INsite August 2014

August/September 2014 | $10.95

AGED care & retirement

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

news

Election 2014:

Political parties’ views on aged care funding

training

Portrait of a workforce:

caregivers speak up

a sector divided? aged care

focus

Nutrition:

Spotlight on food safety

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In this issue...

FOCUS: AGED-care & retirement

INsite Magazine August/September 2014 Volume 8/Issue 6 Editor: Jude Barback @INsite_NZ T: 07 575 8493 E: editor@insitemagazine.co.nz Advertising: Belle Hanrahan T: 04 915 9783 E: belle@apn-ed.co.nz Production: Aaron Morey Dan Phillips Editor-in-chief: Shane Cummings @ShaneJCummings General Manager/Publisher: Bronwen Wilkins Subscriptions: T: 04 471 1600 F: 04 471 1080 E: subscriptions@apn-ed.co.nz Publisher’s note: © Copyright 2013/2014.

No part of this publication can be used or reproduced in any format without express permission in writing from APN Educational Media (NZ) Ltd.

5 Ed’s LETTER If you haven’t seen Ryman’s Diana Isaac Retirement Village’s parody of Pharrell Williams’ hit song Happy, you really ought to stop reading this and get onto YouTube right now. It features (spoiler alert!) residents dancing and lip-syncing with pool cues, walking frames, mobility scooters; staff dancing while wheeling the tea trolley, kneading bread, folding washing; even maintenance men boogeying with street cones in high-vis vests. Cynics are bound to pick holes, but if we ignore them for a minute, what you’re ultimately left with is a four-minute tour around an attractive village and a chance to “meet” the people who live and work there. It’s a clever piece of marketing by Ryman, but no doubt the staff and residents had fun putting it together and then watching it together at the special red carpet premiere.

One of the more contentious subjects emerging from this year’s Retirement Villages Association conference was the media’s portrayal of New Zealand’s retirement village and aged care industries. Herald editor Shayne Currie faced some barbed questions about the angle the newspaper took on aged care articles and many delegates decried the lack of positive stories about their sector.

Nutrition and diet in aged care

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United we stand, divided we fall?

5

Rise of Senior Chef

6

Portrait of a workforce

10

Taking the purple path

13

Food safety: recognising best practice

14

Nutrition and dementia: pooling global knowledge

16

Conference Corner RVA Conference report

18

On the soapbox …

Pre-election political policies

20

Bupa boards the interRAI train

United we stand, divided we fall?

With an election looming and funding levels still a concern, JUDE BARBACK examines the cracks beginning to show as residential aged care providers differ on significant issues.

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But the questions should be put back to rest home and retirement village operators: are good things happening at your facility? And are you proactively promoting them?

One message emerging from the Careerforce conference earlier this year was that very few young people are opting to work in aged care. I decided to look into this in more depth, and the operators and staff interviewed all agreed that employers could do more to raise the profile of working in aged care.

Of course, the funding arguments continue – and we address these in this issue as well – but there is more to working in aged care than pay, particularly for younger employees.

Editorial & business address Level 1, Saatchi & Saatchi Building, 101-103 Courtenay Place, PO Box 200, Wellington 6140, New Zealand T: (04) 471 1600 F: (04) 471 1080 ISSN 2324-4755 INsite is distributed to key decision makers in the aged care sector and its distribution is audited by New Zealand Audit Bureau of Circulation (ABC).

So, although it goes against every self-deprecating, tall-poppy fibre of our being, we have a duty to sell ourselves, a responsibility to let everyone know that aged care is a good place to be.

Only so much can be achieved through policy change. It is changing perception that is the hard part. And that is a shift that we can collectively begin to affect.

Editor, Jude Barback editor@insitemagazine.co.nz www.insitemagazine.co.nz

For news, updates and opinion pieces please visit www.insitemagazine.co.nz Connect with INsite Magazine on Twitter Follow INsite for breaking news, the latest innovations, and conversations with editor Jude Barback on the professional issues close to your heart. Find us on Twitter@INsite_NZ

www.insitemagazine.co.nz | August/September 2014

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aged care

United we stand, divided we fall?

With an election looming and funding levels still a concern, JUDE BARBACK examines the cracks beginning to show as residential aged care providers differ on significant issues.

I

n the run up to the General Election in September, the New Zealand Aged Care Association (NZACA) is lobbying for increasing funding for the sector to allow an increase in caregivers’ pay. The Association’s election campaign is hardly surprising, given the mounting pressure on this issue of unfair wage levels in the aged care workforce – the Caring Counts report and the Bartlett vs TerraNova case just two examples that have drawn attention to it in recent years.

To sign or not to sign – that is the question

However, the united front projected by the Association begs some scrutiny, given its recent u-turn on signing the variation on the age-related residential care (ARC) services agreement, the national contract between district health boards and aged residential care providers. This year’s variation proposed a one per cent fee increase.

NZACA’s earlier announcement that providers would refuse to sign the ARC contract on the basis of underfunding and a lack of commitment to the interRAI quality initiative, was a bold step.

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August/September 2014 | www.insitemagazine.co.nz

Underfunding is not a vague notion.

NZACA chief executive Martin Taylor says the changes to KiwiSaver contributions, the minimum wage increase, inflationary increases, and insurance premium increases have all led to increased costs in the delivery of aged residential care. He maintains the aged residential care sector needs an increase of 7.6 per cent, or $76 million – which in terms of the $14.5 billion healthcare budget is 0.53 per cent – to even allow it to maintain the status quo.

But suddenly, the Association changed track and recommended members sign the ARC contract variation after all. Its change of heart was apparently based on gains made for interRAI, which include a review of the interRAI roll-out, more training and support, and an extension of the training deadline.

Associate Minister of Health Jo Goodhew’s announcement of an additional $4.5 million a year for four years was confirmation of the amount to be spent on support and training for interRAI. It also became clear that some providers and their representatives did not want to risk jeopardising the new premium charging clauses in the contract, which are the result of six years of negotiation.

But what about the funding issue, which was clearly the major reason for refusing to sign in the first place? It would appear there may be more to the volte-face than meets the eye.

Taylor maintains that despite the interRAI improvements, the signing of this year’s variation does not mean the Association believes that one per cent is sufficient.

“It does not mean the current subsidy levels are appropriate or that we are happy only being able to pass on small or no increases to staff.”

The recent Retirement Villages Association conference in Auckland featured a chief executive panel, with representatives from Metlifecare, Selwyn, Oceania, Bupa, and Summerset answering questions about challenges facing the sector. Interestingly, it was aged care funding that emerged from the panel as one of the biggest issues for the retirement village sector.

If this is truly a concern for these large operators, why the u-turn on signing the contract, which specifies a one per cent increase to subsidy levels, well short of what is needed to sustain market growth and demand.

aged care

Political pressure

One possible answer could lie in political pressure placed on the big corporates. It has emerged that some of the larger providers were requested to meet with Health Minister Tony Ryall, where they were asked to reconsider their stance on the contract, and sign accordingly.

When asked about pressure from Government, Ryman Healthcare chief executive Simon Challies told INsite that while there “wasn’t a meeting as such” he confirmed that some of the larger operators did communicate to the NZACA their concerns about refusing to sign the contract variation.

“We are keen for the sector to work proactively with Government.”

Lead district heath board chief executive for health of older people, Chris Fleming, also believes a collaborative approach is key.

“What I want to try to do is stop all this pointing fingers at each other and say: ‘How do we get into a room to really tackle some of these?’” he told the Otago Daily Times.

“Somehow, as a country, we have to figure out where our priorities lie and how we fund it.”

Challies says Ryman had never agreed with the NZACA’s proposal of refusing to sign the contract.

“You have to ask, are you going to achieve anything with such a confrontational approach? Government doesn’t have a bottomless pit of money from which to raise funding,” he says.

Challies felt it was important for the sector to acknowledge the Government’s progress on interRAI, and also the certainty granted around premium fees.

Summerset chief executive Julian Cook says Summerset has followed the NZACA’s lead with regard to signing the contract.

“In line with the advice from the NZACA, we are signing the A21 review,” he said. Cook could not be drawn for further discussion on the topic, including on whether or not Summerset had initially supported the NZACA’s stance in refusing to sign.

Similarly, Alan Edwards, chief executive of Metlifecare, refused to comment.

“I can only confirm that we are a very small member of the ACA with less than 400 beds in total,” he said.

That may be so, but many other, much smaller providers, particularly those who had indicated their support not to sign the contract and were prepared to approach the Government with more belligerence in order to make themselves heard, are left feeling confused as to what exactly happened.

Support for the election campaign

If the sector is divided in its approach to working with Government, then where does

this leave support for the NZACA’s election campaign?

The four-week campaign, released on 30th June, features 92-year-old Rosalie and caregiver, Jess. With the strap-line “Your Mum deserves dignity and respect. So does her caregiver. Support increased funding for caregiver wages”, the campaign’s message is clear.

Taylor confirms the campaign has cost the Association $250,000 – an amount they hope to recoup through donations from members.

Despite fluctuation over the contract, Taylor says he is confident members will support the campaign. He says the Association has never had a problem with this before.

Yet, he also calls for members to remain united in their support for the campaign.

Simon Challies says Ryman supports the NZACA’s election campaign, and indeed “anything that raises the profile of the sector”.

He agrees there is a need to lobby for an increase in funding for aged care workers, a statement that seems to slightly contradict Ryman’s stance about working with Government, and his acknowledgement of the lack of a ‘bottomless pit’ to increase funding.

At the suggestion that the Government has, as yet, not placed a high priority on aged care in the build-up to this election, he agrees.

“There is nothing new there,” he says. He points out the stark contrast between the Australian Government’s approach where aged care is carefully reviewed each year and the New Zealand Government’s, where it doesn’t get the same level of attention.

Support for TerraNova case

In addition to supporting the election campaign, providers have also been asked to lend their support to the Bartlett vs TerraNova Homes and Care case.

The case has morphed into a strange scenario where both parties are essentially hoping that it will eventually result broadly in the same outcome – more funding for aged care that can allow operators to pay caregivers more. The NZACA’s election campaign certainly supports this assumption.

The general hope appears to be for pay to be linked with training, to enable a workforce that is not only better paid but also more competent and valued.

To this end, NZACA and TerraNova formed an agreement at the end of last year that handed the legal reins to the Association, stating that it would help reimburse TerraNova for its legal costs, and take on any further costs from here on in.

It seems the parties agreed the total costs of the litigation was estimated to approach $400,000.

Until the end of last year, TerraNova was fighting this battle alone, and has paid a total of $206,000 of that $400,000 in legal fees defending the Bartlett case.

A meeting took place in Auckland prior to the agreement being signed, at which all 10 larger operators present verbally committed to financially supporting the cause, including the reimbursement for TerraNova’s costs as recommended by the Board of the NZACA. On the strength of this commitment, NZACA signed the Litigation Funding Agreement and advanced $82,000 from its reserves as a contribution towards TerraNova’s cost.

A large-scale whip-around followed, resulting in just under $235,000 raised from the sector. Members were encouraged to contribute on the basis of $20 per bed.

While Martin Taylor says the Association has had “good support from all members”, he will not disclose who gave what, so it is unknown what proportion of this was derived from the larger operators; however, the amount seems to fall somewhat short of what might be expected from a team of healthy cheque books taking a united stance.

A rough calculation that assumes those large operators accounted for 40 per cent of the sector’s 35,000 odd beds indicates they alone should have raised $280,000.

Of the actual $235,000 raised to date, $70,000 will go to the NZACA for their costs so far since taking on the case. If legal expenses continue to accrue, as expected, then it is unlikely TerraNova will recoup its outstanding costs.

“I assure you that TerraNova has paid its contribution to this fund-raising! I agree the sector’s inability to raise the $400,000 suggests we do not yet have broad support for this cause. I do wonder if we have not yet communicated the importance of acting collectively on the issue,” says Terry Bell, executive director for TerraNova.

“What I’d love is for everyone to sit around a table and figure this thing out – perhaps that will happen after the Court of Appeal releases its decision, but there’s been none of that so far,” says Bell.

Has TerraNova a right to feel somewhat aggrieved that despite initial appearances, sector support is somewhat lacking?

Have operators hidden behind the anonymity afforded by the agreement?

Taylor says all such requests are done in this way, whereby an issue is sold on its merits and then left to the discretion of the members. He suggests naming and shaming would be tantamount to bullying.

Therefore, does the amount raised signal that some operators don’t really believe in the cause, that TerraNova should be held accountable to a certain extent?

It has been suggested that TerraNova has brought matters on itself to a certain extent.

The operator appeared in the courts prior to www.insitemagazine.co.nz | August/September 2014

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aged care the Bartlett case over a dispute concerning employer KiwiSaver contributions. Two TerraNova caregivers who earned minimum wage argued it was a breach of the Minimum Wage Act they had to pay their own and TerraNova’s KiwiSaver contributions under their employment agreement. The judge ruled in their favour, and the Court of Appeal upheld the decision in September last year, just days before the Bartlett case was decided.

The case shed light on some legal murkiness surrounding employer KiwiSaver contributions and TerraNova publicly welcomed the clarification on this issue.

It feels rather too coincidental that TerraNova should be at the heart of both cases, both of which represented issues that affect the wider sector.

However, Alastair Duncan from the Service and Food Workers’ Union, puts this down more to “serendipity” than strategy.

He says Kristine Bartlett was the right sort of person, and TerraNova was the right sort of operator to take the case forward.

“Can you draw a straight line between the two cases? Probably not,” says Duncan.

He does, however, admit to some disappointment that TerraNova, and by extension the NZACA, was unable to learn from the outcome of the KiwiSaver case that such employment matters can’t simply be settled by the judiciaries.

Few providers have been prepared to inform INsite on where they stand on supporting TerraNova and NZACA on this case.

However, Simon Challies says Ryman’s decision to lend support for the Bartlett vs TerraNova appeal was straightforward.

“Quite frankly, we feel the court decision was wrong. We think the court has come up with its own interpretation of the law and didn’t give clear direction as to what is the next step.”

Challies says that if the case is followed to its natural conclusion, it should result in an increase in funding for caregiver wages.

However, he clarifies that he is “well and truly in support of rewarded training” rather than just a blanket increase. He says the pay rate the unions are pushing for “doesn’t feel appropriate”.

A question of democracy

It is understandable that members’ positions on various topics are protected by the NZACA, as evidenced by the TerraNova case.

Even so, there have been some questions cast over how democratic the Association’s processes are, with some members expressing concern that not all views are taken into account under the current mode of operation.

No one could accuse the NZACA of invisibility, and certainly, there are regular opportunities for members to have their say, 4

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such as the Association’s Annual General Meeting, branch meetings, and of course, direct communication.

However, in this technological day and age, it seems odd the Association has not introduced ‘vote buttons’ or a similar mechanism in order to glean a more accurate reflection of where its members stand on such decisions. Taylor says they have considered such systems but said the idea was dismissed on the grounds that it was too expensive and would likely prove too limiting for members to put forward their viewpoints.

Taylor also says operators’ votes do not carry the same weighting. Indeed, it would seem unfair for Oceania’s vote to have the same weight as that of an independent 20bed rest home. But as things stand, it is not apparent whether the needs of the 20-bed rest home are truly being heard. A one-voteper-organisation system might disadvantage the big corporates; however, it could be argued that the lack of voting system is to the detriment of the smaller providers. As evidenced by the u-turn on the contract signing, the big corporates are likely to have their way in any case.

Simon O’Dowd, chairman of the NZACA, adds that members rely on the Association’s board to accurately reflect their needs – a statement that implies overarching trust from the membership.

A question of moral obligation

Do the larger operators have a moral obligation to advocate for the good of the entire sector?

There are two answers here, and one cannot be uttered comfortably.

The words ‘moral obligation’ are loaded and emotive; they imply doing the right thing. But is that right thing looking after your own staff and residents, and ultimately your own business interests? Or is it helping the sector as a whole fight for a fairer deal for aged care?

The retirement village/aged care industry – because we can’t think of the sectors as entirely separate anymore – is becoming increasingly competitive, and competitiveness does not sit easily alongside being collaborative. When there are investors to answer to, financial statements to be publicly scrutinised, charity no doubt must start at home.

The question of whether Ryman, as a larger provider in the sector with more clout than others, feels morally obligated to fight for issues that extend beyond their own interests is answered in true diplomatic fashion.

“We would never advocate a position that would be damaging for the sector. We look for outcomes that work for everyone,” says Challies.

“The issues are the same whether you’re a small or a large operator.”

If the issues are indeed the same, then it would seem providers need to take a more united stance to reflect this, especially with some cracks appearing in the sector’s veneer as it creaks under the pressure of underfunding and a forthcoming election.

FOCUS

Rise of Senior Chef Earlier this year, Senior Chef, a cooking course designed for older people, celebrated its 100th course and its 1000th participant. INsite talks to Senior Chef coordinator ROBIN SPENCER about the programme’s growing success.

INsite: How did Senior Chef begin?

Robin Spencer: In 2007, our team, Healthy Eating Healthy Ageing Project, conducted a study in Christchurch and found 31 per cent of 152 community-living older people in Christchurch were at high risk of poor nutrition. Eating alone and difficulty with cooking were among the common risk factors. Thus, Senior Chef was developed to stimulate interest in cooking and eating, building skills and bringing older people together to share meals.

What does it involve?

The course is free to attend and each threehour weekly session involves some nutrition education, a hands-on cooking class, followed by a shared meal with the food cooked that day.

How is it funded?

In Christchurch, Senior Chef is funded by the Ministry of Health and partially funded by community providers and local government organisations. Senior Chef is now nationwide and our team here in Christchurch trains people around the country who are interested in delivering the programme. Other places around the country find their own funding and are separate to our team.

What have you learned about the way older people cook for themselves? Any surprising observations?

This is extremely variable and there is no norm. Some older people don’t cook at all until they are widowed and others don’t cook, they just eat takeaways and order Meals on Wheels. The majority can cook standard meals and are bored of the same meal and struggle to cook for just one or two people.

What is the gender balance? Are the men typically comfortable in the kitchen?

It is 50/50 men and women. I wouldn’t say men are typically comfortable in the kitchen, some are and some are not.

The video clip on the Senior Chef website makes mention of “the odd romance blooming”! Is the social side of Senior Chef just as important as learning to cook?

The social side is very important. We hold classes of 8–12 people; a minimum of eight because eight people create a nice social atmosphere. Our classes are good for people who suffer from social isolation and some groups continue to socialise regularly after

the eight-week course has finished. We hold social events four times a year where the Senior Chef graduates bring a plate of food and we bring in speakers and do various things like food demonstrations.

Is it starting to snowball?

Each year we make it a goal to expand the programme to wider areas. For example, this year we hope to start a class in Akaroa. We aim to have 25–30 classes per year. Some locations, such as Darfield, only need one class a year due to the smaller population size.

How will you accommodate the growth of the programme?

We have a set budget so one way to grow the programme is to look for donations, such as donated venues and equipment.

What have been the challenges in getting Senior Chef up and running to this level?

We have recently changed the programme from self-referral to participants needing a referral from a health professional or community support worker. It has been a challenge to get these people referring sufficient numbers and promoting the programme has been important.

What has been the most rewarding aspect about running such a programme?

Running this programme is very rewarding for everyone involved. The participants have a great time and make great friendships, as well as improving their confidence in the kitchen and motivation to cook. They also learn about nutrition and meal planning and are very appreciative of everything they learn.

People can join a Senior Chef course simply by contacting their GP, practice nurse, or other health professional, who will refer them to the course coordinator. For more information, visit www.seniorchef.co.nz

www.insitemagazine.co.nz | August/September 2014

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aged care

Portrait of a workforce In an effort to understand the realities of working in New Zealand’s aged care sector, JUDE BARBACK interviewed four people in different roles, organisations, and parts of the country to glean what really matters to them. Jenny, Marianne, Josie, and Christiane do not represent every aged care worker – but they collectively give an insight into working in an industry that has suffered much criticism in recent years. These are their stories.

Meet Jenny Goodman: the Community Support Worker Age: 62 Time in job: 15 years. Jenny did household management for 10.5 years, then was encouraged by her employer to take on personal care responsibilities.

Pay rate today: $15.86/hr for personal care.

Starting pay: $8.50 in home management role. The DHB rate for home management increased to $14.10 in December 2007 and stayed at this level for seven years until minimum wage recently increased to $14.25.

Advanced care is about $17/hr.

Journey into aged care: Prior to working in this area, she worked in a host of government jobs – for a tourism department, at the High Court, IRD, lawyer’s office, then property management. She ended up in community support work “not for the pay but for the love of the job” and her huge respect for older people: “they’re our national treasures”.

What job entails: Household management, personal care, shopping, passive exercises and so on. Her clients are all over 75 years, funded by the DHB; the oldest is 97.

Training: A good induction and orientation programme. Completed Level 1 – ‘Care of the older person’. When taking on personal care duties, she was also encouraged to complete Level 2 – ‘Good to be Home’, training around restorative care. “It can be difficult for some women who have never 6

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received any qualification, are illiterate, and have not been exposed to a classroom environment in a long, long time. A colleague admitted she couldn’t read or write, and the employer set her up with a friend and they underwent literacy training and then went on to get Level 2.”

Employer pays for training: Yes Career progression: Jenny’s employer encourages people to go on to do advanced care and the equivalent Level 3 training.

Level 3 is required to be a CREST support worker.

Workplace satisfaction: »» A rewarding job: “It’s great to make a difference.” »» Training. »» Glimmers of hope: Jenny has drawn hope from the sleepover case, the pay equity case with Kristine Bartlett, and now the travel time negotiations. »» Integrated Service Model: “Before the integrated service model was introduced two years ago we just took orders, now it is refreshing to be able to use our initiative all of a sudden.”

Workplace concerns: »» Pay levels: • Wages don’t reflect level of responsibility associated with the role. “We might be the only person a client sees all week.

We’re expected to manage and report any changes in health or behaviour we notice; we’re there in a life-saving capacity. If we get it wrong, we face disciplinary action. That’s a hell of a lot of responsibility for $14.25/hr.”

Jenny thinks this doesn’t seem fair, especially when compared with “a check-

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out chick or a dude serving burgers who are on the same wage, with none of the same level of responsibility, but typically with more training opportunities and career progression”.

Jenny says community support workers work in isolation, compared with DHB healthcare assistants in the hospitals who will have someone mentoring them and overseeing what they do.

Wages don’t reflect level of training, qualifications, or experience. “The problem with the training is that there isn’t a clear correlation between the qualifications and the pay.”

Household management isn’t considered to be of the same value as personal care. “Some clients have told me they’ve had people who can’t make a bed, another who can’t iron.”

Travel: Travel allowance rate varies from DHB to DHB, but Jenny’s is $0.77 per hour, with a maximum of three hours per client. Jenny downgraded to a more economic car to allow for this but she knows of workers who travel around 600km per week visiting rural clients.

Questionable work practices: Workers taking on too much work to make up for poor wages. “I’ve learned to say no, but some of the girls take on a lot of work, piling it on to make up for the poor wages.” Jenny says her employer is good at enforcing the rule of no more than 50 hours per week, and no more than 100 hours a fortnight.

However, she says enforcement of some day-to-day practices is poor, with lunch breaks not being taken or enforced

aged care •

Poor communication. “We can never speak to a coordinator; it always goes to voicemail” is problematic if a solution is needed there and then; for example, if a support worker can’t get into a client’s home. The support worker is not allowed to ring the client, so Jenny says as a result “you find yourself on the back foot apologising for someone else’s incompetence”. At the same time, Jenny says she also feels sorry for the office coordinators – “they get abuse from support workers, from the clients. There simply isn’t enough resourcing.”

»» Lack of consistency between DHBs: pay rates differ from DHB to DHB. “I once asked Tony Ryall about central DHB funding and he said they would put more money in the Budget. That seems obvious to me – a bandaid approach. It’s the system that needs fixing. Tony Ryall says he expects us to do more with less. What a ridiculous thing to say. The only thing you can do with less is less.” »» Feels undervalued: “We’re no longer prepared for Government to play on our good nature.”

Meet Marianne Bishop: the Rest home Caregiver

Age: 55 Time in job: 17 years Pay rate today: Carers with a qualification are paid $15.63/hr (or $14.75/hr without qualification) although Marianne has negotiated a

slightly higher wage.

Starting pay: $10/hr (which included an allowance of $0.40 for having an enrolled nursing qualification) Journey into aged care: Marianne started working as a hospital aide in a private hospital where she helped care for geriatric and surgical patients. She was encouraged to do nursing, so after one year, she went to Wellington Hospital and completed her 18 months training to become an enrolled nurse. She didn’t have School C English (even though she had 6th form certificate subjects) so she wasn’t able to go on to become a registered nurse. Upon completion, she stayed working at the hospital in the geriatric ward for four more years, then she had children and left the industry for a period of time. She then did home help work for several years. In 1997, she started her current position as caregiver.

What job entails: Marianne describes her job as doing everything for a person that they can’t do themselves, or assisting or

supervising them to do it for themselves.

This includes washing, showering, toileting, feeding, and also tasks like making the beds, cleaning commodes, and so on.

She describes the work as “mentally and physically challenging”.

Qualifications held: Qualified as an enrolled nurse (EN). Her training was paid for by the hospital.

Training: There is regular in-service training on things like elder abuse, residents’ rights, infection control. When the rest home was granted status to provide hospital level care, Marianne went to the managers and asked whether more training would be given to meet the higher expectations and was told they only had to have eight hours a year. However, attitudes have since changed and they’ve started providing Level 2 and Level 3, which Marianne thinks is great. “Staff have really enjoyed doing this. The five who completed their Level 2 all went on to do their Level 3 and are considering going higher.”

Employer pays for training: Yes. “Caregivers had to go to the polytech to do any training – the rest home did assist with this, although they had to be chased at times”.

Career progression: At her rest home, there is no opportunity to do Level 4 to become ‘Caregiver in Charge’ – but other facilities offer this opportunity.

Workplace satisfaction: »» Rewarding job: “I love looking after the elderly. I had a very good relationship with my grandmother. In my first job in the hospital, they described me as a natural carer and encouraged me to do nursing.” »» Good approach to training. »» Collective agreement: “My workplace has a collective agreement in place, so employment conditions are good, but “I worry about places without a collective agreement”.

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Workplace concerns: »» Pay levels: Marianne says the level of pay for aged care workers “stinks”.

• “I’ll still be working when I’m 75. I don’t take KiwiSaver as it’s such a chunk out of the wages.”

• She says of her personal situation, “We have two wages coming in, so we get by, but many others are really struggling. Many carers, cleaners, and kitchen staff are working two jobs, working six days a week to make ends meet.”

• She feels the pay rate does not reflect the level of responsibility. “You could work in a supermarket for the same money but without the level of personal responsibility or challenges.”

Age: 65. Josie is not considering retiring any time soon – not because of the money; rather, she loves the work and firmly believes you’ve got to keep busy and physically and mentally stimulated.

She’ll retire when it “gets too much”. “I know I can still handle patients safely,” she says.

Time in job: 11 years Pay rate today: Will not disclose, but says, “I earn quite good money”.

Starting pay: She says the starting rate for her position at her DHB is around $20/hr.

“After my third year, I reached the most you could earn for my level and after that I went up by automatic annual pay increases”.

Journey into aged care: Josie worked in a printing company before a personal health

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“I think many employers would like to pay their staff more. I think they are restricted by the funding they receive.

I do feel employers, government and DHBs all need to work together to fix this.”

“It’s not right that elderly people are treated like this after being taxpayers all their lives. The people making the decisions will be able to afford private care when the time eventually comes. It’s the manual workers who will probably fall into ill health earlier and need more input from the system.”

Unregulated workforce: “It is ridiculous to think that someone can come off the street with no skills and do this job. It does require skills to do this job properly and these skills are not being recognised.

There should be a minimum qualification in place.” Marianne also believes that training and qualifications need to be nationally recognised. “In-house training doesn’t translate from one employer to another,” she says.

Collective agreements: “My workplace has a collective agreement in place, so employment conditions are good, but I worry about homes without a collective agreement.”

Ageing workforce: Turnover is mainly older people getting too old for the job.

“At least half who leave are retirees, and of these, virtually all are over 65 years old, and even then they will often change their role from that of caregiver to recreational coordinator or receptionist.” Marianne says not a lot of younger people are attracted to working in aged care. “There’s not a lot of money in it and for want of a better word, it’s not a sexy career.”

Feels undervalued: “I feel undervalued and overworked.”

Meet Josie Bidois: the DHB Healthcare Assistant (specialised health services for older people)

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aged care crisis forced her to stop. She worked in a home support role very briefly before taking the DHB HCA role.

What job entails: She helps to rehabilitate patients back to home or rest home. This includes helping with showers, mobility, feeding, and other tasks. She also works within the community. She is part of Falls Prevention Group. She is also a core trainer for manual handling and has taken on a health and safety role.

Qualifications held: Has a Diploma in Employment Law. Training: When Josie started, there wasn’t mandatory DHB HCA training like there is now, so she hasn’t had to do it, as she’s been doing the job for so long. She says some who have taken the HCA training have found it more relevant to working in the community and not so relevant for working in hospital.

There is plenty of in-service training.

Employer pays for training.

Career progression: Josie says there is definitely the opportunity for career progression. There is a whole range of ages working as HCAs, including younger people, whom Josie says often see the HCA role as a stepping stone to nursing.

Workplace satisfaction: »» Rewarding job: Loves her job and the personal satisfaction that comes with helping people, such as helping stroke patients do things for themselves. »» Pay is fair. »» In-service training. »» Turnover isn’t an issue. Some people have been there for 15 years.

Workplace concerns: Josie describes the biggest frustration of working in hospitals as the hierarchy – mostly driven by management, not so much from nurses.

“My boss once asked if I’d ever come across any racial conflict or ageist attitudes in the workplace. I told her that here you’re discriminated against by the colour of your uniform, not your skin,” Josie believes this has lessened since she took on her role of core trainer, and has a level of health and safety responsibility, but she feels that others without this still feel very much at the bottom of the hierarchy, and are treated accordingly. “I object to being spoken to like I haven’t got a brain.”

Josie says it is also limiting in terms of patient care. “You have to let the nurse know a patient’s condition, who then decides when or whether to get a doctor to see the patient.

I don’t want to be medicating – but I think I should be advocating for the patients’ needs.”

She feels for nurses, too – “they spend so much on education, yet they still have to get certified for this and that before they can carry out certain tasks”.

Josie doesn’t believe that HCAs are 8

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necessarily undervalued, but says it would be nice to feel more appreciated. “It would be nice if the general manager came onto the floor occasionally and praised the good work we’re doing.”

Thoughts on pay inequities and feeling valued: Josie says she can’t comment on whether the pay inequities between public and private aged care are justified, as she hasn’t worked in a rest home. Josie doesn’t believe the role of HCA can easily be compared with the role of a caregiver in a rest home. She says the hospital takes a more restorative focus, compared with a rest home that appears to be more about taking steps to make the job easier for the workers. She gives the example of a rest home caregiver wanting to use incontinence products, compared with on her ward where they will focus on trying to get the patient back to normal function.

However, when recalling the brief time she spent working in the home support sector, she describes the pay as “terrible”. She recalls that poor pay led to cramming in lots of people and prioritising clients on the basis of geography to get around the fact that they weren’t reimbursed for fuel.

Meet Christiane Telfer: the registered nurse in aged care

Age: 46 Time in job: 13 years Pay rate today: $28.92/hour. Her pay is increased annually – her last annual increase was from $28.07 to $28.92.

Starting pay: $17.02/hour (took a pay cut after working at a DHB hospital).

Journey into aged care: Trained in Germany 1985–1988 at the Order of St John Hospital, then worked on a surgical ward for six years.

“Love” brought her to New Zealand in 1994 and she finished her New Zealand nurse’s registration in 1995, before she took a nursing position at Te Kuiti Hospital for the DHB, where she worked for six years. In 2001, her family moved and she took a position in a rest home. Christiane says she considered district nursing but found that she enjoyed working with older people.

What job entails: There are two RNs – Christiane is team leader and the other is a clinical leader. Christiane says they have assessments, care plans that need to be kept up to date, communication with the family advocates – only RNs can access the Power of Attorney.

Qualifications held: Registered nurse qualification.

Training: Professional development requirements are 60 hours every three years.

Employer pays for training: No. Training needs to be done in own time and there is no reimbursement for travel or cost.

Career progression: Christiane says the difficulty is that once you reach the top in an aged care facility, it’s hard to progress.

Workplace satisfaction: »» Rewarding job: Finds it “very rewarding” – there is a wide variety of care, and she enjoys the communication between the resident, family and medical staff. “It’s their last home, and I treat them like I would like to be treated if I was in my last home.” »» Feels valued: Christiane is proud to be a nurse, and that nursing is among the most trusted professions. However, she doesn’t think that it is valued enough in terms of the attitude to education and career progression.

Workplace concerns: »» Keeping up education and training: Christiane says at her rest home the nurses need to undergo their training in their own time and there is no reimbursement for travel or cost, whereas the DHBs will pay for training and travel. “It should be more aligned with the public sector.”

Christiane says health care assistants at the rest home can get adequate education and training through in-service training.

However, the nurses need to cover a wide variety of skills and therefore need to travel further afield for their ongoing training. »» Workload: • Documentation has become a huge burden in recent years – “we are really struggling,” says Christiane. The enrolled nurse used to be able to help with this, but it has come back to RN now. As an example, Christiane explains that the care plans that need to be kept up to date are more in-depth than hospital care plans.

• Staffing hours across the board are getting reduced a lot, and as a result, staff turnover is high and the skill mix is not as great. “It is understandable as they [healthcare assistants] can go to Warehouse or Countdown or New World on the same pay and can make better career progress. We have had some great staff leave.”

• Prioritising care: These pressures make it difficult to get the smaller jobs done.

Christiane says things like trimming nails are important, but get pushed down the list as they have to prioritise. “More often we have to count on a volunteer to help out with these sorts of tasks.”

• Accountability: It also makes it more likely for mistakes to creep in. “The RN is accountable for everything in the facility; it doesn’t matter which area.”

»» Pay/career progression: Happy enough with remuneration but has concerns about the pay ceiling for nurses in aged care and lack of obvious career progression pathways. »» Underfunding in sector: Christiane expresses her admiration for the courage displayed by Kristine Bartlett, and is pleased to see attention being drawn to the underfunding in aged care through her case and the Caring Counts campaign, although she is concerned it hasn’t resulted in any action from Government.

What can we learn from Jenny, Marianne, Josie, and Christiane?

Based on the responses of these four women, we note the following: »» Job satisfaction: All interviewees said they enjoy their jobs and find the work rewarding. »» Pay inequity: Our rest home caregiver and community support worker felt they were poorly remunerated and that pay levels were unfair and did not reflect the work, skills, responsibility involved, or even the training undertaken. Our DHB HCA and RN did not feel aggrieved about pay, with the HCA happy with her level of pay. »» Training is good: Employers appear to be generally taking a good approach to training across the board, but there are concerns that it is not linked to pay and not nationally recognised. Our RN felt more support was needed for nursing staff at her workplace.

»» Feeling undervalued: Our RN feels valued; our DHB HCA feels valued, but would like more appreciation from within the organisation; our rest home caregiver and community support worker felt decidedly undervalued. »» Feeling stretched: Our RN, community support worker, and rest home caregiver all spoke about feeling overworked and stretched in their roles. Our DHB HCA did not. »» Appeal of aged care to younger people: With the exception of our DHB HCA, they all mentioned that there was a dearth of younger people in their workplaces and suggested that working in a supermarket or fast food restaurant would be a better option for younger people than aged care as it featured comparable pay, better career progression, and not the same level of responsibility.

»» Hierarchy: Only our DHB HCA felt prejudiced by her position in her organisation. »» Workforce is ageing: This was noted by all, although our DHB HCA said there were people of all ages at her workplace.

What is being done about it?

Political pressure: »» »» »» »»

NZACA election campaign Caring Counts campaign Kristine Bartlett vs TerraNova case Travel time negotiations and other examples of specific action Workforce reform:

»» Kaiāwhina Workforce in Action Plan »» Careerforce’s conference and resulting actions »» NZQA qualifications review.

Certificate of Attainment Are your staff qualified? Careerforce graduates: Have the knowledge to maintain a safe and secure environment keeping risk of

� falls to a minimum Have the communication skills needed to understand and support the elderly � Are able to apply the five R’s when supporting clients taking medication to � ensure right patient, right drug, right amount, right route, right time Are trained to give first class care and support to your clients to enjoy a better � quality of life Can provide so much more to clients in your workplace. � www.careerforce.org.nz

info@careerforce.org.nz

0800 277 486

CAREERFORCE TRAINING - much more than just a certificate www.insitemagazine.co.nz | August/September 2014

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Education and Training

Taking the purple path JUDE BARBACK looks at what is preventing younger people from working in aged care.

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he health and disability workforce, and the carer workforce in particular, is ageing. At the inaugural Careerforce workforce conference earlier this year, economist Dr Ganesh Nana described how half of the carer workforce is over 50 years old – substantially older than the total New Zealand workforce. What’s more, this workforce is continuing to age. The number of carers aged 65 years and older has dramatically increased in the past eight years, again surpassing trends for the total New Zealand workforce.

These statistics would be nothing more than idly interesting if it were not for the trends occurring in the ageing population, for which these carers are caring. Thanks to advances in healthcare and technology and the encroaching wave of baby boomers, the number of New Zealanders aged 75 and over is expected to more than double from 250,000 to 516,000 over the next 20 years. This, coupled with the boomer factor – older people are going to become more demanding – and the dementia factor – the number of older people with dementia is going to nearly double every twenty years – means it seems clear the workforce in its current form will be unable to adequately care for this demographic.

Shaina Nathan, 19, laundry assistant, Bupa

Nineteen-year-old Shaina Nathan offers an insight into what currently motivates younger people in looking for employment.

Nathan works as a laundry assistant at Bupa’s Northhaven Hospital. She joined the company last February, straight out of school upon completion of NCEA Level 3. She had initially considered going straight to university or joining the Navy, but is so pleased she is now gaining experience in the health industry.

Nathan says there are plenty of training opportunities at Bupa – “they’re trying to convert me into a caregiver,” she laughs – however, she is likely to go on to university at some point, and she is now considering studying mental health.

Nathan believes remuneration is an important factor for young people. While her wage of $16/hour is above industry average, she feels it doesn’t reflect “the huge responsibility” that comes with working in aged care.

“The money will never be worth it. It is constant hands-on. It is 24/7.

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Who will supplement an ageing workforce?

What to do? This was one of the key questions asked at the Careerforce conference.

Although caregivers are working until later in life, who is waiting for their jobs when they retire?

Part of the answer lies abroad. Migrant workers form a significant chunk of the carer workforce. Thirty-two per cent of carers were born overseas, and a quarter of these arrived in New Zealand within the past five years.

To this end, Immigration New Zealand’s introduction of new guides for employers and migrants in the aged care sector was welcomed by conference attendees.

Another part of the answer lies in the younger generation. One of Minister of Business, Innovation and Employment Steven Joyce’s pet projects has been getting vocational pathways up and running as a means of directing younger people from school into vocations. Approximately 70 per cent of school leavers do not enter degree level study, so there are many students looking at alternative options and careers via a different pathway. It is now acknowledged that NCEA Level 2 or an equivalent is the minimum qualification that young people now need to “I think younger people are too scared of hard work. They can’t handle the pressure. And they’re generally just thinking of the money.”

She says many young people look for jobs in fast food restaurants or supermarkets, which offer comparable pay, but without the responsibility or emotional challenges.

Marie Howlin, 26, caregiver, Selwyn. The young migrant worker

Twenty-six-year-old Marie Howlin has worked as a caregiver in the rest home at Selwyn Heights Village in Hillsborough, Auckland for three years. She is also currently acting activities coordinator.

Howlin completed a three-year degree course in Social Care level 7 in Waterford Institute of Technology, Ireland, with the aim of becoming a social worker. As part of the degree, she underwent a three-month placement in aged care, where she was offered a part-time position. Upon completing her degree, she worked full-time in aged care as a caregiver for almost two years before moving to New Zealand aged 22 years old.

succeed in New Zealand’s economy, and the Government has set a target for 85 per cent of 18-year-olds to have Level 2 in 2017.

To this end, there are six vocational pathways covering the road to employment in primary industries, services industries, creative industries, social and community services, manufacturing and technology, and construction and infrastructure. Each pathway is colour-coded, and the colour for the social and community services – the pathway under which aged care falls – is purple.

The purple pathway is designed to help young people obtain the skills and competencies, including literacy and numeracy, to enter and progress in this sector.

The objectives of the newly launched Kaiāwhina Workforce Action Plan are aligned with the pathways. One of the key actions is to develop the NZQA registered health and disability New Zealand qualifications, which provide pathways for school leavers, informal carers, and employees for levels 2 to 6 and into the regulated workforce.

While it would appear the pathways are being paved, it is going to take a huge cultural shift to get more younger people in the aged care workforce.

Howlin is paid $14.97, which is fractionally above the minimum wage. For someone who has completed a three-year degree and has over five years’ experience, this seems wide of the mark.

Howlin explains that her degree is not recognised in New Zealand.

“As I haven’t completed the ACE course, my rate of pay is a lot less than those who have completed the course. Also, as my degree isn’t recognised in New Zealand, my rate of pay is based on the amount of experience I have working in New Zealand, which is just over three years.”

“There are definitely not enough young people in aged care. Even where I work, there are not many caregivers/RNs under the age of 30. I think young people only see a negative side to aged care – they think it’s all about cleaning up messes. They haven’t got the experience of working with older people and see it as a job for older adults and not for people in their 20s.”

Howlin thinks that college or university courses associated with nursing, community and health should make it compulsory to do a

Education and Training

Are younger people suited to aged care?

Then there is the question of whether younger people are suited to the sort of work demanded of them in aged care.

Summerset human resources and business support officer Kay Morgon claims that caregiving is a job in which maturity is valued but that maturity doesn’t necessarily translate to age.

“Some of our older caregivers might have had experience with their own parents or have couple of weeks’ placement in aged care.

“This would get people to experience the work personally, rather than have pre-conceived ideas or be influenced by what others say.”

Candice Cull, 24, diversional therapist, Selwyn.

Aged care good place to start

At 24 years old, Candice Cull is the youngest person working at Selwyn Oaks Village in Papakura, Auckland. Cull works as a diversional therapist, running the activity programme for the residents.

Upon qualifying with a Bachelor of Health Science, majoring in occupational therapy, last year, Cull went travelling before securing her first job, at Selwyn Oaks.

“Aged care is a great place to start, as the skills are transferrable to many other industries,” she says. “I think younger people should work

had children, which brings particular skills, but younger caregivers could have also had experience with the elderly – say, their own grandparents.”

Bupa Care Services’ managing director Grainne Moss agrees that a person’s age doesn’t come into it.

“It is suited to all ages – it’s about being kind, caring, and valuing the older person.”

However, community support worker, Jenny Goodman, believes younger people are generally not suited to working in aged care. in aged care as it can teach them a lot, such as patience, compassion, and kindness.”

She admits it has its challenges, but “you learn to manage that,” she says. Cull is happy with her current level of pay.

“For a first job, the rate is fine,” she says.

Ultimately, she thinks aged care work could be advertised in more appealing ways.

Tracey Sprott, village manager, Ryman Healthcare.

From caregiver to manager

Tracey Sprott left school knowing she wanted to look after people. It wasn’t until she took a Topps Course run by the Salvation Army that she realised she wanted to focus on aged care.

From the position of care assistant, she has worked her way up to that of village manager for Ryman’s Shona McFarlane Retirement Village. Here, we chart her path up the ladder:

“It’s not just a job that needs NZQA. You need life skills. People wonder why young people aren’t keen to work in the industry, and it’s because you need to be able to communicate with older people.”

Leanne Pickering, general manager people and performance for the Selwyn Foundation, agrees, to an extent.

“Older people have life experience that enhances their levels of compassion and empathy with the elderly, and sometimes the Continued on page 12 >> 1987: Took year-long Salvation Army’s Topps Course, which focused on child care and aged care – she decided on the latter.

1988: Work experience at Benhaven Rest Home, then offered job there as a care assistant.

1998: Senior care assistant for Ryman’s new Malvina Major village.

2000: Set up and training staff at new Shona McFarlane village; took on quality assistant role.

2001: Set up and training staff at new Rita Angus village; took on quality Assistant role.

2002: Quality co-ordinator for Ryman’s three Wellington villages.

2003: Service department coordinator role at Rita Angus village.

2006: Administration position at Rita Angus village.

2009: Village manager at Rita Angus village.

2012: Village manager at Shona McFarlane village.

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Education and Training << Continued from page 11

resident is more comfortable with an older caregiver who may better understand the changes that occur with age.”

However, Pickering is quick to add that younger people bring another dimension to the workplace.

“Residents equally enjoy the company of a younger person, if that individual has the right personality for the demands of the role, and younger staff can bring another dimension to the industry, which adds value in different ways. We find this particularly with those who are young mothers and are able to communicate and share stories about their children.”

Morgon agrees.

“Our residents enjoy having younger people around them, for the energy and youthfulness they bring ... that said, the people we are looking for need to have certain qualities, like empathy and maturity, regardless of their age.”

Pickering acknowledges that the work involved can be physically and emotionally challenging. She points out that older staff may find the physical demands of the role a greater challenge than their younger colleagues, while younger adults may need additional support with things like palliative care and the terminal nature of many of the conditions affecting some residents.

Pay, progress and perceptions

Morgon believes more could be done to communicate the possible career pathways within aged care to younger people. She says young people entering the workforce are looking for a job in which there is a clear pathway in their career, or a way to get skills and experience.

“Some see caregiving as a way into nursing; they can see that there are skills and experience to be gained doing this kind of work, and a clear career path ahead of them, but perhaps there could be more work in this area.”

Pickering agrees.

“We could also do better in highlighting the professional leadership roles that are available with the larger providers – the opportunity to work within modern, state-of-the-art facilities, the benefits of ongoing education and professional development, and the prospects for career progression.”

She believes the lack of younger people in the industry can be attributed to three things: a lack of reasonable remuneration, a lack of a formal career pathway, and the way the aged care industry is presented and perceived.

“The problem really extends to all ages and all jobs – to registered nurses and caregivers alike. Many of the physical tasks are the same as those undertaken in other care settings, such as childcare and hospital HCA roles, yet these attract younger people. Therefore, it’s fundamentally a problem with how the sector is perceived generally, so more positive promotion is called for that focuses on and values our elders.”

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Josie Bidois who works as a District Health Board healthcare assistant in the Specialised Health Services for Older People, confirms there are many young people in her department, with many viewing the healthcare assistant role as a stepping stone to nursing.

Conversely, registered nurse Christiane Telfer says at 46 years old, she is one of the youngest at the rest home where she works.

Grainne Moss believes employers have a responsibility to promote aged care work as a career option for younger people. She also believes the media could do more to present aged care and the ageing process in a more positive light.

Ryman Healthcare, one of the larger aged care providers in New Zealand, is taking up the challenge.

“We need to increase awareness of the potential for career progression, job security, and the opportunity to build a great career at all levels in the industry. There is also the potential for staff with plenty of aptitude, energy, and ambition to work through the ranks into management within a reasonably short time frame,” says Ryman group human resources manager Nicole Forster.

Ryman has increased pay rates for caregivers by five per cent a year over the past two years, but Forster says this is just one piece of the jigsaw.

“We offer extra training, scholarships, and clear career paths. We encourage, for example, caregivers who are interested in becoming registered nurses by offering training scholarships. “[Ryman has] been selected to take part in a Government pilot scheme, called the Industry Training Fund. This gives us direct access to funding and has meant we can extend the training we offer caregivers and housekeepers,” explains Forster.

The issue of pay does not appear to be a strong deterrent for younger people. New to the workforce – indeed to any workforce – generally they do not carry high expectations for their starting pay rate.

The issue is a lack of pay progression, linked to a lack of career progression opportunities.

Training actually appears to be well-executed

at many facilities, however the attainment of qualifications or new skills is linked to pay in an ad hoc manner across different facilities.

As an unregulated workforce, there is no formulaic system for recognising that the better you become at your job, the better your pay and the better your chance of promotion.

A young person considering the industry will recognise a lack of pay and promotion opportunities and for the same money may opt for a job at a supermarket or a fast-food restaurant, where the pay is comparable, yet the avenues for progression are better defined and publicised.

There are notable exceptions, however – true success stories that serve to demolish these arguments.

Tracey Sprott, manager of Ryman Healthcare’s Shona McFarlane Retirement Village, provides a shining example of someone who has managed to progress her career in aged care. She joined Ryman in 1998 as a caregiver and took up any opportunity for training and progression within the company. In the space of 11 years, she moved from caregiver to senior caregiver, to quality assistant manager, to service department coordinator, to administration, to village manager.

“I tell my care staff that opportunities can open up for everybody, but you’ve got to be willing to put the hard yards in and push yourself forward. There are lots of opportunities in this company,” says Sprott.

Bupa’s Shaun Brown, who won the EEO ‘Walk the Talk’ Award in 2012, is another prime example that it can be done. Brown started out as a caregiver, trained as a registered nurse, then moved on to become a clinical leader before becoming operations manager for Bupa Care Services. In this role, he helped others progress their careers in similar fashion.

Connecting the pieces

Of course, bigger players like Bupa and Ryman are more likely to offer more career opportunities. Sprott acknowledges the role that Ryman has played in her climb up the ladder and concedes that such opportunities may be harder to come by in smaller facilities.

The good news is that the wheels are in motion to change this. The NZQA qualifications review is expected to tie in well with Careerforce’s objectives and the Kaiāwhina Workforce Action Plan.

But this is just one part of the puzzle.

Career progression, achieved through training, qualifications, and clear pathways within organisations, needs to be linked to employees’ pay. By now, we all know that this is not easily achieved without a lift in Government funding.

The jigsaw is certainly coming together, but there are a vital few pieces missing. Only when it all comes together can we truly expect to see young people taking the purple pathway, and into aged care work in particular.

focus

Food safety: recognising best practice With lab testing for listeria costing food manufacturers a considerable amount, some have called for a system to recognise their efforts in taking every precaution to ensure the safety of their food supplied to rest homes and hospitals. JUDE BARBACK considers the viability of this idea in light of the changing food law and an industry that likes the status quo.

I

n 2012, a listeria outbreak that caused the death of two elderly patients in Hawke’s Bay Hospital made headlines. Understandably, there was an uproar. Finger-pointing quickly shifted from hospital to food retailers to manufacturers. National recall notices were issued. The Ministry of Primary Industries got involved.

It isn’t the first or last incident of its kind in New Zealand, but it exemplifies exactly the sort of situation a food manufacturer and supplier wants to avoid.

Ensuring food safety a costly business

To this end, many manufacturers take extra precaution when supplying food to aged care facilities, by putting their high-risk products on hold when they are made. ‘High-risk’ includes unbaked products and those with fresh cream, for example. A sample of each batch is sent to a lab that tests for listeria. The test result is received two days later, and if the result is clear, the products can then be released and sold to the customer.

However, manufacturers incur high costs with operating such a hold/ release programme.

A representative from AsureQuality, one of the leading food testing labs in New Zealand, says such a test for listeria could range from $30 to $70 per test, depending on the type of product, with additional costs likely to detect other things.

Some have raised the question of whether there should be some system of recognition within the aged care industry to acknowledge the manufacturers’ extra effort to ensure the utmost safety of the food provided.

To help make it “worth their while” one manufacturer suggested some sort of “tick” for food manufacturers that have a hold/release programme in place, so that aged care providers know to look for this when choosing their food supplier.

Trusting suppliers

Jessica Bowden, national dietitian for Oceania, says all food suppliers should be audited to a Quality Management Plan level that includes a Hazard Analysis and Critical Control Point (HACCP) plan.

These plans cover sample retention processes and action if a retention sample exceeds food safety guidelines.

To support this, Roana Bellew of the Compass Group says all Compass suppliers are provided with clear performance criteria and depending on the food in question this may include a testing regimen to confirm safety.

“This is an additional check that allows Compass to monitor the companies’ performance and complements their own standard testing.

We expect but also stipulate in contracts that product must comply with national standards and also our Vendor Quality Assurance Protocols. All Compass Group suppliers have approved Food Safety Plans based on HACCP principles.”

Bowden says Oceania uses “reputable suppliers” so expects all products are delivered safe for consumption. However, she acknowledges that the food industry is not completely watertight.

“In saying that, there is a well-known supplier who had a significant outbreak of listeria two years ago and ever since then we have refused to allow their products to be purchased by our sites.

“If food is high listeria risk, all suppliers should make sure that it is safe for consumption and if that cannot be guaranteed then come with a warning label for pregnant, elderly and other immunocompromised [people] to be aware the product comes with listeria risk.”

Allan Cawood, national procurement manager for Bupa, says they are aware of the hold/release programmes and confirms they do check whether the manufacturer operates such a programme when purchasing food products.

However, Cawood points out that with there are varying degrees of risk for different products, which needs to be taken into account.

“Within the ‘high-risk’ categories there are some [products] that are more and less risky, so what we look for depends on more specific definition of product than just ‘high-risk’.”

He gives the example of whether a product has been cooked or not.

Two products with the same risk profile after manufacture will change if one product is to be cooked and one is not. www.insitemagazine.co.nz | August/September 2014

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At the suggestion of a system of recognition for manufacturers who take extra measures to ensure the safety of their food, both Bowden and Cawood are sceptical.

“I do not believe that there should be a reward for companies to ensure that food they are profiting from is safe to eat. Maybe this clause could be added in with the proposed new Food Bill,” says Bowden.

Cawood agrees.

“I don’t believe that an additional ‘tick’ is appropriate, although I understand why this is suggested, as this is certainly an indication that there is an additional level of protection in place.

“However, there is a lot of subjectivity in terms of the word ‘risk’ and what this tick would potentially do is be used out of context with the risk and inappropriately create a comparison of two products – that one is safer than the other when, in fact, the risk is such that the [hold/ release] programme might not be necessary.”

Cawood also doubts whether the market would see the benefit for the additional cost of introducing a system of recognition.

“What I do believe is that increasingly customers/the market will prefer products that have this protection, and it will become standard practice for all quality processors/manufacturers of products where risk [is a factor].”

New Zealand Aged Care Association’s Martin Taylor acknowledges food safety is an important area, but he believes current food safety measures are adequate.

“My feeling is if it ain’t broke, don’t fix it. Is there a problem? There is no research to support that that there is any problem with the current regime.”

Roana Bellew of Compass says any company who is in the business of preparing food for sale and consumption should meet the same high safety standards.

“It isn’t an area where we can have a scale of suitable, better, or best.

We all need to be at our best.”

Changes to food law imminent

Bellew believes food safety testing is already a given for any commercial food processor or manufacturer in New Zealand.

“Suppliers are legally obligated, based on New Zealand food regulations and Ministry of Primary Industries requirements to produce products that are safe and suitable for use by the general population.”

However, the new Food Act 2014, expected to come into force by March 2016, will replace the Food Act 1981 and its one-size-fits-all approach to food safety. Over the next 20 months, the Ministry of Primary Industries will be conducting “extensive consultation” and developing regulations, tools and guidance to help food businesses manage food safety themselves based on the level of risk associated with the kinds of food produced and in a way that suits their business.

The central feature of the new Act is a sliding scale, where businesses that are higher risk from a food safety point of view will operate under more stringent food safety requirements and checks than lower risk food businesses.

Under the new Act, higher-risk food businesses – that prepare and sell meals or sell raw meat or seafood, for example – will operate under a written Food Control Plan (FCP) where businesses identify food safety risks and steps they need to take to manage these risks.

Under the new law, individual operators will be able to influence their own compliance costs. Those businesses that are performing well will be rewarded with less frequent checks, while businesses not managing food safety well will receive extra attention.

The notion of ‘performing well’ could possibly be encapsulated in some sort of recognition programme. In the same way a four-year certification audit for a rest home indicates a high standard of operation, perhaps food manufacturers will wear an equivalent badge for adhering to very high standards.

To state that all manufacturers are operating to the utmost safety is a comforting notion, but perhaps not wholly accurate. Any system to encourage and reward best practice can surely be no bad thing when it comes to providing food for New Zealand’s rest homes.

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focus

focus

A ‘tick’ for food testing?

Nutrition and dementia: pooling global knowledge Registered dietitian GAYE PHILPOTT considers the findings of Alzheimer’s Disease International’s Review of Nutrition and Dementia Research.

P

eople today are living longer and healthier lives. However, this has resulted in a worldwide increase in the number of people living with chronic conditions, including dementia. While dementia is not a normal part of ageing, it is more common in older people and is more likely than other chronic conditions to lead to a person’s loss of independence and a need for care.

Dementia is a condition that affects memory, thinking, behaviour, and the ability to perform everyday activities. There are a number of different types of dementia, Alzheimer’s disease being the most common and best known. Others include vascular dementia (usually caused by small strokes), dementia with Lewy bodies, and dementia associated with conditions such as Huntington’s and Parkinson’s disease.

In the absence of any cure, disease-modifying therapy or treatments that can alter the course of dementia after its onset, there is an urgency to reduce the risk and slow the progression of the condition. With many chronic conditions – such as heart disease and diabetes – being influenced by nutrition factors, it would be logical to expect dementia would also be influenced by nutrition. However, Alzheimer’s Disease International’s recently published Review of Nutrition and Dementia Research could find no clear or consistent evidence to support a protective effect of the nutrients it might be expected would (i.e. vitamins B6 and B12; the antioxidant vitamins C and E; omega-3 polyunsaturated fatty acids). It also casts some doubt on the existing evidence that obesity in mid-life may be a risk factor for developing dementia later in life.

What it found was that the strongest and most consistent evidence to date for a dietary pattern that reduces the risk of dementia in later life is a Mediterranean diet, one that includes high intakes of fruits, vegetables, fish, and grains.

By far the more pressing issue regarding dementia and nutrition is the increased risk of undernutrition and weight loss. Numerous studies support the fact that people with dementia are more likely to experience a significantly greater decrease in body weight in older age. Studies reviewed in Alzheimer’s Disease International’s Review of Nutrition and Dementia Research found that 20 to 45 per cent of those with dementia living in the community experience clinically significant weight loss over one year and that up to half of people with dementia living in aged care facilities have an inadequate food intake.

The reasons for this are complex and multifactorial. Dementia itself may affect regions of the brain that are involved in appetite control, putting a person at risk of not eating sufficient to maintain their

weight. For a person living at home, the amount of food eaten will be influenced not only by their appetite, but also by their ability to shop and prepare meals, and by what help they receive. For those in care, it can be influenced by the eating environment, how familiar the meals are, and what they taste like.

As dementia progresses, cognitive and behaviour changes can disrupt many aspects of feeding. A person may forget how to use cutlery, be easily distracted and not complete their meal, play with their food, resist being helped or hold food in their mouth and not swallow it. Add to this behaviours that challenge, such as restlessness and incessant walking, and the increased calorie needs further jeopardise a person’s ability to maintain their weight.

The consequences of undernutrition and weight loss are significant: increasing frailty, reduced mobility, skin fragility, and an increased risk of falls and fractures – all of which affect a person’s quality of life and level of dependence. Undernutrition and weight loss also causes considerable anxiety and strain for family/whānau members who provide care and support, as well as community support staff and aged residential care staff.

Monitoring of body weight is therefore important. It helps identify an inadequate food intake, especially early in the condition process so that strategies can be put in place to prevent further weight loss and improve nutrient intakes.

Better still is the use of a validated nutrition screening tool such as the six item MNA (mini nutritional assessment – previously known as MNA-SF) or MUST (malnutrition universal screening tool).

Many aged care facilities in New Zealand use such tools to determine the risk of undernutrition, commonly referred to in such settings as malnutrition. Some district health boards are also preparing to introduce nutrition screening in community dwelling older adults.

Where malnutrition or its risk is identified, a more detailed assessment helps to establish the contributing factors and the extent of the problem. This would usually involve keeping a record of all food and fluids consumed over a specified period of time, observation of the person’s eating and feeding behaviours, and, where indicated, referral to a dietitian.

The desire to prevent weight loss and improve the nutrition of people with dementia by those who look after them is strong. A number of strategies are recommended and used to achieve this, but what evidence is there to confirm whether or not they are effective. The recent review of nutrition and dementia research by Alzheimer’s Disease International provides some key findings.

It found that the eating environment in aged care facilities can affect how much a person eats, with one Canadian study suggesting that the greatest nutritional benefit was gained by the most cognitively impaired residents. Smaller dining rooms that are well lit and are decorated with ‘bright and welcoming’ colours and other residential features such as sideboards and objects d’art are associated with increased food intake. Linking dining areas with the kitchen allows the diffusion of

cooking smells and sounds, which can help cue that a meal is about to take place and stimulate appetite. While too much noise was found to be distracting, familiar background music may increase calorie consumption.

Their review found there was strong evidence that oral nutritional supplements were effective in maintaining or improving the weight of people with dementia who were at risk of undernutrition or who were normally nourished. It found that the supplements were generally well tolerated and the calorie value of the supplements was not offset by a reduction in the usual food intake. This occurred in studies that were conducted in both aged care facilities and the community. The additional calories provided daily ranged from 125 to 680 and were given for either short intervals or long periods of time. However, no improvements in cognitive function were observed and there was insufficient evidence to judge the impact of such supplements on mortality or whether they are effective among people with dementia who are already undernourished.

What the review also does not tell us is whether, if the same increase in calories was achieved by other calorie dense foods, the same improvements in body weight would occur. It could surely be assumed they would.

Another area that the review investigated was the impact of carer education and training. It found that while most carers (including family/whānau, paid caregivers, and residential care facilities) understood that nutrition was an important component of the care they provide, it cannot be assumed that they are naturally equipped with the knowledge and skill to assess and manage the often complex feeding needs of a person with dementia. Where such behaviours existed, categorising the challenging behaviour was an essential first step in planning measures to overcome it. The review also found that education and a positive attitude from those involved in feeding residents helped decrease negative outcomes and increase quality of life. However, the review supports the findings of other reviews that where advanced feeding and swallowing problems persist, tube feeding does not confer any benefit to people who have dementia and that these problems should be seen in the context of holistic palliative end-of-life care.

While many questions remain unanswered about the role nutrition plays in the development and progression of dementia, evidence-based research has provided some systems level and individualised approaches that can lessen the risk of undernutrition in people who have dementia and help overcome the many feeding problems they may experience.

A problem-solving approach and commitment to further research can only further enhance the nutritional care of those who have dementia and provide support for those who care for them.

For more articles, including ‘Nutrition myths exposed' by CPIT's Dr Nick Kimber, visit our website: www.insitemagazine.co.nz

www.insitemagazine.co.nz | August/September 2014

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conferences

Conference Report

Retirement Villages Association 2014

Above: Delegates at the RVA golf tournament.

Left: RVA’s John Collyns (right) presents a very large cheque.

Pictured are the teams that played the inaugural ‘Grant Adamson Memorial Golf Tournament’ held to commemorate the memory of our RVA Executive member who died from a brain aneurism late last year. This was also the purpose of the fund raiser for the Neurological Foundation of New Zealand.

A growing industry learning to defend itself The RVA celebrated its 25th birthday at this year’s conference, held at the Langham Hotel in Auckland in June. A birthday party and a special 25th anniversary yearbook served to mark the occasion.

The industry has experienced huge growth and changes in the past 25 years and many of the key trends and themes were brought under the microscope at this year’s conference, among them: managing public perceptions and remaining innovative.

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RVA executive director John Collyns said the conference had been a success. The large number of delegates and exhibitors in attendance, including a mix of new and familiar faces, was indicative of a rapidly growing retirement village industry, he said.

“From a supplier’s perspective, the industry has a huge future,” said Collyns.

It is perhaps this ‘huge future’ that made public relations a hot topic at this year’s conference.

There was some defensiveness from delegates around the media’s portrayal of the retirement village and aged care industries, and New Zealand Herald editor Shayne Currie was faced with some biting questions over recent Herald coverage.

Managing perceptions around the deferred management fee (DMF) model, which has suffered public criticism at times, cropped up at several sessions including the CEOs panel, with one panellist describing it as “the ultimate ‘buy now, pay later’”.

Collyns said while the DMF was

becoming much more accepted by residents, it was inevitable that some would fail to see its benefits, as it was counter-intuitive to the way New Zealanders typically think about property ownership.

Panellists agreed the challenge was to keep family involved from the outset and to educate people about what the DMF model essentially delivers for residents.

Keynote speaker Bryan Mogridge reminded delegates that “the model for aged care in New Zealand is without peer around the world” and suggested operators steer their focus away from the balance sheet and onto the high-quality services they are offering instead.

Comparisons with retirement village industries around the world was another key theme at this year’s conference, bringing some new ideas to the table. Katie Smith Sloan from the International Association of Housing and Services for the Ageing (IAHSA) talked about the rise of multigeneration villages in Singapore, while Jennene Buckly spoke about the role that technology can potentially play in helping people to age in place.

With the General Election looming, it was surprising the programme did not have a more political emphasis. However, Collyns said there was not a lot that the Government or opposing political parties could offer at this stage.

“The industry is in good heart and doesn’t need state intervention.”

conferences

Upcoming conferences New Zealand Aged Care Association 2014 Conference Wellington 15-17 October, Shed 6 + TSB Bank Arena ‘Facing Tomorrow’s Challenges Today’ The NZACA for 2014 will look at Facing Tomorrow’s Challenges Today. This is about creating the best possible future from existing knowledge, analysis, and creativity. It’s about operators taking the sector’s known building blocks and using them to make decisions that ensure positive business continuity for the coming decades.

These known building blocks show us that consumers are looking for more choices and more flexibility. These consumers are wanting

and will want, person-centred care based around their activities of daily living. They will also want all care to come to them, so as their needs change they ‘age in place’.

Our challenge as providers is delivering on these consumer demands by creating an environment that supports choice and flexibility within the regulatory and financial constraints imposed on us by our funders and regulators.

Conference highlights and key speakers Davina Porock – Person-centred care

Davina Porock is professor and associate dean for research and scholarship at the State University of New York at Buffalo, where she moved in 2010. She has worked in nursing practice and research in Australia, where she received all her formal nursing education, in the UK, and in the USA .

Most of Dr Porock’s work has been in the care of older adults approaching the end of life and more particularly in understanding the transition from recovery-focused care to end-of-life care; a holistic process she called recognizing dying. She recorded a TED talk on this topic, called ‘Healthy Dying’ in April 2013.

In 2012 Dr Porock established the UB Institute for PersonCentred Care (IPCC), which aims to build the evidence base for person-centred care through collaborative interdisciplinary research and dissemination. The focus of Dr Porock’s current research is to understand the biological and psychosocial mechanisms underpinning person-centred approaches to care for these very vulnerable people.

Rob Hankins – Challenging Decisions: what is your purpose for being?

Rob has had an extensive career in acute care and rehabilitative private hospital management in both the charitable and for profit sectors in several states in Australia and South Africa, including standalone facilities and corporate groups. In the mid-1990s, he spent several years managing a charitable organisation providing acute care, independent living units and high care on the same campus. This gave him the desire to focus his career in more recent years in the aged services sector.

He is currently the chief executive and a director of ECH Inc., a charitable organisation and one of the largest affordable home and support providers to older people in South Australia and the Northern Territory.

Danielle McIntosh – Good Design: We know what we want but how do we get it?

Danielle is a senior consultant with the Dementia Centre, HammondCare. Danielle has a background in occupational therapy, aged care quality assessing and residential aged care management.

Danielle has expertise in designing and operationalising enabling environments for older people and people with dementia and has presented nationally and internationally on how to ensure that effective care and good design is implemented. Danielle has co-authored three books related to dementia care.

Mark Sainsbury – What do the election results mean for us now and in the future?

Mark Sainsbury, born, bred and still residing in Wellington, is one of the country’s most experienced journalists. Former host of TVNZ’s Close Up and three times Qantas award-winning presenter, he has held all the major roles in New Zealand television journalism and interviewed world figures from every spectrum, including every New Zealand Prime Minister and opposition leader since Rob Muldoon.

Martin Snedden – Meeting expectations and successfully delivering the outcomes

Martin is currently a director of both New Zealand Cricket and the International Cricket Council and also of Auckland World Master Games 2017. He has recently retired from the role of CEO of the Tourism Industry Association.

Between 2007 and 2011, he was CEO of Rugby New Zealand 2011 Ltd, the company responsible for staging the extremely successful Rugby World Cup 2011.

Between 2001 and 2007, Martin headed New Zealand Cricket during a tumultuous period punctuated by issues relating to terrorism, politics and player contract negotiations, a period where the Blackcaps New Zealand cricket team consistently ranked high in both tests and one-day internationals. During his own playing days he represented the Blackcaps between 1980 and 1990.

Prior to his role of CEO of New Zealand Cricket, Martin has practised as a lawyer, including 11 years as a partner of an Auckland law firm. In January 2012, he was made a Companion of the New Zealand Order of Merit.

New Zealand Association of Gerontology 2014 conference 14-17 September, 2014, Dunedin. ‘The Age of Ageing’ Given the increasing numbers of older people, and our increased longevity, we have to ask: do we know how to age? Do we know what’s happening for us as older people?

Older people in 2014 are the pioneers of how to age well. That includes care for the disabled and sick, it includes remaining physically active, and it includes communications both near and far, both face-to-face, and even via the internet.

To learn more about how we are ageing and what we should do, the New Zealand Association of Gerontology in its annual conference has focused on ‘The Age of Ageing’ – a title epitomising how we are ageing.

The conference themes range from chronic conditions, social, and cognitive aspects of ageing, health promoting communities and the fields of policy and wellbeing of older people. Fascinating presentations include spirituality and ageing, and the focus on health communities, issues confronting migrants, and issues of gender and sexuality. The multi-disciplinarity of the New Zealand Association of Gerontology is clearly demonstrated in this conference.

Equally exciting are the workshops, one on writing for publication and the other on ‘Spatial science and ageing research’, a field includes geographic gerontology, says the presenter Hamish Robertson.

www.insitemagazine.co.nz | August/September 2014

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News

On the soapbox …

INsite asked political parties National, Labour, the Green Party, New Zealand First, and the Māori Party for their response to the New Zealand Aged Care Association’s election campaign to increase funding to allow fairer pay for caregivers. Here is what they had to say.

National – Associate Health Minister Hon Jo Goodhew

Despite tight world times, which have seen many countries freezing or even reducing funding for health services, the National-led Government has increased DHB spending on aged residential care from $744 million in 2008/2009, to $975 million this year.

This extra $231 million now being spent on aged residential care is a 30 per cent increase over National’s six budgets, which includes volume increases.

National believes the aged care workforce is the base upon which quality aged care of the elderly is delivered. That is why additional funding has been provided, as well as investments in nursing quality and supervision, dementia respite care, home based support, and training in aged care.

The pay rates paid by the private sector employers are, however, a matter between the employer and their workers.

The National Government is committed to increasing funding to the aged care sector as the economy improves, and an announcement is imminent on the use of the additional $10 million for aged care delivered in the recent Budget.

There is a provision in the ARC contract under clause A23 that allows providers to claim for events outside the control of either party to the agreement. This provision has been tightened, through mediation, to cover events that have more than a 1.5 per cent impact on the sector.

The Government has also required DHBs to pass on at least the increase in funding they receive to aged residential care providers as a contribution to cost pressure. This requirement does not apply for most other DHB contracted services.

A National-led Government will take into consideration the impact of any changes 18

August/September 2014 | www.insitemagazine.co.nz

in government policy when it makes critical funding decisions.

National will continue to increase investment in aged residential care, as strongly as can be afforded, and will continue to work closely with the sector to deliver the best possible care for residents.

Labour – Annette King

Labour realises the important role the elderly play in New Zealand society and recognises the unique concerns the elderly population have in New Zealand.

Three of the major areas we are aiming to target are to help the elderly are: cost of living, quality health services, and security in retirement.

Firstly, Labour recognises the stress older Kiwis are under when it comes to paying the weekly and monthly bills. We have a strong economic policy, which will give the Reserve Bank new tools and broader mandate to keep inflation at bay. We are underlying our commitment to compulsory KiwiSaver so all employed New Zealanders can save for a nest egg in retirement.

In addition, through our NZ Power policy, we will bring down power prices, and through our KiwiAssure policy, we will address the costs of insurance.

We are committed to rebuilding the economy and bringing down costs so that New Zealanders are able to retire with dignity and not have to worry about how they will pay their next bill.

Secondly, Labour recognises the health budget in New Zealand hasn’t been keeping up with the needs of older people. This is why we will ensure the health and education budgets keep up with rising costs and the growing population by setting aside a billion dollars of new spending every year, in addition to any new health spending announcements. This

will ensure health services have the funding they require so that every New Zealander can access quality affordable healthcare.

Labour is committed to quality aged care. We will work collaboratively with providers, unions, and representatives of older people to improve wages for caregivers, to set agreed standards for care, and to make home-based care work more effectively for the people receiving care. There will be an agreed plan with agreed timelines for reaching our targets.

Thirdly, we have listened to those in the sector and have committed to establishing an Aged Care Commissioner tasked as a watchdog for the rights of older New Zealanders. As New Zealand’s population ages we need to ensure that there is a strong voice able to draw attention to problems and provide recommendations for solutions. This is what Labour will deliver through the establishment of an Aged Care Commissioner.

In addition, we will also commit to bringing the Minister for Senior Citizens back into cabinet as part of our push to ensure that the issues and needs of older New Zealanders have a dedicated voice within government.

Labour recognises the importance of the elderly in New Zealand and we are committed to ensuring that New Zealand can sustain decent standards of living for older New Zealanders.

New Zealand First – Barbara Stewart It is completely unfair that rest home caregivers earn over $100 a week less than others doing the same work for

District Health Boards.

New Zealand First wants pay parity with the DHB workers for those who work hard to look after our elderly.

The Prime Minister promised this change in 2012 and said it is something the Government would love to do when they are back in surplus.

Now we are in surplus, and in the most recent Budget 2014, we saw nothing for aged care!

News In view of the importance of the elder care sector and the ageing population, New Zealand First is calling for a national plan for the future of elder care.

New Zealand First has always been committed to the wellbeing of our senior citizens.

New Zealand First made a commitment to address this funding deficit and was responsible for the additional $587million secured for the aged residential care sector in 2006 and 2007 under the NZ First-Labour 2005 Confidence and Supply Agreement.

We support increased government funding to the aged residential care sector, and this should be targeted towards pay parity for care workers.

The Green Party – Kevin Hague

The Green Party is committed to a fairer society for all New Zealanders, including older New Zealanders and those who care for them.

In Government, the Greens will ensure the provision of a high standard of care in residential aged care facilities and fair wages for the many dedicated workers who work in the aged care sector.

Aged care providers must be adequately funded to enable caregivers in to achieve pay parity with those doing equivalent jobs in hospitals and to transition all aged care workers to a living wage.

The Greens in Government will ensure this happens.

The Green Party is aware that in 2007 aged care providers took legal action to avoid having to pass on funding increases intended for increased wages. Funding increases will need to be accompanied by appropriate legal steps to ensure additional funding is ring-fenced for wage increases.

The Greens will also work towards the elimination of the exploitative and discriminatory asset testing regime for older people in residential care that was locked in by the National-led Government in 2012.

The Māori Party – Te Ururoa Flavell

John Walden, in his report entitled Oranga kaumatua: perceptions of health in older Māori people, found from a survey of more than 400 older Māori that higher standards of health are strongly associated with active participation and cultural affiliation, home ownership, and higher incomes. The survey participants expressed an enormous sense of satisfaction from the reciprocity of care experienced within their whānau.

Our signature policy is Whānau Ora. Whānau Ora is an inclusive inter-agency approach to building the capacity of all New Zealand families in need. It empowers whānau as a whole rather than focusing separately on individual family members and their problems.

Whānau Ora operates from the very strong philosophical driver that we must restore to ourselves the capacity to believe in our ways; to be proud of the kaupapa that have always stood us in good stead. We must not be reliant on others outside of the whānau to provide services that are better followed by our own.

Whānau Ora is also driven by a focus on outcomes: that whānau will be self-managing; living healthy lifestyles; participating fully in society; confidently participating in te ao Māori (the Māori world); economically secure and successfully involved in wealth creation; and cohesive, resilient, and nurturing.

Whānau Ora will increasingly bring a greater focus to address the issues of employment, housing, educational achievement, and the wellbeing of the most vulnerable members of

society, including those on low incomes.

This is the context from which we respond to the priorities of the aged residential care sector.

We support the call for ensuring funding to the aged care sector is not undermined by insufficient attention to minimum wages. The Māori Party would like to raise the individual and collective living standards through promoting employer incentives to introduce a living wage of $18 plus CPI adjustments.

In Budget 2013, $1.5m was allocated to train staff to use interRAI software.

This was then expanded in Budget 2014 where interRAI was funded alongside an e-prescription tool and Whānau Ora information system, all three of which were allocated a total of $12.4 million. We would expect to see comparable support be continued to ensure that the use of the information tools are properly provided for.

The Māori Party believes that whānau should feel safe and secure and should be able to live with dignity. We believe in adequately resourcing formal and informal caregivers to enable whānau members to stay in their own homes especially older people to be supported to live in their homes as much as possible.

Assessing quality of life for a person on life support and how long they should remain on life support is one of the biggest decisions whānau may have to make.

The Māori Party believes that as far as possible, elderly people should be able to remain living in their homes and that they are able to move to a form of special housing if they have substantial needs or if they do not feel secure. We support Māori provider development focused on outcomes in primary care where services need to grow, such as those required as the population ages. We are also committed to review the work conditions, pay, and training opportunities for those working in the elderly, disability, and home care sector.

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www.insitemagazine.co.nz | August/September 2014

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Technology

Bupa boards the interRAI train After initially taking a ‘wait-and-see’ approach to interRAI, Bupa has finally committed to a training delivery programme for the assessment tool – but on its own terms. JUDE BARBACK talks to Bupa’s Gina Langlands about her concerns surrounding the roll-out of interRAI, and why Bupa is now happy to join the interRAI party.

Bupa’s decision to get on board with interRAI training took many by surprise. In the early stages of interRAI’s entrance onto New Zealand’s aged care landscape, Bupa was openly cautious about the assessment tool.

Now, in partnership with Selwyn Foundation, the organisation is establishing interRAI development sites and is in the process of rolling out training to all its facilities. What prompted the change?

Initial reservations

Gina Langlands, project sponsor of Bupa’s interRAI training programme, says Bupa’s initial decision to be a slow follower was based on a view that as a company Bupa could see massive implications with the implementation of interRAI. She also says there appeared to be a “complete absence of any national strategic document or overarching framework that explained the whys and the hows”.

“From the start, we were told that implementing interRAI would vastly improve the quality of care for people in residential aged care – but measured against what? Where is the base we are starting from and how will we know it’s achieved the objective?

“In fact, what is the objective? Because without an overarching framework that clearly defines this or clearly articulates quality measures, the general view is that the overarching objective was to have a great database – and no one can deny that objective has been achieved.”

But Langlands’ doubts about interRAI’s introduction in New Zealand go deeper still. She says any evaluation of the interRAI pilot has not been disseminated, nor has any documentation emerging from the interRAI Steering Group.

“InterRAI was sold on the back of ‘successful pilot of interRAI in Canterbury’ but I have never seen an evaluation of the pilot. Why wasn’t this communicated?

“The interRAI Steering Group is invisible to us. I’ve never seen any minutes or strategic document. Bupa asked for a seat on the steering group but this was declined. I thought it would have been sensible for New Zealand’s largest aged care provider to have a seat.”

Why Bupa finally got on board

So what did it take to get Bupa on the interRAI train?

InterRAI training was devolved to DHBs, with the offer of a laptop and $650 to backfill a 20

August/September 2014 | www.insitemagazine.co.nz

nurse. Bupa thought they could do it better.

The Ministry of Health was happy enough for Bupa to develop its own training, and a Memorandum of Understanding was signed between the two parties.

“I think they were keen to get Bupa across the line. There was pressure from very high up for Bupa to get on board with interRAI,” says Langlands.

Certainly, there has been a significant push from the Ministry of Health to get interRAI rolled out. At signs of resistance from residential aged care providers in signing the ARC contract variation, some concessions for interRAI were quickly made by the Government.

The concessions included a review of the interRAI roll-out in terms of the impact it will have on providers’ costs and RN hours, training for enrolled nurses, training for allied health use of interRAI, an extension of the training deadline, and agreement on the ongoing provision of training resources and support.

Tailoring interRAI to suit its needs

Bupa will meet the Ministry of Health’s sanctions, albeit via a slightly different approach to most other providers.

Bupa and Selwyn Foundation have partnered in the delivery of in-house training in the use of the interRAI Long Term Care Facilities (LTCF) Assessment Tool. This partnership will see training delivered to 59 Bupa and 11 Selwyn aged residential care facilities (or 331 Bupa RNs and 49 Selwyn RNs) by 30 June 2015.

The two organisations have established interRAI development sites to ‘road test’ the in-house training, making full use of all the interRAI tools, not just the assessment tool. The sites are at Bupa’s Te Puke Home, its Parkwood and Parklands facilities in Christchurch, two Selwyn Foundation care homes in Auckland, and the Counties Manukau District Health Board Franklin Memorial Hospital in South Auckland.

The development sites will help the organisations formulate the training programme required to ensure their RNs can achieve their competency in LTCF assessment.

The development sites will serve another purpose, too – they will be used to work out how Bupa can fully integrate interRAI LTCF tool into their care planning practices and systems.

“The care plan that falls directly out of

the interRAI assessment nowhere meets the requirements we have for our care plans,” explains Langlands.

“If we have an electronic assessment tool, we really needed to be looking to build on this and have the assessment data cut straight across into an electronic care plan.

“It was through discussions with Momentum that we saw there was a separate Care Planning Module that we could ‘activate’. We had a view that surely using the Momentum care plan would give us the most perfectly matched pairing between the assessment and the plan.”

Consequently, Bupa is also piloting the use of the Momentum care plan in the two Christchurch development sites.

Why size matters

Langlands admits Bupa’s large scale enables it to deliver its own interRAI training, in a way that smaller providers may not be able to replicate.

“Bupa is in a fortunate position with both size and resource and from the outset we knew we wanted to roll out our own interRAI training, which the MOH has sanctioned.

We have partnered with Selwyn, who are also doing their own training internally. We have been able to tailor the training to the needs of our own organisation. We have developed our own training resources.”

While she admits to a few challenges – the ability of care homes to release the RNs, a norovirus outbreak at a training venue, trainer illness – she says it is going very well.

Bupa and Selwyn are keen to learn from the exercise and have jointly commissioned an independent evaluation, which is being undertaken by Chris Howard Brown. The findings will help them improve existing processes. Langlands says they plan to share the report beyond Bupa and Selwyn so that it might benefit other organisations as well.

Despite some scepticism around the way interRAI has been rolled out, Bupa is pleased to be on board with interRAI, especially when they can ensure that tools and training are delivered in a way that suits the specific needs of their organisation.

“We are happy to be on the train,” says Langlands.

“New Zealand will be the only country to have a complete line of sight into every aged care facility.”

Tacera

Note to self; New Zealand’s largest supplier of Nursecall Systems for over 20 years 6,000 Hospitals and Aged Care facilities rely on Austco Complete range of traditional, IP based and audio nursecall

Email us at info@austco.co.nz Call us on 0800 287 826 TACERA is an advanced IP based nurse call solution for healthcare facilities that has plug-and-play functionality.

This minimizes the cost of installation and commissioning, as well as making ongoing maintenance more cost effective.

Selecting a Nursecall system is a daunting task, with so many technologies involved how do you choose the right product and the right supplier? Over the past twenty five years, 6,000 healthcare facilities have chosen Austco as their trusted supplier.

Graphical user interface

Our range of Nursecall Systems provide;

TACERA comes with a comprehensive touch screen application that offers centralised activity reporting and system management facilities. The touch screen interface allows users to easily navigate through the software to build reports.

• National support and servicing network • Audio, Non Audio and IP Based Nurse Call Systems • Comprehensive reporting for risk and cost reduction

Infection control

• Compliant with AS2999 and AS3811 • Anti-Bacterial Silicone Rubber for infection control • Wireless Telephony Integration • Touch Screen Workflow Terminals

Text and Audio messages When your patient presses the call button on their handset, the information is instantly displayed at the Nurse’s Station as well as on Annunciators throughout the ward. The call may also be displayed on pagers and wireless telephones, instantly alerting staff that a call has been activated. TACERA’s VoIP interface provides crystal clear voice communications between nursing staff and patients, without the need for third party middleware.

Alerts generated from Patient Monitors, Ventilators, IV Pumps and Stat Lab results may be integrated into TACERA allowing “one click” staff allocation.

www.austco.co.nz

info@austco.co.nz

All ErgoPLUS handsets and SteriButton Callpoints are manufactured from silicone rubber with an anti-bacterial additive for improved infection control. To avoid nuisance alarms during cleaning, callpoints incorporate a cleaning mode.

The cleaning time and date is logged on the central server, providing an audit trail for infection control compliance.

About Austco Austco is a wholly owned subsidiary of Azure Healthcare, an international provider of healthcare communication and clinical workflow management solutions.

The company is headquartered in Australia, has subsidiaries in six countries and supports more than 6,000 healthcare facilities through our global reseller network. Azure Healthcare (ASX:AZV) is listed on the Australian Stock Exchange.

0800 287 826

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Austco

We’re here to help protect your aged care facility With elderly, disabled and less mobile residents, the aged care sector requires specialised fire protection solutions.

With Wormald, you have an organisation that is always right behind you when you need us most. We’ve helped prevent and protect against fires for over 120 years.

From emergency evacuation plans and tailored fire protection systems, to fire equipment and fire safety training, Wormald’s specialist teams can design, install and maintain fire protection systems to match your needs and budget.

So, you can get on with providing care, confident that your residents, patients, staff and facilities are supported by one of the world’s fire safety leaders. That’s peace of mind.

Trust the aged care fire safety experts.

Call 0800 4 WORMALD, email wormaldnz.ads@tycoint.com or visit wormald.co.nz/healthcare

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