registered nurses’ abilities to provide the necessary direction, delegation and oversight is limited due to workload demands and high ratios of caregivers to nurses. The good news is that the Kaiāwhina Workforce Action Plan – a long-term initiative under development by Health Workforce New Zealand and Careerforce – looks set to bring more integration and consistency to caregivers’ jobs. The plan focuses on a range of domains, including quality and safety, sustainability, career development, consumer focus, workforce intelligence, access and workforce recognition. Under the quality and safety domain, for example, the goal is for the workforce to be trained to enhance personal and consumer safety and meet required standards with the support of management. It seems fairer to expect caregivers to take responsibility for the lives of others if their job is underpinned by such requirements. Mistakes will always happen. No amount of policy or workforce planning can totally eliminate the chance of tragedies occurring. However, bringing more structure and guidance to the workforce will help increase accountability, enhance expectations and leverage the status of the job they are doing.

Dementia

Dementia: looking beyond the cure

DR CHRIS PERKINS says we should turn our attention from finding causes and cures and instead focus on enhancing care and support for those with dementia.

irst the bad news: there will be no ‘cure’ for dementia any time soon. ‘Dementia’ is a word for at least 70 different conditions, where the brain fails in some of its functions. There is no reason to believe there will be one cure for all types of dementia; for example, a condition of extreme old age associated with physical and cognitive frailty is unlikely to respond to the same treatment as a familial frontal dementia that affects people in their fifties. Furthermore, since most dementias develop slowly over many decades, the chances of easily reversing such an established pattern are remote. Effective treatments, when they come, will be piecemeal, like cancer treatments: a win with some forms of leukaemia, remission with breast cancer, early detection and management in bowel cancer and so on. Indeed, this is already happening in the management of vascular dementia with blood pressure control, carotid artery surgery and the treatment of atrial fibrillation, for example, and the use of vitamin B to prevent alcoholic dementia in heavy drinkers. Currently, the few drug treatments we do have slow down the progression of Alzheimer’s disease in some people for a time but do not reverse the damage already done. So many other drugs have been unsuccessfully trialled that drug companies might wonder why they continue to invest in this area (but they still will, given the large numbers of people affected, and the seriousness of the condition). Intermittent announcements of a cure for dementia do nothing but raise false hopes, only to subsequently result in disappointment. But, before you despair, there is some very good news: the risk of getting dementia can be reduced. The great news from some European and American studies is that the incidence of dementia, the rate that new cases are appearing, is falling. In the UK, in 2011, 22 per cent fewer people than predicted were diagnosed with dementia. That means that although dementia is still widespread due to the aging population, the prevalence

is less than we had expected. The reasons for the reduction in incidence, we think, are the following, listed here so you can think about them for yourself: »» Better control of blood pressure, diabetes, blood lipid levels (cholesterol etc). »» Stopping smoking. »» Increased physical exercise (1, 2 and 3 come under ‘What’s good for your heart is good for your brain’). »» Better education – more years at school and ongoing learning seem to increase ‘brain reserve’ and delay or prevent the onset of dementia. »» Increased social activity. »» Better management of head injury. More good news is that even when cognitive impairment becomes apparent, deterioration can still be slowed by acting on the points listed above. For example, cognitive stimulation therapy (CST) is a new form of therapy designed to maintain function by keeping people learning and mentally active, as well as providing social stimulation.

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care and residential services and extend education to those who look after people with dementia from day to day. Currently the worldwide research figures are 65 per cent spent on looking for causes, cures and treatment and 20 per cent on care and support. The World Alzheimer’s Report released on 26 August 2015 (www.alzheimers.org.nz) estimates that there are 60,000 people with dementia in New Zealand and this is expected to increase to 150,000 by 2050. For each person with dementia, there are seven others affected: three quarters of New Zealanders over the age of 45 are personally affected by dementia. With no cure in sight and a large cohort of baby boomers reaching old age, we have to do something about it. We are one of only a few developed countries without a national dementia plan. Developing the New Zealand Framework for Dementia Care was a great achievement two years ago, but we now need to take the next step. A plan would still encompass risk reduction, early diagnosis, advance planning, family and community support and high-

With no cure in sight and a large cohort of baby boomers reaching old age, we have to do something about it.”

The focus on finding a cure has meant that providing care for people who already have dementia has received much less attention. While we have a fair idea of how best to support people living with dementia, we don’t often put that into practice. Here I must leap onto the soapbox with Graeme Titcombe (see INsite August 2015) to demand community services that enable people with dementia and their unpaid support people to live enjoyable and fulfilling lives in their own homes for as long as possible. Attention to the ‘care’ side of the dementia equation would mean equal dollars spent on researching the best ways to provide home

quality residential care. With funding to support these goals, we could reduce health and social costs while at the same time improve the quality of life of people living with dementia and their supporters.

Dr Chris Perkins is chair of the New Zealand Dementia Cooperative. The New Zealand Dementia Summit, hosted by the New Zealand Dementia Cooperative, Alzheimer’s New Zealand and Carers New Zealand will be held in Wellington, 5–6 November 2015.

www.insitemagazine.co.nz | September – November 2015 11

Education and training

The cook, the cleaner, the carer... and the quals

Employees at PSC Enliven Central’s Coombrae and Chalmers rest homes share with JUDE BARBACK the impact work-based training is having on their jobs and their lives in general.

The carer – Kelly Wickham

The cook

– Conor Willis

onor Willis is a cook at Enliven Central’s Coombrae Home in Feilding. His association with the home began years ago, when he started working there on a part-time basis after school. He’d always been interested in pursuing a career in catering and took catering classes at high school. “My dad was a chef in the Navy and my brother is a chef. I guess you could say it’s in the blood,” says Conor. Upon finishing high school, he looked at his options. He considered taking a chef course at UCOL, but when he was offered on-the-job training at Coombrae, he jumped at the opportunity. The chance to work towards a recognised qualification paid for by his employer, all while being able to put his learning directly into his work, made good sense to Conor. So the 21-year-old is now halfway through his three-year catering apprenticeship. The apprenticeship involves a combination of bookwork and practical work. His work is assessed by a Service IQ assessor who comes in and looks at both practical and theoretical elements of his course work. Every three months, Conor attends a day’s training session in Auckland with people from a range of different industries that involve catering – like in-flight catering, for example. He finds it interesting to compare notes and share ideas with people from other rest homes or in different roles. At the end of the apprenticeship, Conor will have completed Levels 3 and 4, setting him on the path to becoming a qualified chef. He’ll also be qualified to assess others completing their training. He is looking forward to being able to help others with their training. At present he is encouraging a kitchen worker to complete a paper on food safety. Conor says the training has definitely helped keep him motivated in his job. He has had lots of support from staff at Coombrae, including the head cook, who has helped him with his bookwork. He says he would be keen to take on more training if the opportunity arose in the future.

12 September – November 2015 | www.insitemagazine.co.nz

elly Wickham is a healthcare assistant at Enliven Central’s Coombrae Home in Feilding. She has been with the home for five years, first as a laundry assistant and cleaner, and then as a healthcare assistant for the last two years. She used to work in the community for PSC, before a job at Coombrae came up. Prior to that, she’s worked in a home for the disabled, a day care, and completed some training through Barnados. However she’s found her niche in aged care. “I love the elderly, always have,” says Kelly. “My passion is to work in dementia.” Coombrae has allowed her to pursue this passion, and she is based mainly in the home’s dementia facility. The home has also given her the opportunity to build on the Level 2 qualification she achieved while in the community-based role. Now, she has her Level 3 healthcare assistant and Level 4 dementia qualifications. Kelly completed the bookwork in her own time, by herself, with the support of her team and manager Kelsey Smith. The training, which Kelly describes as “fantastic”, has helped to give context and meaning to the work she is doing on a daily basis. “It’s helped me learn about the various types of dementia and understand a bit more about the behaviours and communication.” Kelly is pleased to have completed it, but says she would take the opportunity to undergo more training if it was offered to her. She has recently become a verifier, which means she observes other healthcare assistants’ work before it goes on to be assessed. She would love the opportunity to go on to become an assessor one day. Kelly says everyone seems to embrace the training culture at Coombrae. “We’ve got a great team here.”

Education and training

The cleaners

– Emma Wilson and Casey Broughton

mma Wilson and Casey Broughton are cleaners at Enliven Central’s Chalmers Home in New Plymouth. Although they’re in the same job, they’ve come to it from very different angles. For Emma, it was her first job out of high school. “I walked in off the street,” she laughs. She’s been in her role at Chalmers for a year and a half, and as a single mum, finds that it works well for her. Casey had previously worked in another rest home as a healthcare assistant. She’s qualified in the hospitality industry, but had been out of the workforce due to family commitments. She’s been with Chalmers for two years. Both Emma and Casey were keen to take advantage of the training offered to them at Chalmers. As a result they now have the Level 2 National Certificate in Cleaning. It has also helped them to understand certain aspects of their job better, such as infection control, dealing with floor stains on different surfaces and using chemicals. Casey gives the example of working with cleaning sprays. “We used to just spray and then wipe straight away, but we’ve now learned that the chemicals need time to work.”

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“It’s reinforced what we see and do every day,” adds Emma. The training consisted of a mix of paperwork and practical work. While home manager Donna Hitchcock assessed their practical work, Fiona – the hospitality coordinator from head office – assessed the paper work. Both Casey and Emma appreciated that Fiona did the papers herself before teaching the staff. They are keen to go on to do Level 3 at some stage, although apparently Fiona has to do it herself before she’s prepared to teach it.

“I love that she does that,” says Casey. They’ve both enjoyed the training, describing it as “interesting” and “pretty cool”. Emma and Casey were among four cleaners who completed the training. “We’re a pretty mixed bunch,” Casey says of the group, “but the training was delivered in a way that could easily be understood by all ethnicities and levels of understanding.” Both are pleased to now have a qualification that is nationally recognised. “It has been good to be able to add a qualification to my CV,” says Emma, “We can take these qualifications anywhere.” They are also well aware that through the revised qualification framework they have the ability to engineer a career pathway that takes them in the direction they want. Emma is considering getting into nursing. “I’ve been told I’d be good at it,” she says, and Casey affirms this. Casey says she is keen to get back to being a healthcare assistant one day. “I said I’d give myself at least 12 months to get to know the place first. It’s been longer than that now, but I’m happy pottering with the cleaning for now.”

sales@activehealthcare.co.nz

www.insitemagazine.co.nz | September – November 2015 13

Research

Are you all right?

Earthquakes’ effects on older people

Five years after the first major Christchurch earthquake struck, new research has revealed the impact the quakes have had on older Cantabrians.

ew research from the All Right? campaign has shown the earthquakes and related stressors are having a major impact on some older people – particularly around isolation. The campaign, which was launched in 2013 to help Canterbury’s people recover from the psychological effects of the earthquakes, has just compiled the results of three focus groups involving older people in Christchurch and North Canterbury. All Right? manager Sue Turner says the results show there has been a lot of stress on older people and it’s having a real impact. “Many are grieving for family who have moved away; there has been an upsurge in health complaints and sadly many older people report that they’re feeling isolated. “It’s hard for all of us to get out and about in this environment, with broken roads and detours in place, but it’s even harder for older people. Those who can drive find it difficult to navigate – so many landmarks are gone – and say they have lost their confidence behind the steering wheel. And those who used to catch buses are finding it difficult to get to the bus stops, with broken footpaths and the changes to routes.” That means more people are staying at home instead of heading out and catching up with friends or going to organised activities. Sue Turner says that can have a serious impact on mental health. “Connecting with other people is one of the five ways anyone can improve their mental health and wellbeing. It can be easy to become stuck in a negative train of thought or feelings of loneliness if you’re isolated. “It is hard for older people to get out… there’s no doubt about that,” says Sue. “We’re not saying everyone has to get out every day but it’s important we all look at ways to do this… connecting with someone else can be achieved through a simple phone call.”

Bev’s story

On 22 February 2011, Bev Broomhall was working in the Cashel Mall bakery in the

heart of the city when the building next door collapsed, killing her friend and co-worker Shane Tomlin. “He was in the wrong place at the wrong time, and it could easily have been me,” she says. “The next few days felt like I was working on automatic. I was very sad and upset because I’d lost my friend, but I didn’t think it affected me too much. Two years later, I got really down. Everything seemed to get to me and I kept thinking about what we’d lost. So I just kept talking about it.” Broomhall says connecting with others helped her to cope and move forward. “I believe talking about what we went through is the best thing to do, because it makes it less traumatic,” she says. “I refuse to let the earthquakes scare me. If you don’t talk about it and you let it get to you, you’ll never recover.” “Sometimes I still feel upset and get a lump in my throat when I talk about Shane and everything that’s happened, but talking about it helps me feel better. If you think you’re the only one with a problem, tell someone else and you might find they’ve got a similar problem too. It helps to connect and go through it together because you’ll realise you’re not alone.”

Five Ways to Wellbeing

The All Right? campaign focuses on ‘Five Ways to Wellbeing’ to help older people struggling with coming to terms with the effects of the quakes: ‘Connect’ (talk and

“

It’s important to remember that while many people are showing signs of recovering from the quakes, you are not alone if you don’t feel that way, so please do take the free help that is available.”

14 September – November 2015 | www.insitemagazine.co.nz

listen); ‘Give’ (your time to other people… even a smile works!); ‘Take notice’ (noticing the good things around you); ‘Keep learning’ (libraries are great places for that) and finally ‘Be active’ (as much as you can). Sue Turner says there are all sorts of ways to practise the Five Ways. “It may sound strange, but laughter can be a great way to be active. It’s a great workout for your abdominal muscles, and releases chemicals in your brain that decrease stress. If you’re getting lost, stressed, or frustrated, try having a little laugh at your situation. It can help you relax and gain a fresh outlook on what to do next,” says Turner. Laughter often helps Bev Broomhall cope with stress. “You’ve just got to laugh at what you can’t control. There’s no point in being uptight, that will just ruin your life.” Broomhall, 67, finds plenty of opportunities to practise the Five Ways. As well as connecting with others, she enjoys taking notice of new developments happening around Christchurch and giving her time by volunteering at Age Concern Canterbury. Sue Turner says there is still help available for people who are having difficulty coping. “We’ve found older people to be among the toughest of Cantabrians – they show real strength in just getting on and doing things, but it’s all right to ask for help. International research shows recovering from the emotional effects of a disaster can take more than a decade and things were particularly tough in Canterbury with more than one earthquake and lots of related stressors.” “It’s important to remember that while many people are showing signs of recovering from the quakes, you are not alone if you don’t feel that way, so please do take the free help that is available.”

One way to access help is via the Canterbury Support Line 0800 777 846.

www.insitemagazine.co.nz | September – November 2015 15

Retirement

On the soapbox... Dick Williams DICK WILLIAMS of the Retirement Village Residents Association urges residents to sit up and take notice.

he history of retirement villages began in New Zealand over 40 years ago, when church and trust organisations began building villas to enhance existing rest home and geriatric hospital services. Over time, commercial operators became involved and increased the facilities offered in standalone villages. Private enterprise flourished and the owners/operators established the Retirement Villages Association (RVA) to which most villages now belong. They have set guidelines to which villages must comply in order to remain members of the Association. The Retirement Villages Act 2003 and the subsequent Code of Practice 2008 had input from the RVA. The legislation passed was influenced by them and has resulted in the terms of the Act and the Code being weighted in their favour. The most common reason to move to a village is companionship. Most of New Zealand’s now 30,000 retirement village residents are over 70, widowed and women. The sheer weight of numbers is on the side of retirement village operators. The number of people aged over 65 will actually double by 2025 and there will be 1.2 million over-65s in 2036 – a quarter of the population, according to latest Statistics New Zealand population projections.

Retirement villages a prosperous industry

Stock market listed retirement villages such as Summerset, Ryman and Metlifecare have barely paused for breath during recent years, with Ryman the fourth largest of all residential builders in the country. Statistics New Zealand began tracking new retirement units in 2009 after it noticed an upwards surge. Since then, developers have built almost 2,000 new units, worth a combined $263 million. Half of them were built in the last year and, in some months, every new apartment built in New Zealand was for retirees. Baby boomers will likely take to retirement villages in the same proportions as the generation before them and the operator sales pitch is firmly on.

We do not realise just how large and prosperous this industry has become and how much it will boom in the next few years, as operators turn golf courses into large retirement villages. The residents are the largest stakeholders in this industry, financing the operators to quickly increase their assets. Residents need to have representation at the national level.

Establishment of the Retirement Village Residents Association

The RVA had a strong influence on the formulation of legislation that was affecting the residents of retirement villages. It was strongly considered that the residents were suffering as a result. From this situation arose the hope that ultimately a national association of retirement village residents would be formed. The Association of Residents of Retirement Villages (ARRV) was established in the Bay of Plenty region in 2006, as an independent advisory body with power to represent member residents regarding matters of common concern. Bob Nicholson, the original chairperson, is one of the ‘first

16 September – November 2015 | www.insitemagazine.co.nz

fifteen’ founding members of RVRANZ Inc. The region covers the Bay of Plenty area of Tauranga, Rotorua and Whakatane. Because of the desirable climate and lifestyle offered here, there is a heavy population of retirement villages. In August 2007, 11 interested Auckland retirement village residents met in the Waitakere Retirement Village. Their interest had been aroused by the establishment of the Bay of Plenty ARRV. The Auckland group had further discussions over the next 18 months, mostly by phone and email. The inaugural meeting of ARRV Waikato was on 18 July 2008 at Perrin Park Retirement Village, Hamilton. Residents came from Tauranga, Thames, and Rotorua, as well as many people in the wider Hamilton area. The inaugural ARRV Taranaki meeting was in March 2012. This was attended by representatives from nine retirement villages, all of whom agreed to join the new Taranaki ARRV. At this point a national organisation was being considered and it was hoped that all residents would see the worth of joining a national body. It was generally accepted that through strength of numbers in a national

Retirement incorporated association, it would be possible to influence government and therefore future legislation. At a later joint meeting in 2013, a working party of representatives Rob Wilson (Auckland), Elizabeth Jones (Waikato) and Dick Williams (Bay of Plenty) was established, with the purpose of putting together a constitution to register a national association as an incorporated society. A constitutional lawyer was engaged and on 10 September 2014 the Certificate of Incorporation was issued in the name of the Retirement Village Residents Association of New Zealand Incorporated (RVRANZ). The name change followed the establishment of the Retirement Village Residents Association of Australia, which had been established in New South Wales.

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The residents are the largest stakeholders in this industry, financing the operators to quickly increase their assets.”

The inaugural RVRANZ (Inc) Annual General Meeting was held at Hamilton Gardens Rotary Lounge, Hamilton on 24 June. The meeting was attended by 66 people, many of whom had travelled a considerable distance from such areas as New Plymouth, Taupo, Whakatane, Wellsford and points in between. Further interest is now being received from residents in Wellington, Hawke’s Bay and Christchurch. Since this time, the RVRANZ has been associated with: »» the Retirement Commissioner over a review of the disputes process

RVA response

JOHN COLLYNS, executive director of the Retirement Villages Association (RVA) responds. The RVA welcomes the creation of a national Residents’ Association because it is useful that residents have a voice to raise issues of concern, such as amending the Rates Rebate Act. We meet regularly with the existing regional associations and we believe these meetings are both constructive and beneficial for both parties. However, in our view it’s important that their spokespeople have a genuine mandate to speak on behalf of the resident body rather than pursuing issues of importance to the individual raising them, and we look forward to continuing to work with them on matters of mutual interest.

What’s making the big difference in healthcare construction projects?

»» the Registrar of Retirement Villages over non-registration of villages »» the RVA over the definition of a village manager »» MBIE, constantly seeking a review of the Act and the Code. Further information is available on the RVA website.

Residents should be free to enjoy their chosen lifestyle

It is always hoped that people who move into a retirement village are happy with their decision and enjoy the lifestyle. However, there are anomalies within the Act and the Code and its implementation, which can result in injustices and can disadvantage residents. The interpretation of the Act and the Code varies from village owner to village owner. It is therefore essential that residents of retirement villages recognise the importance of the RVANZ to monitor such matters and other concerns that arise from time to time. Their support is necessary. A united voice always has greater strength when the need arises.

We are. Reduce noise Save energy Increase building comfort Meet regulatory codes Call us on (09) 274 9133 or email healthcare@nexusfoams.com

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www.insitemagazine.co.nz | September – November 2015 17

Conferences

Conference updates JUDE BARBACK reports on the recent New Zealand Aged Care Association Conference 2015 in Auckland and provides information on two upcoming conferences: Workforce Development Conference 2015 and NZ Dementia Summit 2015.

New Zealand Aged Care Association Conference 2015: SkyCity, Auckland, 8–10 September

t was mostly about technology at this year’s New Zealand Aged Care Association (NZACA) conference. After an unexpected and well-received performance by the Summerset Young at Heart Chorus and a witty welcome by conference MC Te Radar, delegates from all over the country turned their attentions to the impact of technology on aged care – a subject embraced by Canadian professors Jenny Basran and Dan Levitt. Dr Basran discussed the need to take a more collaborative, integrated approach to collecting and utilising data to inform people’s care plans. We’re living longer but with multiple conditions – a situation Basran described as “the new normal”. She said we need to overcome the propensity for all disciplines involved in a person’s care – the GP, nursing staff, pharmacist, physio and so on – to carry out similar assessments and collect the same data for their own purposes. Instead, we should be contributing to a single interdisciplinary assessment tool, which feeds into a single care plan for the person at the centre. Director of the National Health IT Board Graeme Osborne put this message into the New Zealand context, describing the New Zealand Health Strategy’s vision for patient portals, community and hospital e-prescribing, data from interRAI and other systems, to feed into a single shared care plan for each person. It was a message that filtered through the conference, with Dr Greg Garratt providing an example of interdisciplinary integration with MediMap, a Cloud-based medication platform that is joining the dots between pharmacists, GPs and aged care providers. Kristene Powell also demonstrated this through her case study of how smart mobile technology was used to achieve consistency and accuracy in a major Australian aged care provider’s facilities and services. Michelle Dickinson, better known as ‘Nanogirl’, talked about the role that nanotechnology can play in helping people with conditions like Parkinson’s and Alzheimer’s diseases.

Everyone felt for Associate Minister of Health Hon Peseta Sam Lotu-Iiga as he struggled with a nasty cold as he delivered an update on the Review of Older Person’s Strategy, and touched on contentious issues, including interRAI and the ongoing pay equity case. interRAI, while still managing to produce groans from delegates every time it was mentioned, was still a hot topic at this year’s conference. Now that it has been embedded and made mandatory, the focus has shifted to how the assessment data is being used. Outside of technology, palliative care and its place in residential aged care was another big issue and Professor Heather McLeod’s presentation on this topic was well received.

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Excellence in Aged Care. Horowhenua Masonic Village, Elizabeth Knox and Te Wiremu House also featured on stage. As usual, the gala dinner was a highlight of the conference. With the theme of ‘A team game’, delegates transformed into royals and rugby players, Wonder Women and Where’s Wallies, ninjas and ninja turtles. By the next day they had morphed back into members of

… we should be contributing to a single interdisciplinary assessment tool, which feeds into a single care plan for the person at the centre.” Education and training also featured, not only in presentations by Careerforce and Health Ed Trust, but also in the NZACA Excellence in Care Awards. Oceania Healthcare took home the Health Ed Trust Training and Staff Development Award with its two-tiered, colour-coded system for helping staff achieve national qualifications. The awards were presented at the conference gala dinner, held at Eden Park. In addition to its education award, Oceania also won the Bidvest Excellence in Food Award and the Supreme Award for Overall

18 September – November 2015 | www.insitemagazine.co.nz

the aged care industry, ready to embrace the challenges facing their sector. NZACA chief executive Simon Wallace said the main issues for the sector emerging from the conference were around palliative care, interRAI, the ARRC contract and equal pay. He said that while detailed feedback was being sought from delegates, overall he felt the conference went really well. “It was a very well attended conference, with the highest number of delegates and the highest number of trade stands yet.”

Conferences

Careerforce Workforce Development Conference 2015: Te Papa, Wellington, 2–3 November

nternational insights, experiences and opinions to changes and opportunities in the health, wellness, and social service sectors will be shared with the sector when delegates of the Careerforce Workforce Development Conference (CWDC) come together in Wellington in November. With the theme ‘Transform your workplace. Prepare for your future’, the conference brings together a host of knowledgeable speakers from England, Scotland, Australia and New Zealand to discuss the challenges and opportunities that face the workforce in these areas. Dr Glen Mason, director of people, communities and local government, Department of Health, UK, will give an insight into Dr Glen Mason the Workforce Plan for England. He’ll outline the next steps and implications as it implements the new national workforce plan, in the wake of the Government’s refreshed mandate for health. Rod Cooke will also take the podium – as CEO Community Services and Health Industry Skills Council, Australia, he’ll talk about the Australian experience and the changes that lie ahead. Rod will be asking what the likely impact on the New Zealand workforce will be. John Rogers, CEO at Skills for Health, UK, will discuss workforce planning: developing non-registered staff and a more flexible workforce. He’ll present findings and opportunities from a review of the UK National Health Service. Mairi-Anne MacDonald, director of sector development, Scottish John Rogers Social Services Council, Scotland, will discuss the ways in which the Scottish Social Services Council is building a safe, skilled, confident and flexible social service workforce. She’ll also share with us what insights were learned along the way. These are just some of the many interesting and varied speakers at the conference. New Zealand speakers will include top officials from the tertiary education, health and wellbeing and social services sector who will discuss workforce transformations already underway and the planning and actions that are needed to cope with future demands. A full programme of speakers and topics for the November 2–3 conference is available online at careerforceconferences.org.nz.

NZ Dementia Summit 2015: Te Papa, Wellington,

5–6 November

he NZ Dementia Summit is jointly hosted by the NZ Dementia Cooperative, Alzheimers New Zealand and Carers NZ and draws together health professionals, service providers, government officials, educators, researchers and people affected by dementia to share their experience, knowledge, and expertise. Participants will discuss and debate what is being done well locally and nationally, and identify the enablers and barriers to better outcomes. The goal is to identify what needs to be done at the national and strategic level, identify any gaps and explore ways to deliver better outcomes for people with dementia. If you have previously registered your interest in participating via email, the formal Summit registration process is now open. For details on the programme and how to register, visit www.nzdementiasummit.org The NZ Dementia Summit 2015 has been endorsed by The Royal New Zealand College of General Practitioners (RNZCGP) and has been approved for up to 9.00 credits CME for the General Practice Educational Programme (GPEP) Years 2 and 3 and maintenance of Professional Standards (MOPS) purposes.

Are your training plans aligned with the New Zealand Qualifications? • After December 31 2015, Careerforce will not be enrolling trainees into the National Qualifications • The New Zealand Qualifications at Level 2 and 3 available now • New pathway qualifications at Level 4 available soon

Talk to your Careerforce Workplace Advisor to ensure you are making the most of all your training opportunities Find your CWAs contact details... careerforce.org.nz/employers

www.insitemagazine.co.nz | September – November 2015 19

Research

Up close and personal with...

Gabi Hollows

INsite talks to GABI HOLLOWS, the first person to be awarded the Ryman Prize.

abi Hollows has been awarded the inaugural Ryman Prize in recognition of her work over more than two decades to help restore sight to more than one million people. The Ryman Prize is a US$150,000 international prize for the best work worldwide to enhance the quality of life for older people.

Q&A with Gabi INsite: First, congratulations on winning the inaugural Ryman Prize! Do you think such awards are helpful in raising awareness of the various things that can enhance the quality of life in older people? Gabi Hollows: I was very humbled to find out that I had been nominated for the Ryman Prize and feel so honoured to have received such an amazing accolade. I think that any sort of international recognition of work done to enhance the quality of life in older people will automatically bring awareness to the cause, which is why the Ryman Prize is such an incredible award. INsite: What first attracted you to orthoptics as a career? Did you ever consider doing anything different career-wise? Gabi Hollows: As a child I had my first experience in ophthalmology when I underwent surgery for a squint at three years old. Ever since then I’ve been interested in learning more. Physiotherapy was actually my first choice of career. However, I was selected as an orthoptic student and thought this was such an honour and that it was obviously what I was meant to study. INsite: What prompted you and your late husband Fred to establish The Fred Hollows Foundation? Gabi Hollows: Fred believed that everyone had the right to sight and there should be no double standards in ophthalmology. He had a vision for a world where no-one was needlessly blind and indigenous Australians exercised their right to good health. When it was clear that Fred wasn’t going to recover from his cancer, we decided that his work needed to continue, even if he wasn’t around to see it. So, around the kitchen table one night, we set up what is now The Fred Hollows Foundation. INsite: I understand The Fred Hollows Foundation now works in more than 20 countries. How did The Foundation first expand from Australia to overseas? Gabi Hollows: Before The Foundation began, Fred trained and became good friends with Dr Sanduk Ruit. Dr Ruit is a Nepalese

ophthalmologist who has personally performed more cataract surgeries than anyone else in the world. Before he passed away, Fred was determined to bring world-class eye care to developing countries like Nepal. Dr Ruit is our medical director at Tilganga in Kathmandu. One of the last projects Fred worked on was setting up factories in Eritrea, Nepal and Vietnam to produce cheap, high-quality intraocular lenses. These factories allowed The Foundation to expand its work overseas because we could do cataract surgeries for as little as $25.

INsite: I understand you provide eye health services for people of all ages. What particular eye health problems typically affect older people and how do these affect their quality of life? Gabi Hollows: For older people, cataract blindness is the biggest problem. Avoidable blindness not only impacts the person who is blind but also those who have to look after them. In particular, it affects the young family members who typically look after their blind grandparents while their parents are working. This takes children out of school. So restoring sight to the elderly allows them to return to the community and allows their young carers to get an education.

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The Foundation wants to eliminate avoidable blindness globally by 2020, so we are working with our global partners to try our best to achieve this.”

INsite: Aside from eye-related problems, do you come across other common ailments or impairments affecting older people in your work? Do you encounter other organisations that are working to address these? Is there any collaboration between organisations on health issues? Gabi Hollows: Working in the healthcare sector, it is impossible to be exposed to just one thing, such as eyes. Around the globe there are many organisations who are trying to address different areas of health that affect older people, and many strategies tie in with our strategies for eye health. INsite: What is the most rewarding aspect of your work? Gabi Hollows: The most rewarding aspect, by far, is giving the gift of sight. The look on

20 September – November 2015 | www.insitemagazine.co.nz

people’s faces when the patches are removed and they can see something they haven’t seen in 10 years. Those moments are what help to get you through the hard times. But a close second is being able to thank all of The Foundation’s donors and staff, who make Fred’s dream come true.

INsite: What are the biggest challenges or frustrations you face with your work? Gabi Hollows: The biggest challenges that the eye care industry faces is the shortage of eye care facilities and workers. Without these, we are unable to restore sight and the backlog of people requiring surgery increases dramatically. A lot of countries we work in require us to invest in training and building infrastructure before we are able to start eye surgery. INsite: Was it difficult in the earlier days attracting fundraising and donations? Is it easier now that The Foundation is on a larger scale? Gabi Hollows: It was a little difficult when we were starting out, but things are much easier now that we have a team of staff focusing on fundraising so that we can continue our sight-restoring work. But it really makes me feel so proud that people still keep Fred in their hearts and they continue to empty their pockets for this worthy cause. INsite: What’s next on the cards for The Foundation? Gabi Hollows: There are some pretty audacious projects that The Foundation is focusing its attention on. The Foundation wants to eliminate avoidable blindness globally by 2020, so we are working with our global partners to try our best to achieve this. There is still so much to be done and we have a great team that is making that possible. INsite: I understand you have five children. Have any followed in the footsteps of their parents to work in the field of eye health and vision? Gabi Hollows: Although none of my children are working directly in eye care, all of them are very involved in the work of The Foundation and are very passionate about social issues, just like Fred was. INsite: When you’re not working, how do you like to spend your time? Gabi Hollows: In my spare time I enjoy seeing my children the most. They are the most important part of my life and I can never spend enough time with them.

Clinical

Spotlight on...

sexual health: over the hill or still rock ‘n’ rollin’? Dr CATHERINE COOK discusses intimacy, sexuality and sexual health in retirement and aged care.

lthough some see ageing as a release from the demands of sexual relationships, for others, sexual intimacy continues to be a priority, strongly associated with happiness and a sense of quality of life. Modern images of sexuality and the promotion of sexual health focus on the young and beautiful and portrayals of older people’s bodies, especially in reference to sexuality and intimacy, are often denigrating. Although these cartoons or films might be accompanied by humour, they are ageist, portraying sexual desire in older people as unnatural and ‘dirty’. Another way the sexuality of older people is dismissed is by interpreting expressions of intimacy, such as holding hands or kissing, as cute; as almost childlike. These attitudes deny the reality that intimacy is a human right and sexuality is a core aspect of human identity. When people move to a retirement village or an aged care facility, aspects of what have been important parts of their private lives risk becoming public. This situation is more so when there are degrees of increased dependency and, for some, cognitive decline. During the intake assessment it is rare for questions to be asked about people’s sexual needs and concerns. Are facilities ready for the baby boomers, many of whom have embraced sexual experimentation and choice? Do facilities create an inclusive environment for people who don’t identify as heterosexual? Would your clinical and management staff have any difficulties or dilemmas in responding to the following scenarios and balancing people’s rights with ensuring safety? »» A widower ‘comes out’ as gay and forms an open relationship with another resident »» A lesbian couple asks about attitudes towards same-sex relationships and the availability of a shared double bed in the rest home »» A single woman with a slight degree of cognitive decline initiates a new relationship with another resident, but the family want staff to stop the relationship »» A widower wants to pay for the services of a weekly escort or sex worker »» A resident who is HIV-positive commences a relationship with another resident and assures staff they are using condoms »» A resident who has always cross-dressed throughout his life wants to continue this practice

“

Are facilities ready for the baby boomers, many of whom have embraced sexual experimentation and choice?” »» A resident who experiences nocturnal incontinence and wears protective pants finds this gets in the way of masturbation »» A resident with an in-dwelling catheter asks if there are any alternatives as he wants to masturbate »» A staff member sees a resident watching adult pornography on his laptop »» A resident appears to be having sexual relationships concurrently with a number of residents »» A resident contracts a sexually transmitted infection. If you answered ‘yes’ – that responding to any of these situations would be challenging – then your organisation is in the same boat as many throughout the world. Adult children’s opinions, although sometimes important, cannot always guide decisions where issues of competency are involved as they often know little about their parents’ sexuality. Therefore they may not be the best advocates for their rights in this regard. There’s a growing focus on research and education as intimacy and sexuality in the aged residential and care sector remains a troubling, misunderstood and frequently contended issue. Negotiating the sometimes competing interests of residents, staff of various disciplines, families, and regulatory bodies is not simple. In the absence of specific guidance and education, staff are likely to draw on their own values and experience.

In New Zealand, one of the challenges is that although well over 85 per cent of residents of residential aged care facilities are of New Zealand European descent, only 56 per cent of employees identify as New Zealand European. There may be significant cultural and religious differences in carers’ attitudes to intimacy and sexuality. The good news is that research shows brief, educational interventions for staff work. International studies show that workshop participants’ attitudes and beliefs towards older people expressing their sexuality in longterm care were more open and supportive following education. A group of researchers based at Massey University, Albany, are about to pilot a study looking at what’s needed in the New Zealand context. The views of residents, families and staff will be collected and this research will lead to a larger national study and on to an educational package that will be made available to all levels of residential living.

Dr Catherine Cook is a senior lecturer at the School of Nursing, Massey University, Albany. Associate professor Mark Henrickson (School of Social Work, Massey University, Albany) and Sandra McDonald (nursing lecturer, NorthTec, Whangarei) also assisted with this article. For other resources, please contact the editor at editor@insitemagazine.co.nz.

www.insitemagazine.co.nz | September – November 2015 21

Aged care

A day in the life of...

a health social worker Health social worker MALCOLM FOSTER looks beyond a typical working day and discusses how his role has changed over the years, and what he’s learned along the way.

hen I graduated from Waikato University back in 1977 with a Bachelor of Social Science degree, I thought I was well equipped to work with people, which is what I had always wanted to do. After several years working with intellectually disabled clients, I moved to community social work with the then-named Extramural Hospital in the Waikato, where a large proportion of my caseload was made up of those aged over 65 years, all living in the community, and some very frail and vulnerable. It was then I realised that social work with older people was quite complex and multifaceted, and I went “back to school” and completed a postgraduate diploma in social policy and social work through Massey University in the 1980s. This gave me the knowledge base and analysis to underpin my social work with older people. I had always been interested in ageing and resilience and the importance of life experience to the individual, and now I was more able to practice in a way that collaborated with older people to gain control over their own unique environment and circumstances. In my 33 years of health social work with Waikato District Health Board and its predecessors, I have developed a strong interest in the rights of vulnerable older people. This includes those living with elder abuse and neglect, and I soon associated with Hamilton Age Concern and a wider networking group based in Auckland. For many years I attended monthly Elder Abuse resource team meetings where, as a multidisciplinary group, we brought our professional skills together to consider and advise on cases. This included social work, nursing, police, geriatrician and lawyer colleagues collaborating with the local Age Concern staff. Along with other social work colleagues, I also joined the local Waikato branch of the Gerontological Society, where advocacy for the older individual was more political. For several years my health social work role allowed me to participate in assessing

the standards of care in local rest homes and hospitals throughout the greater Waikato DHB region. This meant that every year a registered nursing colleague, who concentrated on nursing matters, and myself, whose brief was the social and emotional wellbeing of residents, would visit every facility in the region and provide a report to the Ministry of Health. Sometimes if there were issues that needed addressing, there would be recommendations made and constructive advice given tactfully. At the core of this work I always saw the rights of vulnerable older people and the need to protect these rights and enhance independence wherever possible. For many years I led the team of community health social workers who, along with other staff, assessed the needs of older people in their own homes, under Disability Support Link. A particular challenge we faced was the older person living in isolation, often in an isolated rural area, with few natural supports. That was where creativity and solid networking with local community agencies proved its worth. In 1988 legislation was passed in New Zealand that provided for at-risk vulnerable adults. This was the Protection of Personal and Property Rights Act, and as a health social worker I was actively involved in using this legislation to ensure the safety of the most vulnerable and at-risk older people I worked with. The dilemma inherent with such powerful legislation is that it

22 September – November 2015 | www.insitemagazine.co.nz

takes away the rights of people to live as they wish if they are deemed incompetent, and social work is very much concerned with human rights. So for over two and a half decades I have had to balance my duty to care and protect the most vulnerable in our society with the individual’s basic human right to autonomy, or tino rangatiratanga. This is where consultation and supervision is highlighted as essential with local and national colleagues – not only social workers, but also lawyers and doctors, for it is the doctor’s report that establishes whether a person is competent or not. My long membership of the national social work association ANZASW has been crucial in maintaining practice skill and knowledge, and more recently becoming registered with the Social Workers Registration Board ensures accountability of practice. I have recently transitioned to renal social work, where there are also many older clients, but I look back on my time working in the community with vulnerable older people as a particularly rewarding time in my career. I have learned many things – the value of resilience, the depth of life experience in the very old, and the fact that just because a competent older person makes a decision others may not agree with, that is their inalienable right – don’t trample it underfoot.

Retirement

Let’s snoop around...

Summerset by the Sea JUDE BARBACK takes a tour of Summerset by the Sea in Katikati.

ummerset by the Sea is the first Summerset village I have had the pleasure of visiting.. Not for lack of invitation, mind you – former chief executive Norah Barlow was always quick to extend a welcome to their various facilities as they shot up like mushrooms. In the three and a half years I’ve been with INsite, I’ve witnessed the company’s change of leadership, the decision to go public, and the staggering rate of growth. They now have 20 villages and there are more on the way. It is a beautiful Bay of Plenty cusp-ofspring day as I drive to the outskirts of Katikati to the grand entrance of Summerset by the Sea, which is set on six hectares of coastal land. The village Leisure Centre opened in November 2014 and has all the finesse and sparkle I’ve come to expect from large retirement village operators. With size on their side, large operators know what works in terms of layout, interior design choices, landscaping, even background music. With construction of the new care apartments, care facility and stage three of the retirement villas underway, I’m not seeing the finished product – something village manager Sue Hough is slightly apologetic about – but I am pleased that Summerset has allowed me to see a work in progress.

Newly opened

In fact, the builders and workmen are barely noticeable – they seem to work noiselessly and on the peripheries of the site. I do sense I’ve caught the village at a busy time, however, with the care apartments and care facility due to officially open on 18 September – less than three weeks away at the time of my visit. The village is expected to be fully completed in 2018. The 10 care apartments and 30 care beds opening in September will eventually increase to 20 care apartments and 49 care beds. At present there are 47 independent villas, but this number will increase to 156. Sue Hough is no stranger to opening new villages. In her six years with Summerset, she managed the opening of the Warkworth village. At present she lives on site to attend to residents’ needs but she will no longer need to do so once the care facility is up and running. Sue gives me a tour of the village on a golf buggy, for which, given my inappropriate choice of footwear, I am grateful. We cruise around the 47 villas, 10 of which are two-

bedroom, 18 are two-bedroom with a study, and 19 are three-bedroom. Along the way I get the opportunity to inspect one of the nine two-storey villas, with its magnificent views across the harbour. It is spacious, modern and new. Sue says the upstairs bedroom with ensuite is often used by residents as a guest room. It is so tranquil and lovely with its sea vistas I feel like I wouldn’t mind staying here for a holiday. Sue says they’ve used one of the

“

It is so tranquil and lovely with its sea vistas I feel like I wouldn’t mind staying here for a holiday.”

apartments for that very purpose, as a ‘motel unit’ for residents from other Summerset villages who might fancy a short break in the Bay.

High demand

She admits that it is unlikely they will be able to continue this practice in the long term, given the demand for villas. Just three villas are yet to sell. There is already demand for the apartments, Sue says, and she anticipates they will be highly sought after as people from the Katikati region often like to stay in the area close to family and friends. The new care centre will bring the arrival of 23 new staff including registered nurses, enrolled nurses, caregivers and housekeepers. Sue believes firmly in not keeping the care residents separate from those in the villas and intends to encourage everyone to mingle. The positioning of the communal lounge reflects this, with access easily obtained from both the care facility and the main lobby entrance. The village has all the bells and whistles you would expect: a café, bowling green, spa pool, hair salon, gym – and plans for a heated outdoor swimming pool are in the pipeline. An activities manager starts soon, but under Sue’s management there has been plenty for residents to get involved with. She reels through some of the activities: movie nights, lunches at local restaurants, girls’ shopping trips to Tauranga, boys’ trips to the Fieldays, concerts, summertime barbecues, welcome evenings for new residents, and so on. I don’t see many residents on my tour, which is a shame, but I expect they are out enjoying the sunshine. It will be interesting to visit again when the village is complete and witness the difference the extra villas, apartments and care facility make. www.insitemagazine.co.nz | September – November 2015 23

Management

Last Word… Graham Wilkinson President of the Retirement Villages Association (RVA) Executive Committee GRAHAM WILKINSON looks at what lies ahead for the retirement villages industry.

Matching and exceeding expectations

fter almost 20 years on the RVA executive, I received the consolation prize of being appointed president, possibly the only way my colleagues could get to see me to leave after the requisite stint. When INsite asked me to reflect on those years, and what the future might bring, I had to stop and think back pretty hard. The days of virtually no regulation, the lifestyle versus care debate, and no publicly listed retirement village companies all seem so long ago. Our industry is now publicly accepted, with a mainstream product, operating in a sound regulatory environment. We are seen as world-leading and we have four public companies and more likely to come; the 75+ population is about to expand considerably in the near term and new villages seem to be announced weekly. Industry cohesiveness is truly impressive and customer satisfaction is at levels only dreamed of by almost every other industry. Even Apple Corporation would be happy with our NPS!

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All beer and skittles?

So, is it all beer and skittles? Clearly the current real estate market is favouring projects that are underway, particularly in the upper North Island with unprecedented sales levels, but is this a case of, as Warren Buffet would say, “waiting for the tide to go out to see who is swimming naked”? While the good times continue to roll, almost any project underway can gain traction, but real estate has a horrible habit of being cyclical. An economic downturn, coupled with an overbuilding regime, will quickly expose those with their togs off. Smaller villages with structural issues may find their new, large, corporate neighbour hard to compete against if they don’t have that unique selling point. While the public entities have large capital resources to withstand economic downturns, even they could be susceptible to advances in homecare technology, particularly with advances designed for the future market, the currently pre-village baby boomers. Personally, I am optimistic that regardless of the issues any particular village may

… is this a case of, as Warren Buffet would say, ’waiting for the tide to go out to see who is swimming naked’?”

have, or any slowdown in the economy, the fundamental desire for security and companionship will ensure villages continue to evolve and satisfy the needs of senior Kiwis for many more years. In fact, the only real risk our industry faces is shooting itself in the foot by a failure to collectively deliver on the basic promise that a village offers: “We welcome you to live here, and we will look after you for the rest of your natural life, and when you leave us we will pay you or your estate in a timely manner”, leading to a negative public perception. Provided that promise is delivered on, and no ‘wrinkles’ develop, then our industry will continue to grow regardless of any media sideshows or one-off failures.

24 September – November 2015 | www.insitemagazine.co.nz

But here’s the crux. Together we need to lead the evolution of the industry and ensure that terms and conditions for our clients match, or better still exceed, public expectations. A short-term benefit in loading a capital loss onto a resident will not make for a happy family. After taking sometimes hundreds of thousands of dollars from a resident on exit, why would anyone charge them a few thousand for weekly charges that in no way relates to their occupation or issues? Is it fair that regardless of the circumstances that delay the return of capital to an estate, should an operator simply say “sorry”? Australian company Aveo recently introduced a six or 12-month buyback guarantee for residents but at the same time increased the deferred management fee to 35 per cent. The result: more sales and more profit because the promise is always kept. One day, we could easily see something similar in this country. Subject to continuing to meet those public expectations, the future is certainly bright. Consolidation and corporatisation is likely to continue but a well-located, wellrun individual village can always succeed. Branding will become more important but so will segmentation, where the public start to differentiate between what they may see as homogenous versus upscale offerings. Technology has the ability to be the wildcard both in existing villages and in new offerings. Twenty years ago, a vertical village was seen as unlikely; is a “virtual village” the next iteration? We will see more scrutiny and regulatory attention, but provided we ensure our members operate with a clear moral compass, we have nothing to fear. The RVA will continue to represent the interests of members and, in doing so, the residents of those villages that those members operate. It is only a matter of time before we see 100,000 New Zealanders living in villages of all sizes and sorts. I hope I can be around for another 20 years to see it happen.

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