INsite December 2014

December/January 2015 | $10.95

AGED care & retirement

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

On the soapbox:

Julie Haggie – In-between travel time

Education & training

Best practice: training and staff development Technology

Healthcare in 2025: exploring new care delivery models

Aged care

The case and its consequences:

implications of the Bartlett v TerraNova case

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12 AGED-care & retirement

INsite magazine December/January 2015 Volume 8/Issue 8 Editor: Jude Barback @INsite_NZ T: 07 575 8493 E: editor@insitemagazine.co.nz Advertising: Belle Hanrahan T: 04 915 9783 E: belle.hanrahan@nzme.co.nz Production: Aaron Morey Editor-in-chief: Shane Cummings @ShaneJCummings General Manager & Publisher: Bronwen Wilkins Subscriptions: T: 04 471 1600 F: 04 471 1080 E: gunvor.carlson@nzme.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 NZME. Educational Media Ltd.

Editorial & business address Level 1, Saatchi & Saatchi Building, 101-103 Courtenay Place, PO Box 200, Wellington 6140, New Zealand T: 04) 471 1600 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).

Healthcare in 2025

Ed’s LETTER Within this issue and other recent INsite articles lie some well-reasoned and clearly articulated opinions on areas within aged care and home and community support services that are in need of more resourcing. Calls to fund an integrated mental health and aged care nurse specialist in the community. Calls for more funding to tackle loneliness as a way of moderating risk factors that delay the onset of dementia. Calls to invest more in restorative support for older people in the community. Calls for a more consistent approach to funding community support providers across the country. And of course, calls to increase funding to aged care providers to allow them to pay their staff more.

My initial gut reaction to the news that the New Zealand Aged Care Association (NZACA) sought leave to appeal the Court of Appeal’s judgment on the TerraNova v Bartlett case was surprise. I really thought that if aged care providers wanted to see this resolved, they would let the case play out through the Employment Court, thereby forcing the Government’s hand to increase funding.

But of course, with closer inspection, it is more complicated than that. There are very real fears that the Age Related Residential Care (ARRC) contract won’t provide the safeguard needed, that the Government won’t step up, and that operators will be forced to make awful decisions about reducing beds, laying off staff, and compromising the quality of care.

I’ve noticed a subtle shift among providers recently.

Previously, it has struck me as quite a competitive sector. Lately, I have noticed a stronger sense of collaboration. There appears to be more of an eagerness to learn from each other, to share what is working well, to collaborate on issues that affect everyone. You’ll note I’ve introduced a ‘Best Practice’ section in this issue to capitalise on this.

In this issue...

FOCUS:

Trends in Home Health

2

The case and its consequences: Implications of the Bartlett v TerraNova pay equity case

6

Innovation important but consistency crucial – hopes for home-based care

8

Addressing the gap between mental health services and aged care

10

Best practice: Training and staff development

12

Healthcare in 2025: Exploring new care delivery models

13

Let’s snoop around ... Home Instead

14

On the soapbox … Julie Haggie

15

Conference report

16

Up close and personal with ...

Todd Perkinson

17

Last word ... Maggie Barry

15

Conference Report

I wonder if the pay equity case has anything to do with it, this sense of ‘we’re all in this together’.

Certainly my questions to operators, both large and small, about the potential effects of increasing caregiver wages without additional government funding have been answered unanimously, with the message that it will be damaging for every provider.

Unfortunately, the decision to appeal has exacerbated tensions between providers and the union, and in that respect, the aged care sector is more polarised than ever.

There is a real need for solidarity as this case continues through the courts. As the calls for funding in this issue alone demonstrate, the ageing population is going to continue to tug on the Health purse-strings in a multitude of ways. If increasing caregiver wages is to make it to the top of the list, the sector needs to take a unified stance.

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 | December/January 2015

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Aged care

The case and its consequences:

Implications of the Bartlett v TerraNova pay equity case With the Bartlett v TerraNova pay equity case proceeding to the Supreme Court, JUDE BARBACK analyses the twists and turns of the case so far, and the far-reaching ramifications for aged care and other sectors.

T

he New Zealand Aged Care Association (NZACA) has, on behalf of aged care providers, appealed the Court of Appeal’s judgment on the case brought by caregiver Kristine Bartlett against her employer TerraNova Homes & Care. The case will now proceed to the Supreme Court, presenting yet another bend in this long and complicated road to addressing the issue of how much caregivers should be paid.

While the NZACA’s decision to appeal is met with the frustration of the Service and Food Workers’ Union, this is far from a tale of “us and them”, with many questions being asked from all sides about the Government’s obligations and priorities, the legal context, and the deep-seated funding inequities in aged care.

The case so far

The case began in 2012 when Bartlett, with the support of the Service and Food Workers’ Union (SFWU), lodged an application with the Employment Relations Authority claiming her $14.46 hourly wage paid by her employer TerraNova was in breach of the Equal Pay Act 1972. The case was directed to the Employment Court, where in June 2013, the Equal Pay Act was closely examined to first establish the interpretation of the Act before the case was taken any further. The clause under the microscope was section 3 (1) (b) of the Act, which states that for work predominantly done by females, the remuneration should match that paid to males who have similar skills, working in jobs requiring similar responsibility, effort, and work conditions.

Bartlett and the SFWU argued that as caregiving was largely viewed as “women’s work” and was undervalued, male caregivers suffered the same low wages. Therefore, they argued, in order to establish the appropriate rate of pay, it would be acceptable to look to other industries outside of aged care. The Employment Court ruled in their favour.

In January 2014, TerraNova, with the support of the NZACA, appealed the Employment Court’s decision, and the appeal was heard in the Court of Appeal in February, with a decision released at the end of October.

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December/January 2015 | www.insitemagazine.co.nz

Kristine Bartlett

Although it took a more balanced view of the issues at hand, the Court of Appeal ultimately upheld the Employment Court’s decision that in determining what the appropriate rate of pay should be for Kristine Bartlett, it may be relevant to consider wages paid by other employers, not only within aged care, but also in comparable sectors.

The Appeal Court was to turn the matter back to the Employment Court to establish a basis for comparison, which will provide “a workable framework for the resolution of Ms Bartlett’s claim”.

However, with the case now to be heard at the Supreme Court following the NZACA’s appeal, this process is looking more distant.

Should the case find its way back to the Employment Court following a Supreme Court hearing, finding a fair basis for comparison is unlikely to be an easy task in any case. It would essentially involve looking closely at other industries, weighing up whether they are free from gender discrimination, and deciding whether they present an appropriate hypothesis for the pay of aged care workers.

“Women’s work”

How did we find ourselves here? Before we speculate about the final decision and its implications for aged care and other sectors, let’s peer a little deeper into the past to try and understand how we arrived at this point.

Former Equal Employment Opportunities (EEO) commissioner Dr Judy McGregor, who led an inquiry into the aged care workforce, states in the Caring Counts

inquiry report that the low pay rates of the predominantly female workforce reflect the historic systemic undervaluation of the roles played by women in society.

Historically, caregiving and nursing were seen as the sort of work a woman might do until she found a husband who would then support her. These jobs were also commonly perceived as a means to supplement a family’s income.

It would appear aged care work has dragged its historical vocational baggage with it into a modern age and consequently finds itself at odds with the importance we place on our older people in their care.

Caregivers in residential aged care facilities earn on average $15.31 an hour, with many hovering just over the minimum wage level of $14.25. Their wage rate is comparable with, or slightly lower than, that paid to cleaners, supermarket checkout operators, and fast food workers.

Pay parity with DHBs

However, not all caregiving roles suffer low pay. The mid-range level for a district health board (DHB) healthcare assistant’s pay is $19.50 an hour; the minimum is $17.50 per hour.

The disparity between DHBs and residential aged care has existed for almost a decade. In 2005, the multi-employer collective agreement (MECA) between DHBs and the New Zealand Nurses Organisation (NZNO) led to the Ministry of Health boosting its funding to DHBs to allow them to increase pay to nurses and healthcare assistants in accordance with the agreement.

The NZACA has been calling for the disparity between DHB and residential aged care pay rates to be addressed ever since.

In 2006, the NZACA – then known as Healthcare Providers New Zealand – released a document that stated, “Unless this disparity is addressed, the inability to attract staff will seriously undermine the long-term viability and sustainability of the aged care sector”.

It goes on to say, “Aged residential care providers are in a position similar to that of DHBs prior to their settling the MECA. DHBs could not absorb a substantial wage jolt that increased costs above their baseline funding levels without a huge injection of

Aged care additional funding, and aged care providers cannot increase wage costs above levels that can be sustained under present funding”.

NZACA chief executive Martin Taylor says they have been asking the Government to increase funding levels to address the pay parity issue ever since, but to no avail.

A longstanding issue

Victoria Brown from Care Association New Zealand (CANZ) says the TerraNova case is just one in a long line of factors that may mean the financial viability of smaller providers is seriously challenged.

“It is not just the TerraNova case,” she says.

“There are many other decisions that have put the aged care sector squarely behind the eight ball with respect to proper funding.”

She points to the findings of the PricewaterhouseCoopers investigation in the 1990s, which revealed the sector was underfunded by 32 per cent, and the fact that each year the funding has not kept pace with inflation.

Each year, the Ministry of Health and DHBs amend the contract with aged care providers with the expectation that additional costs should be absorbed by the sector, while continuing to deliver a quality service.

Consequently, aged care providers now have to fund costs related to incontinence products, transportation to medical appointments, ambulance charges, dressings and doctors’ visits. Costs relating to interRAI, KiwiSaver, and certification and compliancy also fall on the wallets of the sector.

In her foreword of Caring Counts, Dr McGregor states that in her time as EEO commissioner, “there has seldom been the degree of unanimity about a work-related issue than there is about the low pay of carers”.

Yet, aside from lobbying efforts on the part of the NZACA and the building momentum from the unions, there has been nothing in the past 10 years to really push the Government into increasing funding to support a lift in caregiver wages.

Until now, potentially. Kristine Bartlett and the SFWU found a way to bring the matter into the courts. Whether testing the Equal Pay Act was the best way to do this, is debated by many. But regardless of the path taken to get there, the topic of low caregiver wages is finally centre stage.

Pressure on Government

While the case is before the courts, the Government cannot comment on whether it would, could, or should increase funding for aged care providers to allow them to increase wages. However, earlier statements from Health Minister Jonathan Coleman suggest that a funding increase is unlikely.

Dr Coleman told The New Zealand Herald that $1 billion goes into the aged care sector

“Closure of small rest homes would be inevitable if the ruling were to be upheld as we would be unable to maintain the high level of care that is currently provided without putting elderly lives at risk.” – Victoria Brown each year, including funding boosts of $250 million over the past six years, and how they allocate this money is up to the providers.

“It would be great to pay workers more but the issue at the end of the day is there’s so much money that goes in there from the Government. The issue is really that providers get to decide how to spend it and that’s the decision they make.”

It isn’t surprising the Government is treading cautiously. The case has the potential to affect a number of industries, not just the aged care sector.

Prime Minister John Key acknowledged the wide-ranging implications of the case when interviewed by TV3’s Firstline.

“The cost for the Government is hundreds of millions of dollars, so it is not just a few million and the Government being awkward here. It is hundreds and hundreds of millions of dollars, potentially.”

While most understand the pressure the Government is under, it is felt that perhaps its stance is based on the aged care sector’s current situation, rather than on what lies around the corner.

“I think the Government feels safe at the moment because there is no pressure on capacity,” says Simon Challies, managing director of Ryman Healthcare.

He points to the Aged Residential Care (ARC) Demand Planner on the DHB Shared Services Health of Older People site, which shows that even in the conservative scenario, by the year 2031 approximately 26,000 beds will be needed in residential care.

Ryman is building beds at the fastest rate – around 200-300 beds per annum – and Challies says this is nowhere near enough to meet even the conservative estimates of future demand on the sector.

A23 – the get-out clause?

However, despite the Government’s protestations, it would seem aged care providers may be relying on the Age Related Residential Care (ARRC) agreement between DHBs and aged care providers as the mechanism to bring government funding into line.

Clause A23 of the ARRC agreement states that the terms of the contract may be varied if any law changes or cost changes come into play, which would imply that government has an obligation to honour the contract and DHBs would accordingly be required to increase funding to help providers meet their increased costs.

However, with the case before the courts, the Ministry cannot consider any possible variation to the agreement, and the A23 mechanism remains hypothetical.

It could remain this way for a long time to come. A ‘variation event’, which would see clause A23 come into play, cannot be triggered until an increase in cost has been quantified, and this will not be possible until the Employment Court has identified a similar non-female industry and then sets appropriate rates for the aged care sector.

And that is assuming it will get back to the Employment Court.

However, in a letter to DHB Shared Services Health of Older People chief executive Chris Fleming, Martin Taylor expresses the inevitability of an A23 claim and the NZACA’s desire to address the issue of caregiver wages now, rather than later.

“We believe we should not wait for the litigation to conclude. Instead, DHBs need to agree on increasing aged residential caregiver wages over a four-year period to bring them into line with their public sector counterparts.”

The A23 clause indicates that the parties need to negotiate in good faith to reach a prompt agreement on any issues. However, this does not mean that the contract must be varied by an amount equivalent to the increased cost to the business.

On these bases, while the A23 clause might provide some hope to the sector, it by no means provides any certainty that funding will be increased to the levels required by the sector, or in a timely manner.

How will it affect aged care providers?

So with government looking unlikely to boost funding to the levels needed, if the Employment Court decides Kristine Bartlett’s pay rate should be increased to $17.50 an hour – to take the minimum DHB healthcare assistant’s wage as a possible example – what are the repercussions for the aged care sector?

The NZACA believes such a scenario would be “catastrophic” for providers.

The Caring Counts report stated that based on modelling completed by the University of Auckland’s Associate Professor of Accounting Paul Rouse, the cost of parity between the carers working in home support and residential facilities in the community and healthcare assistants working in public hospitals is between $139 and $141 million per year. www.insitemagazine.co.nz | December/January 2015

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Aged care This tallies with the NZACA’s estimates of between $120 and $140 million a year.

Taylor says if the Government does not meet the shortfall, it is likely that half the country’s rest homes would close within 12 months.

Victoria Brown from CANZ says smaller facilities wouldn’t survive.

“A big hike in wages would be the ‘nail in the coffin’ to an already undervalued and underappreciated sector,” says Brown.

“Closure of small rest homes would be inevitable if the ruling were to be upheld, as we would be unable to maintain the high level of care that is currently provided without putting elderly lives at risk.”

For the care organisation at the heart of the case, this is certainly a very real scenario.

TerraNova executive director Terry Bell says the effect of increasing wages would cost TerraNova around $750,000 a year, and could eventually drive the organisation into receivership.

TerraNova is not alone. New Zealand’s largest single site residential aged care provider – who does not wish to be identified – says they have a scale of hourly rates for health care assistants.

Ensuring all healthcare assistants were paid at least $17.50 an hour would increase their minimum rate by 13.7 per cent. This would force a similar percentage increase to all other steps in the scale in order to maintain pay parity around length of service, as their pay scales are built around length of service.

The provider said that although it would not lead to insolvency, they would not be able to financially support such an increase without an equivalent funding increase.

“We would keep operating but with reduced capacity. We would not consider keeping the same number of beds and reducing staffing ratios as that would bring into question issues around safety and standard of care but we would be forced into considering closing beds and laying off staff.”

The provider points out that making staff redundant would bring about more expense, owing to the substantial one-off redundancy costs outlined in the redundancy clauses in their employment agreements.

Even providers that already pay above the average say they will be affected.

Staff at Sprott House, for example, are paid a dollar more than the industry average of $15.31 per hour, with the opportunity to increase this by a further two dollars if they choose to advance their careers through education facilitated by Careerforce.

Even so, general manager Chris Sanders says that if the Government did not come to the party to cover the costs of increased wages, then charitable stand-alone single entities, like Sprott House, would have to 4

December/January 2015 | www.insitemagazine.co.nz

consider moving away from the sector and using charitable funds in a different way.

“We have already had to absorb costs associated with increased insurance levies, KiwiSaver and the normal increases associated with the provision of agedcare, with very little input from government, regardless of their recent much-vaunted increase for rest-home care. The only other way to ‘find’ the money would be a diminution in our service quality and that would not be acceptable to us.”

Larger operators Bupa and Ryman both pay their staff above the industry average, yet both claim that despite their size, they would also struggle if forced to pay higher wages without government funding.

“With the gaps that are being talked about, there is no question we would be in absolute financial difficulty,” says Bupa managing director Grainne Moss. “I think it would affect the vast majority of providers, regardless of their size or scope.”

Ryman’s Simon Challies agrees that it would have a “major impact”.

“We haven’t done the figures yet, but I would expect the cost to Ryman to be around $10 million.”

Do larger providers stand to gain?

The public has long found it difficult to swallow the argument that rest homes are struggling to pay their staff, when the likes of Ryman Healthcare, Metlifecare, and Summerset appear to be making significant profits and are performing well on the NZX. As one Radio New Zealand online correspondent stated: “Check out Ryman Health[care]’s share performance since it was listed and tell me that they cannot afford to pay their care workers more. This industry is all about maximising profits on the backs of the front line workers.”

It is a view held by many, but in reality, the aged care sector is very fragmented. The largest aged care operator in New Zealand is Bupa, which is a not-for-profit organisation

with 60 facilities. Bupa, Oceania, Ryman, and Radius account for just under a quarter of the aged care sector. The remainder are run by religious or welfare organisations and independent small-to-medium operators.

The 2010 Grant Thornton Aged Residential Care Review found that 25 per cent of all aged care operators were making a loss and 50 per cent were making less than required to cover their costs of capital; just a quarter of operators were making an appropriate return on investment.

Although some providers would cope better than others with a blanket wage increase, Martin Taylor says all providers would acutely feel the change.

“The interests of the bigger providers are entirely aligned with others. They have shareholders to answer to, so any impact on the costs is going to have an impact.”

Even so, there has been some suggestion that the larger providers are driving the push for higher wages, regardless of government funding levels. A rather Machiavellian view is that higher wages will force smaller operators out of business, giving larger operators the opportunity to increase their market share.

As this Radio New Zealand online correspondent puts it, “...given that it would weed out the weak operators that would shut shop, paying higher wages could in fact be in the interests of Ryman & Co. With smaller operators unable to be viable because their operations are not as profitable, the resultant gap would allow the likes of Ryman & Co. to prosper, despite having to pay higher wages.”

But Victoria Brown of CANZ argues that the closure of small stand-alone facilities would create a downhill spiral in the aged care industry.

“It’s imperative to have a mix of corporate and smaller facilities as they both play an important role in the community and clients deserve the right to choose,” says Brown.

“One size doesn’t fit all and so long as stand-alone facilities provide high quality, personalised and homely service, then they deserve the right to remain in business alongside the facilities owned and managed by a corporation.”

It is worth noting that the Government has shown a preference for working with a smaller number of larger providers in a range of industries. However, Simon Challies say this is not the case for aged care. Rather, he says the current landscape precludes smaller providers investing back into the sector at the same level as the larger providers like Ryman.

However, INsite’s earlier investigation into the NZACA’s U-turn on signing the ARRC contract reveals larger operators appear to be more concerned with maintaining strong relationships with government than lobbying for an increase in funding.

Aged care The NZACA’s initial recommendation was that providers did not sign the contract, based on insufficient government funding for the sector. However, an eagerness on the part of the larger operators to work proactively with government saw the NZACA change its position. The association subsequently recommended members to sign the contract after all, to the confusion and disappointment of many smaller operators.

While gains were made in the areas of premium charging and interRAI, it seems the issue of underfunding was sacrificed on the way. The NZACA claimed it was still not happy with the current subsidy levels, but its decision to roll over on that issue perhaps signalled to government that the sector – characterised by the larger operators – could survive without increased funding.

So why spend yet more money on dragging the case to New Zealand’s court of final appeal?

There has been some suggestion that the decision to appeal was made mainly to buy aged care providers more time, in the event that increased wages become a reality for the sector.

It is expected to be another six months before the case is heard at the Supreme Court, and possibly months and months thereafter before a judgment is released.

SFWU spokesperson Alastair Duncan agrees delay tactics are at play here.

“We are, however, very keen to know what process NZACA has followed to assess its members’ views, given any appeal will only delay what we see as clearly now being an inevitable and positive outcome.”

Why proceed to the Supreme Court?

Equal Pay Act – a clumsy vehicle

It remains to be seen what the Government makes of the NZACA’s decision – informed largely by the views of the larger operators – to appeal the judgment. The distance the Government has maintained thus far will surely have to come to an end as aged care providers prepare to battle this out in the Supreme Court.

Or perhaps the Government will continue the game of wait-and-see and watch which path the case takes. Although it is most unlikely the Government would stand by and watch smaller providers go under, there hasn’t been any indication of a ministerial life raft yet.

Or perhaps – particularly if this case continues to drag out at its current rate – the Government will choose to legislate over the Equal Pay Act and move the goalposts on the issue completely?

All scenarios are possible. Given the uncertainty with which government may react, it begs the question of why aged care providers opted to appeal. The decision not to appeal would have sent a much stronger message to government about the necessity to increase funding and soon.

Certainly, the decision to appeal, yet again, seems at odds with what aged care providers are saying. It appears to contradict the wish, as expressed by many providers, for all parties to collaborate on this issue.

TerraNova’s Terry Bell said previously that he hoped after the Court of Appeal released its decision, that everyone would “sit around a table and figure this thing out”, but it would appear this isn’t happening yet.

Similarly Bupa’s Grainne Moss said she would like to see government, unions and employers all work together to find a way forward.

And certainly, this has been the union’s plea all along.

The other motivation for appeal is the strong feeling among providers that the Equal Pay Act is a clumsy vehicle by which to address low caregiver wages.

It is difficult for many to articulate their desire to see caregiver wages increase on one hand, but on the other, that the Equal Pay Act should not be the means to achieve this.

The Prime Minister, when questioned on Firstline, said in one breath that “there is no question that carers work very hard, and they provide a tremendous service” but in the next that “the case here is not about that; it is about whether there is discrimination in what is a largely female workforce, and that was the test under the Equal Pay Act”.

The unions, unsurprisingly, are strong advocates for the approach taken by the courts thus far, however there are a number of reasons to support providers’ reservations about the case.

Firstly are the wide-ranging ramifications.

A precedent that is set with Kristine Bartlett’s level of pay will not only affect the wage level of other aged care workers, but potentially employees in other femaledominated industries.

“While it would cost the Government about $120 million to increase caregiver wages to $17.50, it would cost even more to do the same for homecare, mental health, disability, and community workers. Just like aged care providers, the Government is in a cleft stick,” said Martin Taylor.

The head of the Council of Trade Unions Helen Kelly told Radio New Zealand the case has the potential to affect 63,000 unregulated health workers and 91,000 retail workers, as well as child care teachers and school support staff.

Also of concern is that the approach as taken through the courts does not take into account any other employment conditions.

In the Caring Counts report, Professor Matthew Parsons argues that any pay increase should not be done in isolation from a package of reforms designed to improve employment in the sector. With particular reference to the home support sector, he says such reforms should include security of hours, travel and training costs, as well as the hourly rate.

Simon Challies expresses his concern that discussion under the legislation does nothing to link pay to training and qualifications, for example. He points out that a housekeeper could effectively be placed on the same pay level as a caregiver overnight with no training.

“It’s a very complicated situation. We’d all like to pay caregivers more, but the Equal Pay Act is not the right mechanism to address this.”

The bizarre irony is that New Zealand’s legislative history came close to plugging the leaks that have now sprung from the Equal Pay Act. The Employment Equity Act was passed in July 1990 by the Labour Government, with the aim of promoting and enforcing pay equity and equal employment opportunities in both public and private sectors. Ten pay equity claims were lodged with the Employment Equity Commission by unions representing large numbers of women members.

However, the timing of the Act’s entrance was to see it doomed; it was repealed just a few months later by the new National Government, which replaced it with the Employment Contracts Act (ECA). Equal pay complaints could then be made under the ECA’s personal grievances section, the Human Rights Act 1993 or the amended Equal Pay Act. Yet only a handful of cases claiming gender discrimination were heard through these avenues and not one was successful, demonstrating the difficulties in establishing equal pay claims through the available legislation of the time.

Employment law firm Cullen Law notes that while the Employment Relations Act in 2000 and subsequent amendments have helped to restore some power to the unions, collective bargaining “remains a pale echo of what it had been”.

“Bartlett’s case is therefore somewhat of a step back to the days when union power and centralised wage fixing were supreme.”

It suggests that the outcome could leave employers left asking where their freedom to bargain for wage rates with their employees has gone.

Indeed, there are many questions this case leaves us grappling. We all – employers, employees, government, unions, the wider public – must continue to watch as this thing plays out, each one of us weighing up our own ethical and commercial dilemmas, and those of others, in an effort to understand what solutions are both fair and feasible. www.insitemagazine.co.nz | December/January 2015

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Community care

Innovation important but consistency crucial

– hopes for home-based care Julie Haggie

JUDE BARBACK talks to Julie Haggie from the Home & Community Health Association about what the home-based care sector hopes will emerge from the New Zealand Productivity Commission’s inquiry into more effective social services.

Why an inquiry?

The Government spends around $34 billion a year on health, education, and other social services, but when a number of government agencies expressed uncertainty around what was being achieved with this annual spend, it prompted the Government to ask the New Zealand Productivity Commission to carry out an inquiry into the effectiveness of social services.

New Zealand Productivity Commissioner Sally Davenport says the inquiry will look at how to improve outcomes for New Zealanders from social services funded or supported by government. It looks to improve accessibility of services, while promoting efficient use of public funds and striking “the right balance between central government support and individual, family and community responsibility”.

In doing so, the inquiry will examine the strengths and weakness of current approaches to commissioning and purchasing social services, both here and overseas. It will also look at how to improve coordination within and between government agencies and service providers and how to combine the expertise of public, not-for-profit and private sectors.

An Issues document was released in early October and submissions were received by 18 November. The draft report of the inquiry is due March 2015 with the final report due in June 2015.

Spotlight on home-based care

The inquiry focuses on a number of case studies, including home-based care for older people and services for people with disabilities.

The Issues document states that the right mix of services to achieve better homebased care services is “best worked out at a local level, and requires flexible budgets and decision makers sharing the same goals”.

Finding the right balance between centralised and devolved models for the delivery of social services is a key aspect of the inquiry.

When it comes to home-based care in New Zealand, there are various types of contracting and funding, devolved to each 6

December/January 2015 | www.insitemagazine.co.nz

funder. Fee-for-service and bulk funding are the two dominating funding models.

The devolution of funding has resulted in uneven levels of services across New Zealand because of how district health boards prioritise their funding, typically prioritising provider arm funding over outsourced community funding.

Julie Haggie, chief executive of New Zealand Home & Community Health Association, says while it is important to ensure that the right mix of services is needed in each area, owing to the different population health needs in each region, there are some things that need to be nationally consistent. She cites a lack of depth in understanding of client need as the primary example.

Generally at the moment, there is no policy that requires the funding of the service to meet the needs of the people receiving that service. Some DHBs have a clearer understanding of the size and health needs of older people living in their homes, but most have little idea and poor data. This leads to the loading onto our service of support for people with very high levels of need. Needs assessment is too often lagging behind the services being provided. This problem desperately needs national leadership, so that services can be provided safely..

“We need to see more consistency in terms of funding provided for essentially the same services between regions, and we need to be clearer about whether people are getting consistency of access and reasonable consistency of service quality, no matter where they live.”

Funding models “inadequate”

Haggie says the current models of contracting and funding are inadequate for the future needs of home-based care.

“We need to look at what models are more likely to support the outcomes we need because we don’t have enough workers to cope with the demand now, let alone in the future, and that is a failure of the model.

“We need to be able to offer surety of hours. Our workers need to be more highly trained. They need to be incentivised to do so because of the financial reward, career recognition, and mobility it offers them.

They and our clients’ families need access to advice and training on maintaining wellbeing, reducing injuries, self monitoring and more expert advice and linkages. That sort of leadership needs to come from the top.”

The Public Services Association (PSA) agrees. The union believes the inquiry must address workforce standards and appropriate funding levels in its inquiry.

“Fair pay and conditions remain out of reach for many support workers as providers either struggle to deliver services year after year without funding increases, or when there are funding increases, providers refuse to pass them on to workers. These support workers are among the lowest paid workers in New Zealand,” says national secretary Richard Wagstaff.

The PSA says it doesn’t want the inquiry to focus solely on cutting costs, but rather on achieving better outcomes for social service users. It believes this can be achieved by identifying existing successful arrangements and designing systems around those.

“There are some NGOs doing great work out there but we also know that there are some aspects of the current commission and purchase of services that need fixing, and in fixing them, there could be some real productivity gains to be had before we start messing around with alternative contracting arrangements.” says Wagstaff.

“We’ve seen NGOs, in many cases the natural champion for service users, being effectively gagged because of the funding arrangements in place. It’s hard to be an advocate and vocal critic of the Government when they hold the power in terms of awarding the next contract.”

There is certainly a large degree of scepticism around the way funding is currently operated.

The Issues paper talks of the benefits of introducing more flexibility into budgets and funding arrangements, but Haggie says while this sounds promising, in reality flexibility is often exploited by funders and used as an excuse to pay lower contract rates to community providers. She describes this problem as endemic in New Zealand across many community services funded by DHBs.

Community care “Providers under bulk funding situations have reported that after accepting capped bulk-funded contracts, they are then put under pressure to accept increasing proportions and numbers of clients who have very high support needs all within the original contract price.”

Haggie favours alliance contracting, as it “gets away from the ‘take it or leave it’ approach”. Alliance contracting essentially assumes that organisations can achieve better things by working together.

The Issues paper poses questions around the use and effectiveness of “client-directed budgets”. While these are now embedded in disability support, it is not clear whether they are the answer in aged home-based support.

Haggie says homecare agencies working in the disability scene have found that client-directed budgets work brilliantly for some clients, but not for others. This would be even more marked in relation to the support of older people, who are more likely to be in a position of declining health and have less direct carer support than those living with disabilities. She is keen to watch how Australia gets on with client-directed budgeting before taking the plunge here.

“In the meantime, there is much that needs to happen in New Zealand to ensure more consistency of funding and easier access to needs assessment. Restorative and rehabilitative care also relies on the client setting and working towards their own goals, using home support to do so, and that requires a culture change for organisations, workers and clients.”

Scope for better integration

Another aspect the inquiry looks to improve is the level of interagency cooperation and how the public, private and not-for-profit sectors work together.

Haggie believes there is more scope for collaboration between GPs, pharmacies, needs assessment agencies, hospitals, DHBs, and homecare providers. She says homecare providers are often not included or valued in conversations about population health, particularly when that is driven by clinicians.

Service integration is a key focus in the inquiry’s Issues document.

Integration can take various forms, including linkage, coordination and fullmodel integration. Haggie sees benefits for integration in some areas of home and community support services. For example, she points to “huge potential” for community support workers to play a greater role in supporting wellbeing in the community, which would require linkage to,

or coordination with, health promotion and public health training.

The Issues document highlights health alliances – networks of primary health service providers and DHBs that deliver integrated services – as a good example of moving services from hospitals to the community by supporting self-care and community care.

However, like the DHBs, each of the nine health alliances operates quite differently.

While some might have good connections with home support agencies, in general referral to home support is directed via some form of needs assessment process.

There are a few models in New Zealand where there are more collaborative linkages between primary care, community care and secondary care, such as Canterbury’s Community Rehabilitation Enablement & Support Team (CREST) and Waikato’s Supported Transfer and Accelerated Rehabilitation Team (START) programmes.

In these, doctors can refer directly and there are good relationships between homecare agencies and primary practices.

But Haggie thinks more is needed.

“What we need is integration that can really make a difference: that means integration of needs assessment, community nursing and allied rehabilitation, homecare, and community respite, with strong linkage to primary care via quality IT and relationships developed through cooperative structures.”

Contestability – raising or lowering the bar?

The Issues document explores the notion of contestability and questions its worth in the context of providing good outcomes for social services. The tendering process for contracts makes the home-based care sector highly contestable. While Haggie says she can understand the need for service reviews and contestability, she has some reservations.

Haggie makes the point that for the past eleven years there has been no contestability on price. In every service review that included a tendering process, the price has been set prior to the review, by the funder

either as a capped bulk amount or a set hourly figure.

This typically leads to a “study for the exam” approach, as Haggie says, one that stifles innovation, and limits quality as providers are forced to aim for the lowest common denominator.

Further, the base numbers or case mix identified by funders for the tendering process, has at times been a long way from the actual numbers. Haggie says in more than one case this has caused considerable dispute, as the funder, with no more funding, puts the pressure on the provider to take on more risk and cost.

Innovation important but consistency crucial

Haggie’s point, that contestability “stifles innovation”, is right on topic. The Issues paper asks for examples where government contracts restrict the ability of social service providers to innovate, or where contracts are so specific they result in poor outcomes for clients.

In the context of the homecare environment, Haggie says she knows providers would like to be able to innovate in ways they can support client wellbeing, and would like to have this flexibility within their contracts.

“There is a place for simple homecare support. But there is also great potential for us to assist in reducing injury, promoting wellbeing and supporting families to care for themselves and their family members, with the idea that we can reduce the amount of homecare we need to provide on an individual level.”

However, while innovation is important, Haggie’s main hope for her sector is to achieve consistency and accessibility within the system. She thinks policy needs to be strengthened in a number of areas, particularly around interRAI and needs assessment. She points out that there are long delays for needs assessments in some areas, and that many clients miss out. Where providers are able to undertake a needs assessment there is much more efficient matching of need to support, she says.

“We need an evidence-based approach, to ensure that we are tracking our population needs, and actively addressing them.”

Ultimately, it comes down to improving coordination within and between government agencies and service providers.

It is hoped the Commission’s inquiry into social services will deliver this for the homebased care sector, so it might achieve the consistency, accessibility and fair approach to funding that it currently hankers after. www.insitemagazine.co.nz | December/January 2015

7

Aged care

Addressing the gap between

mental health services and aged care MAX REID draws attention to the growing demand for a service model that addresses the specific needs of older people with both age-related and mental health needs.

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he Ministry of Health’s 2006 document Te Kōkiri: The Mental Health and Addiction Action Plan 2006–2015 envisaged that, within 10 years, people with experience of mental illness and addiction, and their families and whānau, would be “having their needs addressed earlier through access to a broad range and choice of services that are responsive to their communities”. It outlined the Ministry’s aim to deliver a more integrated model that coordinated early access to primary health care alongside community-based specialist mental health and addiction services.

While this goal may have been achieved for many in our community, for one significant – and growing – cohort, it has yet to be realised. It is well recognised that older people are New Zealand’s fastest growing demographic group, and specialist health services are already beginning to feel the fiscal pressure arising from such growth.

By 2021, 2.3 per cent of the population will be aged 85 years and over. Based on current rates of expenditure, they will consume around 15 per cent of Vote Health expenditure.

Such projections have particular relevance for the development and delivery of mental health and addictions services for older people. While three per cent of the general population live with enduring serious mental illness, it is estimated that this proportion doubles to six per cent for those aged 65 years and over. Similarly, it is estimated that 25 per cent of people aged 65+ have symptoms of depression severe enough to warrant clinical intervention.

In 2011, in response to this projected increase in demand for mental health and addiction services amongst New Zealand’s ageing population, the Ministry of Health produced Mental Health and Addiction Services for Older People – a guideline for district health boards on an integrated approach to mental health and addiction services for older people and dementia services for people of any age.

The document noted the need to provide specialist mental health and addiction services not only to people aged 65 years and over, but also with a degree of flexibility, in order to meet the needs of those people with both mental health and addiction conditions 8

December/January 2015 | www.insitemagazine.co.nz

and age-related health conditions. The recommendation of the Ministry’s guideline – allowing access to funded age-related health services for those aged under 65 with both mental health and addiction conditions and age-related health needs – reflects a similar impact of enduring mental illness and chronic addiction upon life expectancy.

Despite such recommendations and rhetoric, however, there remains a significant lack of integration between DHB-funded specialist mental health and addiction services, and health services for older people.

Put bluntly, specialist mental health and addiction services are neither contracted nor funded to carry a level of gerontology or aged care related expertise, nor are aged care providers contracted or funded to carry a level of mental health and addictions expertise. The implications of this gap are highlighted in the following case study.

Case study: meet Marjory

Marjory is a 56-year-old New Zealander of European descent. Diagnosed with schizophrenia, she has lived in the same council flat for the past 15 years. While she has no local family support, Marjory receives regular support from a DHB-contracted mental health team, and she has developed a strong rapport with visiting staff. Others in the complex of flats receive similar support – and a strong sense of community exists among the residents.

Four weeks ago, Marjory tripped and fell at the clothesline, fracturing her hip. She was admitted to hospital and underwent successful hip replacement surgery. On assessment pre-discharge, it was determined that both Marjory’s shortmedium term convalescence and the early presentation of other age-related health conditions warranted a level of registered nursing coordination of her care. Given the immediate issue of her mobility, it was decided that this care could most effectively be provided to Marjory in a rest home setting. The only bed available at the time of her discharge was some 10 kilometres from where Marjory had previously lived.

Towards a solution

The decision to admit Marjory to an aged residential care facility was largely

a pragmatic one. Marjory’s need to remobilise, the need for a level of registered nursing coordination of her care, together with her mental health needs, would have made for a complex package of care were she to return to her council flat. District nursing, home support, and mental health support would all have been needed – potentially involving coordination across a number of different agencies.

But was this the right decision for Marjory?

Marjory’s placement in an aged residential care facility, separated from her community and friends, has increased her sense of loneliness and distress, exacerbating her mental illness. Nor should the impact on Marjory’s mental wellbeing be seen as unusual. The decline in mental health status upon admission to aged residential care for those with existing mental disorders is well documented, as is the increased likelihood of developing a mental illness (particularly depression) while in an aged residential care setting. The New Zealand Guidelines Group suggests, for example, that while the prevalence of depressive disorders among community-dwelling adults aged 65 and over in New Zealand is about two per cent for men and five per cent for women, older adults in residential care are at much higher risk of depression, with a prevalence of about 18 per cent at rest home level.

There is also extensive research from both New Zealand and overseas that evidences that, regardless of an older person’s mental health status, admission to an aged residential care facility – even if only for a short period of respite care – can dramatically reduce function in terms of activities of daily living.

One immediate alternative to the current pathway that Marjory’s case study reflects would be to fund a level of integrated specialist mental health and aged care registered nursing expertise in the community. Other such specialisations have already demonstrated their worth.

For example, wound care nurses at clinical nurse specialist level (employed by home support providers, albeit on a trial basis) not only provide specialist wound care support to community-based clients upon their discharge from hospital, but they also make

Aged care available a level of wound care advice and training into aged care facilities, obviating the need for unnecessary admission to hospital.

Older persons mental health nurse specialist

The availability of an equivalent ‘older persons mental health’ CNS position would not only have addressed a number of concerns that Marjory’s case study highlights but would also have offered potentially wider utility.

Remember, a key reason for Marjory’s admission to rest home level care was to provide a level of registered nursing (RN) coordination of her care, in conjunction with ‘on site’ caregiving support. It is important to note that only RN coordination of care was required. Had Marjory’s convalescence required a higher level of nursing input, she would have been admitted to hospitallevel aged residential care, where 24/7 RN oversight would have been available.

Were a community-based aged care and/ or mental health provider to employ a registered nurse with both mental health and addiction expertise and aged care expertise, such RN coordination would be able to be offered in conjunction with a restoration of Marjory’s existing lower level mental health support. This would address the ‘integration’ component that Marjory’s admission to an aged care facility was, however pragmatically, designed to ensure. It would also enable Marjory’s return to her flat and the community and support staff with which she already held such a strong connection.

The establishment of such a CNS position would create a number of other opportunities. As earlier indicated, aged residential care facilities are themselves neither contracted nor funded to provide specialist mental health support for their residents. Yet clearly there are a growing number of residents being admitted with – or acquiring – significant mental health needs. Such facilities (and of course, their residents) would benefit from the availability of staff training in this area, and the ready accessibility of specialist mental health and addiction advice, tailored to the particular needs of older people. The need for specialist mental health and addiction support spans the breadth of aged residential care (including, for example, residents with Korsakoff’s syndrome – the result of long-term alcohol addiction – admitted to dementia-level care).

A further opportunity relates to older people with mental illness or addiction being discharged from either medical hospital wards or mental health wards back into the community. Frequently discharge is delayed – either because of inadequate inpatient resources for discharge planning (in the case of medical wards) or the unavailability of suitable community placements or support (in the case of mental health unit discharges). Various ‘facilitated early discharge’ models have demonstrated their worth – including the highly successful ‘Meet and Greet’ service piloted by Canterbury District Health Board in partnership with Healthcare of

New Zealand and the Nurse Maude Association. Evaluation of the pilot demonstrated not only a significant saving to the DHB in terms of hospital bed days, but as importantly, a significant reduction in readmission rates for those patients whose discharge had been coordinated via the pilot service.

Yet there are no equivalent facilitated early discharge models designed to coordinate the transition of older people with mental health needs back into the community, despite clear evidence that many patients remain on mental health wards not because they are continuing to improve, but simply because of difficulties coordinating either their discharge or community placement.

United States author and facilitator Mark Friedman, suggests that funders – in whatever sector – have, to date, largely judged the outcome of services solely on the basis of volume (have we delivered the volume of service we have been funded for?) and quality (in the case of the New Zealand health sector, are we maintaining HDSS certification?). Only in very recent years are New Zealand health funders beginning to ask the more critical question, ‘What difference does it make?’ Any provider wishing to remain ‘ahead of the game’ in terms of service development, needs to be able to demonstrate that the services they are providing do, in fact, make a tangible and measurable difference. Fundamentally, as important as contractual compliance and adherence to Health and Disability Service Standards unquestionably is, surely every aged care provider should be assessing their success by the tangible difference that their services make to those who utilise them.

Max Reid is currently acting area manager for Access Home Health (Southern Region), and policy, research and communications adviser for Dunedin North MP and Associate Opposition health spokesperson, Dr David Clark. Please contact editor@insitemagazine.co.nz for references to this article.

Advantages of introducing a community-based specialist role 1. It would enable older people with mental health and/or addiction needs to remain living with appropriate support in their own community (rather than being prematurely admitted to an aged residential care setting).

2. It would offer more integrated care, making better use of existing mental health and addiction support services, ‘closer to home’ – and potentially reducing the number of agencies involved in coordinating and delivering that support.

3. It would provide specialist mental health and addiction training and support to aged residential care staff.

4. It would facilitate earlier discharge from secondary level inpatient services – reducing the demand on hospital and mental health inpatient beds, potentially reducing readmission rates.

5. Older people with both age-related health needs and mental illness would receive support that addresses their situation in a more individualised and comprehensive way.

6. Aged residential care facilities would have ready access to specialist age-related mental health and addiction training and support.

7. DHBs would have greater confidence that older people with co-existing mental health and/or addiction needs were being appropriately discharged into a more integrated environment of care, consistent with the Ministry of Health guidelines. The establishment of such a position lends itself to a partnership approach – between a DHB, one or more aged care facilities in a community, and Healthcare of New Zealand. Some DHBs may be open to funding such an initiative by way of pilot funding or as a ‘demonstration’ contract.

www.insitemagazine.co.nz | December/January 2015

9

Education & training

Best practice: Training and staff development JUDE BARBACK talks to four organisations that are seeing results with changes they have made to their approaches to training and staff development.

PSC Enliven: embedding quality and training into every job

Niggling concerns about non-compliance and quality at Presbyterian Support Central (PSC) led the not-for-profit organisation to undertake a major quality review of its Enliven Residential Services in 2013. General manager Nicola Turner says they’d noticed some worrying trends emerging – people were making mistakes yet not fixing the problem, and there was a growing tendency to default to the quality coordinator for such issues.

“We needed to address the way quality was delivered and taught,” she said.

As such, one of the major outcomes resulting from the quality review was the decision to gradually phase out the quality coordinator role and instead look to make quality part of the job description of every employee, so that it became everyone’s responsibility. Turner says they researched this aspect carefully and looked at DHBs and other facilities to identify the best approach to embedding quality into an organisation.

Rather than undertake a massive structural change, it is a gradual process whereby quality coordinators are not replaced when they decide to leave, and all new employees have a commitment to quality written into their job description.

New employee contracts also carry the expectation for all employees to have at least a Level 2 qualification. If they don’t have Level 2 on joining PSC, they will be given the opportunity to gain this qualification during their employment. Staff are also encouraged to go on to Level 3, and although this is not mandatory, their pay will increase according to the level of qualification they hold.

PSC is working with Careerforce to deliver group training to help employees achieve their Level 2, and with Service IQ for its kitchen staff. They have enlisted Sadler’s to undertake literacy assessments.

Turner says is it is proving to be a very effective approach, and she gives the example of the “significant difference” that it’s made to the first 18 cleaners to undergo the group training. Despite some initial reluctance, often due to a mistrust and fear of education, 10

December/January 2015 | www.insitemagazine.co.nz

the cleaners soon became excited by their progress.

“They’ve really blossomed. Some are saying they can now understand and help with their kids’ homework. It’s really boosted their confidence.”

She says as a result of achieving their Level 2, the cleaners are now entitled to wear badges, giving them the same status as support workers.

PSC funds 12 hours for each employee to work towards Level 2 and 24 hours for Level 3, with the expectation that employees will give up some of their time as well.

Turner is keen to roll out the workshops training model to all staff; ideally, these would take place in one location with staff travelling from the various sites to attend these.

Turner says they are still working out the best way to deliver mandatory training cycles across PSC’s various sites. At present, each site delivers training in its own way, and while Turner does not wish to remove sites’ flexibility to deliver training as they wish, she is keen to introduce more consistency across the sites. It is likely they will all work to the same training plan and resources.

While it is a work in progress, as a result of the changes PSC is making now, Turner hopes in two years’ time to see all staff with Level 2, with a shared commitment to quality. She hopes to see the workshops training flourish and policy changes more formally communicated and embedded into the mandatory training cycles.

Oceania: innovative, scalable and accessible training options

Oceania Healthcare’s business and development manager Mike Knowles says his challenge is to find engaging ways to train people that are scalable and accessible across Oceania’s 49 locations and team of 3,000 carers.

“It needs to be highly relevant to their dayto-day lives caring for our residents, as well as rewarding.”

This has been the driver for Oceania to continually come up with innovative training programmes like the tablet mobile training devices, which won the Health Ed Trust Training and Staff Development Award at this year’s NZACA–EBOS Excellence in Care Awards. It is the second year running that Oceania has taken home the accolade, with last year’s award recognising the organisation’s planning for training throughout the business.

In the past six years, Oceania has run in excess of 1,800 formal courses for its staff, with more than 19,100 staff attending courses. Oceania staff have achieved more than 940 national certificates, with another 300 people each year working towards the national certificate. Linking the courses to NZQA gives staff more options going forward, allowing them opportunities to progress to higher NZQA qualifications.

Susanne Harzer, business and care manager of Whareama Rest Home and Hospital,

Education & training says that her team are really into the Oceania training programme.

She says that those who have come from overseas or other facilities can now see a career pathway, with qualifications as they complete more training modules.

“They see the annual training planner in the nurses’ station to encourage and support each other to do courses. They soon realise that the training is actually connected to what they are doing every day and that encourages them to learn even more,” says Harzer.

It makes good business sense too. In addition to a workforce that is better trained, staff are reportedly more satisfied and Oceania is seeing an increase in staff retention.

“Having staff who are happy and engaged in learning about how to deliver great care to our residents makes achieving our business goals a lot easier,” says Emma Butler, general manager of human resources.

Bupa: showcasing staff’s personal talents for mutual benefit

Bupa’s Personal Best initiative is essentially about giving staff the opportunity to share a talent, passion or interest with residents. They are encouraged to undertake a project that will enrich the lives of their residents in some way. But the beauty of Personal Best is that it benefits not only the residents, but also the staff.

There are many, many examples across Bupa to showcase the initiative, as it extends to employees at every level, should they wish to take it up.

Abraham Antonio, a rehabilitation coach, led a group of male residents to build a gazebo together. His dad was a builder, he explained, and it was something he knew

he could do that he knew the men would enjoy. It gave them the opportunity to build something they could own and take pride in it.

Pearl Haimona, a cleaner, kitchenhand, and laundry assistant at The Gardens Rest Home and Hospital, decided to share her Māori heritage with residents by forming a kapa haka group with other staff and performing to residents.

At Flaxmore Care Home, administrator Terri Coldicutt decided she could make birthday celebrations a bit more special for residents and their families, with personalised cards, gifts, and even party hats and decorations to accompany the cake.

At Tararu Retirement Village, manager Judy Port wrote down the residents’ stories and memories and had them published in a book called I Remember When...

As managing director Grainne Moss says of Bupa staff, “They bring all of themselves to work. They bring their heart, their soul, their talents … people at Bupa do more than just turn up. They turn up to make a difference on a day-to-day basis, and they also make a difference to themselves. That’s just really inspiring.”

The Personal Best is just a small part of Bupa’s emphasis on training and staff development. Its Competence Assessment Programme, Progress Steps, Professional Development Recognition Programme, and internal leadership development programmes are just some examples of its dedicated approach.

Careerforce: Peer Mentor programme

Industry training organisation Careerforce has introduced a new Peer Mentor Programme as part of its goal to help facilities

build a productive and highly skilled work place. Totally funded by Careerforce, the programme is made free to workplaces.

Having a peer mentor embedded in the organisation as a ‘go-to’ person for learning support avoids training assistance filtering from ‘top-down’ and instead makes it easier for employees to get the help and motivation they need to complete their training.

Through the programme, peer mentors are expected to help co-workers identify and overcome their barriers to learning and support them to complete qualifications. It is also hoped they will take a role in raising workplace awareness of literacy and numeracy issues as well as become champions for new ways of working or new technology.

Careerforce is working with facilities to help them get the right people within their workplace to become successful peer mentors, and support them with resources, training and further opportunities for professional development. The focus is on meeting the needs of individual workplaces rather than a one-size-fits-all approach for every organisation. To this end, the programme is customised to suit each workplace.

The recently launched peer mentor programme is just one way in which Careerforce is supporting the five-year Kaiāwhina workforce plan, which aims to raise the profile of the care and disability sector workforce.

At this year’s New Zealand Aged Care Association Conference, Careerforce outlined its commitment to supporting facilities get their staff trained with the new qualifications being rolled out next year following NZQA’s comprehensive qualifications review. Level 2 and 3 qualifications will be available in the first quarter of next year, with Level 4 expected to follow later in 2015.

www.insitemagazine.co.nz | December/January 2015

11

Technology

Healthcare in 2025:

Exploring new care delivery models RON EMERSON discusses the increasing role that telehealth will play in New Zealand’s healthcare system.

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hen it comes to a vision for the future of healthcare, it is clear that organisations and governments are recognising the need for many changes in the way we care for patients. At the heart of healthcare reforms lies the need for massive improvements in productivity and efficiency, in light of challenges such as physician shortages, delivering healthcare to rural populations, rapidly ageing societies, and unnecessary expenditures.

Studies show that better care coordination and reducing avoidable hospitalisation results in better clinical outcomes for patients, thereby reducing costs. There is also renewed focus on prevention and wellness programmes to reduce hospitalisations and a shift towards more patient-centred care models. This would rely heavily on such factors as changing patient behaviour through better education and awareness, and treating patients at the point of care (such as their homes or local community centres).

Within New Zealand, the Productivity Commission is currently undertaking an inquiry into improving outcomes for New Zealanders from social services including healthcare. Currently, the Government spends around $34 billion a year on social services, but agencies can be unclear about what that investment is achieving. This inquiry seeks to find out what the public, not-for-profit and private sectors can learn from each other, and how government agencies and service providers can coordinate social services more effectively.

So what does this mean for the state of healthcare in the decade to come? For a start, changes in mindset and strategic objectives are becoming evident, as healthcare organisations focus on three main areas to increase efficiency and reduce costs: 1. How to keep in contact 2. How to keep people healthy 3. How to keep chronic disease from quickly turning into an acute episode (and thereby reduce hospitalisation and treatment costs).

Distance technology for healthcare – particularly the growth of telehealth – has offered opportunities to realise these 12

December/January 2015 | www.insitemagazine.co.nz

Distance technology for healthcare – particularly the growth of telemedicine or telehealth – has offered opportunities to realise new models of care delivery.

new models of care delivery. Telehealth is the electronic exchange of medical information – this could mean something as simple as sharing a photo of a lesion, to viewing a patient’s blood pressure status or accessing a patient’s complete medical history. The growth statistics for telehealth are staggering: market research firm IHS predicts the U.S. telehealth market will grow from $240 million in 2013 to $1.9 billion by 2018, representing an annual growth of 56 per cent.

According to IDC Health, New Zealand healthcare IT spending shows the most mature pattern in the Asia/Pacific region.

IDC Health states that 2013 ICT spending by the healthcare sector in New Zealand was estimated to be US$156.8 million, a modest growth of two per cent over the previous year’s estimates. By 2018, IDC Health Insights forecasts that healthcare ICT spending will reach US$183.1 million and top priorities for healthcare IT executives appear to be upgrading technology and introducing newer technologies such as mobility.

There is also an increasing shift towards homecare and remote patient monitoring (outside hospitals, clinics, and rest homes), to deliver effective healthcare services with reduced expenditure.

Statistics show that three million patients worldwide are already receiving professional care by being connected to home medical monitoring devices; this number is expected to grow to 19.1 million patients around the world by 2018. A greater emphasis is also now being placed on population

health management, focusing on preventing problems before they develop for better clinical and patient outcomes and more costeffective delivery of care.

The New Zealand Government recently commenced the procurement process to develop an integrated national telehealth service, scheduled for launch on 1 July, 2015.

This will be a much-needed game changer and we should expect to see a continued shift towards more widespread telehealth deployments.

Video-Enabled Care Delivery

Video collaboration technology and telehealth are effective tools in shaping these new care delivery models. In addition to traditional doctor-patient consultations, video technology enables face-to-face collaboration across the whole spectrum of stakeholders – between doctors and hospitals, patients, their families and consultants, and other supporting professionals – independent of physical barriers.

Fundamental to any technology deployment in healthcare is that quality of care is not compromised. There is now a broad range of technology delivering customised solutions for patient examinations that support multidisciplinary healthcare delivery. This means that with high definition visuals, bespoke accessories on telemedicine carts, or remote patient monitoring capabilities on mobile devices, clinical workflow becomes much more efficient and collaboration happens naturally – without the barriers of distance and accessibility.

Community Care

Let’s snoop around... Home Instead

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ince introducing INsite’s ‘snoop around’ column, I’ve visited and reported back on many rest homes and retirement villages but never a homecare organisation. Of course, the very nature of home-based care makes it considerably more difficult to ‘snoop around’, but it didn’t stop me from contacting Debra Jager, manager of Home Instead Tauranga, to see if she might be willing for me to pop by.

Home Instead’s headquarters are nestled amongst the quaint buildings comprising Tauranga’s Historic Village. It’s a full house due to training being carried out, so we decide to move our chat down the ‘street’ to the village’s cafe.

While we wait for our coffee, Debra brings me up to speed with Home Instead’s history. I hadn’t realised it was international – the largest non-medical homecare organisation in the world, in fact – with a presence in 21 countries, but predominantly the United States, where it began in 1994.

Debra’s involvement with the Tauranga franchise began in 2007, and in 2011 she bought the master franchise. Significant changes in the homecare sector and a drive for excellence and accountability saw Debra pare down the operation to two franchises – in Tauranga and Hamilton – and build a more effective business, with a strong emphasis on training and quality of care delivery. I get the sense that while this hasn’t been easy, the outcome for Home Instead has been positive.

Being a private player in this industry isn’t easy, Debra tells me. New Zealanders are extremely fortunate to have strong, statefunded healthcare; however, because of this, professionals can be resistant to suggesting private pay options and referring a company such as Home Instead.

It seems a little unfair, considering Home Instead makes the effort to point out opportunities for government funding for clients wherever applicable. Debra says about 50 per cent of the phone calls they get enquiring about care do not go ahead due to a funded solution being found for them by Home Instead.

Debra recognises that today’s seniors typically feel that as they have worked hard and paid taxes their whole lives, they are entitled to be looked after by the government. Older people prefer not to ‘rock the boat’; they are content having care allocated to them on the government’s terms. However, Debra says she is noticing that this is starting to change as the baby boomer generation begins to make decisions about their elderly parents’ care.

This is where private home care has its place. Home Instead offers flexibility and care that is tailored closely to the needs of the clients. There is a strong focus on matching skill level and personality with what the client needs and wants. As Debra gives examples of the sort of care provided, I can sense that much effort is taken to go the extra mile, to get it right for the clients.

Debra Jager

Debra says a large proportion of their work is topping up government-funded care. For example, an elderly lady’s needs assessment might entitle her to assistance with four showers a week. However, her family thinks she would also benefit from some help with getting to appointments, and with shopping and housework during the week, as well as the extra companionship this would provide. Home Instead is regularly contracted on this basis.

The scope of what they do extends far beyond outings, housework, and companionship, however. Personal care, dementia care, 24-hour care, and palliative care is all covered by Home Instead.

Debra says that given the prevalence and accessibility of nursing specialists, being a non-medical care provider is generally not restricting. However, she does acknowledge that one of the key issues in home-based care is the increasingly blurred line between what is medical and what is not.

With people staying at home much longer with multiple chronic conditions, coupled with frailty, there is increased need for assistance with many things, such as continence issues and medications, she says.

These are concerns shared across the home-based care sector. Being private doesn’t preclude Home Instead from concerns about workforce pay either. Staff start at around the minimum wage and their pay progresses according to a range of factors, including training, qualifications, and job performance. Debra says she wishes caregivers could earn more to better reflect the importance of their work but says driving up costs for clients is not feasible to achieve this.

Debra is clearly passionate about training.

All caregivers must have at least Level 2, and new staff go straight into training. Home Instead’s training sees its participants come out with a New Zealand Qualification, rolled out over 12 weeks in a classroom setup. Debra says their training extends up to Level 4, with some caregivers having gone on to pursue nursing or diversional therapy careers.

She has plans to roll out a new training arm of the business that will see training extended to the community, delivered free in exchange for volunteer hours.

Debra says they are also in the throes of setting up a charitable trust that will broaden the scope of what they do. She gives the example of a rest home that asked for Home Instead’s services to help a resident with no family and showing signs of loneliness.

This is the sort of situation in which she envisages a need for the charitable trust.

Debra hopes the charitable trust and the new training model will help to challenge some of the widely held misconceptions around private operators in the sector.

She says it can be difficult to shake off the preconceived ideas that come with the ‘private’ label. I find this interesting, as Home Instead already strikes me as quite a philanthropic enterprise – one example is the way it donates a number of free hours to the hospice.

Our chat over, as I walk back through the mock street of the village to my car, it strikes me that I’ve learned a lot about a corner of the care industry that I hadn’t really ventured intro before – an important corner, given the combination of a growing, older population, the emphasis on ageing in place, and the increasing pressure on the funded side of the sector. It will be interesting to watch how Home Instead’s new initiatives play out, and I look forward to another trip to the Historic Village one day to hear how it continues to progress and evolve. www.insitemagazine.co.nz | December/January 2015

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Community Care

On the soapbox …

Julie Haggie

Chief executive of Home and Community Health Association JULIE HAGGIE says that moves towards compensating home support workers fairly for the time and cost of travelling between clients is a step in the right direction for the sector.

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or a group of around 20 people, time seemed to slow this year during the five months they spent in intense negotiations on an in-between travel time settlement. The parties comprised the Government, Ministry of Health, unions, employers, and district health board representatives, chaired by chief government negotiator Doug Martin. A settlement agreement was finally reached in early September of this year. From July next year, under this settlement, support workers will be paid the minimum wage for the time they travel between clients, and in addition, from March 2016, they will be reimbursed a standard national minimum rate of 50c per kilometre for travel costs (mileage, use of car).

Legal challenge from the unions to recognise ‘in-between travel’ as work was the main driver for the negotiations, and there was also pressure for a fair solution from multiple parties, including employers and the Human Rights Commission. It was clear to all parties that there was an obvious inequity. Home support workers should be compensated fairly for the time and cost of travelling between clients, and currently, this is not the case. The problem is a structural one. The contracting of the service is largely ‘fee for service’ – each unit (hour, half hour) of home support to the client is purchased by the funders, and there has been no specific allowance for travel time in that rate. ACC is an exception – it funds travel time at half of the contract rate but only for time associated with travel over 20 kilometres.

Current travel cost payments (to cover mileage and use of car) to support workers vary considerably, but in almost all cases, the funding available only partly pays for the amount of travel that is undertaken.

All parties recognised that the current funding could not be used to address the cost of settlement, and the Government agreed to foot the bill. There was also a common desire to address broader workforce and sector issues, and this led to a two-part settlement agreement; one (Part A) focusing on travel, and the other (Part B) aiming for the regularisation of the workforce (guaranteed hours, more training, and competency-based pay), as well as a comprehensive review of the service by a Director-General’s inquiry.

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The service suffers from an historically appalling lack of funding that has directly caused an erosion of providers’ purchasing power, to the extent that close to 50 per cent of the workforce are now sitting on the minimum wage. The current contractual rates do not allow providers to adequately compensate workers for gaining qualifications and skills, and as a result, turnover is rising rapidly. Many providers will be unable to afford to deliver this so-called publicly funded service when the next minimum wage comes through (expected on 1 April 2015).

The settlement process is now in a phase focusing on Part 1, which involves gaining ratification of the settlement by employers, workers, and funders, and there are meetings taking place across the country to enable workers to ask questions, and to vote. Also underway is an independent assessment by KPMG to verify the costs of Part 1. Although the parties did their best to estimate the total number of client visits and the average cost of travelling between clients, this isn’t a service where people or units have been counted well. Where the hours of support delivered in any year are in the tens of millions, small percentage inaccuracies can make a huge difference at a national level. Close scrutiny of data during the negotiations resulted in an increase in the government contribution but much still remains uncertain, and the negotiating parties need more assurance that the $38 million government injection of funds will be enough. A major piece of work to be undertaken is the development of travel bands (based on grouped postcodes) that can fairly but approximately allow for averaged travel between clients and help identify exceptional areas of travel.

An important inclusion in the agreement was a principle that no worker would be worse off overall, and there is still a good deal of work to ensure that this is the case. For example, one clause of the settlement states that workers will not receive travel time or travel reimbursement for their first client visit each day. Some may argue that this is not unreasonable in terms of the general principle that most of us self-fund the cost of ‘getting to work’. However, home support is not like a lot of other jobs. Many workers have only one to three client appointments on any day, and often face visit cancellations. Some have to

Support worker ratification meeting.

travel a long way from their home or between clients to support clients with particular needs or because there is just no worker closer who can support the person. And they all have to use their own vehicles as they generally don’t have travel options. How we can ensure that support workers will not be worse off under the settlement agreement and its funding envelope will be a major challenge.

Another issue is home support funded by the Accident Compensation Corporation.

Most workers support clients across several funding streams, including clients recovering from injury or living with long-term injury.

ACC was not party to the negotiations, though a clause in the settlement agreement requires that a similar arrangement with ACC needs to be put in place. Ideally, ACC will adjust its travel payments and move to the same client visit model to ensure that workers and providers are not disadvantaged in undertaking ACC work.

Part 2 of the settlement will be another very large challenge, as well as an opportunity. It envisages the majority of the 23,000 workers shifting from a casualised employment arrangement to a system of more regular working hours. It also means that more workers need to be trained to Level 3 and requires providers and funders to implement a competency-based pay framework. The process needs to be done carefully because it is so important that the service retains its current staff. There will obviously be a substantial cost to this new reality, and that has yet to be addressed. However, it offers the opportunity to genuinely value this workforce.

So the negotiations produced a good outcome. All parties lifted their eyes above the immediate legal threat or potential costs.

It also shows that the Government and some of its agencies are starting to recognise the presence and value of the community support workforce.

In its briefing to the incoming Minister this month, Health Workforce NZ discussed a shift from supporting the medical workforce to a wider focus on multidisciplinary healthcare teams to improve prevention and self-care. It acknowledged the need for more and bettertrained home-based and residential carers to support the ageing population.

Home support employers and their workers have for many years been stuck in a policyfree, structureless wasteland. There is some distance to go, but we are now seeing intent to grow this service towards its much fuller potential.

Conferences

Conference report New Zealand Aged Care Association annual conference, Wellington, October 2014

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round 320 delegates and 95 exhibitors joined this year’s NZACA conference held at Shed 6 and the TSB Bank Arena on Wellington’s waterfront in October.

Attendees were kept entertained, informed and challenged by a host of excellent speakers, including Athol Earl from Rowing New Zealand, who spoke about his experiences with toplevel competitive sport. There were also a number of speakers from across the Tasman – Dianne Adamson, Cam Ansell, Danielle McIntosh, and Rod Young – who shared insights into various aspects of aged care in Australia, including lessons in dementia design, developments in telehealth, and sector analysis.

Getting away from an institutionalised approach to a more person-centred focus was one of the key messages emerging from the conference. Keynote speaker Dr Davina Porock from the University of Buffalo in the United States told conference attendees that facilities that take a clinical or bio medical approach to caring for older people, particularly those with dementia, could potentially fail to meet the individual needs of their residents.

This message was reinforced by the experiences of Nicola Turner from Presbyterian Support Central and Jill Woodward from Elizabeth Knox Home and Hospital, who each highlighted ways that systems such as the Eden Alternative had helped to promote person-centred care at their facilities. Helen Delmonte from Mercy Parklands also shared how the Spark of Life approach was helping to promote more person-centred care delivery at their facility.

A number of familiar names and faces also took the stand to talk about specific business or clinical aspects of aged care, including Chris Fleming on the future of premium charging, Ray Lind on workforce planning, and Michal Boyd on hospitalisation rates before and after admission to aged residential care.

The conference dinner carried the theme “The Wonderful World of Wearable Art” with a great effort made by many to dress up accordingly.

Winners of the NZACA/ EBOS Healthcare Excellence in Care Awards were announced at the dinner.

Next year’s conference will be held at SkyCity Auckland from 8–10 September.

NZACA conference manager Robyn Gray reflects on 20 years of conferences Who would have thought when I joined the New Zealand Licensed Rest Homes Association staff back in 1994 that I would still be involved in their annual conference 20 years on?

Many changes have taken place over the 20 years. We went from the New Zealand Licensed Rest Home Association, to Residential Care New Zealand to Healthcare Providers, to New Zealand Aged Care Association, which reflects more on what the association is about.

In earlier days, we were very much a cottage industry; all of the conference planning and printing of programmes was done in house. We had an outsider dedicated to selling trade space, where we averaged between 35 and 40 companies exhibiting.

Twenty years on and 95 exhibiting companies later, we have grown into the largest aged care conference to be held in New Zealand. All of the planning and management is done by a very dedicated team here in national office. Exhibition space, sponsorship, programme planning, social functions, and all matters associated with conference is handled within our small team.

I was very privileged and surprised to be recognised at the annual awards and conference dinner for my involvement over the years. Along the way, I have met so many dedicated owners, managers, and staff from the various facilities throughout New Zealand, and I have built up a great relationship with the many companies who return year after year to support us.

I am grateful to the NZACA board and Martin Taylor for the opportunity of a guided fly fishing trip in the North Island as a thank you for my 20 years of conferences.

Ranfurly scoops big prize at the NZACA awards It was its food that saw Ranfurly Village Hospital triumph in this year’s New Zealand Aged Care Association /EBOS Excellence in Care Awards.

The newly developed facility received the EBOS Healthcare Overall Excellence in Aged Care Award, along with the Bidvest Excellence in Food for Care Homes and Hospital Award.

NZACA chief executive Martin Taylor, who was among the judging panel, said Ranfurly had set the bar very high with its food service. Fellow judge and nutritionist Pip Duncan described it as “an outstanding process”.

Ranfurly’s food service allows residents to select their meal options from a tablet device and meals are prepared to a restaurant standard by executive chef Terence Austin.

Austin was delighted with the award but described the real reward for him as getting clean plates back each day and seeing older people rediscovering their food and looking forward to meal times.

Images of the fresh and beautifully presented food prompted many conference attendees to question Ranfurly’s costs at delivering such a food service. However, Ranfurly manager Helen Martelli says they

have actually managed to reduce their food costs per resident per day from $8.95 in December last year to $5.96 in September this year.

Ranfurly withstood some stiff competition from other award finalists. Among them, Presbyterian Support South Canterbury was runner-up in the Bidvest food award and also joint winner of the QPS Benchmarking Innovative Delivery Award with its Eden Alternative journey, along with Mercy Parklands with its Spark of Life initiative.

Bethlehem Views won the Jackson Van Interiors Built and Grown Environment Award for its new dementia care facility.

Aria Gardens Home and Hospital won the Medi-Map Community Connections Award, with the judges particularly impressed by the way the facility sponsored and assisted groups within the community, such as the RSA and Plunket.

Oceania Group’s therapeutic moving and handling training package took the Health Ed Trust Training and Staff Development Award.

Like Ranfurly’s food service, the training package also incorporated tablets, allowing facilities to easily roll out training to staff.

www.insitemagazine.co.nz | December/January 2015

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Management

Up close and personal with ...

Todd Perkinson

Jude Barback asks TODD PERKINSON, New Zealand-based chief executive officer of RDNS, about running a trans-Tasman organisation and the challenging funding environment of the home-based support services sector.

INsite: You have previously worked in a range of industries. Why the healthcare and community support sector more recently? What differentiates this sector from other industries in which you have worked in the past?

I have worked for a number of commercial organisations. However, I ‘stumbled’ over healthcare a few years back through my consultancy services. The health organisation was over hauling itself and the entities that it operated under its group, therefore my skill set was well matched. As I got more heavily involved with the organisation, I felt a greater sense of achievement with the work that I was doing as the sector is well intentioned however sometimes lacking commercial intent to ensure that we remain sustainable and viable into the future.

What differentiates the sector from others is the passionate people that work within it. People are passionately driven by the quality and level of services to people in less advantageous positions and do the work under the banner of strong values, both from a personal and organisation perspective.

The sector is no different from other organisations I have worked in as there still needs to be a quality service that someone is willing to engage with. This needs to be coupled with ensuring that the organisation is run efficiently and effectively, and in this business in particular, has the ability to make a return, which, in turn, is in reinvested back into the people and infrastructure.

When RDNS first started to expand into the New Zealand market and competed successfully for some major contracts here, the organisation was perceived with a degree of animosity from some who felt the contracts should have been gone to New Zealandbased organisations. Is the tide changing? Do you think there is more acceptance of RDNS’s footing in the New Zealand home and community support services sector these days?

I can’t comment back in the time that the contracts were won as I was not here, however, even though we are part of an Australasian group, we are very much independent in the services that we operate and how we operate from a day-to-day perspective. I have a very strong working relationship with the executive team within Australia, but I operate autonomously and report to a New Zealand board.

We are a charitable limited liability entity registered in New Zealand, employing and investing in the New Zealand workforce and communities that we work within.

As part of a larger group, we enjoy the benefits that any subsidiary would whereby scalable services become cheaper as the group grows.

We also enjoy the history of lessons learnt from our parent, which has been around for over 100 years and has a very good reputation; we are looking at replicating this within our New Zealand services.

I do believe that the tide is turning in regards to opinions that may have circulated back in the time and that is due to the level of services that we are delivering. We are working very closely with the funding 16

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arms we contract with and this is all with the client at the centre of this premise.

I’m curious to know what the key challenges are with leading an organisation with one foot on each side of the Tasman. When I interviewed Stelvio Vido some time ago, he said New Zealand’s system was more integrated than Australia’s – that in New Zealand, the client has a more seamless access to service regardless of whether they are an older person, a person with disability, or an ACC client. The Australian system, by contrast, is more segmented, and Stelvio felt there were opportunities to inform Australian practices with aspects of what is working well here in New Zealand. Do you agree that there are opportunities for the two different systems to learn from each other?

In many ways – my recruitment has been to focus on the challenges that New Zealand faces for delivering services into as opposed to a foot in both camps.

I am heavily involved with what is happening at group level, and where applicable, we share the IP across the Tasman for best practices. I know that we can learn off each other, so working collaboratively as a group, we will succeed in that perspective.

Australia is about to embark on a period of significant change, so we are learning about their model about the same time that they are aligning themselves, therefore, we can apply applicable components to our own operations. One of the largest areas we are sharing is the ability to leverage technology across the group around mobility devices for our workforce and the efficiencies that can be gained, which is timely for the recent ‘in between travel’ discussions.

Funding levels continue to be one of the biggest concerns for the homebased support services sector, in New Zealand at least. What would you like to see the new New Zealand Government bring to the table for the sector, in terms of funding, but also any other policy variables?

I agree that services within the community have struggled to attract appropriate funding over the years. However, community-based services are now becoming part of the health options that are available to people, and people are becoming more aware of the effectiveness of these models.

The maturity of the model is becoming increasingly better understood from both the client and funding in an outsourced model to providers like us.

I would be excited to see greater integration between the funding and provider arms to make it as seamless as possible for the client’s experience.

I believe that value could be created from offering a seamless service from pre-natal to older adult and to do that we need a workforce that is skilled to deliver the needs of each and every client.

I would like to see the sector collaborate more efficiently and get the most out of the Crown’s funded dollar and to achieve that will take input and leadership from all parts of the sector.

opinion In the past you have specialised in business transformation. Do you hope to drive any significant changes to RDNS while you are at the helm?

Thank you – I seem to follow change around and normally have greater clarity the murkier it gets.

I try and keep things as simple as possible and not to over complicate issues or functions. I have a very autonomous way of working that allows people to get full ownership of the function they are working within and have a high sense of accountability and responsibility. I offer advice and direction where I can.

I would love to see RDNS NZ with a national footprint and being a leading healthcare provider in the sector, with a highly talented and engaged workforce.

Since I have been here, I have already conducted a restructure of the support services to the services that we provide and that was to ensure that we have the right people doing the right job, delivering fundamental information that is timely, accurate, and allows effective decision making, both internally and externally.

We now have the structure in place to allow ourselves to deliver comprehensively more services to a wider stream of funders, who can enjoy the quality services that we provide.

We are still currently reviewing our statement. However, I am more than willing to share our ‘draft’ statement with you, which is: “RDNS delivers proactive, personalised care that improves quality of life through self empowerment, family engagement and caring about the little things”.

I am also extremely passionate about the use of technology to assist with transforming the sector; we as a sector need to embrace technology and remove the complexity of using it especially for clients as a consumer. I see this as a key differentiator for ourselves.

What have you enjoyed most about your time as CEO for RDNS so far?

I have thoroughly enjoyed making that first CEO move and the responsibilities that come with it. As with any leader, you are only as good as the team that supports you, and I am more than confident that I now have that team in place to drive leadership and growth within RDNS NZ and been seen as an influencing factor within the sector.

I have also enjoyed being part of a larger team (as a subsidiary) and also the autonomy that the governance of the organisation has allowed me to make change and have faith and confidence in us to deliver the desired or planned outcomes.

Additionally, I have also enjoyed the role that we play in the services; they can be seen as being complex in some circumstances, but I understand that everybody is different and the needs are individual. Therefore, we as a business need to be accommodating and ensuring that this is delivered in a meaningful and efficient manner.

What has been the biggest challenge or steepest learning curve?

I believe the steepest learning curve is understanding the overall sector and how it all hangs together and understanding the sector landscape, which is quite different from previous roles. However, I am all too familiar with the drivers for better outcomes and more independency for our clients, especially within a home environment.

When you’re not at work, where can you be found?

I have a wife and two kids (Louis, 4, and Ava, 3) – both of them occupy my spare time sufficiently and they are both at a great age to enjoy as both are finding their own personalities. Louis is into tennis and rugby so my weekends are occupied carting and teaching him around the various grounds.

In my spare time I enjoy tennis, golf, rugby, travelling, cooking, socialising with friends, and reading various books.

We spent a lot of time whilst in the UK travelling around and would love the opportunity to take the kids back to south of France, Spain, and Italy whilst they still want to travel with us both.

Last word...

Maggie Barry The new Minister for Senior Citizens makes her introductions.

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s the new Minister for Senior Citizens, I intend to be a strong advocate for older New Zealanders and being invited into Cabinet by the Prime Minister means the voice of your sector will now be heard around the top table.

My ‘trifecta’ of Senior Citizens, Arts, Culture and Heritage, and Conservation is a dream-cometrue portfolio line-up for me. The wellbeing of older New Zealanders is close to my heart, and I will be travelling around the country to meet as many of the seniors groups and key stakeholders in the sector as I can.

As Minister for Senior Citizens, I take a whole of government advocacy role on behalf of older people, particularly in relation to policy development and decision making.

This means supporting positive ageing and the wellbeing of older New Zealanders in a range of areas, and I’ll be your advocate across retirement income, employment, housing, transport, ageing in the community, disability support, community and voluntary sector involvement, and the protection of older people’s rights and interests.

I’m very aware after experiences with my own mother’s decline into dementia that there are many vulnerable older people who don’t always have the advocates and safeguards they need and they deserve dignity and respect in their final years.

I have also been actively involved in the palliative care sector for many years as a former patron of Hospice New Zealand. Prior to entering Parliament, I chaired a working party into the care of those who are dying and during the last Parliamentary term I founded the All Party Palliative Care Group, a cross-party initiative to raise awareness and support in Parliament for the care of people who are dying.

I am also a co-founder of the Care Alliance, which is a coalition assembled to oppose euthanasia and assisted suicide.

Before being elected to Parliament, I was an award-winning news and current affairs television and radio broadcaster, a magazine feature writer, and co-producer and presenter of the television programme Maggie’s Garden Show. I was awarded the Order of NZ Merit for services to broadcasting and intend to use all my skills to be a champion for issues that matter to older New Zealanders.

As the Minister for Senior Citizens, my priorities will include working to change attitudes towards ageing by encouraging people to value the role of older people in the workforce, as taxpayers and consumers.

Most importantly, I will be raising awareness of elder abuse and neglect and social isolation, issues which I believe need to be taken seriously.

The number of people aged 65 and over has doubled since 1980 and is likely to double again to around 1.2 million over this next 30 years, and I am very much looking forward to being a strong voice for New Zealand seniors in this 51st Parliament. www.insitemagazine.co.nz | December/January 2015

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Your Life Your Health Your Choices • Personal care Assistance with showering, dressing, meal preparation and more • Domestic help Including housework, laundry and grocery shopping • Restorative activities From exercise programmes to socialisation activities • Child care Supervising activities including feeding, transportation to child care facilities or school • Respite in the Home Providing assistance to full time carers

• Nursing General and specialised home nursing including wound care, medicines management, stomal care and more.

To find out more about our tailored services please call 0800 RDNSNZ (0800 736 769) or (09) 589 8900 24 hours a day, 7 days a week or visit us at: www.rdns.org.nz

“RDNS NZ provides the support I need to live my best life at home.”