Insite aug sept 2012 by NZME. Educational Media

AGED-CARE & RETIREMENT

August – September 2012 | Vol. 6 Issue 6

WE’VE GOT YOUR INDUSTRY COVERED I www.insitemagazine.co.nz

6 I FOCUS ON:

32 I REGULARS

LAST WORD:

NANO TUNNICLIFF ON ‘MODERN DAY SLAVERY’ IN THE AGED CARE SECTOR 3 I NEWS

METLIFECARE DEAL GOES THROUGH AT LAST

NUTRITION AND DIET IN AGED CARE

THE ART OF MENU PLANNING IN AGED CARE FACILITES

28 I CONFERENCES

HIGHLIGHTS OF THE 2012 RVA CONFERENCE

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In this issue...

www.insitemagazine.co.nz AGED-CARE & RETIREMENT

INsite Magazine Vol. 6 Issue 6 EDITOR: Jude Barback T: 07 575 8493 E: editor@insitemagazine.co.nz ADVERTISING: Belle Hanrahan T: 04 915 9783 E: belle@apn-ed.co.nz PRODUCTION MANAGER: Barbara la Grange LAYOUT Aaron Morey EDITOR-IN-CHIEF Shane Cummings GENERAL MANAGER/ PUBLISHER: Bronwen Wilkins SUBSCRIPTIONS: T: 04 471 1600 F: 04 471 1080 E: subscriptions@apn-ed.co.nz PUBLISHER’S NOTE: © Copyright 2012. No part of this publication can be used or reproduced in any format without express permission in writing from APN Educational Media (NZ) Ltd.

EDITORIAL & BUSINESS ADDRESS Level 1, Saatchi & Saatchi Building, 101-103 Courtenay Place, PO Box 200, Wellington 6140, New Zealand Ph (04) 471 1600 Fax (04) 471 1080 ISSN 1177-9268

What’s on the menu? A closer look at the challenges of aged care menu planning.

Dietitians dispel 10 common nutrition myths for older adults.

CAROLINE BARTLE gives some practical advice to help make meal times easier for those with dementia.

Catering decisions: is it better to contract out or do it yourself?

INsite considers research and perceptions about the risk of malnutrition for residents in aged care facilities.

Nutrition at home: JUDE BARBACK looks at what resources are available to keep people healthy in their homes for longer.

Malnutrition for residents in aged care facilities.

The long road to literacy: addressing literacy and numeracy concerns within the aged.

ED LETTER

Make meal times easier for those with dementia.

I WAS FORTUNATE to attend the annual Retirement Villages Association conference in Wellington at the end of June. A personal highlight was the gala dinner, at which the INsite/RVA Manager of the Year award was presented to Diana Triplow of Mary Doyle Lifecare in Hastings, making her the fourth recipient of the annual award. In this issue, we chat not only to Diana, but to the previous winners about their thoughts on some of the main issues facing the retirement village industry today. At the dinner, I was seated on the same table as a dietitian and an executive from a catering company, which proved to be rather serendipitous as the theme for this issue is nutrition and diet in aged care. Nutrition is an interesting topic. As I watched everyone enjoy the excellent food served at the RVA dinner, it was hard to imagine these same people one day reverting to the fare typically served in many care facilities today. With the evolving needs and expectations of the growing ageing population come changes to the taste preferences of older people. Residents’ personal preferences are just one aspect to be considered when it comes to menu planning in aged care facilities; meeting Ministry regulations and nutritional requirements to satisfy the scrutiny of a registered dietitian’s audit are the main considerations for facility managers. Catering for the specific dietary requirements of individual residents, cost, the availability of staff, and resources are other factors concerning menu planning. We consider the issue of malnutrition in aged care facilities: what defines it in older people, how to identify it, and what to do about it. We look at managing nutrition in dementia care and also the pros and cons of contracting out catering services. In this issue, our regular columns carry some hard-hitting topics, including the New Zealand Nurses Organisation’s stance on the Human Rights Commission inquiry into low pay levels for aged care workers and Associate Health Minister Jo Goodhew’s response. We appreciate your opinions on these topics. Strong feedback was received for the article appearing in the last issue about the couple who could not be accommodated by a village on the basis of their power chair. There is certainly plenty of food for thought in this issue of INsite, so keep your views coming in. Jude Barback, Editor, editor@insitemagazine.co.nz

REGULARS 2

NEWS Snippets and updates from the industry

ON THE SOAP-BOX... Martin Taylor

LET’S SNOOP AROUND... Te Hopai

SPOTLIGHT ON... dental care for the elderly

RESIDENT CHITCHAT... with Les and Jean Williams

A TYPICAL DAY IN THE LIFE OF.... Ainslie McMaster

CONFERENCE CORNER... Report on 2012 RVA Conference

RETIREMENT VILLAGE SECTOR UPBEAT Richard Hincliffe

UP CLOSE AND PERSONAL WITH... Diana Triplow

LAST WORD... Nano Tunnicliff

RESIDENT CHITCHAT... with Les and Jean Williams www.insitemagazine.co.nz | August/September 2012 1

News NEWS IN BRIEF

»» AGED CARE WORKERS TAKE STRIKE ACTION Employees of Aranui Home and Hospital recently took industrial action in pursuit of fair pay following months of failed negotiations. The strike follows the release of the recent Human Rights Commission report, which exposed the low levels of pay for aged care workers. »» WAIKATO REHAB SERVICE Waikato DHB has implemented a personalised rehabilitation service to help older people recover in their homes following a stay in hospital or admission to an emergency department. »» METLIFECARE DEAL GOES THROUGH AT LAST After much tweaking of the initial proposal, shareholders voted through the $216 million deal to expand the Metlifecare operation by merging with Vision Senior Living and Private Life Care Holdings. »» FOUR-YEAR CERTIFICATION Bupa’s Parkhaven Care Home recently joined the relatively small number of care homes in New Zealand with four-year certification status following a recent audit. »» OLDER PEOPLE STRUGGLE TO AFFORD HEALTH INSURANCE National health insurer, Accuro Health Insurance, is challenging the Government to provide tax rebates for older people who can’t afford their own health insurance. »» PIN AND PASSWORD SECURITY The case of a recently imprisoned caregiver and her husband, who had stolen a large sum of money from a 99-year-old rest home resident, highlights the need for older people to take care with sensitive information such as PIN numbers and passwords. »» RESEARCH FROM AROUND THE GLOBE »» AUSTRALIA: New report shows healthcare system will struggle to keep up with the growing ageing population. »» USA: Comprehensive new review on international dementia research has been published. »» UK: Groundbreaking new study published on the causes of osteoarthritis.

PERSONALISED REHAB

SERVICE FOR OLDER WAIKATO PATIENTS W

aikato District Health Board has introduced a personalised rehabilitation service to help older patients who have been in hospital recover faster. The Supported Transfer and Accelerated Rehabilitation team (START) aims to support their recovery in their own homes. START is similar to the Canterbury DHB programme following the earthquake. The teams are made up of community and hospital specialist older person’s nurses. When a person over 65 presents at a Waikato emergency department, the team supports that patient so he or she doesn’t need to be admitted into hospital. They also provide postoperative care at home so older patients can return home sooner. Patients are set individual rehabilitation goals and the team works intensively with the patients and their

families in their own homes to achieve these goals – sometimes up to four times a day, seven days a week. START currently operates in Hamilton, Thames/Hauraki, and South Waikato. Suitable clients are assessed to have a potential for partial or complete recovery with home rehabilitation within six weeks. Their home has to be an appropriate and safe environment for the client and the team to work in. Health Minister Tony Ryall believes it is a good example of partnerships between primary and hospital health care. “Integrating health services between hospitals and health professionals in the community not only makes sense, most importantly, it is better for patients.” The initiative is in line with the Government’s plans to invest an extra $40 million into home-based support services over the next four years.

Aged care

workers strike

JUST UNDER 70 members of the New Zealand Nurses Organisation (NZNO) and the Service and Food Workers Union Nga Ringa Tota (SFWU) employed at Aranui Home and Hospital recently took industrial action. The strike follows the recently released Human Rights Commission’s report exposing low levels of pay for residential aged care workers. Negotiations between union members and employers for fair pay have been happening since October last year. The majority of Aranui rest home care staff are paid the minimum wage of $13.50, and over the past 11 years, have only had increases when the law has been changed to increase the minimum wage. NZNO Industrial Advisor, Rob Haultain, says Aranui is a good example of the ‘slavery’ depicted in the HRC report. “These workers are shown little respect for the complex work they do or the fact that they are the core of the employer’s business.”

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August/September 2012 | www.insitemagazine.co.nz

NEWS

In village news METLIFECARE DEAL GOES THROUGH AT LAST

After changing some of the terms of its much-debated merger deal, Metlifecare’s shareholders eventually voted through the $216 million deal to expand the business by taking over Vision Senior Living and Private Life Care Holdings. The changes included reducing the number of Metlifecare shares issued to Vision Senior Living shareholders from 20 million to 10 million shares. Metlifecare also announced that instead of raising additional capital from third party investors to reduce debt, it will rationalise its property asset portfolio. The Metlifecare board said it would also appoint two further independent directors, the first within 30 days of completion of the deal. Metlifecare chief executive and managing director, Alan Edwards, said it took a lot of understanding between all the parties to make the deal work and was reportedly delighted after it was announced that 79 per cent of shareholders had agreed to the deal. The merged entities will have 24 retirement villages and $1.9 billion of investment properties – although debt has to be deducted to reach total net assets.

SUMMERSET’S EXPANSION

Metlifecare is not the only village operator expanding. Summerset Group has recently been granted consent from the Overseas Investment Office to buy a large Hobsonville site – the 7.6ha Monterey Park. Summerset will spend $80 million building about 300 units, along with hospital-level care and rest home facilities. The project is expected to take around seven years to complete. Summerset is reportedly developing five villages and has a target of building 155 units this financial year. The company also has land in Karaka in South Auckland and Katikati in the Bay of Plenty that could potentially allow for the development of a further 1052 units.

FOUR-YEAR CERTIFICATION

A MARK OF SUCCESS FOLLOWING AN AUDIT against the Health and Disability Services Standards, few care facilities are granted the maximum four-year certification period, an indication of very high quality care provided to residents. Bupa’s Parkhaven Care Home and Hospital in Mangere, Auckland, has recently joined the club of facilities with four-year certification following its recent audit. This marks the eighth Bupa care home with the four-year certification period. Of the 679 care homes in New Zealand, only 28 have achieved the four year status. Parkhaven’s recent certification means Bupa owns just under a third of those with four years. Bupa’s success echoes that of Presbyterian Support Otago Holmdene’s four-year certification announced earlier this year, gives five out of seven PSO rest homes four year status. Audits look at facilities’ compliance with 249 criteria, rating each as either unattained, partially, or fully attained. Continuous Improvement ratings are where the criterion is fully attained, with the service demonstrating continued review and improvement. Audit reports for all residential care facilities are available on the Ministry of Health website.

CARER THEFT HIGHLIGHTS

IMPORTANCE OF PIN PROTECTION A RECENT $37,500 theft from a rest home resident by her caregiver has sparked a call for tighter PIN and bank card security. The caregiver and her husband, who stole a large sum of money from 99-yearold rest home resident, Emilia Antunovich, were recently sentenced to 10 months in prison. Their case highlights the need for older people to take care with sensitive information such as PINs and passwords. Caregiver Ranita Devi and her husband, Ahlokh Chand, both 32, used Antunovich’s stolen bank card and PIN to withdraw $37,500 to pay for a cooking course, immigration fees, and daily household expenses. It was a lawyer who eventually noticed ATM transactions in March, and knowing Antunovich never used ATMs, raised the alarm. Devi gained access to Antunovich’s money as the PIN was kept in close proximity to the card.

Ed Thomas of the Retirement Villages Association says the case reinforces the need to follow strict guidelines around PIN and password protection, including never keeping records of passwords or writing them down, never using the same password for multiple accounts, and never disclosing them to anyone, including bank staff, police, or family members.

www.insitemagazine.co.nz | August/September 2012 3

NEWS

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August/September 2012 | www.insitemagazine.co.nz

A new report by GlobalData suggests that the Australian healthcare system will struggle to keep up with its swiftly growing ageing population. The Australian population aged 65 years and older is projected to account for approximately 18.3 per cent of the population by 2020, due to a longer life expectancy, improved healthcare facilities, and strong financial and healthcare support by the government. The report says that although the Australian healthcare market is presently in good shape, driven by universal healthcare coverage and good access to facilities such as governmentsubsidised medicines, the growing ageing population will challenge Australia’s ability to maintain this level of care. The Australian Government currently has a high level of financial and policy responsibility for health services. As the elderly population increases, so, too, does the Australian Government’s cost burden. In spite of this, Australia has well-defined regulatory guidelines and increasing pharmaceutical research and development spend: the GlobalData report predicts the growing ageing population will lead to strong growth in the medical care and diagnostic markets. The report echoes concerns in New Zealand about how our healthcare system is ill-prepared for the ‘grey tsunami’. A recent documentary on Close Up discussed the urgency of increasing the number of care beds to meet growing demand.

USA: COMPREHENSIVE NEW REVIEW OF DEMENTIA RESEARCH A new study published in American journal Clinical Gerontologist brings together the latest international research on dementia family caregivers. The study, ‘International Perspectives on Nonpharmacological Best Practices for Dementia Family Caregivers: A Review’, has been described by the journal’s editor, Larry Thompson, as “one of the most comprehensive articles on this topic ever to be published.”

The review includes studies of evidencebased programmes from various countries, including counselling, psycho-educational, and skills training programmes, as well as emerging treatment models such as Internetbased programmes, telehealth, and other technological interventions. Authored by scholars from around the world, the review presents several specific policy recommendations, providing a critical resource to researchers, service providers, and policy makers. In April 2012, the World Health Organisation (WHO) released a report on international preparedness for growing dementia care needs. Global policy efforts are under way to assess needs and provide cost-effective care for the growing population with dementia.

UK: OSTEOARTHRITIS BREAKTHROUGH

Ground-breaking research by UK scientists surrounding the cause of osteoarthritis was published earlier this month in leading medical journal The Lancet. The study included the discovery of more genetic regions associated with the cause of osteoarthritis, a disease that affects around 40 per cent of people over the age of 70. Previously, only three osteoarthritis genetic regions had been identified. Now, the Arthritis Research UK-funded arcOGEN consortium has highlighted eight genetic regions linked to the development of osteoarthritis. Several of the genetic regions encompass genes that are known to regulate how joints are made and then maintained. Another genetic region contains a gene involved in the regulation of body weight, which is a strong risk factor for osteoarthritis. The study, which was one of the largest of its kind, has been described by researchers in the field as a significant breakthrough in understanding the genetic risk factors that cause the disease. There is currently no cure for the osteoarthritis. Painkillers and physiotherapy are initially used until joint replacement becomes a viable option.

NEWS

HEALTH INSURER

CHALLENGES GOVERNMENT NATIONAL HEALTH INSURER, Accuro Health Insurance, is challenging the Government to provide tax rebates for older people who can’t afford their own health insurance. Chief executive, Bruce Morrison, says too many older people are cancelling their policies with health insurance companies and entering the public health system, placing a huge burden on the public health spend. While Morrison acknowledges many older people can’t afford private health care, he says others would be able to contribute to ongoing health insurance if the Government offered an

incentive, like the Australian system, which provides incentives for everyone with private health insurance. “Their government has an effective public/ private model and, as a result, nearly half of Australians have health insurance, up from 30 per cent in 1999. In comparison, less than a third of New Zealanders have health insurance, down from 48 percent in 1990,” says Morrison.

“

He suggests that a subsidy such as a tax rebate to retain health insurance for people over 65 is far more valuable than a range of Gold Card concessions for bus travel and cheap cinema tickets. Accuro is inviting Health Minister Tony Ryall to its Wellington headquarters to discuss the issues of retaining older people in the private system.

A tax rebate to retain health insurance for people over 65 is far more valuable than a range of Gold Card concessions for bus travel and cheap cinema tickets.

”

Your dedicated sponsor for years and years and years.

We’re proud to be sponsoring the Retirement Villages Association conference for the 14th year in a row. Having worked so closely with your industry for many years, we understand how access to knowledge and expertise can make all the difference. Whether you’re in it for profit or not for profit, don’t wait until the conference to talk to us about your plans. If you currently have a Retirement Village, are planning new stages or are considering a new Village altogether, give one of our Healthcare Relationship Managers a call today to discuss how we can help. Auckland: Richard Hinchliffe, Head of Healthcare (09) 252 2952. Reuban Dalzell (09) 252 3095

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www.insitemagazine.co.nz | August/September 2012 5

FOCUS

WHAT’S ON

THE MENU? JUDE BARBACK looks at how aged care facilities balance legal, nutritional, and specific dietary requirements with budget, resources, and changing taste preferences when it comes to menu planning.

once read a letter in a magazine, of the agony aunt variety, from a young twenty-something wondering what to serve her visiting eighty-something grandmother to eat. Her preconceptions of ‘old people’s food’, drawn from her limited experience of care homes, included over-cooked vegetables, mash, meat in a stew or drowned in gravy, stewed fruit, and custard. The responses from the readers ranged from scathing to enraged. Didn’t Miss Whippersnapper know that older people enjoy the same sorts of food as younger generations? Didn’t she realise they enjoyed a variety of different foods from different origins? The heated, if rather lightweight, debate left me wondering about the difficulties that must confront the menu planners in aged care facilities. In addition to meeting legal nutritional requirements and the specific dietary needs of residents, they must also have to take into consideration the changing and varying taste preferences of older people. 6

LEGAL REQUIREMENTS

Pushing all taste preferences aside for the moment, it is worth noting that the industry is fundamentally guided by the Health and Disability Services standard NZS 8134.1.3.13: A consumer’s individual food, fluids, and nutritional needs are met where this service is a component of service delivery. The criteria underpinning this overarching standard highlight the importance of meeting recognised nutritional guidelines, any additional nutritional requirements and personal taste preferences of consumers, as well as adhering to legislation and guidelines for food procurement, preparation, storage, and delivery. It links in with the Ministry of Health’s Food and Nutrition Guidelines for Healthy Older People, which, in turn, supports the Ministry’s Health of Older People Strategy. The guidelines recommend specific numbers of serves from each of the four food groups daily – for example, at least six serves of grains, at least five serves of fruits and vegetables,

August/September 2012 | www.insitemagazine.co.nz

at least three serves of milk (or foods made from milk), and one to two serves of meat or meat alternatives. Facilities must also adhere to the stipulations of the Age Related Residential Care Agreement, which complies with the Food Hygiene Regulations 1974, the Health Act 1956, and the Health and Disability Commissioner Act 1994. The agreement requires ‘a food service of adequate and nutritious meals, and refreshments and snacks at morning/afternoon tea and supper times, that reflects the nutritional requirements of older people, and as much as possible takes into account the personal likes/dislikes of the Subsidised Resident, addresses medical/cultural and religious restrictions, and is served at times that reflect community norms’ (Clause D15.2). While the agreement includes some safety clauses around food handling, it will soon become an additional legal requirement for all food providers to meet the standard in the Food Act 1981 that says they must have a written food safety programme that includes addressing

any potential hazards of food preparation (based on the principles of Hazard Analysis Critical Control Point), the skills and competence of those preparing the food, and the types of food that should not be served or sold. Some organisations follow additional standards, which may include reference to their mission statements or specific resident agreements. For example, Oceania Living’s philosophy of care document shows they will “provide food choices from which residents may make their selection and allow, within reason, the resident to make the decision of where they wish to dine.” Oceania’s dietitian, Jessica Bowden, says that in addition to the Ministry of Health guidelines, Oceania also adheres to the Australian standardised definitions and terminology for texturemodified food and fluids.

DIETITIAN INPUT

The Dietitians New Zealand Menu Audit is designed by dietitians ‘to help ensure facilities meet the requirements for certification

FOCUS under the Health and Disability Sector Standards and DHB Accreditation’. The audit, which also incorporates assessment of the food purchases that can assess if the facility is purchasing enough food to meet the residents’ needs, appears to keep facilities in check with regards to nutrition and dietary variety. While it is not currently a legal requirement to have a dietitian involved in menu planning, the audit process means a dietitian is often involved by default. Janice Petty, manager of Albert Park Residential Care in Gisborne, a 33-bed independent rest home, says they have the input of a dietitian for menu planning. Menus are sent for review and approval and any recommendations are taken into account. “Although it’s not a legal requirement, most facilities do have the input of a dietitian as it is one thing closely scrutinised in the audit process,” she says. Sue Prowse, manager of Rosebank Rest Home and Hospital in Ashburton, says they have a registered dietitian reviewing the menu and making recommendations if required. Their meals are constantly audited by both internal and external processes. Prowse says it is a very useful way of maintaining quality control. “If we are lacking in some areas, like protein or calcium, for example, they inform us and suggest ideas on how we can improve on those areas. Internally, we measure plate wastage and food temperature.” Te Ata, a small independent rest home in Te Awamutu, relies on the auditing process revise anything lacking. A nurse at Te Ata believes strongly in quality control. “At the end of the day, it all comes down to audit process to ensure quality of care,” says a nurse at Te Ata. This emphasis on quality control is shared by general manager Andrew Russ. Employing a dietitian is another cost to factor in, but one that Petrina Turner-Benny, chief executive of Dietitians New Zealand, believes is definitely worth it. “In many cases it is a perceived cost,” she says. Turner-Benny says that many facilities fail to acknowledge the importance of including a dietitian

in their service. She says many do not understand that a dietitian can help to achieve savings on food costs as well as provide the expert input into the menu planning. When tube feeding or a special diet is required, a dietitian has prescribing rights and the specialist knowledge for assessment, treatment, and monitoring of the resident. Turner-Benny says Dietitians New Zealand is currently in the process of releasing a draft checklist to ensure optimal levels of nutrition in aged care facilities. The checklist is currently being discussed with a range of relevant bodies, including designated audit agencies and Standards New Zealand. A survey of aged care facilities will also shortly be under way, in order to better comprehend where the deficits in understanding of nutritional care lie.

the national resident, facility, and kitchen requirements for the menus. A criticism sometimes voiced about standardised menus is that the one-size-fits-all approach does not for allow for flexibility in the individual facilities or fully cater to the needs of individual residents. However, Bowden says a menu policy has also been developed at Oceania to outline areas for flexibility; for example, the facilities can provide food suitable for themed days while ensuring nutritional standards are maintained. She says individual resident requirements are maintained by dietary requirement forms completed by residents on admission to a facility and when requirements change. Facility managers take ownership of the kitchen outcomes by way of spot checks and food service audits.

“

staff and the importance of these requirements, and adherence to the standardised menus. Staff knowledge is important. A recent Otago University study about the dining environments in New Zealand rest homes found that common barriers to optimum nutrition for residents included menu changes by staff with inadequate nutritional knowledge, failing to provide adequate portion sizes to meet nutritional needs, and failing to get feedback from residents on meals. Turner-Benny, who has had experience in the rest home sector, agrees that training is an important aspect. She stresses the importance of an annual education programme for staff on food and nutrition. Rosebank in Ashburton is a good example of an organisation that takes education in this area

This new generation will pose an increase of variation in the menus so that they do not develop food boredom. Choices are important.

STANDARDISED MENUS

As expected, most large aged care facilities with multiple sites employ dietitians to ensure standards are met across their range of facilities. Bowden, Oceania’s dietitian, says Oceania maintains nutritional standards by the use of standardised menus and recipes designed and approved by a dietitian. This winter marks the launch of the third standardised menu for Oceania. Feedback systems have been established to understand

”

Bowden says that while the Bureau Veritas section on nutrition is useful in ensuring facilities keep necessary documentation, it is really just a snapshot of one moment in time and is unlikely to maintain nutritional standards or address ongoing quality control issues on a daily basis. To ensure that nutritional standards are consistently met requires ongoing assessments and processes, such as training, policies, manuals, understanding of residents’ nutritional requirements by kitchen

seriously. Manager Sue Prowse, says training in nutrition is provided for staff along with food hygiene courses. The cooks take the food and hospitality unit standards.

RESOURCES

Aged care providers certainly have a lot on their plates when it comes to menu planning. Meeting regulations and nutritional guidelines are only part of it. Providers and facility managers also need to ensure staff members have the necessary resources to Continued on page 8 >>

www.insitemagazine.co.nz | August/September 2012 7

FOCUS <<Continued from page 7 execute the menu. The appropriate recipes, level of skill, time to prepare the food, equipment, and capacity are all essential. A realistic food budget is important, too, regardless of the size of the operation. Bowden says catering to the varying needs, whilst fitting into procurement and budgetary constraints, needs to be managed carefully. Financial reporting, consolidation of products, and building supplier relationships all help Oceania keep within budget. Some facilities employ more creative strategies for enjoying luxury foods within budget. At Rosebank, for example, the residents run raffles to fund purchases for things like oysters or whitebait when they are in season.

VARIETY

Resident satisfaction in terms of taste, texture, temperature, familiarity, and variety are all important factors in menu planning. Nutrition expert Gaye Philpott says that from

a menu planning perspective, food satisfaction is closely linked to menu variety, choice, and familiarity of foods. “Repetitive menus are boring and likely to impact negatively on meal satisfaction and oral intakes. For this reason, it is recommended that menus for long-stay organisations are a minimum of four weeks (acute care facilities such as hospitals may operate shorter menus) and that only a limited number of dishes are repeated during the cycle and repeated only once. Ideally, there should be a separate menu for warmer and colder months, offering different choices and not merely be a rearrangement of the same meals.” The Otago study findings tally with Philpott’s recommendations, showing that menu cycles should be at least four weeks, with menu audits by registered dietitians. The study also reveals that portion sizes should be adequate for key components of the meal, and meals and snacks should be served frequently, preferably with 24-hour availability. Choice should be

available to residents, as should familiar foods according to culture, age, likes, and nutritional needs. Meal service systems should also encourage familiarity. Worryingly, Philpott says that in reality there is often little choice at meals apart from breakfast. “I work in many rest homes in the lower North Island and am involved in the menu planning of some major national providers, and none provide a choice at the main meal – for example, the choice between chicken casserole or roast beef – and only one offers two distinct choices at the secondary meal.” Philpott says that while rest homes will generally cater for strong food dislikes, residents don’t usually get a lot of choice on the day. “This will very likely change,” she says. “I don’t expect younger generations will accept no choice when they get older and need care.” Philpott is right. The baby boomers, the next generation to descend on the aged care industry, are unlikely settle for a ‘take it or leave it’ approach to food.

CHANGING TASTE PREFERENCES

The baby boomers and subsequent generations are also likely to have enjoyed a diverse range of different ethnic foods, vastly differing from the overcooked vegetables, meat, and gravy stereotype. Philpott concurs. She says that while potato is currently served most days at the main meal, future generations are likely to enjoy more pasta meals or rice accompanying a curry or stir-fry. Bowden agrees, saying that the sweet and sour chicken recipe on the Oceania menu this winter has received a lot of positive feedback from residents. “This new generation will pose an increase of variation in the menus so that they do not develop food boredom. Choices are important so that residents who prefer a traditional ‘plain’ meal are still catered for,” says Bowden. Oceania, like other large providers, is in constant touch with suppliers with new products and developments. Such new products

COMMON NUTRITION MYTHS

There are many schools of thought and opinions regarding good nutrition for older adults in residential care, but what is actually true? LAUREN SCOTT dispels 10 common nutrition myths.

“They’re old – just give them anything to eat.” While it’s important that everyone is able to eat foods they enjoy, balance is still important. Poor nutrition leads to increased frailty, which, in turn, results in increased likelihood of falls, general illness, pressure areas, and delayed wound healing, as well as the requirement for increased assistance for daily activities.

“They aren’t that active so it’s OK for them to skip meals.” Skipping meals will almost automatically result in impaired intake of essential nutrients – older adults have increased requirements for key nutrients such as protein, calcium, and vitamin D and need regular and balanced meals to ensure adequate quantities are obtained. Activity should also be encouraged as it can assist in improving appetite.

“Mouli and thickened describe requirements for texture/ fluid-modified diets.” There is not one texture for all! There are three recognised modified texture diets and fluid grades – providing the incorrect textured meal or fluid thickness will not only unnecessarily impact on nutritional intake but will increase risk of aspiration. Ask your dietitian if you are unsure.

“Just give them a small serve – a standard portion will overwhelm them.” A smaller portion will essentially result in a smaller intake for someone who does not eat well – try offering a standard-size meal combined with encouragement to eat, or alternatively, second helpings to ensuring nutritional intake is maximised. This is especially true for texture-modified meals,

which should also be served in a standard portion.

“Diabetics must have a sugar-free diet.” Except when determined on an individual basis , all older adults, including those with diabetes, should be encouraged to have a balanced diet, including foods containing some sugar such as baked products and desserts. General restriction of sugar for all older adults with diabetes can result in impaired nutrition intake and malnutrition.

“If you drink more fluid, you will need to go to the toilet more frequently.” Surprisingly untrue! The more fluid someone drinks, the less likely they are to have the urge to go to the toilet. When your urine is less concentrated, your bladder doesn’t communicate to your brain that it has a full load and needs to empty as frequently.

“Nutrition supplements should be given as soon as someone loses weight.” It is important to investigate the cause of weight loss first. Is it due to illness, loss of appetite, depression, declining ability to self-feed, deteriorating swallow, or something else?

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FOCUS Manager Pakize Sari says that after considering research that showed that it was better for residents to have their main meal in the evening due to the long wait until breakfast, especially as residents often miss the late evening supper, they surveyed their residents on whether they wanted to change. The survey showed a clear preference for keeping the main meal in the middle of the day. Resident feedback is important. Despite the Otago findings, which â&#x20AC;&#x153;Residents are not fond of too show that a failure to obtain resident much change, which can sometimes feedback was a barrier to optimum make it difficult trying to bring in nutrition, the facilities I investigated new styles of cooking. We do add all appear to have good mechanisms new ideas into our menus and go by in place for resident feedback on any the feedback that we receive from aspect of residential care, including the residents in whether we continue food. with this change,â&#x20AC;? says Prowse. At Rosebank, annual resident The changes are not limited to satisfaction surveys include a taste. It is expected that gradually question about the food service. At residents will come to expect their the residentsâ&#x20AC;&#x2122; meetings, the kitchen main meal, which is currently served supervisor informs residents of in the middle of the day at most any changes to the menus, with an facilities, to be served in the evening. opportunity for residents to raise Te Hopai recently looked into issues with the menu. bringing about the change but At Te Hopai in Wellington, the found the residents werenâ&#x20AC;&#x2122;t ready. contracted chef joins the residentsâ&#x20AC;&#x2122;

meetings and also does the morning tea round to get daily contact with the residents. At Albert Park Residential Care in Gisborne, manager Janice Petty says they rely on residentsâ&#x20AC;&#x2122; feedback via monthly residentsâ&#x20AC;&#x2122; meetings, where they are encouraged to discuss any thoughts on the food with the activitiesâ&#x20AC;&#x2122; manager. There is also a suggestion box for residents and family members to use.

Leaders in Emergency Call Systems

can be trialled at sites to assess how readily they are accepted by residents. Although elderly taste buds may be changing, introducing change to residents can sometimes be thwarted by the residents themselves. The Otago study found that residents claimed to enjoy the food similar to what they had eaten when they were younger â&#x20AC;&#x201C; therefore reflecting age culture. Sue Prowse has experienced this, at times, at Rosebank, where they are keen to add new flavours to reflect the growing ethnic diversity of the residents.

BALANCING PREFERENCE WITH NUTRITION There are occasions when taste must give way to suitability. At Rosebank, manager Sue Prowse says although other aspects, such as budget and residentsâ&#x20AC;&#x2122; opinions, are taken into consideration, nutritional value is the main factor in menu planning. Nutritionist Gaye Philpott, says that while cooking is likely to change to reflect a modern preference for crisp and crunchy vegetables, the current practice of cooking vegetables until soft is sometimes necessary because older Continued on page 10 >>

TRUST THE EXPERTS IN CALL SYSTEMS TO ASSIST YOU caLL systems Selecting a nurse Leaders call systeminisemergency a daunting task. With so The solution might involve a number of actions that promote how do you choose the right solution food rather than a fluid supplement, the taste andmany texturetechnologies of which will fatigue over time and therefore be consumed less and the best partner? consistently. At Austco, we understand aged care. Over the past 25 years, â&#x20AC;&#x153;The dining environment isnâ&#x20AC;&#x2122;t as important as what is on the plate.â&#x20AC;? Itâ&#x20AC;&#x2122;s all very well producing a balanced,more nutritious, than 6000 facilities have trusted us to assist them. and tasty meal, but if it isnâ&#x20AC;&#x2122;t eaten, there is no benefit. The environment residents eat in plays a significant role in us for an obligation free consultation. Call ensuring they eat well. Social interaction combined with a dignified environment free from distraction such ABOUT as loud noise AUSTCO from the kitchen, television, disruptive residents, and clinical Leaders owned in Emergency Call Systems of Azure Healthcare Austco subsidiary procedures or medication rounds will ensure residents are is a wholly given the opportunity enjoy their meal. Ltd, an international provider of healthcare communication â&#x20AC;&#x153;Overweight residents are well nourished.â&#x20AC;? Not necessarily and clinical workflow management â&#x20AC;&#x201C; being overweight can result from eating energy-dense solutions. but nutrient-poor food and fluids. If combined with reduced activity levels, skeletal muscle mass can decrease and being www.austco.co.nz overweight can also mean being frail.

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TRUST THE EXPERTS IN CALL SYSTEMS TO ASSIST YOU Selecting a nurse call system is a daunting task. With so many technologies how do you choose the right solution and the best partner? At Austco, we understand aged care. Over the past 25 years, more than 6000 facilities have trusted us to assist them. Call us for an obligation free consultation. ABOUT AUSTCO Austco is a wholly owned subsidiary of Azure Healthcare Ltd, an international provider of healthcare communication and clinical workflow management solutions. www.austco.co.nz

Selecting a nurse call system is a daunting task. With so many info@austco.co.nz (09) 271 3712 technologies how do you choose the right solution and the best

â&#x20AC;&#x153;Care givers donâ&#x20AC;&#x2122;t need to worry about food safety â&#x20AC;&#x201C; thatâ&#x20AC;&#x2122;s the kitchenâ&#x20AC;&#x2122;s responsibility.â&#x20AC;? Everyone that enters the kitchen and serves food to a resident should consider food safety part of their responsibility â&#x20AC;&#x201C; hats should be worn at all times in the kitchen, food should be appropriately labelled and stored, and hands washed regularly.

Lauren Scott (NZRD) is Strategic Partnership Manager for Compass Group Cathy Oâ&#x20AC;&#x2122;Leary (NZRD) is Nutrition & Risk Manager for Medirest Robyn Nesbitt (NZRD) is National Dietitian for Compass Group â&#x20AC;&#x201C; non-healthcare divisions

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people may have ill-fitting dentures or lack or have sore teeth. Philpott says in order to satisfy nutritional requirements, menus should offer wholegrain breads and cereals daily, a variety of fresh and frozen vegetables over a week, including coloured and green vegetables daily, a variety of canned fruits, and access to at least one serve of raw fruit or vegetable daily. Heart-friendly fats and moderate amounts of iodised salt should be used in food preparation. Desserts based on milk and fruit, such as apple crumble and custard or creamy rice and peaches, should dominate in any week. Dietitians New Zealand has established recommended serving sizes, which they audit against. For example, 100g cooked meat or meat alternative is a daily serving (noting that this is equivalent to 130g meat as purchased, because one can expect 25-30 per cent shrinkage and waste on cooking), which may be served between two meals when appetites are small. The changing generations also present an increasing number of people with allergies and intolerance to certain foods. Years ago, ‘glutenfree’ was not a familiar term in rest home kitchens, but increasingly, chefs will need to be mindful of providing food that caters for people with such conditions.

CATERING FOR DIFFERENT LEVELS OF CARE

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It is no surprise that individuals will have different dietary requirements, but it does mean facilities need to be conscious of each resident’s specific needs. An aged care facility may have a variety of levels of care and differing dietary needs within each level. The inhabitants of retirement villages tend to be younger and healthier and are generally able to prepare or purchase their own meals, rendering café/restaurantstyle catering more appropriate. Meanwhile, rest home residents typically enjoy familiar foods and often prefer lighter meals. Bowden says residents with dementia typically have high energy outputs due to higher activity levels or uncontrollable shaking. Some with dementia have restrictive food behaviours, which impacts on food acceptance.

Hospital-level residents require the most nutritional care. Bowden points to a nutrition survey across 56 hospitals in Australia and New Zealand that identified an overall malnutrition prevalence of 32 per cent, consistent with malnutrition figures in Europe and USA. Consequently, Bowden says food fortification is important. Adequate protein and energy contents of meals are needed to prevent and treat malnutrition. Medical or cognitive conditions can sometimes affect a person’s ability to safely swallow food, in which cases texture-modified meals are required. Medications can also impact on the saliva content; therefore, additional gravies and sauces are required to ease the person’s ability to consume a meal. Residents who require texturemodified food should also be provided with an adequate and varied menu, including pureed, minced, or moist options at all meals and snacks. Similarly, alternative proteins should be provided for vegetarian residents or those who exclude certain foods for ethnic or religious reasons. While nutritional aspects of medical conditions should certainly be taken into serious consideration, Philpott says highly restrictive diets for managing specific conditions or the risk of such conditions, such as diabetes and heart disease, are generally not necessary. “There is good evidence that strict avoidance of sugar when a person has diabetes is unlikely to change diabetic outcomes. Adding salt at the table if it enhances a resident’s meal experience should not be shunned either. The likes of such are more important for younger people whose food choices today are very likely to influence their long-term health outcomes,” says Philpott. There is certainly a lot to take into consideration when it comes to menu planning in aged care facilities: regulations, nutritional requirements, cost, changing tastes, resident preferences, and specific dietary requirements. Perhaps the young twentysomething who penned the letter asking what she should feed her elderly grandmother could be excused as there appears to be plenty of food for thought in this aspect of aged care.

FOCUS

Dementia and nutrition CAROLINE BARTLE discusses the importance of good nutrition for people with dementia and gives some practical advice to help make meal times easier.

ood nutrition is vital for a person with dementia. However, maintaining a healthy weight can be a challenge for many people with dementia. Difficulty with eating and drinking is more noticeable as dementia progresses, and unwanted weight loss is a common problem but not an inevitable part of the disease process. The impact of good nutrition on the health of our brains cannot be dismissed. We know that malnutrition affects physical and mental wellbeing. Despite the research conducted on this topic, there are no conclusive guidelines on consuming actual quantities of nutrients to help to reduce the risks of developing

dementia or the progression of dementia once diagnosed.

A person in the early stages of dementia may lose the ability to concentrate on the activity of cooking or feeding long enough to CAUSES OF POOR NUTRITION complete it. They may experience changes in Eating and drinking involves coordination of their taste sensations, sometimes preferring physical and mental activity. These activities sweet foods to savoury or vice versa. In the are often affected by ageing as well as the case of Lewy Body dementia, a person can progressive impairment of memory, thinking, experience taste hallucinations that might perception, planning, organisation, and impact on nutrition. Depression can be a communication. For example, a person with common feature of dementia, which can lead dementia may lack the motivation to eat, to nutritional difficulties. or in the later stages, lose the coordination The physical changes in the brain can skills to feed themselves or develop problems lead to poor motivation, which leads to lack swallowing. They may forget if they have of activity, which can cause other physical Continued on page 12 >> eaten or that they need to eat at all. www.insitemagazine.co.nz | August/September 2012 11

FOCUS <<Continued from page 11 problems, including constipation. Quality organisations address this by taking both preventable and remedial action, including exercise and increasing fibre and fluid in the diet. We also need to be aware that some people with dementia may experience difficulties with their sight and visual perception. They may be unable to see or recognise the cutlery, crockery, or the food in front of them. Difficulties with depth perception and colour contrast can make it difficult, for example, to identify white fish against a white plate. This may give us the impression that they are not hungry or uninterested in eating. However, this may be an incorrect assumption to make, and may be easily solved by providing a red plate to support colour contrast difficulties.

A PERSON-CENTRED APPROACH It is up to us to identify what the difficulties are and not make the assumption that they do not wish to eat. We need to understand the challenges faced by the cognitive deficits, whilst at the same time identifying how to use strengths to encourage active participation in meal times. A person-centred approach should be taken at meal times. For example, meals should be provided in a way that is familiar

to people. A person with dementia may be used to eating their main meal in the early evening by themselves, sitting in a comfortable chair, listening to the radio. If this person is suddenly offered their main meal at lunch time and expected to sit at a dining table with others, it would be no surprise if they refuse to eat the meal or leave it uneaten. This new situation may be confusing and unfamiliar to the person or they may just not be hungry at that time of the day. The social environment plays an important part in the care of a person with dementia. As memory is contextual, changes can be made in the environment to help reinforce a person’s identity and their reality. Finding out through continuous assessment what the person’s perception is will enable you to identify what works. For example, a person might prefer a cup and saucer as opposed to a mug for tea. Supporting a person’s reality will give them a sense of well-being, and enable them to be more independent at meal times. Food and images of food can be used as part of reminiscence activities. This can help stimulate discussion and interest in food and meal-times by helping the person to reconnect with familiar food from their past. This can be part of the assessment process or form part of a group activity process.

CHECKLIST Is the person able to express food preferences? Is the person able to feed themselves independently? Does the person have insight into what is a balanced diet? Does the person have memory problems and need prompting to eat? Is the person experiencing other physical or mental health problems that are impacting on their nutritional state? Is the person on any medication that affects their appetite? Does the person present with any behaviours that affect the process of eating? Does the person experience any depth, perception, recognition, or have coordination problems? Does the person require any specially adapted equipment to enable them to eat? Are there any environmental factors that influence eating?

“

The social environment plays an important part in the care of a person with dementia. As memory is contextual changes can be made in the environment to help reinforce a person’s identity and their reality.

”

August/September 2012

Does the person have problems with their oral health that may lead to difficulties eating? Does the person have any sensory difficulties that are impacting on meal times? Is the person more alert at certain times of the day? Does the person have problems with swallowing? Based on the information above, what recommendations do you make for the care plan? Do you need to seek advice from other professionals? If so, which professionals?

www.insitemagazine.co.nz | August/September 2012 13

FOCUS

To contract out or do

ow to cater for residents can be a difficult issue for retirement villages and aged care facilities. Should they contract catering services out to a professional company? Or employ people to do this on site? John Collyns, director of the Retirement Villages Association (RVA), says this is a topic that crops up now and again in discussions had by the RVA’s food and beverage forum. Collyns says many villages have subcontracted out their catering and then brought it in-house, or vice versa, struggling to find the best option for them. “It seems a cyclical thing – people do it themselves, get all tangled up and subcontract it, then that doesn’t work (because they’re giving away margins) and bring it back inhouse again ... and so on.” Bruce Cullington, manager of Acacia Cove retirement village, says he is split on the issue. His village currently does it all in-house and runs at a loss. He believes that financially they would be worse off still if they were to contract out, purely because Acacia Cove doesn’t have the economies of scale to support such a decision. Although a relatively large village with 320 people, as a standalone

“

it yourself?

That is the question JUDE BARBACK considers here, looking at the pros and cons of contracting out catering services. contracting companies have the necessary expertise and appropriate training for their staff, which can be a difficult aspect of employing staff to take care of the catering in-house. Job-share arrangements, which are common, can also be problematic, in Cullington’s experience. “Because of job-share arrangements, I feel that no one really takes ownership for the service as a whole,” he says. Cullington is quick to point out, however, that the residents appreciate the familiar faces of their own catering staff. He believes that an employer has more control over who is involved with food preparation and service. Villages that contract out their catering service have been known to lament the frequently changing staff, often with poor English skills, with whom their residents have little rapport. However, this isn’t the case at Te Hopai Rest Home and Hospital in Wellington, which contracts its catering to Spotless. Manager Pakize Sari says the contracted chef, in addition to cooking on-site, attends

The decision by a retirement village to contract out food and support services is motivated by commercial, operational, and systems-based considerations.

”

operation, Cullington doesn’t think Acacia Cove could afford to contract out the catering. If the figures stacked up, though, it would. “In a perfect world, we would contract out,” Cullington says. He believes contractors are likely to achieve better value in food purchases, as they are buying in bulk and have access to better deals. Cullington says it is difficult to plan for the right quantities. “They never go for the healthy option,” he says of his residents. “They pour the salt on. And any form of physical exercise is always followed by a chocolate biscuit and a cup of tea!” The recession hasn’t helped matters. Cullington has noticed a downward trend with people’s disposable income. “Typically, 60 or 70 come to our annual dinner, which is $25, but this year, just 21 have signed up so far.” The importance residents place on food hasn’t waned, however. Cullington says the very few complaints they receive at Acacia Cove tend to revolve around food service: ‘the plates aren’t heated’ is a common one. Cullington believes 14

August/September 2012 | www.insitemagazine.co.nz

the residents’ meetings and even serves the morning tea so as to chat with the residents and glean feedback on yesterday’s meals, to improve the service and build relationships. Sue Prowse, manager of Rosebank Rest Home and Hospital in Ashburton, also thinks contractor or not, the main issue is for the people responsible for the preparation and cooking of the food to have a presence in the kitchen and a connection with the staff and residents. “I believe cooking on-site, whether inhouse or contracted, is an essential component of this service as the residents often give feedback both positive and negative to the kitchen staff,” says Prowse. Certainly, due to more competition and greater expectations of village and facility operators and residents, it seems contractors expect to go the extra mile.

Compass Group New Zealand, a vast organisation, encompassing a plethora of catering companies including Medirest, aimed at meeting the needs of the senior living and healthcare industries, well understands its role in relation to villages and care providers. “We know food is an integral part of life and our community; contractors allow an organisation to define their core business outside of food services and allocate resources, while maintaining a level of assurance that an agreed standard of services is delivered,” says Lauren Scott, Compass’ strategic partnership manager. “The decision by a retirement village to contract out food and support services is motivated by commercial, operational, and systems-based considerations.” Scott echoes what Cullington says about contractors achieving economies of scale when utilised across multiple sites. Scott says contractor organisations can achieve large-scale purchasing cost efficiencies and provide a robust senior management structure to support site management. The expertise held by contractors is another area Scott highlights. With highly trained dietitians and executive chefs on board, they can provide expert advice to organisations, meaning facilities aren’t faced with the price tag that comes with contracting out the services of highly trained individuals. Often, the expertise of contractors, especially those on a large scale like Compass, extends beyond the food into the business of food service delivery systems and processes, ensuring they are up to date and drawing on knowledge and best practice from catering for other sectors. Alliance Catering, owned by the Spotless Group, also sees itself as an expert and innovator. Catherine Mitchell, National Operations Manager for Alliance Catering, says, “Apart from outsourcing compliance management and HR management, and capitalising on purchasing benefits, you are also inviting in our innovation based on experiences in our many other facilities where we see overarching trends.” Mitchell says they can test ideas and, in their customised service delivery model, match client requirements, and develop new ways of serving food and keeping residents happy. “Over the next decade or more as the baby boomers enter villages, the expectation will be quite different –

FOCUS ‘retail cafes’ and ‘home delivery’ meals will play an increasing part in village life, as will restaurant-style service and self-service style dining,” says Mitchell. It will be interesting to watch over the next ten years the evolution of services provided by companies like Spotless and Compass. However, for the time being, contracting out the catering isn’t everyone’s preferred option. Rosebank is one facility that prefers to do it themselves. “Food is a very important component in our residents’ lives. Staying inhouse allows us to be responsive

tea this morning was freshly baked scones straight out of the oven,” says Taylor, by way of example. “We are also in a better situation to respond to residents’ likes and dislikes. Because our chef is on-site, he can receive immediate feedback and can respond rather than have residents fobbed off with the excuse that the food has come from a contractor,” says Taylor. Taylor doesn’t think the cost-saving argument is enough to sway him from providing what he perceives to be the best possible service to residents.

“

I believe cooking on-site, whether in-house or contracted, is an essential component of this service as the residents often give feedback both positive and negative to the kitchen staff.

”

to their individual needs. When people are unwell or in the palliative stage of life, they often feel like food that is not on the menu and this can easily be catered for. Also, our kitchen often cooks special meals for special feast days or for theme days we have at the home; this flexibility is more difficult with a contractor,” says Rosebank manager, Sue Prowse. Napier District Masonic Retirement complex at Taradale is another proponent for managing the catering themselves. Manager Graeme Taylor says the village’s current chef has been involved in both models and ultimately prefers keeping the catering inhouse. Taylor believes they are providing a fresher option to the residents. “Morning

“We actually struggle to see why we would change as our residents are our priority, and we do not believe in compromising this even if it were cheaper to contract the service out.” However, contractors argue that the cost factor should not be a deterrent to facilities that shirk from using their services. Catherine Mitchell of Alliance Catering says understanding the real cost of managing a food service in-house in not just dollar terms helps determine whether outsourcing is the right model. “The most important thing is that your food service partner understands your care philosophy and embraces and supports it there’s more to it than just putting meals on a plate.”

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www.insitemagazine.co.nz | August/September 2012 15

FOCUS

MALNUTRITION:

Are residents at risk? infection. Increased physical activity levels can also be a factor, particularly for those with dementia, who may ‘pace’. “Their nutritional needs might also be more complex due to comorbidities such as diabetes, heart failure, kidney disease, or cancer or because there are specific barriers that prevent a person eating normal textured foods, such as stroke, lack of teeth, Parkinson’s Disease, and so on,” says Philpott.

IDENTIFYING MALNUTRITION

INsite consults expert opinions to understand why malnutrition is of such concern in aged care facilities and what can be done about it.

Arlier this year, Dietitians New Zealand expressed their concerns about the prevalence of malnutrition in New Zealand’s aged care facilities. This isn’t the first time such claims have been made. Concerns about malnutrition in older people have been voiced for many years. More recently, in 2010, several Members of Parliament and various news media pounced on a report commissioned by Whanganui District Health Board that identified malnutrition as a health challenge of aged care. At the time, the New Zealand Aged Care Association was quick to point out to those accusing aged care providers of poor quality care that malnutrition was a clinical challenge and not the result of a deficiency in care. Yet concerns like those expressed by Dietitians New Zealand persist. Regardless of the cause, it remains undisputed that the risk 16

August/September 2012 | www.insitemagazine.co.nz

of malnutrition increases with age and therefore, is an issue worthy of concern for New Zealand’s residential aged care facilities. Why is malnutrition a problem among older people? And what can be done about it in the aged care setting?

WHAT IS MALNUTRITION?

To pare the issue to its core, malnutrition is commonly defined as when an individual does not meet his or her nutritional needs. In older people, it tends to refer to under-nutrition, resulting from a decreased intake of protein, energy, vitamins, and minerals. Older people tend to be more susceptible to malnutrition due to a number of factors brought on by the ageing process. Alterations to the senses, particularly taste, smell, and sight can also have an adverse affect on food intake. Dentures and reduced saliva flow resulting in a dry mouth is another common factor. Nutrition expert, Gaye Philpott, says compared to healthy older adults, those living in aged care are nutritionally more vulnerable because they may have small or poor appetites. They may have increased nutritional needs caused by wounds or ulcers, or illness, such as

Research suggests that as the onset of nutritional problems is often gradual, it can be hard to detect. Malnutrition can be identified in older people by a number of signs, including muscle wasting (sarcopenia), loss of subcutaneous fat, skin bruising, flaky dry skin, and oedema. Malnutrition can be serious for older people, increasing their risk of infection, decreasing muscle function, and potentially leading to breathing and heart difficulties. Poor wound healing, memory loss, and fatigue are other known consequences. Oceania Living has a nutrition and hydration policy in place to help monitor weight loss. It also details criteria for referral to a GP or dietitian based on low body weight. Oceania is also currently trialling weight monitoring assessment spreadsheets in order to assist with risk assessment and intervention plans. One such device used by many organisations is the Malnutrition Universal Screening Tool (MUST), used in residential and community settings, and increasingly, in acute settings. Although fairly complicated for the uninitiated, including tables that allow scoring of BMI and weight loss percentages, MUST is said to take less than five minutes to complete and includes clear treatment plans, depending on the level of risk identified. Oceania dietitian Jessica Bowden says food and fluid monitoring is undertaken if there is food refusal. This is also documented by caregivers in the resident’s clinical notes.

WHAT CAN BE DONE ABOUT IT?

Philpott says there has been little research into the nutrition care in New Zealand aged care facilities until recently. She says one study yet to be published confirms what dietitians suspected – that the energy and nutrient content of ‘small’ serves in aged care are not

FOCUS sufficient to meet nutrient and energy needs, so that residents often need access to fortified foods. For example, porridge should be made with milk rather than water, milk should be calcium-fortified and high calorie extras such as ice cream and high-protein drinks should be offered. Philpott says the ‘little and often’ principle is crucial and says more frequent access to food and fluids is needed for residents. She says between-meal snacks are important to increase the frequency with which residents have access to food. “With a meal gap of often 15 hours between the last meal of the day and breakfast, dietitians see a need for a ‘substantial’ supper, by which we mean a snack that includes protein and carbohydrate.” Philpott gives the examples of a protein sandwich, milky drinks, cheese, and crackers in preference to just a cup of tea and a commercial biscuit. Philpott’s advice is echoed by online resource bpac nz, which suggests under-nutrition in older people can be prevented by eating a variety of foods through small frequent meals each day, with plenty of fluids to ensure hydration. The guidelines also recommend the consistency of meals is important. If chewing certain foods creates a problem, soft-textured foods should be selected. Alcohol should be consumed in moderation. Regular dental check-ups are important to ensure good oral health. It may be necessary to consider vitamins and mineral supplements.

SUPPLEMENTS

Interestingly, Australian research by Gaskill et al of malnutrition levels in Australian residential aged care facilities found that of the 43 per cent of residents moderately malnourished and the six per cent severely malnourished, very few (18 per cent) had been seen by a dietitian in the past six months or were receiving commercial supplements (29 per cent). The research is there to support the use of supplements. Information on bpac nz based on a study by Wilkinson and McLeod and published in Best Practice Journal recommends oral nutritional supplements are a top-up to food intake rather than a replacement: they should be given between meals, not at meal times. The study also is an advocate for the “Food First” approach – eating small but frequent high-energy, high-protein snacks

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and meals – and says this should be the first treatment option for elderly people who are malnourished. Oral nutritional supplements are generally not recommended until a Food First approach has been trialled. Bowden says Oceania rest homes introduce high-energy, high-protein drinks such as Complan, Sustagen, Ensure, Fortisip, and smoothies when weight loss or food refusal becomes an issue.

THE PSYCHO-SOCIAL ELEMENT

Research shows that malnutrition is a complex condition as it often has a strong psycho-social aspect. A recent study led by Otago University investigated the dining environment in a convenience sample of rest homes throughout New Zealand and provided some interesting insights into which factors enhanced the opportunity for a positive dining experience and which did not. A major factor was the attitudes of the staff. Residents appreciated staff members who took care to ensure they had meals they enjoyed, chatted with them, said grace, and read out the menu before the meal was served. It was also found that the ambience of the dining room was important; residents liked their dining environment to be newly refurbished, relaxed, and comfortable. Residents also enjoyed food reminiscent of what they ate when they were younger and appreciated variety and having dining companions. The study revealed many negative comments as well. Some residents claimed the dining room and/or the food was often cold. Some found the meals “boring”, referring to a fourweek cycle menu. One resident commented that “she found eating her meal too much work”. Many residents said they didn’t like to “cause a fuss” if something wasn’t right with their meal. The same mentality was applied to asking for a second helping – although this option was available to them, most did not like to ask. The researchers noticed that this natural reticence in asking for help was often not picked up by the staff, who failed to anticipate or notice the needs of the residents. Observations of this nature included residents who didn’t have the right utensils or those who missed out due to an interruption, such as a hairdresser appointment. Desserts served before the main course was finished meant residents rushed or did not finish their meal.

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The research outlines a number of factors that could improve the opportunity for a more positive dining experience. The study suggests there needs to be an adequate number of staff to assist with meal times, as inadequate staffing at meal times is a significant contributor to malnutrition and dehydration in aged residential care. The attitudes of staff towards nutrition are important. Staff members need to be aware of the importance of offering assistance and positive encouragement to residents. Medications should also be dispensed before the meal, so that medical care is separated from meal times.

EDUCATION AND TRAINING

The Otago study also revealed that uptake of staff training opportunities in food and nutrition was generally low. Staff should be trained in nutrition knowledge, specialised diets, and feeding assistance, as an untrained staff member will fail to notice the signs of poor nutrition and the need for intervention by a dietitian or nurse. A valuable contribution to keeping staff informed while ‘on the job’ are the RN Care Guides for aged residential care, which provide a quick reference for 18 common conditions encountered when caring for older people in residential aged care. They are based on the best available evidence and published guidelines and produced by Waitemata District Health Board in collaboration with residential aged care clinical and managerial staff. The Nutrition and Hydration Care Guide, like the other guides in the series, is formatted in a clear, concise, linear manner with flowcharts to quickly assist staff with queries they might have in caring for a resident. It gives indicators for dehydration and malnutrition, how to treat the problems, advice on identifying and ruling out possible causes, and when to refer for further help. A series of similar guides aimed at carers is also planned. As malnutrition is more prevalent in older people, this aspect of care is extremely important in aged care facilities. It seems the more research we have on malnutrition in older people, particularly in New Zealand, and the more tools available for understanding, identifying, and treating the condition, the better chance aged care workers will have of effectively caring for those residents with malnutrition.

www.invisabeam.com

www.insitemagazine.co.nz | August/September 2012 17

FOCUS

Nutrition at home

Nutrition and diet can often be an area overlooked by older people living independently at home. JUDE BARBACK looks at what resources are available to keep people healthy in their homes for longer. TOM IS 88. A widower, he lives by himself in his own home and generally copes very well, but struggles with the cooking side of things. As a solution, his family arranged for a ‘Meals on Wheels’ service, which bring him his main meal at midday during the week, allowing the weekends as an opportunity for Tom to either go out for his meal with family or friends or gain confidence in cooking for himself. His son, a farmer with access to ample home-kill meat, regularly supplies Tom with frozen mince and sausages, which he cooks for himself in the evenings and weekends. Upon enquiring once how Tom was finding the meat, his son was dismayed to hear Tom’s response: “The first four days are good. By the fifth day, I feel a bit queasy.” It transpired that Tom was letting the mince defrost slowly on the kitchen bench, and rather than wasting food, would still eat the fifth portion even when it disagreed with him. Tom’s situation is not uncommon. Food is often a tricky part of living alone in old age, particularly if you are suddenly faced with catering for yourself after years of having a spouse do it for you. Misjudging the use-by date of food is just one aspect. Of more concern is that older people living independently may not be meeting their nutritional requirements. How is this relatively understated problem to be addressed?

participants were at high risk of malnutrition. The research, which was published last year in Journal of Nutrition Health and Aging, showed that the major underlying factors associated with being at nutritional risk were low self-rated health, disability and social factors such as, loneliness, losing a spouse, or being born outside New Zealand. Wham concludes that strategies are needed to identify early on the risk factors leading to poor nutrition. Again, there is the suggestion of engaging older people at nutritional risk to share meal preparation and dining experiences. It sounds good in theory, but how is such a strategy to be implemented among the quiet masses of elderly people in their homes, cooking for themselves? How are people like Tom, who may be making poor choices with regard to food preparation, to be assisted by community programmes?

“

Older people living independently may not be meeting their nutritional requirements.

”

THE RESEARCH SHOWS

It may be understated, but the evidence is there to show that this is a very real problem for older New Zealanders living independently at home. Researchers Carol Wham and Jennifer Bowden investigated the perspectives of single-living New Zealand men aged 75 to 89 years towards healthy eating. The study, published in 2011 in Nutrition and Dietetics, found that half the participants were at high nutritional risk, with eating alone emerging as the most common nutritional risk factor, despite reliable support networks. Limited finances, a lack of personal transport, poor nutritional knowledge, and cooking skills were also found to be barriers to healthy eating and meal enjoyment. Wham and Bowden suggest that community programmes need to identify those at nutritional risk and provide them with knowledge and skills as well as promote meal sharing. In another study led by Wham, involving over 50 independently living people in their eighties, it was found that a third of 18

August/September 2012 | www.insitemagazine.co.nz

ADDRESSING THE PROBLEM

Sue Pollard, chief executive of New Zealand Nutrition Foundation (NZNF), agrees this is a difficult area to address. She says there appear to be gaps of knowledge about nutrition among many older people and those who are responsible for their care. “We need to reassess what education needs to be delivered – to the older people in the community, their carers, and their families,” she says. Pollard puts the gaps down to a general lack of accessible resources. The NZNF has undertaken a number of initiatives over the years to generate awareness, including distributing book marks and brochures with key information and holding seminars in various parts of the country.

One such resource is a brochure, Good Food, Safe Food for Older People, that includes information on how to keep food safe by outlining the four Cs: Clean, Cook, Cover, Chill. The brochure, which also includes ideas and meal suggestions for older people to help with gaining and maintaining weight, was produced by NZNF in partnership with MAF Food Safety and Auckland District Health Board. However, Pollard says it is difficult to know what sort of impact these strategies are having or even whether the messages are getting through to people. Geography appears to be a problem here. It seems that where an organisation or individual driving an initiative is based is often where the programme will begin before it is rolled out to other areas in an ad hoc manner. This is unlucky for the older people who happen to live independently outside the areas where resources are made accessible. Had Tom received the Good Food, Safe Food brochure, would he have then realised he should defrost his meat in the refrigerator and consequently have avoided illness? Obviously, the ‘what if?’ game could be played all day; there are no blanket solutions here. Even national campaigns cannot ensure the entire population is educated. However, they may go some way to help address the task at hand. Take Senior Chef, for example; a free, eightweek cooking course designed specifically for people aged 65 and over, who live alone or with one other person and who want to improve their cooking skills, confidence, or motivation around cooking. Senior Chef is a Canterbury District Health Board initiative. It was developed and is co-ordinated by the DHB’s Healthy Eating, Healthy Ageing project, which is run by two registered dietitians and a nutritionist who are based at the Princess Margaret Hospital in Christchurch. The project receives funding from the Ministry of Health. While its roots are in Canterbury, Senior Chef is slowly being rolled out across the country. The courses are also run in Hawke’s Bay, Blenheim, Timaru, Dunedin, and the West Coast, and according to demand, will expand to other areas. The courses are delivered in small groups with one session each week involving nutritional education and a hands-on cooking class followed by a shared meal with the food cooked that day. Participants get to keep the Cooking for Older People recipe book, which

the course uses. The education side of the course focuses on eating well for older people, menu planning, budgeting, and shopping tips. The NZNF is well aware of the correlation between rising food costs and malnutrition in vulnerable older New Zealanders. “It can be tempting to skimp on food when the budget is tight, but it is so important to eat a healthy and balanced diet as we grow older,” says Julian Jensen, chair of NZNF’s Committee for Healthy Ageing. Jensen advocates careful shopping and common sense to control those costs. She suggests a number of tips for older people including eating a variety of fresh, canned, frozen, and dried fruit and vegetables; having a good intake of protein foods such as smoked fish, red meat, beans, and eggs; sticking to budget cereals that are low in sugar and high in fibre, like Weetbix or oatmeal; and remembering to include dairy foods. She recommends buying just what you need; in order to help resist temptation at the supermarket, the NZNF have produced in partnership with Heinz-Watties, a weekly shopping list aimed at older people. Jensen suggests getting out the old recipe books and reserving more expensive ready-made meals for emergencies. Like research from Wham and others, Jensen also recommends sharing meals with friends and family. Jensen also says it is important to keep active and maintain a good weight. Losing weight can increase the risk of health problems. According to research, being a little overweight makes you less susceptible to ill health.

THE HOME CARE FACTOR

Home care workers play an important role in terms of monitoring changes in weight, nutrition, and hydration and ensuring that any concerns are passed on to the appropriate health professional via the coordinator. However, there is surprisingly little to guide carers on areas concerning nutrition. The revised Home and Community Support Sector Standard has a section on nutrition and safe food management (Standard 4.9) that says the consumer’s nutrition and hydration is supported by service delivery. The standard offers the only relevant statement about the role of carers around nutrition and hydration. It reflects the support function, rather than any specific responsibility for the client’s state of nutrition. Consequently, depending on their allocation of tasks, some carers may be involved in food preparation and can throw out food that does not look safe. Home carers are not responsible for the type of food the client has. Where a person is a diabetic or intolerant, it will be noted in their care plan, which usually does not require a radical change of practice. Julie Haggie, chief executive of New Zealand Home Health Association (NZHHA), says carers encounter problems with nutrition frequently, often noticed as loss of weight or skin integrity due to lack of sufficient hydration. Tony Stack, national franchise manager of home care provider, Home Instead, believes

nutrition concerns, like other aspects of care, are best addressed through building a relationship with the client. He says often problems relating to nutrition and hydration are identified upon the initial stage of setting up the client for care. The ‘care consultation’ is held in the client’s home, where tell-tale signs, such as expired food in the refrigerator, can hint that there might be an area of concern. Stack says that through the companionship of the care provided, the carer is able to get alongside the client to tactfully address such concerns. “We call this relationship over task,” says Stack. Home Instead includes nutritional aspects in its CAREGiver training programmes. Carers are taught the signs of malnutrition and dehydration to look out for, how to introduce the subject of nutrition to their clients, how to maintain awareness of a client’s specific dietary requirements, among other things. “Because we are there in more than just a task capacity, we find the client is, over time, more receptive to engaging with the CAREGiver on this topic,” says Stack. Home Instead’s Cooking Under Pressure programme recognises that poor nutrition is a main reason for hospital readmissions. Once again, the importance of preparing and sharing meals with others is highlighted. Initiatives like this, and those mentioned above, are reassuring for people living independently like Tom. It appears the key is in making people aware that such resources are available and easily accessible to them and their support networks. www.insitemagazine.co.nz | August/September 2012 19

FOCUS EDUCATION & TRAINING

A recent Close Up report hailed aged care workers for doing ‘God’s work’ for very little financial reward, but can God’s work really be done by people struggling to read clients’ charts or give out medications? JUDE BARBACK reports.

The long road to literacy S

tatistics can be alarming. Those resulting from the 2006 Adult Literacy and Life Skills survey are certainly unsettling. The survey showed that 1.1 million New Zealanders (that is 43 per cent of adults aged 16 to 65) have literacy skills below those needed to participate fully in a knowledge society. Over 80 per cent of those people are in the workforce. We’re not just talking about reading and writing here. Workplace literacy and numeracy is about a whole range of skills, from accomplishing a task, to communicating, to working within a team, to adapting to new technology and approaches. In general terms, literacy skill issues reveal themselves in lower productivity and higher error rates and can be a barrier to learning new things.

THE AGED CARE WORKFORCE

When these statistics are extrapolated into a workforce that is typically low paid, older, unqualified, and marginalised through parttime hours and shift work, it is no surprise that literacy concerns are high among those working in the aged care sector. A Careerforce survey supported by the New Zealand Home Health Association confirmed that the major skills shortages for community support workers lie in the areas of literacy and numeracy. Australia is facing similar problems with its aged care workforce. “The shortage of staff means recruitment is often unskilled labour with no previous training or qualification or people returning to work after long absences from the workforce. Cultural diversity of both staff and clients also contributes to communication problems in the workplace,” says Rod Cooke, chief executive officer of Australia’s Community Services and Health Industry Skills Council (CSHISC). The Australian experience shows that initiatives such as the Workplace English Language and Literacy (WELL) programme, administered by the Department of Innovation, Science, Research, and Tertiary Education can be effective. “Employers are well aware of the need for workplace literacy, especially around documentation, communication, information technology, and workplace health and safety. Literacy might require a significant investment of time and money, but there are direct benefits,” says Sue-Ellen Evans, a WELL broker for CSHISC. While those of non-English speaking 20

August/September 2012 | www.insitemagazine.co.nz

backgrounds were reportedly appreciative of the training, they weren’t the only ones to benefit. This was the experience of Uniting Church Homes in Western Australia. “Reading a material safety data sheet, writing up an incident report, understanding a risk assessment matrix – there is scope for improving literacy levels in aged care,” says training manager Margaret Antonucci.

TACKLING WORKPLACE LITERACY

There is certainly scope for improving literacy levels here in New Zealand, too, and it is pleasing to note many similar programmes have been established to help target this problem, not just in aged care, but across many sectors. While the primary and secondary education sectors have initiatives in place to tackle literacy and numeracy from an early stage, improving literacy in the New Zealand workforce falls mainly on the shoulders of the industry training organisations (ITOs). In 2007, the Industry Training Federation (ITF) partnered with Business NZ, the New Zealand Council of Trade Unions, and Workbase (the national centre for workplace literacy and numeracy) to produce a blueprint for addressing workplace literacy issues: Key Steps Forward for Workplace Literacy. A number of initiatives arose from the blueprint, including the ITO Literacy and Numeracy Good Practice Project, which was funded by the Tertiary Education Commission (TEC) and helped establish resources to support ITOs embed literacy and numeracy into industry training.

help build workplaces’ capabilities to deliver the National Certificate in Community Support Services (Foundation Skills) Level 2 as well as (Core Competencies) Level 3. Careerforce’s efforts appear to be paying off. Many organisations have now established training teams that look closely at their resources, training, and assessments to ensure they are supporting the development of the trainees’ LLNL needs. Careerforce is continuing its literacy crusade – although reduced funding from the TEC Embedded Literacy and Numeracy funding pot is a blow to their mission. This year, $100, paid on a monthly basis, is available for each trainee who completes both a pre- and post-literacy assessment. Trainers and assessors must attend a one-day professional development workshop that looks at adult education principles and techniques and how to administer the National Literacy and Numeracy Tool.

SKILLS HIGHWAY

Another useful tool aimed at addressing literacy and numeracy concerns is the Skills Highway programme. Managed by the Labour Group, Ministry of Business, Innovation and Employment, the programme was initiated in 2009 to champion the benefits of workplace

CAREERFORCE’S APPROACH

Careerforce has been one of the standout ITOs in addressing literacy concerns, which is reassuring given the high level of literacy skill gaps in the health and disability sector workforce. In 2007, Careerforce established the Integrated Workplace Learning Project, a TEC pilot to integrate literacy and numeracy learning and industry qualifications within on-site workplace training. The aim of the project is to enable workplaces to develop the infrastructure necessary to ensure that literacy learning takes place as a natural part of on-site training. The scope of the project encompasses ‘literacy, language, numeracy, and learning’ (LLNL) to better reflect the needs of the sector. The focus is to

“

Cultural diversity of both staff and clients also contributes to communication problems in the workplace

”

FOCUS literacy training and to connect New Zealand employers to organisations and resources that will help them through its website. Counties Manukau District Health Board (DHB) used the Skills Highway as a starting point to address the growing need for literacy training in its workforce. Organisational learning and development consultant Sandy Millar says the complexity of needs within the DHB prompted the introduction of workplace literacy training. “About 40 per cent of our nurses and healthcare assistants speak English as a second language (ESOL). ESOL speakers and lowskilled migrants make up the majority of our aged care workers. And a large chunk of our patients come from parts of our community characterised by low levels of formal education and low levels of literacy and numeracy. “Nurses with a tertiary qualification are highly professional, but they may have the literacy and language issues that come from being ESOL speakers, especially when they are migrants to New Zealand. They are able to meet the English language requirements set by the profession, but they may still struggle to converse freely in

colloquial English or write appropriate notes in a second language.” The DHB piloted StepUP, a literacy, communication, and numeracy programme with employees from non-clinical areas, which was then broadened to include healthcare assistants.

ONE ORGANISATION’S PATH TO TACKLING LITERACY CONCERNS

In addition to national tools and programmes, there are many smaller independent organisations out there also aimed at addressing literacy deficiencies in companies in different sectors. Literacy North Shore (LNS) is one of these. A not-for-profit organisation and member of Literacy Aotearoa, LNS’s main aim is to offer confidential literacy and numeracy support to enable members of our community to improve the quality of their lives and employment potential. Among LNS’s clientele is Creative Abilities, a North Shore-based social services organisation that employs people from Indonesia, Croatia, Chile, Argentina, Tonga, Burundi, Russia, India, Philippines, Poland, and Thailand to name a few. While well-educated in their own countries, many find communicating with clients – many with speech, hearing, or cognition impairments – and their families in English a challenge. Complaints from clients increased; most could not understand the support workers over the phone, messages were relayed incorrectly, and of even greater concern, there were medication errors. Increasingly, the organisation became aware of documentation being incomplete and prone to grammatical errors. Creative Abilities was already working with Careerforce to offer training, but training manager Julie Renner realised literacy needed to become the priority. She envisaged a non-threatening initiative that would benefit the team in their personal lives as well as the workplace. LNS developed a plan to help identify employees’ skill levels, and cater for individual needs with full employee buy-in to the programme. A letter was sent to team members identified as needing support to gauge their responses. Renner was amazed at the positive feedback but also shocked by the results of LNS’s Initial Needs Assessment process. Only two of the 15 employees were speaking at the required level, had the required listening skills, or could read and comprehend at the required level. Not one of those assessed had the required

skills necessary to complete the organisation’s workplace documentation. Creative Abilities promptly initiated a literacy programme and revised its manuals and documents to become more user-friendly. As part of the process, LNS evaluated workplace documentation, identified job demands such as writing (service delivery plans, accident/incident reports), reading (ability to understand documents and procedures), and oral communication skills. Creative Abilities management and the whole team got right in behind the literacy programme, maintaining wages and providing cover for students so clients’ needs were not compromised during training times. Life and Wellbeing supporters helped team mates by picking up the extra workload. “Everyone was so accommodating and positive, showing total respect for one another,” says Renner. LNS manager Jane Rigby believes that many employers don’t realise how literacy problems can affect their workplace and service delivery. “Yet in the Auckland region, we face greater challenges than anywhere else in the country,” she says. “While at least a quarter of those living in New Zealand have literacy difficulties, in Auckland, over 40 per cent of the population are immigrants. Many of them are skilled and educated but hampered by poor English literacy skills. So we see immigrant doctors, scientists, nurses, caregivers, and other qualified people pushing supermarket trolleys, driving cabs, or cleaning!” Workplace programmes are currently government-subsidised, but this does not extend to those not currently working who want to improve their skills and are seeking employment. As a result, LNS is working with businesses to sponsor unemployed individuals and expand resources. There have been some grants from various trusts and charitable organisations as well as some generous contributions from businesses: Toshiba recently supplied a state-of-the-art multi-function printer-copier at no cost and HarperCollins Publishers are supplying books suitable for English student beginners.

THE ROAD DOESN’T END HERE

It is heartening to see philanthropic measures like these directed towards encouraging people to improve their literacy to improve their job prospects, in addition to the plethora of programmes and initiatives aimed at those already in the workforce. Although we still have a long way to go, particularly in the aged care sector, it would appear we are on the right track. Information obtained from Industry Training Federation of New Zealand (www.itf.org.nz), Skills Highway(http://www.skillshighway.govt.nz), CS&H Industry Skills Council (https://www.cshisc.com.au) and Literacy North Shore (www.literacynorthshore.org). www.insitemagazine.co.nz | August/September 2012 21

OPINION

On the soap-box... Martin Taylor Each issue, INsite seeks opinion on a contentious issue concerning aged care and retirement.

WHO GETS WHAT WHEN: IT’S ALL ABOUT CHOICES

ver the last few months, there have been three public debates bubbling along. The first surrounds the age of eligibility for superannuation, the second is about pay parity between aged care and District Health Board (DHB) caregivers, and the third, which has had much less prominence, is about the investment gap in aged residential care. All these issues are interconnected because they go to the core of the health budget and the core of the Government’s financial position. These issues also show that government funding is not so much about ‘cannot’ and more about ‘will not’, as the Government can change its fiscal position at any time through different policy choices. Nothing underpins this reality more than the superannuation debate, where a onemonth delay in the age of eligibility would result in an immediate $50 million plus gain to the public purse. This raises questions about trade-offs and what the Government could do if it chose to.

For example, a one-month increase in the age of eligibility for super each year for four years releases enough money to resolve the entire $200 million underfunding of aged care. Another way of releasing funds is to remove the maximum contribution ceiling, which effectively gives someone who has already exceeded the $213,000 asset cap a second chance of receiving a government subsidy. Alternatively, the Government could look at general taxation. A 0.9 per cent increase in the top tax rate would fully fund pay parity between the private and public sectors, and another 0.9 per cent would fully fund the investment gap.

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August/September 2012 | www.insitemagazine.co.nz

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Unfortunately, all of these options are choices the Government refuses to make. The first because the Prime Minister has boxed himself into a corner on superannuation. The second because National believes it would upset the elderly and lose votes, and the third because it’s ideologically opposed. However, future governments are unlikely to have the luxury of delaying decisions in these areas as health and the superannuation costs spiral out of control, driven by the grey tsunami. So at some time in the not too distant future, someone in power will have to make some of the hard decisions and work out which voter base to annoy. The bottom line: it is the choices this government is making that determine whether we have enough funding for aged residential care, and it could, if it wished, alter policy settings to fully fund pay parity and the investment gap without putting the Government into a worse financial position.

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EDITOR’S EYE Caption

Pakize Sari

Te Hopai

Let’s snoop around...

JUDE BARBACK has a look around one of Wellington’s oldest and most central aged care facilities.

am intrigued by the ‘Inmates’ Register’ displayed in a glass cabinet in Te Hopai’s reception area, its yellowed pages and ornate handwriting hinting at an interesting history. The manager, Pakize Sari, tells me that Te Hopai is built on land adjacent to the Wellington Hospital, originally vested by Her Majesty the Queen in the late 1800s, and was one of the first care homes in New Zealand designated for the aged and needy. I sense that Pakize, who has managed the 104-bed facility for the past seven years, is proud of the home’s stake in history. However, she is quick to point out that today it is a thoroughly modern operation. Certainly, there is not an inmate in sight. Renovations and upgrades occur throughout the rest home, hospital, and dementia wings approximately every 15 years. The developments in 1996 saw rooms in the hospital wing altered to include ensuites, sacrificing every third existing room to achieve the expansion. The matron’s flat was also converted into part of the dementia unit, which with the latest development in 2006, increased the number of dementia beds from 10 to 16. Despite a waiting list of over a year for the dementia beds, Pakize was quick to quash my enquiry about increasing the number of beds to 20; she clearly thinks 20 is too many and that the current level of 16 is just right. I can’t help but agree with her as I enter the dementia suite. The residents, who are just about to enjoy morning tea, seem to fit the common lounge and kitchen area perfectly. The care staff and volunteers buzz cheerfully about. The suite is light and airy and still maintains its ‘new’ feeling from the 2006 renovations. Pakize is keen for me to meet Julie, the care manager of the dementia unit. I get the impression she is proud of her staff, particularly the managers of the separate wings. Two of the care managers are currently studying towards a Master of Nursing degree. There is strong emphasis on research and academia among the management staff. Pakize tells me this is largely due to the importance placed on research by some of the trustees of the Te Hopai charitable

”

Te Hopai has more development on the horizon. The architectural plans Pakize rolls out in front of me reveal a major expansion.

”

trust and their links to research institutions. These alliances allow students to carry out their research at Te Hopai; recently, a music therapy Masters student completed a placement in the dementia unit and two postgraduate-level studies are undertaken by Victoria University of Wellington. Education and training in general are important aspects at Te Hopai. I met Sam, the facility’s quality and training manager, who is also involved in further study; she is working towards her nurse practitioner qualification. Sam tells me that in addition to the ACE programmes, literacy and computer training, and general caregiver training days, Te Hopai also offers targeted training for caregivers, which involves monitoring and observing the caregivers and then addressing any specific gaps in their training or skills. Te Hopai also collaborates with other institutions where possible. For instance, they take part in training provided by the Mary Potter hospice about nutrition. Perhaps this is one of the reasons why Pakize says Te Hopai has low levels of staff

turnover. She also says the central location and the public hospital’s nursing hostel are drawcards for staff. Despite the fun that must take place – as evidenced by the bright decorations for the recent Royal Jubilee celebrations and photos of residents at various activities – there is a real sense of calm and peacefulness at Te Hopai. In the dining room, a group of residents listen quietly to the activities coordinator read through the newspaper for them. In another nook, a gentleman sits in his wheelchair, with his own newspaper and a cup of tea, enjoying the sunshine and solitude. I sense that beneath the serene veneer, there are a lot of busy people working to ensure the warm atmosphere and high-quality care. Pakize admits that keeping everything running smoothly to a high standard is certainly one of the challenges of running Te Hopai. Meeting compliance requirements and managing the expectations of family members are also ongoing challenges. Pakize says she is well supported by the board of the Te Hopai charitable trust, which is run by a chair and eight volunteer trustees, who provide a balance of business, quality of care, and research expertise in their leadership of Te Hopai. Pakize also speaks warmly of her relationship with the Capital & Coast District Health Board (CCDHB) and describes its funding manager as responsive and supportive. This is refreshing to hear. Te Hopai has more development on the horizon. The architectural plans Pakize rolls out in front of me reveal a major expansion of the facility into the existing car park. A further 100 hospital beds will be added, allowing for some of the existing hospital beds to be converted into a second dementia unit. Construction is expected to begin next year. As I wait for my taxi, I look at the ‘Inmates’ Register’ again and I wonder if the founders of Te Hopai envisaged the thriving and expanding facility it would become over a century later. If the management of Te Hopai has always been of the calibre it appears to be today, then quite possibly, they did. www.insitemagazine.co.nz | August/September 2012 23

HEALTH

JON’S WINNING TIPS FOR BETTER ORAL HEALTH

Spotlight on...

Dental care for the elderly Dentist DR JON MAHONEY discusses why it is important for older people to look after their teeth. FROM MY EXPERIENCE, dental care among the elderly tends to get put on the backburner as more serious health issues begin to take precedence. In light of this, dental care should not be overlooked, as this could be a source of general health problems. Gum disease can directly cause cardiovascular disease (which may lead to heart attacks and strokes) and diabetes. As the average life expectancy of the population increases and the quality of dental treatment improves, people are managing to retain their own teeth for longer. Consequently, we have to take extra measures to maintain a high level of oral awareness to prevent the most common types of dental problems, such as tooth decay and gum disease, from rearing their nasty heads.

”

Brush every single surface of every single tooth, including the area where the tooth meets your gum.

”

BRUSH YOUR TEETH FOR TWO MINUTES TWICE A DAY. There are no excuses for not brushing your teeth twice a day. I hear the excuses daily: “I haven’t got time” or “I use mouthwash instead”, and sometimes when patients tell me they do brush twice a day, I often question which end of the toothbrush they are using! The key to good brushing is to: »» take out any prosthesis you may be wearing »» concentrate on just brushing; do not multi-task. »» use a pea-sized amount of fluoridated toothpaste, such as Colgate Total®, on a medium/soft-bristled brush. This can be an electric or a manual toothbrush »» brush every single surface of every single tooth, including the area where the tooth meets your gum. »» those who have missing teeth need to take more care to brush the teeth adjacent to any gaps. Follow the above points correctly for at least two minutes twice a day, and your mouth will be a much healthier place. FLOSS YOUR TEETH AT LEAST ONCE A DAY. Purchase a Reach® Access® Flosser from your local supermarket for increased ease of use. If you have a dental bridge, use Oral-B® Super Floss® to keep it clean. LOOK INSIDE YOUR OWN MOUTH. To see if you are cleaning properly, assess your mouth in a mirror before and after brushing. Plaque (bacteria) is visible to the naked eye (furry looking) when it is not removed. Pull your upper/lower lip away from your teeth and inspect the area where your teeth meet your gums. If after a week of improved cleaning your gums still look red and they readily bleed when brushed or you can’t get rid of the plaque with your toothbrush, visit your dentist/hygienist. KEEP YOUR DENTURE CLEAN. By keeping your denture clean, you are less likely to suffer from bad breath and fungal infections. My advice for cleaning your denture is: »» rinse the denture thoroughly after every meal and remove debris with a soft brush, soap, and warm water (ideally, over a basin full of water, in case you drop it) »» in the evening, clean your denture thoroughly with a soft toothbrush and denture cleaning paste/solution such as Steradent®. »» do not soak your denture in a hypochlorite-based cleanser »» remove your denture overnight and leave in cold water. VISIT YOUR DENTIST EVERY 6–12 MONTHS. Most dental problems are preventative, and getting into the habit of regularly visiting the dentist instead of visiting them when there is a problem will more likely result in less pain, less cost, and fewer visits in the future.

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INTERVIEW

Country Lodge in Matamata

Resident chitchat

...with Les and Jean Williams

Nearly a decade ago, Les (93) and Jean (89) Williams sold their family home and moved into a new two-bedroom chalet at Country Lodge in Matamata. They now reside in an assisted living apartment at Country Lodge, from where they speak to INsite about their experiences of assisted care living. INsite: How long have you been residents at

Country Lodge? Jean: We have owned a chalet here for nine years and then we moved into an assisted living apartment, where we’ve been for three and a half years. INsite: What prompted you to make the move

into retirement/assisted care living? Les: When they first started building the chalets here at Country Lodge, we bought one off the plan – a two-bedroom home. We watched it getting built. We chose the site ourselves, opting for one with a sunny, northfacing position. Jean: We sold our own home, making the decision to move while we could enjoy the benefits of living in a new, warm house, and maintaining our independence. We have our own car and we are still very involved with our community. Les: Years later, when the opportunity came up to move into a nice, north-facing apartment within the assisted living part of the Country Lodge complex, we jumped at the chance. As we were getting older, we thought it would be a good move to have more assistance on hand, if and when we need it. INsite: Was it a difficult decision to make? Jean: Not at all. We both agreed that it was a

good decision to make before we really had to.

INsite: Did you consider many alternative

options? Jean: Not really. We were familiar with the chalets and we liked the idea that there were options down the line as we got older. We love the apartment we are in now, especially because it is sunny. We are happy here. INsite: What role did your immediate

family play in this decision process? How do they feel about you living in Country Lodge? Do they live nearby and do you see them often? Les: We have four children and two grandchildren. All but one of them lives overseas. One lives in Athenree. They were all very supportive of the move into Country Lodge. I suppose it gives them peace of mind to know we have security here. INsite: What do you value most about living

at Country Lodge? Jean: A while ago, Les had a fall and by pushing the help button on the wall, within minutes, we had help on hand. The network was in place. Within the half hour, Les had seen a doctor and was taken care of. It is a comforting thought that we will be taken care of when the need arises. Les: And above all else, this place gives us security.

Les and Je an

INsite: What do you enjoy about the lifestyle

here?

Jean: It suits our lifestyle here. The midday meal

is provided now we live in an apartment. We get the other meals ourselves, but we can use the services here if we want. We still drive our own car places, but if we wanted to, we could use the Country Lodge van to go shopping in town twice a week – once to the main centre, to banks etc., and once to the supermarket. Les: I love the sunny, warm apartment. We still choose what we want to do each day. You can live life as you please – either participate or don’t. The choice is yours. Sometimes, we go on group outings in the van. We have many friends here. Also, you have all the privacy you want. People don’t invade your space. INsite: What are the downsides of living in a

retirement complex? Jean: I suppose you can’t choose your neighbours and other residents. You live a little way from the shops, but then the van takes you there twice a week, so that’s OK. INsite: What advice would you give to anyone

considering making the move into retirement living or a care facility? Les: Do it in good time. Make enquiries early so you get to choose. Remember, you can still be part of your community when you live in a retirement set-up.

☛ GOT AN OPINION? Have your say online at www.insitemagazine.co.nz 26

August/September 2012 | www.insitemagazine.co.nz

Williams

INTERVIEW

A typical day in the life of … Ainslie

McMaster

Ainslie McMaster is head cook at Kowhai Manor Rest home and hospital in Greymouth.

fter nearly 20 years working as a caregiver (most of that time I worked at Kowhai Manor), I thought it was time for a change. The opportunity came when a vacancy for a cook’s position came up. With only two cooks at the time, I worked five days, Saturday through Wednesday, starting at 7am until 1.30pm. The residents then were mainly independent, with only a few classed as hospital-level. Now, my day begins at 6am with checking temperatures in the fridge and freezer. Any leftover food from the day before is discarded. I make the soup for the evening meal and sandwiches as an option for tea if the residents don’t want the main of the day. The home baking for afternoon tea is then chosen, along with the pudding of the day, which can be hot or cold, depending on whether we are doing a winter or summer menu.

The main course of the day can be a roast, casserole or chicken dish, cottage pie, corned beef, sausages, lamb’s fry and bacon, or fish and chips (their favourite on Fridays). Having a lot of our residents now being fed or on a soft diet, we mouli all veggies and meat for these people. Some of our residents are diabetics as well, so we need to cater for them, too. The main meal for the evening is prepared, which can be scrambled eggs, macaroni cheese, Oakhill potatoes, quiches, tomatoes and bacon, scones, or cheese toasties. By this time, around 9.30am, morning tea is prepared and served by the kitchen hand. Veggies for the next day are left out for the night girls to prepare, and porridge, which is put on about 4am. We have a four-weekly rotating menu, one for winter and one for summer, with a roast

dinner every Sunday, sometimes during the week in winter, too. Lunch is served at 12pm. We have a main dining room for mobile residents, and for the other people, the meal is transported in a bainmarie to the hospital wing dining room for the caregivers to serve. After lunch, it’s dishes and cleaning up for the day. As head cook, my responsibility is to order the groceries, vegetables, and frozen foods once a week. I also order any crockery, cutlery, and kitchen needs. I work Monday to Wednesday from 6am to 1.30pm. I enjoy my work and appreciate good comments from the residents. Having been a cook at Kowhai Manor for about 10 years, I find it rewarding. The kitchen staff is a great bunch and we have a lot of laughs.

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CONFERENCES

CONFERENCE REPORT:

2012 RETIREMENT VILLAGES ASSOCIATION CONFERENCE, 25-27 JUNE, WELLINGTON

Margaret Owens RVA president

This year’s RVA conference was all about forward-thinking and fun.

he delegates who attended the 2012 Retirement Villages Association (RVA) conference were probably not expecting to hear on the opening night the suggestion of Te Papa, the conference venue, being converted from a museum to a place to house the elderly. This was one of Raybon Kan’s many tongue-in-cheek jibes used to open the celebrity debate, for which the moot was ‘that age and treachery should always overcome youth and skill’. The comedian and fellow celebrities provided the perfect icebreaker for what would turn out to be a successful and enjoyable conference. Some of the more pertinent debates began on the second day. RVA president Norah Barlow outlined some of the key

issues surrounding the retirement village industry – the need for a review of the Code, Regulations, and Act, whether villages should be subsidising the Government’s promise to provide more funding for aged care, the swift-paced growth and evolution of the industry – before declaring her decision to stand down as President, saying that someone new was needed to ‘embrace new ideas and new thinking’. That someone is to be Margaret Owens, General Manager of Independent Living at Bupa Care Services, who was elected at the RVA annual general meeting and announced at the gala dinner that evening. Owens said she was “delighted” to take on the role.

Another person in the limelight at the dinner was Diana Triplow of Mary Doyle Lifecare, who won the INsite/RVA Manager of the Year award. Even for those who didn’t take the stage, the dinner, set in the beautifully presented Amora Ballroom, appeared to be enjoyed by all, with many hitting the dance floor as soon as their plates were cleared. In more sober moments during the conference, delegates were kept well informed by banking, legal, business, and retirement village industry experts of the trends, potential threats, and opportunities for the sector. Among them were top lawyer Mai Chen and chief economist for National Bank, Cameron Bagrie.

WINNERS’ CIRCLE

INsite: The Code of Practice, Regulations, and the Retirement Villages Act were finalised nearly five years ago and are now due for review. What aspects do you think should be changed or carefully scrutinised in such a review?

Rose: We don’t actually have any problems with the Code of Practice at all. Perhaps because we are a small village with only me and my husband employed, we overcome any problems quickly and effectively. All of our policies and procedures abide by the Code of Practice and have been worked through carefully.

JUDE BARBACK asks the three previous winners of the INsite/RVA Manager of the Year award their views on some of the major issues emerging from this year’s RVA conference.

Left to right: Denise, Bruce, Diana and Rose

August/September 2012 | www.insitemagazine.co.nz

Denise: Generally, I believe the Code of Practice has met everyone’s expectations. It has provided the industry with a robust set of regulations that are practical, and for the most part, easy to follow. It is obvious after Christchurch that Clause 18 required review and this is now happening. Bruce: The main focus of any review should be the insurance aspects. The Christchurch earthquake highlighted a lack of understanding most New Zealanders had around this area. Insofar as this is concerned, I support the RVA’s decision: if a village is destroyed and unable to be rebuilt, the residents should be repaid the original purchase price without any reduction. Although such a significant event is unlikely where we are located in Auckland, there is a huge financial risk undertaking to do this, as we are unable to insure the deferred management portion of the capital sum. I also agree that operators should be required to list in disclosure statements all insurance policies held, including those offering temporary accommodation.

INsite: What are the biggest challenges facing your village as the industry continues to grow and evolve? Denise: Creating a point of difference for intending residents and residing residents is essential; ensuring the village keeps moving forward in the way their provision of services, both human and environmental, is imperative to the village’s ongoing success. Gone are the days where villages can rest on laurels alone; a village manager needs to have vision to ensure the point of difference is the thing that makes the difference between intending residents settling in their village or moving to another. As we are aware the grey tsunami will hit in the next few years and villages need to be ready for the ‘new age resident’. This resident will be IT savvy and have a greater understanding of the COP and Act than most previous residents.

CONFERENCES Left to right: Geoff McPhail, Katrina Holywell, Ian Hurst, Terry Pratley, Diana Triplow and Selwyn Triplow

Certain talks covered specific details of village operation, including a discussion led by Martin Taylor and Chris Fleming on the new solution reached between the district health boards and the NZACA for operators to provide residents with an ORA option that encompasses higher levels of care when needed. Attendees also received timely advice on what to do in the event of an emergency from experts in this field. Bill Atkinson, from the Association of Residents from Retirement Villages, presented the audience with some frank feedback collated from 75 villages, which, at times, may have been difficult for many operators and managers to swallow.

Atkinson also participated in a panel including consumer advocate Kevin Milne, Norah Barlow, and others, about whether the retirement village industry offers value for money. The value of villages was generally agreed, although as Barlow summed up, it is important the industry, ‘a needed part of society’, continues to change and adapt in order to maintain this value. This forward-thinking approach, of how to evolve to keep up with growing consumer demand and political pressures, emerged as one of the key themes for the conference as a whole. No doubt delegates returned to their villages with more knowledge, an expectation of what the future might bring to their industry, and a renewed sense of how to adapt to such changes.

Bruce: Meeting the needs of the ageing residents and workforce. Over the last 12 years, I have noticed their health needs and priorities change.

Bruce: We don’t have an aged care facility, so this isn’t applicable to us.

Rose: Our biggest challenge is keeping the villa prices and weekly fees as low as possible, to make our village affordable for people in Levin to come in to.

INsite: The NZACA and DHBs appear to have found a solution for residents under an ORA that require higher levels of care and are eligible for a DHB subsidy: signing a standard notice that clarifies the circumstances for the resident. Do you think this will prove to be enough to resolve the problem or do you think government regulation or a formula-driven contractual arrangement will end up being necessary? Denise: I personally do not think this is enough; it will only take one serious complaint and all operators currently operating this ORA bed agreement will be affected, not to mention the residents. To put standards or legislation in place retrospectively will take longer and be more of an encumbrance than being proactive and starting to format some kind of industry standard for this practice. It was quite apparent the feedback at the conference that this is not a ‘one-off’ thing and operators are tending to look at this service more and more.

Rose: At this stage, we haven’t had any problems regarding care and outside providers looking after our residents in their own homes. As our village is for independent living only, once residents need 24-hour care, at that stage they go into a rest home.

INsite: Bill Atkinson from the Association of Residents from Retirement Villages found in his survey of 75 villages that many residents had concerns about the ability of their managers to effectively run the village. Do you think all managers should have to undergo some form of proficiency training or qualification to avoid this perception? If not, what sort of training or professional development, if any, should be undertaken by managers? Denise: The role of a village manager is very diverse. Many of the skills of the present managers have not been learned through books or university but through experience. The implementation of the Code of Practice and Act, with the changing dynamics of both the residents and their families, requires a manager to have an in-depth knowledge of a vast range of skills, including – but not confined to – people management, property management,

Diana Triplow 2012 INsite/RVA Village manager of the year with Selwyn Triplow and business management. However, without life experience, this still would not make a good village manager. Bruce: I think some of the respondents must be a bit tough! The role of a manager is difficult at the best of times, trying to balance the needs of residents with the commercial side of running a business. It can be difficult for managers of independent villages as they often lack the resources that are available to larger groups. I was originally a manager of a group-owned village and now it is an independent, I find it is necessary to make an effort to network and continually work on self-improvement by attending RVA managers’ forums, training seminars, and conferences. The RVA is also developing training for managers around compliance issues, which will be excellent. Rose: At present, I am instigating with the other Managers of the Year a handbook for all managers and staff in villages throughout New Zealand, which will have a lot of very useful information and help in it, covering all aspects of not only running a village but improving many areas. Seminars are held throughout the country in all areas during the year which cover many topics. These are run by the RVA. Good networking and topics are brought up at these meetings.

www.insitemagazine.co.nz | August/September 2012 29

CONFERENCES

RETIREMENT VILLAGE SECTOR

UPBEAT

RICHARD HINCHLIFFE discusses the results of the RVA conference survey.

t the recent 2012 RVA Conference, The National Bank surveyed retirement village owners on the issues affecting their business. The results of this survey are like a temperature gauge for the industry and provide valuable insights into the issues and opportunities affecting the retirement village sector. The overall picture is positive. Organisations in the sector are feeling positive about the future. Itâ&#x20AC;&#x2122;s widely acknowledged that New Zealand has an ageing population thatâ&#x20AC;&#x2122;s living longer and will need to live in retirement villages. In fact, 62 per cent of survey respondents will look to expand their aged care facilities in the next 12-24 months alone.

GRAPH 1

Performance expectations are particularly positive, with 82 per cent of owners claiming they are optimistic or very optimistic about their business over the next three years. Adding to this, a significant majority of respondents, 90 per cent, believe that their village is worth more than it was two years ago. The top three actions for the next 12 months for village owners are building more villas, building more apartments, and expanding care facilities, as shown on graph 1.

CONCERNS

When we asked owners what the three biggest issues were for their business, the responses were consistent with what private

business owners across New Zealand tell us through the ANZ Privately Owned Business Barometer 2012. The Barometer is a report on survey findings of almost 5000 business owners that was undertaken earlier this year. The issues affecting owners are availability of skilled staff, government regulations, and domestic competition. The biggest constraint to growth is economic conditions, specifically in retirement villages, which is impacted by the housing market and the elderly wanting to release value out of their houses in order to move on.

SEEKING ADVICE

The results show that while 76 per cent claim there are no barriers to seeking advice, there is a group that has concerns about the cost and the value of advice provided. No issues were identified with how to seek advice or willingness to work with external parties, as shown in graph 2.

PLANNING

GRAPH 2

Retirement village owners understand the importance of planning, with 91 per cent having a 12-month or longer-term plan. It is well known that businesses that plan are more likely to be successful, so this result shows an industry that is focused on future opportunities, growth, and ultimately success. The retirement village sector is outperforming the economy. With the population growing older and living longer, the demand for aged care is growing. Operators are going to raise prices, valuation expectations are up, and now is not the time to be selling. In fact, now is the time to be expanding, with almost two thirds of respondents planning to do so. Performance expectations within the industry are high, certainly within the next 12 months, but even more so over the next three years. In short, we see an industry that is planning for a bright future as demographic trends in New Zealand change. Richard Hinchliffe is head of healthcare at The National Bank.

August/September 2012 | www.insitemagazine.co.nz

INTERVIEW

AGED-CARE & RETIREMENT

Up close and personal with...

Diana Triplow

JUDE BARBACK chats with the 2012 winner of the INsite/RVA Village Manager of the Year Award.

“I

Feel like I’m at the top of my game,” says Diana Triplow, who is clearly buzzing from winning the INsite/ RVA Village Manager of the Year Award at this year’s RVA Conference in Wellington. I catch up with Triplow for a quick coffee and a chat in the conference exhibition space, the morning after she claimed the accolade. It is morning tea time and the hum of delegates around us adds to her excitement. Triplow says she feels very proud of her achievement. And rightly so. As general manager of Mary Doyle Lifecare in Hastings, one of three aged care facilities privately owned by the Hurst/Pratley Group, Triplow runs a large and thriving operation comprising 115 villas, 80 apartments, 34 rest home beds, 60 hospital beds, and 64 dementia care beds.

“

You have to have plenty of passion and energy and care to do this job.

”

Mary Doyle has been in operation since 1995, with Triplow, a registered nurse with 35 years’ nursing experience under her belt, at the helm since 2001. Over the past decade, Triplow has managed the development and growth of Mary Doyle from two to 19 hectares. She attributes her success to her residents – all 395 of them. “My residents kept asking me to enter this competition, so I finally did.” She says various circumstances, such as having a grandchild living with her and a sick husband to care for, prevented her from entering in previous years, but at last, the time was right. It isn’t hard to see why the residents – among them, Triplow’s parents – are happy at Mary Doyle. Triplow’s presentation to RVA delegates prior to the award ceremony

showed an entertaining array of photos: residents enjoying a trip to the Gold Coast, tending to the garden allotments, participating in education programmes, and more often than not, in some form of fancy dress attire. I was particularly taken with the way the village made its own olive oil from its crop of olive trees, providing an apt metaphor for the growth and cultivation at Mary Doyle. Triplow believes that innovation is her biggest strength and what has got her where she is today. “I’m grateful the directors allow me to be innovative. I got a café up and running before anyone really knew what was happening!” she laughs. This café, Riverstones, is now the social epicentre for Mary Doyle. She is also full of praise for her “fantastic” 240 staff. Triplow is very proud that 28 of the original 80 staff who were there when she took over the management of Mary Doyle are still working there today. “We have relatively low turnover,” she says. There are challenges, of course, and chief among them are maintaining the values, high standards, and levels of enthusiasm in a large and growing workforce. Succession planning is also a concern. Triplow strikes me as a proactive woman, someone who gets things done. “I manage things as they happen,” she confirms. “You have to have plenty of passion and energy and care to do this job,” says Triplow, and under these criteria, I think the Manager of the Year award has gone to a deserving recipient.

NEXT ISSUE:

OCTOBER/NOVEMBER WE FOCUS ON INFECTION CONTROL AND WOUND CARE »» The burden infection has on our resources »» Exploring alternative treatments and the best products around INsite homes in on the in-depth topics of infection control and wound care in this issue. Medical research and expert opinions are given alongside practical case studies and advice. We look closely at new research emerging in this field to bring readers up-to-date information on providing the best possible care in all areas of the aged-care sector. AND NEW RESEARCH: Attitudes towards gay and lesbian aged care workers NZACA conference report PLUS: THE REGULARS: ‘SPOTLIGHT ON ... ’ A section dedicated to relevant issues including education and training, therapies, falls prevention, infection control, palliative care, dementia and more. ‘A DAY IN THE LIFE ...’ An insight into the lives of everyone from caregivers to chief executives, residents to retirement village managers. ‘Q & A’ Opinions sought from experts on relevant news items. ‘LAST WORD’ Giving sector leaders the chance to air their views on the current status and direction of aged care in New Zealand.

www.insitemagazine.co.nz www.insitemagazine.co.nz | August/September 2012 31

LAST WORD

Last word... Nano Tunnicliff “MODERN DAY SLAVERY” IN THE AGED CARE SECTOR

President of the New Zealand Nurses Organisation (NZNO), NANO TUNNICLIFF, says the NZNO welcomes the recent release of the Human Rights Commission’s (HRC) report.

he Human Rights Commission’s (HRC) report, Caring counts, Tautiaki tika revealed discrimination and breaches of aged care workers’ fundamental human rights. The HRC used its inquiry powers to examine equal employment opportunities (EEO) in the aged care sector and gathered evidence from 886 participants over 12 months in 2011 to 2012. The EEO Commissioner, Judy McGregor, who was responsible for the report, worked unpaid six-hour shifts for several days in an aged care facility in January this year. The report says the reliance of all New Zealanders “on the emotional umbilical cord between women working as carers and the older people they care for at $13-$14 an hour is a form of modern day slavery”. There has been much comment about Judy McGregor’s use of the word slavery, with some pooh-poohing the phrase and calling it an exaggeration. Perhaps not surprisingly, NZNO agrees with Judy McGregor entirely. Caregivers perform punishing work for extremely low pay – that’s slavery. Even the Oxford Dictionary concurs: a slave is a ‘person who works very hard without proper remuneration or appreciation’. The 48,000 caregivers who care for our elders’ every need are among the very lowest paid in New Zealand. They are (almost all) women, who after working as carers for 20 years and more are still getting the minimum wage, women who are described by the multinationals who employ them as “unskilled”. These caregivers are women who invest a huge amount of mental and emotional energy into

loving our mums and dads and then go home at 3pm or at 11pm or at 7am and do the same for their own families – and they do it for around $450 in the hand a week. In her foreword, McGregor says, “A much repeated comment up and down the country when the Commission undertook its field work was that the value we place on older people in New Zealand society is linked to the value we place on those who care for them.” That’s a sentiment we at NZNO share. I can’t help thinking that in all our years working with and advocating for caregivers in the aged care sector, it is the fundamental reason why we have not yet been successful in securing decent pay and conditions for these most valuable workers. It is only in relatively recent years that we have, as a nation, given up our collective responsibility as extended families to share our homes and labour with our ageing parents and grandparents. Of course, there are many reasons for this, economic and social, but the fact remains that we have abrogated our collective responsibility for our elders. Could this be the reason why we allow workers in the aged care sector to be treated as modern day slaves? Are we so ashamed of ourselves that our elders and those who care for them have become invisible and unworthy of our respect? The work these women do for our elders is based on trust, mutual respect, dignity, obligation, and reciprocity. NZNO suggests that these are the very attributes required to

make the changes needed to properly value our elders and to properly value the women who care for them. It is time for us as a nation to learn again to respect our elders, to respect and value those who care for them, and to come to terms with the reality that looking after our frail and dependent parents, grandparents, aunties, and uncles is not a job we are equipped to do. We have an obligation to make sure they are cared for with dignity by skilled carers who are valued properly. The Human Rights Commission has spelled out the solutions for us. The ten recommendations acknowledge that to care for our mums and dads, we must care for their carers – and the only way for us to achieve that is by working together. That means government, rest home providers, DHBs, unions, rest home residents, and workers coming together in trust and with a sense of obligation to eliminate the modern day slavery that has been ignored for so long. What does that change look like? Well, we know it needs to start at the top. Government will show real leadership and fully fund the changes that need to be made. DHBs and residential aged care providers will be obliged to use that money for pay equity, training, and staff retention. Unions, residents, and workers will be valued, empowered, and energised. A cultural shift will have occurred. Our elders and the workers who care for them deserve respect. When the HRC report recommendations have been implemented, we will know that they have it.

RESPONSE FROM HON JO GOODHEW, ASSOCIATE MINISTER OF HEALTH The Government is carefully considering the Human Rights Commission’s report on their inquiry into equal employment opportunities in aged care. Many of the recommendations in the report are consistent with the current initiatives and directions already set by the Government. For example, care staff in governmentsubsidised aged residential care facilities are already required to undergo foundation skills training in aged care within six months of their

August/September 2012 | www.insitemagazine.co.nz

appointment. The same will apply to workers in home-based support services when the new mandatory Home and Community Support Sector Standard is rolled out over the next two years. The new standard will also result in a more consistent application of safety standards for home and community-based care, as well as more reliable, readily available consumer information on providers, similar to that which already exists for aged residential care facilities. The Government has also introduced spot audits of aged residential care facilities, thirdparty accreditation of aged residential care auditors, and a new comprehensive clinical assessment tool that will provide robust information to help assess quality of care. Summaries of audit results are now available

online with an easy-to-interpret traffic light system and work is under way on a similar system for home-based care providers. We also acknowledge the importance of ensuring sustainable home-based support services in areas where significant travel is required to care for older New Zealanders. The Ministry of Health will be working with district health boards to ensure that arrangements are in place with providers to address this. This year, we will invest more than $1.4 billion in aged care and we have increased spending by an average of almost four per cent per year since 2008, despite difficult economic circumstances. The challenge for the Government is how best to balance the many competing demands for additional funding in the aged care sector as the population ages.

Do you have questions about living in a retirement village? The Department of Building and Housing provides free independent advice and information for people living in or thinking about moving into a retirement village. Call us free on: 0800 83 62 62 or visit our website www.dbh.govt.nz The Department of Building and Housing is the government agency responsible for overseeing the Retirement Villages Act.

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