AGED-CARE & RETIREMENT
February – March 2013 | Vol. 7 Issue 2 | $10.95
WE’VE GOT YOUR INDUSTRY COVERED I www.insitemagazine.co.nz
2 I NEWS
UPSET OVER SOUTHLAND’S HOME SUPPORT SERVICE CONTRACTING 14 I FEATURE
REJUVENATING THE BODY THROUGH
EXERCISE AND DIET 16 I REGULARS
THE PREMIUM CHARGING DEBATE
6 I FOCUS ON:
A SECTOR SPLIT:
CORPORATES VS PRIVATE VILLAGES
Do you have questions about living in a retirement village? The Ministry of Business, Innovation and Employment provides free, independent advice and information for people living in or thinking about moving into a retirement village. Call us free on: 0800 83 62 62 or visit our website www.dbh.govt.nz The Ministry of Business, Innovation and Employment is the government agency responsible for overseeing the Retirement Villages Act 2003.
In this issue...
www.insitemagazine.co.nz AGED-CARE & RETIREMENT
INsite Magazine Vol.7 Issue 3 EDITOR: Jude Barback T: 07 575 8493 E: editor@insitemagazine.co.nz ADVERTISING: Belle Hanrahan T: 04 915 9783 E: belle@apn-ed.co.nz PRODUCTION MANAGER: Barbara la Grange EDITOR-IN-CHIEF: Shane Cummings GENERAL MANAGER/PUBLISHER: Bronwen Wilkins SUBSCRIPTIONS: T: 04 471 1600 F: 04 471 1080 E: subscriptions@apn-ed.co.nz PUBLISHER’S NOTE: © Copyright 2013. No part of this publication can be used or reproduced in any format without express permission in writing from APN Educational Media (NZ) Ltd.
EDITORIAL & BUSINESS ADDRESS Level 1, Saatchi & Saatchi Building, 101-103 Courtenay Place, PO Box 200, Wellington 6140, New Zealand T: (04) 471 1600 F: (04) 471 1080 ISSN 1177-9268 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).
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New Zealand’s retirement village industry – where to next? Leaders, experts and insiders have their say.
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Corporatisation of the village industry – and what it means for independent operators.
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Revamp of the Ranfurly War Veterans Home and Hospital will see it go from the oldest to the newest care facility.
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More to the cuppa than meets the eye.
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PHILIPPA FLETCHER discusses the long road to recovery for older Cantabrians
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Support for an ageing population with disability. CLARE TEAGUE discusses.
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GARY SYME looks at rejuvenating the body through exercise and diet.
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REVAMP OF THE RANFURLY WAR VETERANS HOME AND HOSPITAL
ED LETTER
WITH A BLINK of an eye, my first year as editor of INsite has finished and I find myself back where I started – the first issue of the year. The focus is once again on the retirement village as a business. It is an interesting topic; seldom does a week pass when the Herald doesn’t make mention of a listed village operator’s stellar performance on the stock market in its business section. It is a thriving industry by all accounts, but in an effort to bring you the opinions of those in the driving seats, we’ve invited various village operators, investment analysts, and the RVA to give their views on where they think the New Zealand retirement village industry is heading. The big corporate operators naturally have a tendency to dominate the sector. In this issue we look at whether this corporatisation trend is to the detriment of private operators. We have some excellent contributors to this issue. Among them is Gary Syme, discussing why retirement villages should consider implementing an exercise programme to keep residents fit and healthy; Alexa Andrew on why cafes in rest homes mean more to residents and their families than a place for a cuppa, Philippa Fletcher on the uphill battle many older Cantabrians continue to face; and Clare Teague on the challenges that come with supporting older people with disabilities in their homes. Remember, if you have a topic you’d like to see discussed, or you wish to pick up on an issue raised among these pages, please get in touch. We look forward to bringing you our next issue, with its focus on long-term care needs.
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RESIDENT CHITCHAT...
Greta and Bill Hewitt
REGULARS
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NEWS Snippets and updates from the industry
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ON THE SOAP BOX... Martin Taylor
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SPOTLIGHT ON... age-related hearing loss
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CONFERENCE CORNER New Zealand Home Health Association Conference 2013
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UP CLOSE AND PERSONAL WITH... Leigh Kelly
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LAST WORD... Rob Wilson WINNER INsite/NZACA Resident Wish competition
Jude Barback, Editor editor@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
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WINNER! INsite/NZACA Resident Wish competition
www.insitemagazine.co.nz | February / March 2013
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News NEWS BYTES »» STREAMLINED REST HOME AUDITING BEGINS In an effort to reduce the regulatory burden on providers while maintaining the integrity of the audit process, a new streamlined auditing process was introduced at the beginning of this year. The new process follows the Ministry of Health’s “successful” trial of streamlined auditing of 23 rest homes last year. Associate Health Minister Jo Goodhew says the streamlined audits focus more tightly on services directly affecting residents. “They produce a more useful result for regulators, operators and the public. They also provide time savings in the review of documents and reporting.” The new audit process is thought to save up to six hours for each audit. “Regular independent checks of rest homes against clearly defined, relevant standards are vital to ensure high-quality care for older New Zealanders in aged residential care. It ensures providers meet current standards and any shortcomings are quickly identified and rectified,” says Goodhew. In addition to the new audit process, the Government has also introduced spot audits of aged residential care facilities and third-party accreditation of aged residential care auditors. »» NEW STROKE UNIT FOR BOP DHB A dedicated stroke unit has recently opened at Tauranga Hospital. The unit is led by a specialist in stroke care from Britain, recruited by the Bay of Plenty DHB. Health Minister Tony Ryall says New Zealand’s 13 large and medium-sized DHBs all now have a dedicated acute stroke unit. Lakes DHB is developing a new stroke unit, which is expected to open in March, and Waikato DHB will be expanding their services when they move into their new stroke unit in June. An audit in 2009 revealed only 39 per cent of stroke patients were being treated in stroke units, but the Government is working towards having 80 per cent of stroke patients treated in a dedicated stroke unit. »» NEW LEADER FOR NZNO The country’s largest nursing organisation, the New Zealand Nurses Organisation (NZNO), has a new president: Tauranga-based practice nurse Marion Guy. She won a three-way contest to co-lead the 46,000-member professional and industrial body.
SOUTHERN DHB’S DECISION HURTS LOCAL PROVIDERS SOUTHERN DISTRICT HEALTH BOARD’S announcement that Presbyterian Support Otago (PSO) would no longer be among its contracted homebased support services providers came as a “huge shock” to the organisation. In addition to the well-known providers Healthcare of New Zealand and Access Homehealth, the SDHB has opted to partner with Australian-owned, Aucklandbased organisation, Royal District Nursing Service New Zealand, a choice that has raised some eyebrows within the sector. Gillian Bremner, chief executive of PSO, says it was unfortunate the board chose an outside provider over a “tried and true” local option. Debbie Webster, general manager of Disabilities Resource Centre Southland (DRCS), which also missed out on selection, agrees. She told the Otago Daily Times that providing the service to the large and mostly rural area covered by the SDHB required specialist knowledge and networks. “That sort of connection doesn’t happen overnight. It’s something that’s established over years and years,” she says. PSO and DRCS are both fighting the decision. According to Bremner, the SDHB made it clear from the outset of the tender process that it would consider between two and four providers, so she is mystified why the DHB has stopped at three. “We want to be that fourth provider. It would also mean our clients and staff will suffer the least amount of disruption to their lives as possible as the SDHB works through the new service provisions.” PSO board chairman Frazer Barton says they won’t let it go without a fight. “We
must challenge why we were unsuccessful, why our high level of service to vulnerable people was rejected, why we are now required to transition our experienced and qualified staff to three providers with a far less local footprint than we have.” DRCS is also resisting the change. The charitable trust is running an online petition for PSO to be the fourth provider, with DRCS as a partner. PSO also has the support of Dunedin Labour MPs Clare Curran and David Clark, who have condemned the decision, saying PSO was a proven provider and should be retained. However, it appears the SDHB did not reach their decision lightly. Executive Director Finance and Funding Robert Mackway-Jones said the DHB has spent 18 months working with local stakeholders to determine how services can best meet the needs of Southern district, establishing a new model of care. “The preferred providers all have significant experience in working with this new model in other parts of New Zealand. We are confident these providers offer high-quality services and work with local communities to maximise benefits for the groups of people they provide care for,” he says. Bremner has expressed her concern that a “particular ideology” appeared to be driving the tender processes of DHBs, which favoured larger entities. This was changing the face of the home-based support sector nationwide, she told Otago Daily Times. Despite the protests, it appears the SDHB is proceeding with the change as planned. A three-month transition process is due to start in March.
SOUTH ISLAND ALLIANCE PARTNERS WITH ORION HEALTH The South Island Alliance announced shortly before Christmas that it has selected Orion Health, a leading provider of health IT solutions, as its preferred provider to work on planning for a new patient administration system for the South Island’s one million residents and five South Island District Health Boards (DHBs). Orion was selected over 12 other organisations that expressed interest in the project. These were narrowed down to three, which were considered by panels of clinicians, IT specialists, and health managers from around the South Island. Building on existing regional IT initiatives, Orion will help the Alliance develop a system that will allow greater collaboration for care providers and patients and help deliver better health outcomes. South Island Alliance Information Services chairman Dr Andrew Bowers said the Alliance was very pleased with how the selection process has gone. “We are confident our process is robust and that we have identified a provider we can work with to develop a truly innovative system. This is not just replacing the incumbent patient administration systems with a similar one – it is an opportunity to implement a system that will address the changing ways that we deliver health over the next 20 years.”
☛ GOT AN OPINION? Have your say online at www.insitemagazine.co.nz 2
February / March 2013 | www.insitemagazine.co.nz
NEWS
INsite/RVA MANAGER OF THE YEAR AWARD 2013 NOW OPEN Does your manager deserve to be recognised for their tireless hard work? manager of Mary Doyle Lifecare in Hastings, said “My residents kept asking me to enter this competition, so I finally did.” After winning the award, she said she felt “like I’m at the top of my game.” Your manager could be recognised for her or his hard work, too, but YOU need to nominate them! The winner will receive $2000, free entry to the RVA conference and gala dinner (Gold Coast, Australia, 23–27 June), $500 donation to
RESIDENT CHITCHAT
INsite talks to GRETA and BILL HEWITT, residents at Summerset Aotea Retirement Village about why retirement village living is a good move for them. INsite: What prompted your decision to move into a retirement village? Bill: Our age and my wife’s health.
INsite: DID YOU CONSIDER ANY ALTERNATIVES TO SUMMERSET AOTEA? Bill: No, this is the only such village in this area.
INsite: What factors did you take into account when making the decision to move into retirement village living? Bill: The security. If I’m out, help is just a press of a button away. No
more worries regarding maintenance, even if it is very slow in this village.
INsite: WHAT ROLE DID YOUR IMMEDIATE FAMILY PLAY IN THIS DECISION PROCESS AND HOW DO THEY FEEL ABOUT YOU LIVING AT SUMMERSET AOTEA? DO THEY LIVE NEARBY AND DO YOU SEE THEM OFTEN? Bill: This was a joint decision. My son Russ and his wife Helen came
down from Auckland early and helped with finalising our decision. We see them about four times a year. INsite: Is there a care facility at Summerset Aotea? Do you consider it important to have a care facility within a retirement village? Bill: Yes, there is. This was a major requirement in our decision of where
to live.
INsite: Are there any negative aspects to retirement village living from your experience? Bill: Yes. We have had our own property since early 1960. I like to fix
things that go wrong right away without filling in forms.
INsite: WHAT ADVICE WOULD YOU GIVE TO PEOPLE THINKING ABOUT SELECTING A VILLAGE? Bill: In this village there are very good facilities and activities that are
paid for in your fee. Don’t leave the decision too late!
their village’s residents’ Christmas function (or similar), and coverage by INsite and Retirement Views for the manager, the village, and residents. Resident nomination forms will be available on www.retirementvillages.org.nz and www.insitemagazine.co.nz very soon. For more information, email RVA Association Manager Mr Ed Thomas ed@retirementvillages.org.nz Nominations close 10 April 2013 (4pm).
PALLIATIVE CARE SERVICES FOR MINORITY GROUPS Elderly people of Asian background are the least likely to access palliative and hospice services in New Zealand due to language and cultural barriers and lack of information, according to the findings of a University of Canterbury (UC) project. The research, which was supervised by UC health sciences researcher Kate Reid and involved collaboration between UC postgraduate audiology student Bible Lee and Partnership Health Canterbury’s ethnic liaison Wayne Reid, found the majority of the Korean, Chinese, and Japanese respondents reported little understanding of palliative and allied health services available in New Zealand, yet many were interested in knowing more about the services. In the study, Korean respondents were the oldest, with many aged 75 years and older. Yet the study found that only a quarter of them knew that bereavement support services were available in New Zealand. Similar findings were found for the Japanese and Chinese groups. Lee says the reason why elderly Asian people were under-utilising care services could be due to a set mentality of not wanting to make a fuss, so they were not actively asking for help or seeking information, but cultural and language differences played a big part. “Statistics show that by 2026, the number of Asian people aged 65 years and over will be five times as great as it was in 2006. Migrant population groups from the 1980s and 1990s – the permanent settlers – are baby boomers. They are also ageing and
RESEARCH CORNER
INTERVIEW
NOMINATIONS ARE NOW OPEN for the INsite/ RVA Manager of the Year Award. Does your manager have what it takes? Winning the award carries significant value and enhances the reputation of the winning village. Past Managers of the Year have reported their village profile grew in their local market and their resident waiting lists increased. It’s a win for everyone – manager, staff, and residents. Last year’s INsite/RVA Manager of the Year Award winner, Diana Triplow, general
have real needs. The question is ‘how much do we know about this group and their health needs?’” Lee says. The study also found that perspectives associated with terminal illnesses, death, and dying could also vary across different cultures. The majority of respondents strongly valued the opportunity of being able to speak in their mother tongue and being offered written information by health professionals in their native language. ANTIPSYCHOTICS USE IN ELDERLY CANTABRIANS New research looks to provide more effective ways of improving prescribing antipsychotics to older Cantabrians. The study, which emerged from the University of Otago’s Christchurch summer students’ annual research programme, was led by student Annie Yau and supervised by Dr Matthew Croucher and Dr Susan Gee. The study addresses increasing concerns about the frequency of antipsychotics prescribing in the older population as side effects may be associated with illness and death, particularly in those with dementia. Yau believes not enough is known about the reasons people are prescribed these drugs. The results highlight several potential limitations of previous research and guidelines relating to antipsychotics use for older people. For example, many publications have focused on antipsychotics use for older people with dementia living in a residential care facility who present with challenging behaviours, but only 19 per cent of prescriptions were in this category and most of the prescriptions were given to individuals who were living at home. Yau believes education and guidelines for antipsychotics use for older people need to include these broader groups.
www.insitemagazine.co.nz | February / March 2013
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FOCUS
New Zealand’s Retirement Village industry –
WHERE TO NEXT? INsite asks a range of different stakeholders for their views on which direction the retirement village industry is heading.
SIMON CHALLIES, MANAGING DIRECTOR, RYMAN HEALTHCARE
“The retirement village industry is playing an essential role in the respect that it provides attractive housing options for older New Zealanders. The Government has identified a need for new housing, especially in the established metropolitan centres, and retirement villages are meeting this need by catering for the fastest growing group of our society. By downsizing to a retirement village, a retired person is not only moving to accommodation that meets their needs, but they are also typically freeing up a family home within an established suburb with access to schools, recreation facilities, transport, and established council infrastructure. “At Ryman our focus is on building and operating retirement villages that offer the full continuum of care, so that we can look after our residents as their needs change. We are building 700 new units and aged care beds per annum in New Zealand, which goes only part way to meeting the growing need for new retirement village units and aged care beds. Our biggest challenge, as always, is executing well and delivering good service to our residents and their families. “We see more differentiation in the retirement village market developing between villages, which are more focussed on independent residents and those which provide the continuum of care. We see both markets expanding dramatically in the next 20 years. “On the Australian front, we have planning approval and are about to commence building our first village in Melbourne. We have made no commitments beyond the first site and won’t embark 4
February / March 2013 | www.insitemagazine.co.nz
on any further villages until we can prove ourselves on the first one. I’m not imagining many other New Zealand companies following suit as there remain plenty of opportunities in New Zealand, and it’s a big challenge crossing the ditch.”
MARGARET OWENS, GENERAL MANAGER INDEPENDENT LIVING, BUPA
“I think a major direction for the industry at the moment is that potential residents are seeking a retirement village that has a plan for how care will be provided to them when needed. In earlier days, this didn’t appear to be ‘top of mind’ for some prospects enquiring at villages. There appears to be a developing trend that this is a factor to be considered when choosing a retirement village. “Bupa has plans to grow the size of the retirement village portfolio by building on sites we already own and greenfields sites that we acquire for development. Our retirement village facilities will generally be co-located with Bupa Care Homes so that our retirement village residents can benefit from our extensive expertise in providing all types of care – including our specialty, the provision of dementia services. One of the hurdles we face in moving forward is obtaining suitable land for development and navigating our way through resource consent processes, which are expensive both in time and cost.”
NORAH BARLOW, CHIEF EXECUTIVE OFFICER, SUMMERSET
“The retirement village industry in New Zealand is in a good place. As a country we are getting better and better at what we do. Summerset is at the front of that; we’ve
been named best retirement village operator in Australasia for the past three years. The opportunities are endless and the best part is that our older population is benefitting from that. “Summerset has always been a fast-moving company, but since listing on the stock exchange in November 2011, its growth rate has accelerated. The company has just announced an intention to be building 300 units per annum by 2015. This means a big year is ahead. “Three new Summerset villages opened in 2012 – Dunedin, Hamilton, and Nelson. A fourth, in Katikati, will be up and running by June this year. At the end of the 2013, Summerset will have 20 villages under development. “People may ask how the population can sustain such growth in retirement villages. They acknowledge the population is ageing but ask how we know these extra people will choose to live in a village. “We have seen the desire for retirement village living increase steadily since we started in the industry more than 15 years ago. There has been a particular rise in the last few years as people’s awareness of villages has increased. A few years ago, 5 per cent of New Zealanders over 75 lived in a village. Today that figure is at nine per cent. Even if that number were to remain the same, the country would need an extra 30,000 retirement village units by 2031. We expect it to keep rising. Really, we can’t grow fast enough. “It is an interesting and exciting time for the sector. Retirement villages are become more and more involved in the aged care sector, with care facilities and beds becoming a requisite part of any new village development.
FOCUS “At Summerset, we have been building care centres as part of our villages from the start. This has been driven off the back of a clear need for the services to be provided by one provider in as seamless a manner as possible. “New Zealand is clearly leading the way in this integrated village model. No one else in the world is doing it nearly as well. New Zealand is innovative and we find it easy to adapt and change our thinking and not be put off by what many around the world think is simply too hard.”
JOHN COLLYNS, EXECUTIVE DIRECTOR, RETIREMENT VILLAGES ASSOCIATION
“From our perspective, we see the retirement village industry continuing to grow at a dramatic rate. Research undertaken by Jones Lang LaSalle (JLL) and published in December 2012 states that there are 63 registered villages with some degree of development, with around 5000 homes at some stage of the consent process or undergoing construction. This is a 50/50 split between new developments and expanding existing villages. As there are 343 registered retirement villages with the Registrar of Retirement Villages, this means that almost 20 per cent of the industry is actively expanding. Of this development pipeline, JLL calculate that about half are being developed by the major groups. “Leaving aside any further financial or property crises, there could be an additional demand for 19,300 dwellings if villages are to maintain their current penetration rate. JLL calculate that we currently have around 4.2 per cent of the over 65s and 9.4 per cent of the over 75s resident in retirement villages across the country as a whole. This obviously varies from region to region, with the Bay of Plenty enjoying the highest penetration rate of 6.5 per cent (65+) and 14.4 per cent (75+). This is closely followed by Auckland at 5.3 per cent (65+) and 12.4 per cent (75+). As the availability of land becomes more scarce, we are likely to see more apartment-style buildings rather than the traditional lowdensity single-story villas. Some operators are taking the opportunity to provide affordable housing for older people, which is an important social policy initiative. “We also expect to see an increasing demand for care being delivered to residents in their own units. The RVA continues to argue for home-based support service contracts to be available to retirement village operators as a matter of course so they can deliver lower levels of care to their residents, thereby avoiding the need to move them to a rest home sooner than might otherwise be the case. The resistance from DHBs to this logical situation is disappointing.”
INVESTMENT PERSPECTIVES Jeremy Simpson, Director – Research, Forsyth Barr
“The retirement village industry in New Zealand is tracking well, with a pick-up in activity over the last 12 months after a number of operators experienced a quiet period post the global financial crisis. In addition to increased sales activity for units and apartments, there has also been increased planning and associated land acquisitions for the development of new retirement villages. A buoyant housing market in Auckland and an improving housing market in other parts of New Zealand have also been very helpful with regard to activity levels generally. Another theme has been planning by some operators to have a level of aged care services integrating into retirement villages or plans to build larger care facilities by operators already offering integrated villages. “The aged care sector has become increasingly significant from an investment perspective, with around $4 billion of aged care assets now listed on the New Zealand exchange and the sector accounting for around 7 per cent of the NZX 50 index. The sector has been a very strong performer for investors over the 12 months ending 31 December 2012, with Ryman Healthcare up 72 per cent, Summerset Group up 67 per cent, and Metlifecare up 37 per cent. Investors are attracted to the growth opportunity for the sector given the ageing population and because operating cash flows have been relatively resilient during a period of subdued economic activity.”
James Beale – Head of Investment Management, Craigs Investment Partners
“The listed retirement village sector has been vibrant over the last 18 months, with some significant positive additions to the market and strong investment returns. “The additions include the acquisition by Metlifecare of Vision Senior Living and Private Life Care Holdings Limited – a $200m transaction in mid-2012 – and the $300m initial public offer and listing on the NZSX of Summerset Group Holdings Ltd in late 2011. Meanwhile, market stalwart Ryman Healthcare continues to grow its portfolio of villages, and its share price has performed strongly. “During 2012, the sector produced stunning returns for investors. The total annual return from an investment in each of Ryman Healthcare, Summerset, and Metlifecare over 2012 was 70.5 per cent, 67.2 per cent, and 36.6 per cent respectively. The size and scale of the retirement village sector can be seen in the combined capitalisations of the three major players, which currently represent close to $3.5 billion of the New Zealand market. This is around six per cent of the entire market capitalisation of New Zealand domiciled listed companies. “Interestingly, whilst the three entities have enjoyed common strong performance,
and each is operating in the same market with the same regulatory structure, the businesses are at different stages of development and have some differentiating strategies. Metlifecare has grown in part via an acquisition strategy and has continued this with the purchase of Vision Senior and Private Life Care. Summerset is internalising its development arm to improve its profitability and is increasing its focus on integrated villages with a greater proportion of care beds. Ryman has stuck to its proven formula of internally developed and managed villages, with no external acquisition. Although it still has significant growth available in New Zealand, it has purchased its first land for development in Melbourne, Australia, and the market will be watching its progress here carefully. “So why are New Zealand investors, including its very largest institutional investors, so enthusiastic about the sector? There are really two significant factors in our view. Firstly, the retirement village business model is very capitalefficient in New Zealand, and secondly, it offers significant growth over a sustained period of time, in a new economic age when growth in mature western economies is a rare occurrence. “Retirement village operators build villages then effectively ‘sell’ the right to occupy to residents. This effective sale releases the investment capital used to build the village and other facilities and enables new land and village investments to be made, whilst leaving in place a sustainable ongoing earnings stream. The efficiency of this model can be seen in the fact that Ryman has grown to be a $2.3 billion entity, without needing to raise even a dollar of additional capital. Since listing in 1999, this reinvestment process has seen its net assets grow from $58m to $691m as at 30 September 2012, whilst it has returned steadily growing dividends to shareholders as well. “New Zealand’s well-known demographics, together with a relatively low penetration rate of elderly in retirement villages, means there is plenty of growth in the sector for years ahead. Provided the businesses operate in a highquality, socially responsible manner, this means there is room for further villages, residents, and ultimately more revenue and profit growth. “We expect the investment return for the sector will be considerably more modest in 2013. Nevertheless, the sector is likely to remain popular with investors, and each of Metlifecare, Summerset, and Ryman can look forward to further expansion this year, with good levels of occupancy, more demand for village spaces, and further development opportunities ahead.”
www.insitemagazine.co.nz | February / March 2013
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FOCUS
The corporatisation of
THE VILLAGE INDUSTRY
With the major corporate operators continuing to dominate the retirement village market, what are the repercussions for independent operators? JUDE BARBACK reports.
E
ven a person with no connection or interest in New Zealand’s retirement village industry could not help but notice the familiar fonts and logos at the entrance to many villages around the country. It has become an industry characterised by the big players, the Rymans, Metlifecares, and Summersets. But is bigger always best? Do smaller, privately owned villages struggle alongside their corporate counterparts? Or do they revel in their points of difference?
sector, suggested that this activity reflects trends of recent years. “Outside the land acquisition market, activity in the retirement village property market has been very subdued since mid-2007, with only a handful of villages changing hands. This follows a period of significant institutional investment activity during the mid-2000s, during which substantial retirement and aged care portfolios were accumulated, particularly by Australian institutions,” says Long.
SECTOR SNAPSHOT
THE NECESSITY TO GROW
The recent research carried out by Jones Lang LaSalle (JLL) as part of its development of the New Zealand’s Retirement Village Database makes for interesting reading. According to the report, around 4.2 per cent of people aged 65 and over and 9.4 per cent aged 75 and over live in a retirement village in New Zealand. As at October 2012, there were 343 registered retirement villages in New Zealand. With ownership of these villages shared among 188 parent companies, the market could be considered relatively fragmented. However, just under a third of all villages are owned by the five major operators: Oceania, Ryman Healthcare, Metlifecare, Bupa, and Summerset. All villages were not created equal, however. Even among the big five, JLL’s research showed that Metlifecare accounts for 18 per cent of the total 21,815 registered retirement village units/dwellings, Ryman for 15 per cent, and Summerset for seven, indicating that these three operators tend to have larger village complexes than Oceania and Bupa. There is regional variation as well. There are parallels between climate and village residency, with Bay of Plenty, Auckland, and Hawke’s Bay villages having the highest market penetration rates. Mergers and acquisitions over the years have contributed to the market domination of these big players. Metlifecare’s acquisition of Vision and Private Lifecare Holdings last year was further proof that the major operators look set to continue their domination of the market. However, most activity appears to have been in the form of the larger operators acquiring proposed village sites, particularly greenfield land on city fringes where population growth has been identified. In a Herald article in August 2012, Colliers’ associate director Anthony Long, who has a focus on the retirement village and aged care 6
February / March 2013 | www.insitemagazine.co.nz
The scramble for land and market share is not in vain. Retirement villages are attractive to investors, hence the efforts of the major listed operators to expand. James Beale of Craigs Investment Partners says this is aided by the nature of the retirement village business model, which is very capital efficient: operators build villages and sell the right to occupy to residents, which releases the investment capital used to build the village, enabling operators to expand or develop new villages. New Zealand’s growing and ageing population is an obvious key factor here as well, and considering the relatively low penetration rates – an indication that there is room for more growth in the sector – it is no surprise operators will attempt to increase their share of the market. While new operators are also attracted to such a growth industry, it is still the big five that account for half of the 63 registered villages in the development pipeline – of which half are expansion projects and half are new developments. Summerset is responsible for 16 per cent of the development pipeline projects, Metlifecare 11 per cent, and Ryman 10. The JLL research shows that after the completion of these projects, Metlifecare and Ryman will still dominate the market. However, Summerset will have closed the gap significantly. While this growth appears significant, the JLL report suggests that if current penetration rates continue to increase along with the growing and ageing population, it will only meet demand for the next few years. Sandy Foster, owner and director of Whitby Lakes Retirement Village, makes the point that growth and development are perceived by many as essential for the corporate players to survive. “As listed entities, there is an expectation from shareholders to see growth and to see their investment being utilised to generate more
development. Balance sheets of retirement village entities are very dependent on and susceptible to the valuation of the assets, and investors expect to see this grow. This creates a bit of a trap for the corporates – the market is not infinite and some commentators would question some of the recent acquisition of development sites by the corporates. “Whilst the private operators may have a harder time acquiring development sites, they are not driven by the same growth imperative or pressure. Whilst they may have to keep their bankers happy, they are not generally in the investment commentaries.”
THE BENEFITS OF BEING BIG
While the listed operators may feel the heat of their investors, there are certainly advantages to being a big player in a growth industry. The larger organisations are arguably better equipped to comply with the regulatory environment that, thanks to the introduction of various legislation – including the Health and Disability Services (Safety) Act, the Retirement Villages Act, and the Code of Practice – now characterise the operation of retirement villages. Summerset’s 2011 annual report states that ‘the complexities and cost of compliance associated with this regulatory environment has been a significant deterrent to new entrants into the retirement village and aged care industry’. Larger operators are also typically able to weather unfavourable economic times. According to CBRE’s Retirement Housing & Healthcare Division, “In 2007 the New Zealand retirement village market was under threat of over-supply as opportunistic, inexperienced, and under-capitalised operators sought to take advantage of favourable market conditions at the time. The difficult economic climate that followed the global financial crisis in 2008 resulted in many large-scale construction projects being cancelled or placed on hold due to the heightened sell-down risk for completed product and construction completion risk caused by funding constraints. In some cases, where retirement villages were proposed, developers either walked away or sought an alternative exit strategy.” The property company believes that as market conditions continue to improve, the major players who have survived the economic downturn and have secure funding and a development pipeline in place are likely to benefit the most.
FOCUS Certainly, the corporates typically have greater cashflows and economies of scale on their side, which allows them to respond to the demands of the market. For instance, larger village organisations are often in a better position to provide the facilities sought after by residents, not least care facilities. Margaret Owens, general manager independent living, Bupa, says that while the provision of care may not have previously been in the forefront of residents’ thinking, it is now. “I think a major direction for the industry at the moment is that potential residents are seeking a retirement village that has a plan for how care will be provided to them when needed,” she says. According to the JLL research, 63 per cent of registered villages had a care facility, 35 per cent did not, and two per cent planned to develop one. This is in keeping with results from a survey conducted by The National Bank at the 2012 RVA Conference, which confirmed that the top three actions over the next year for village owners are building more villas, building more apartments, and expanding care facilities.
THE PROS OF BEING PRIVATE
For all the benefits of being a large commercial operator, Sandy Foster of Whitby Lakes disputes the notion that privately owned villages cannot compete with their corporate counterparts. “I have heard the view expressed that the industry is now at a stage where it is only the
corporates that will or can prosper,” says Foster, “but to accept this view is to ignore the evidence of innumerable industries where corporates exist alongside privately owned businesses and also to ignore the reality of what is happening in the industry. “The evidence of the commercial success of privately-held villages is out there. They are not as visible as the listed entities, but there are several highly successful operators out there doing very good work and achieving great success. “The corporates, in theory, are better able to survive and prosper through economies of scale, developing strong brands, easier access to finance, easier access to new development opportunities, standardisation, and so forth. With scale comes a smoothing-out of cashflows from resales, making their financial performance more stable.” Foster suggests that despite the strong investment attracted by the corporates recently, they are not immune to financial or economic strife. “They can still get into difficulty ... for a number of years, Metlife[care] languished with high levels of debt, high levels of unsold stock, and slow resales, and it is only in the past year that they’ve recovered their momentum.” Foster says while smaller, privately-owned villages do find things harder in terms of cashflows and access to funding, he believes they are more able to adapt to change. He also believes private operators have more freedom to shape their villages in the way they want.
“A corporate operator is probably more constrained in terms of creating points of difference and being creative in terms of design.” Jason Rowling, owner and operator of Carmel Country Club Estate in Tauranga, agrees that privately owned villages perhaps operate with a greater degree of flexibility. “We don’t have to run back to the managers in Auckland or Wellington every time we want to change something,” he says. While Rowling concedes that the large corporates are likely to have more buying power, allowing them to buy insurances and other things on a larger scale, he points out that any savings made through economies of scale do not appear to be reflected in their weekly fees. He claims Carmel’s weekly fees remain among the cheapest in the region. Rowling also dismisses the notion that privately owned villages should struggle with compliance. He says accreditation has always been a straightforward process for his village. Foster agrees. “[Compliance] may be hard for some of the very small villages, particularly those with very low cashflows, but compliance is really easier and more affordable now than it was prior to the introduction of the RVA.” Both Rowling and Foster believe their proximity to the operation of their respective villages allows them to better respond to residents’ needs. “With the best will in the world, a corporate operator’s CEO couldn’t be available in this way – this is probably the privately owned villages’ greatest potential advantage,” says Foster. However, both agree that, in terms of service or quality of care offered at private or corporate villages, there is unlikely to be any significant difference between private or corporate villages. “They may have different styles, but private operators can do as well as the corporates in terms of maintaining high standards and achieving consistency, and corporates can be as personable and interested as private operators,” says Foster. Indeed, it would be misleading to judge a village purely based on its ownership. Yet prospective residents are making these sorts of assumptions about villages every day. As Foster says, “Some residents want the perceived stability and certainty of a corporate, and others like the individuality of the private operators. Some love the scale of a Ryman or Metlife[care] village and others prefer the smaller scale and boutique nature of the smaller private operators.” The diversity of the market is what gives both private and corporate operators their respective places in it, not to mention the others comprising the sector, such as the not-for-profit operators. With the retirement village industry continuing to flourish, it appears there is indeed room for operators of all shapes and sizes. www.insitemagazine.co.nz | February / March 2013
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FOCUS
From the oldest to the newest Building on a long and rich history of care, construction has begun to transform Ranfurly War Veterans’ Home and Hospital in Auckland into a substantial retirement village complex offering a full continuum of care.
F
ew New Zealanders will have heard of Uchter John Mark Knox Ranfurly but almost everyone is aware of the shield he donated to the NZRFU in 1902 – still this country’s premier rugby trophy. Lord Ranfurly, as he was better known when the 13th Governor General of New Zealand, was a man of considerable compassion and vision. He developed Ranfurly House on eight acres of the then outer Auckland suburb of Mt Albert. Originally built for ailing veterans of the New Zealand Land Wars and the returning soldiers of the South African (Boer) War, the two-storey colonial-styled house slowly grew additions and today comprises separate rest home, hospital, and dementia facilities. Like many historic buildings, time has not been kind to Ranfurly War Veterans’ Home and Hospital, as it is currently known today, and in addition the number of veterans has slowly dwindled, which caused its owner, The Ranfurly Trust, to review its future. The dilemma the Trust faced was the need for urgent and substantial renovations, without any major funding base in difficult economic times. After considering a number of proposals, the Trust settled on an arrangement with Christchurch-based Retirement Assets Limited (RAL), a retirement village operator of almost 20 years’ standing. Under the terms of the partnership, RAL secured resource consent for a substantial village complex designed for, and available to, the entire Auckland market. The complex will include a new aged care facility, a fully renovated Ranfurly House as the village community centre, and multiple retirement units in eight separate apartment buildings. The Trust gains an ongoing income from a share of the deferred management fees, and sees a new aged complex developed that can continue to look after its constituency, while their iconic Ranfurly House receives the attention it requires and deserves. Despite being heavily involved in retirement villages, assuming the existing Ranfurly aged care operations late last year was a new experience for RAL. Director Graham Wilkinson explains that it was partly due to recognition of the essential part aged
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care would play in their retirement village development strategy. “While we have previously been involved in solely lifestyle villages, we recognise that having the full continuum of care is becoming essential and we wanted to learn the critical success factors before development of similar facilities at our Christchurch and Bay of Plenty projects,” says Wilkinson. To overcome that lack of expertise, RAL sought out experience, including appointing as general manager of the complex, Helen Martelli, a registered nurse and more latterly a regional manager for a large corporate aged care provider. “Although I loved my old job, the opportunity to be involved in a development of this size and significance with its proud heritage was simply too good to pass up,” Martelli explains. “Ranfurly Trust has previously earned an unrivalled reputation for care and we are conscious of the need to both recognise and build on this going forward, even if the number of veterans has gradually diminished and admissions by the general public now dominate,” she says. Already several changes have occurred since RAL, under the name of Ranfurly Care, have assumed ownership of the existing 69-bed rest home, 35-bed hospital, and 24-bed dementia facilities, including enhanced activities and physiotherapy services and installation of modern technology in readiness for the introduction of a computerised care system. In addition, the Ministry of Health and Ranfurly Care have agreed on converting 35 existing rest home beds to hospital beds due to demand characteristics. “The ability to swing these beds will enable us to accommodate more residents who require the hospital care Ranfurly is well known to deliver and enable us to maintain the skill base of staff, the majority of whom have worked at Ranfurly for over five years,” says Martelli. The first stage of development, involving the construction of the new 60-bed aged care facility, is well under way and will open later this year. At that stage, 60 residents will transfer from the old to the new facility, which will allow for sufficient existing buildings to be demolished for the first stage of 27 retirement apartments.
A second stage of 36 apartments and renovation of Ranfurly House will start as stage one nears completion. Eventually approximately 180 units will be developed. Another veteran – but of retirement and aged care rather than the armed forces – is newly appointed marketing manager Annette Senton. Also a registered nurse, Senton started her retirement village career with RAL in 1995 and is looking forward to the new challenge offered at Ranfurly. “The location is superb, being both close to Auckland Central and one of Auckland’s highest profile corners with over 30,000 cars passing every day,” says Senton. “Having a refurbished heritage building like Ranfurly House as the village community centre is a real point of difference and the size of the site allows for full facilities such as a bowling green, swimming pool, and the like.” Already there have already been sufficient unsolicited enquiries for retirement units to cause RAL to bring forth the appointment of Annette and start the marketing campaign in the second quarter of this year. As with other RAL projects, design and landscaping will figure prominently at Ranfurly. Auckland architects Sumich Chaplin, more usually known for upscale residences and resorts such as Huka Lodge cottages, have been commissioned to ensure the retirement units are both timeless and complement a refurbished Ranfurly House. Wilkinson believes that Ranfurly Village will be a good example of the defining difference between his small private company and the large public corporates. “We are fortunate to be able to take a long-term view. We look to see what is most appropriate for the location and site and rather than seek to maximise the development output now, look to build an enduring village that will stand the test of time and be as attractive in 100 years as it is today,” he says. Lord Ranfurly was known for his strong sense of duty and dignity. The village that bears his name will enter its second hundred years serving all Aucklanders while still retaining its history of dignity and respect for those lucky enough to live there.
RESEARCH
Alexa Andrew’s study of a café in an Otago rest home suggests that cafés may play a more important role in aged care facilities than people might think.
More to the cuppa than meets the eye
“I
’m so glad it’s there …and it’s like going out when you can’t go out”. These were the words of a resident at Ross Home and Hospital in reference to the facility’s café. The impact of Ross Café on residents like this one, and their friends and families, prompted Alexa Andrew, a senior lecturer in Occupational Therapy at Otago Polytechnic, to research the value of a café on the premises of an aged care facility. Andrew’s study, which was conducted this year, involved 11 residents and nine family or friend participants. The café was opened in 2005, following the major redesign and renovation of Ross Home and Hospital. Situated in the foyer, customers are afforded a good view of the comings and goings from the café. It is open seven days a week from 9.45am to 4pm and services the residents as well as being open to the public. The café consists of three distinct areas: indoor tables and chairs, comfortable couches in front of a fireplace, and an outdoor courtyard. Barista coffee, tea, a variety of light meals, sandwiches, and cakes are available at just below market rate prices. Ross Café is funded and supervised by the management of Ross Home.
A PLACE TO GO
Andrew’s study revealed the primary value of the café is as ‘a place to go’. As the opening quote suggests, it provides a venue to visit that’s different from other aspects of life in the home or hospital. Families and friends echoed this point, with one family member saying,“… she can participate in life that’s really different from the hospital”. The café is seen by residents as a place to take their visitors as well as a place to meet with other residents and family. Despite being on the premises of the aged care facility, going to the café is seen as an outing. The presence of the café enables residents to continue to participate in established life roles. This resident described the value of hosting visitors at the café: “Yes, unless its morning or afternoon tea time, you can’t offer a visitor something, so we just go to the cafe ...” Further, the resemblance of the café to a family home assists residents to show hospitality. As one family member says, “… to be able to offer them a cup of tea, it’s like, for her, it’s like family home … it’s a way of showing hospitality”. The design and décor of the café is appreciated by patrons, as is the ambience, which varies from season to season. One resident expressed a particular delight in visiting the café in winter: “…it is nice and cosy in front of the fireplace, ‘cause in the winter time, that fire’s going and its beautiful sitting around on the comfy suite there and having a cup of coffee”. The social atmosphere of the café is also
highly valued by resident participants and café staff members are credited with creating a welcoming atmosphere. One resident spoke of the café’s friendliness, “I have never ever found it disheartening here”.
RELATIONSHIPS
Andrew’s research also identified that the café creates social opportunities, the chance to build on existing friendships, and to make new ones. As one resident says, “you meet people who you have not seen for a day or two”. Family members describe the café as a social hub that can accommodate residents of varying levels of wellness. “So for mum, it was … the last really convenient place where she could experience a social hub, where she could meet people, where she could participate or just observe quietly if she was unwell.” Both residents and family appreciate the café as a place for holding family celebrations. Family particularly emphasized the importance of residents being able to be included in important family celebrations. One family participant described how the family had held birthday celebrations for the resident in the café for the past two years. The café also provides a place for community groups to meet so residents can continue to belong to and participate in various clubs. “… I belong to a clan and we have committee meetings with up to twenty in there for lunch,” says one resident. A daughter identified that her mother could continue to participate in her book club, despite her deteriorating levels of ability: “… her book club was relocated to meet in the café so that she was able to continue having input.” The residents particularly value the way the café promotes a sense of community and feelings of belonging to the residential home. “It’s very friendly,” says one resident, “The the counter staff are all very chatty and friendly, and it’s like a big family.” Family members share in the sense of community, with one participant describing it as her “home away from home”, stating that “everyone knows me”. In fact, the café plays an important role in providing a venue for family members to build invaluable support networks that give the necessary emotional, social and practical assistance. Says one family member: “… we’ve built a lot of relationships in that café, which for me, is like it’s a community … which when you’re caring for an older person it’s very stressful, and that cafe provides a huge kind of support community for family and friends”.
ACTIVITY
The location of the café and its busy atmosphereare also important features. This
family member described the hub of activity created by the café: “… it’s a different scenery, the sun’s still shining on the pansies, there’s still people buzzing around her, and it just gives a nice feeling.” In sight of the front door, this residents clearly appreciated people watching: “… we would watch people come in andthe door opens and people go in and people go out …” Margaret Pearce, manager of Ross Home and Hospital, says the addition of the café has added “life” to the facility.The café staff know all the regulars, including residents, the postie, couriers, taxi drivers, and other regular customers. Pearce points out that the café is not financially driven. “The café is not something any one would go into if they wished to make it a huge commercial success in a monetary way,” she says. “The location of the hospital and rest home within Dunedin is somewhat isolated, but with the good management by our food services manager, Paul Robertson, and the cafe manager, Shelley Milmine, we break even. “The ‘Valuing Lives’ philosophy of Presbyterian Support Otago centered on valuing social roles of residents far outweighs any monetary issues,” says Pearce. Andrew concludes that the addition of a café within an aged care environment can have significant value for the residents of that facility, as well as their family and friends. The café and the staff have created a place where the residents can appreciate the pleasant aesthetic environment but also experience a sense of belonging to a community. It provides a multitude of opportunities for the residents to create and maintain social networks and the sharing of food and drink is an activity that can contribute to the maintenance of life roles, family life, and connections to the community. The café generates a hub of activity that provides stimulation and opportunities for residents to make choices in the eating and drinking of favoured items. Ultimately, Andrew’s research relating to the Ross Café confirms what any facility would hope its café delivers: that it significantly enhances the lives of residents and their family and friends. Aside from not being an exemplary commercial venture, Pearce supports Andrew’s findings and is a strong advocate for her facility’s café. “The café is such a success for the residents and their families.” www.insitemagazine.co.nz | February / March 2013
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CHRISTCHURCH
LONG ROAD TO RECOVERY:
Supporting older Cantabrians PHILIPPA FLETCHER discusses what is being done to support the older people of Canterbury as Christchurch continues its recovery.
O
lder people are a powerful force in Canterbury. Around 15.5 per cent of the population is aged 65 and over. This contrasts with 13.8 per cent aged 65 and over nationally. According to Statistics New Zealand’s Subnational Population Estimates as at 30 June 2012, Canterbury’s population is therefore slightly older than the country’s total, and since June 2010, the population aged 50 and over increased in Christchurch by 2,700, an increase of 2.3 per cent. Many older Cantabrians never expected to make use of Christian social services, but many have done so since September 2010. The New Zealand Council of Christian Social Services (NZCCSS) works to improve people’s lives and members include Anglican Care Network, Baptist Churches of Aotearoa New Zealand, Catholic Social Services, Presbyterian Support NZ, the Methodist Church, and The Salvation Army. These organisations have all assisted older Cantabrians and others during the past two years. NZCCSS recently decided it wanted to do more to assist Cantabrians. We wanted to give people information so they could advocate for themselves, and we also wanted to give the politicians and those in powerful positions some clues about what might be helpful to the Canterbury population. The result was The Canterbury Report. Older people in New Zealand have coped with many hard times before. Those a little over 70 lived through the war years, and those a little over 80 lived through the 1930s’ depression. However, older Cantabrians have
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faced a new collection of struggles in the past two years: housing issues, mental health concerns, increased isolation, insurance difficulties, and the need to seek help. Perhaps the trickiest is the last: seeking help. Older people, who have found their way through many of the exigencies of life, often do not expect to be approaching social services for assistance in their later years.
“We are getting older people who are really unwell presenting for the first time in their lives. Older people who have got through everything until now.” – Vaughan Milner, Chief Executive Officer, Presbyterian Support Upper South Island Asking for help can be very hard:
“People are coming to food banks who have never been before. People are beyond coping and there is a sense of shame and humiliation.”
A CITY IN RECOVERY MODE: Top: Christchurch city mission Middle: Battling the elements Above and bottom left: Well-supported food bank and trolleys
earthquake disruptions, distress, anxiety, and increased alcohol consumption’. Fellow researcher Charlotte Renouf says that anxiety and depression may also be associated with other earthquake-related factors, such as insurance troubles and less frequent – Jolyon White, Anglican Care socialising. Social services are assisting large numbers of people across the age range who Service providers describe isolation and fear have anxiety and/or are depressed. amongst seniors. Both cause stress, and stress Being unable to fix your house is enough to affects people’s health. So it is not surprising distress anyone. Older people in Canterbury that St John Ambulance reported in the often own their own homes and have put Christchurch Press that they attended 4,174 much of their lives into turning them into cardiac-related incidents between September beautiful places reflecting both their love and 2009 and August 2010, 4,541 the following creative energies. It is heart-breaking seeing a year, and 4,899 between September 2011 and garden you have carefully tended ruined and a August 2012. home which you have cared for or where your It is also not surprising that recent work children grew up in tatters. It is even worse at Canterbury University’s psychology when you are stuck waiting for the EQC and department illustrates those in more the insurance companies to make up their earthquake-affected areas report greater minds about what is going on. Or if you live symptoms of depression than those in the in a neighbourhood where others have moved less affected areas. According to University away. Almost two and a half years on, many of Canterbury researcher Amy Rowlands, are still waiting for useful news about housing depression symptoms are often accompanied and the wait is taking its toll on many older by ‘a sense of helplessness, on-going postCantabrians.
CHRISTCHURCH
“Older people who would usually at this time look to move to more appropriate housing, either because a spouse has died or gone into care, or because their own ability to manage in a larger home has diminished, are finding themselves ‘stuck’ while they wait for EQC and/or insurers to agree and make a financial settlement,” says Alison Jephson, director of Anglican Living. “Family members, who would otherwise be the informal carers of older people, have moved away, often to Australia, after the earthquakes, leaving a void for social interaction as well as practical assistance in the home and physical care.”
“You can see the sadness in their faces when they come in. One elderly lady came in crying one day and it turned out she had just been told her house was zoned bluegreen.” – Betty Chapman, Wainoni
Avonside Community Services Trust, Touchstone, September 2012
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Housing people is not enough of a priority according to Canterbury services. Too many cheap houses are either unusable or have been demolished, and available houses have dramatically increased in price. According to Methodist Mission, around 17,000 houses are being demolished; 110,000 houses are being repaired, including 15,000 costing in excess of $100,000. Rents have increased markedly and there is a desperate need for affordable housing. Over 300 central city bedsits were written off and 600 rest home beds lost.
“There are 70-year-olds taking out mortgages. How will they repay them?”– Brian Turner, Wainoni-Avonside Community Services Trust
In the year to September 2012, house prices increased by five per cent nationally. They increased by 7 per cent in Christchurch city, 12 per cent in Selwyn, and 13 per cent in Waimakariri. The graph to the right shows how Christchurch house prices have taken off since September 2010. According to MBIE Market Rents for the second half of 2012, rents increased by 4 per cent nationally, 12 per cent in Christchurch, 3 per cent in Selwyn, and 18 per cent in Waimakariri. At the cheaper end, median rent for a room in Linwood/Phillipstown is $162. A three-bedroom house in Linwood/ Phillipstown is $342. Everyone knows earthquakes affected the insurance industry, and insurance has
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increased by 7.1 per cent nationally in the year to September 2012, according to Statistics New Zealand. Prices generally did increase more in Canterbury than in the rest of the country after the earthquakes. Work and Income provides one-off food grants if people meet the criteria. Government is tightening access to social welfare, but it is notable that while overall food grant provision fell in Canterbury between June 2010, 2011, and 2012, special needs grants for food for superannuitants increased by 21 per cent between June 2010 and 2011. Numbers then fell dramatically (202 to 34) between the June 2011 and June 2012 periods. Ministry of Social Development data shows that accommodation supplements have fallen by almost 13,000 over the last two years overall. However accommodation supplements for superannuitants have increased by 12.2 per cent or 3,231. Numbers of Canterbury superannuitants receiving Temporary Additional Support (the Government’s weekly payment that helps someone who can’t meet their essential living costs from what they earn or from other sources) were 11.6 per cent higher in June 2011 than they had been in June 2010 and another 14 per cent higher in June 2012. Just like everyone else, older people need reason to hope. A wonderful man from Delta Trust pointed out the importance of beauty and making things usable while putting energy into the solid, creative, and long term. Social services are around to help and older people’s needs are just as important as everyone else’s. As Christchurch City Missioner Michael Gorman says, the agencies do care and will continue to work for the recovery of the area while working with those in immediate need. Philippa Fletcher is policy advisor for New Zealand Council of Christian Social Services (NZCCSS).
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www.insitemagazine.co.nz | February / March 2013
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DISABILITY
Support for an ageing population with disability I
CLARE TEAGUE looks at the challenges in providing older disabled people the opportunity to “age in place”.
t is well accepted that New Zealand faces a demographic challenge in its ageing population. Recent figures from Statistics New Zealand indicate that New Zealanders over 65 are projected to be a quarter of the population by 2030 as opposed to 12 per cent in 2006. Statistics also indicate, unsurprisingly, that an increasing number of those people will have a disability of some kind. Of the 494,200 New Zealanders over 65 in 2006, 220,300 reported having an impairment that resulted in some form of limitation in activity resulting from a long-term condition or health problem. Older people therefore make up a sizeable part of the 17 per cent of New Zealanders who experience disability and will continue to do so. Many of these people have a very real desire to “age in place.” Older people with learning impairments may face an uncertain future. The systematic supports that have remained constant throughout their lifetimes may suddenly change without the person being able to authentically have choice or control over these changes. Recognition and support of this population’s right to access agespecific health services and Government/Ministry of Health (MoH) funding is critical for these people to be appropriately supported throughout their lifetime. Many responses to this growing population’s need present challenges to past practices and funding models, and require collaboration 12
February / March 2013 | www.insitemagazine.co.nz
between community support (including disability support providers) and health providers. Consumers of disability support, their families, and the workforce supporting them are considering ways to support quality lives for people across their whole life span. Internationally and within New Zealand, good practice guidance is emerging and yet to be universally implemented.
POLICIES AND LEGISLATION
Most OECD countries have developed long-term disability and older people strategies, and policy frameworks focused on full social inclusion for disabled and older people. Currently, there is an emerging awareness of the similarities and unique points of difference for older people with disabilities. For example, almost no people with learning impairments have offspring who can form part of their support network in later years. Instead, there is often great reliance on very elderly parents who may also be in need of age-related support. New Zealand has obligations under the UN Convention on the Rights of Persons with Disabilities to protect the rights and opportunities of people with disabilities; this includes people with dementia. How the convention applies when a person with lifelong disability becomes older will test some assumptions of policy and practice.
DISABILITY
AGEING IN PLACE
The New Zealand Disability Strategy (produced by the Government in 2001) acknowledged that one of the barriers facing older disabled people is the opportunity to “age in place” and in their familiar surroundings. Many families and disability support providers are committed to supporting people with learning impairments to ‘age in place’, particularly for people who have lived some time already in disability residential homes in their communities. Providers are considering how they can best support people as they age. There are a number of projects and initiatives including: »» a multi-year project to better enable people to age in place, which has highlighted how disability supports must adapt, and workforce development to integrate elements of disability support, community building and personal care »» workforce development to identify when hospice or palliative care is appropriate »» an initiative to promote home design that allows for ageing and disability-related conditions, so people will not have to move as they age »» strengthening connections between disability support providers and local primary and secondary health providers to improve access to health care. The health outcomes of the people with learning impairment of all ages are known to be poorer than the general population. This group experiences chronic mental health conditions three to four times more than the general population and has higher rates of hearing impairment, skin disorders and gastro-oesophageal disease. This group also accesses primary care four times more than the general population and secondary care (including in- and out-patient public
hospital services) nearly three times more than the general population (MoH, 2009). For some people with learning impairments, the prevalence of dementia – especially Alzheimer’s – is especially great. People with Down’s Syndrome are at significantly greater risk of developing Alzheimer’s and at an earlier age. It is important therefore that New Zealand initiatives to promote better supports for people with dementia include consideration of everyone, including those with early onset.
ADVANCE CARE PLANNING AND END-OF-LIFE CARE
An understanding of grief, death, and dying is essential for an ageing person with a learning impairment and their support people. The loss of older family members, friends, and long-term support people can be challenging. Developing strategies around the grief, death, and dying processes ensures people are adequately supported through this time. Providers have developed their own resources to help older people plan for their future, and to promote discussions within families on planning for the future. Older people with life-limiting conditions can and are being supported to have a say in how they want their end of life to be. Disability providers and disability consumer groups are very watchful of potential threats to the decision-making opportunities for older disabled people about where they will age, and with whom. Ultimately, support for people with lifelong impairments needs to be focused on “living in place”. Once this mind-set has been created the idea of people “ageing in place” is a much smaller step. Clare Teague is chief executive officer for the New Zealand Disability Support Network (NZDSN).
ABOUT NEW ZEALAND DISABILITY SUPPORT NETWORK The New Zealand Disability Support Network (NZDSN) is an incorporated society of member organisations that provide support to disabled people. NZDSN’s purpose is to lead and influence change that supports inclusive lives. NZDSN’s objectives are to: »» provide a strong voice to government on matters of common interest »» keep abreast of emerging trends and promote best-practice standards »» ensure good communication with members and support the establishment of special interest networks »» support and disseminate research relevant to the delivery of quality support services »» build strong relationships with members and secure a sustainable support base »» build skills and capacity of members »» work collaboratively with disabled people, their families and allied agencies to foster an inclusive society. Many of NZDSN’s member organisations are involved with supporting disabled people at some stage of their lives; this may be in the context of supported independent living, residential, supported employment, vocational support, and individualised funding hosts. The support disabled people want is not limited to youth and middle age. Developing adequate supports for the ageing population with disabilities is the focus of much attention among disability support providers and families in New Zealand.
www.insitemagazine.co.nz | October/November 2012 13
HEALTH
Rejuvenating the body through
EXERCISE AND DIET GARY SYME discusses how his exercise programme, ‘Born Again Bodies’, combined with a healthy diet, can help older people can stay fit and healthy.
F
red Astaire, American dancer, singer, and actor, once said, “Old age is like everything else. To make a success of it, you’ve got to start young.” So, according to Fred, NOW – whether you’re 35 or 95 – has to be a good time to start.
HOW ‘BORN AGAIN BODIES’ CAME ABOUT
I was late arriving at a church service – the congregation were rising to sing. Although they were finally standing, not one of the congregation had actually stood in the way that nature intended, by leg strength alone. Some of those present in the church that day had pulled themselves to their feet with the help of the seat in front or they had helped their depleted thigh muscles by bringing their arms into play and pushing down on their knees; some were even helped to their feet by those who had already made the ascent. It was that moment that started me on the path to founding the Born Again Bodies exercise programme.
WHAT DOES THE PROGRAMME ENTAIL?
Born Again Bodies is a programme for anyone who can still do their own shopping and put it away, so it is ideal for people in retirement villages. The classes operating in Knightsbridge and Mayfair retirement villages on Auckland’s North Shore have been well received and there are plans to expand the service to Poynton village and other sites this year. All that is needed for the Born Again Bodies programme is a pair of dumbbells and a chair. The programme consists of a selection of resistance exercises with light dumbbells, plus an optional 10-minute session at the end of the programme doing selected Tai Chi-like exercises for balance, coordination, and flexibility. The exercises with dumbbells have been selected to provide the best and safest way to maintain or increase muscle and bone mass and strength. The weight used by each participant varies according to their ability. Participants are also encouraged to walk several times a week to improve their cardiovascular fitness. ‘Catch-up’ walking
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involves periods of faster walking within the participant’s comfort zone. The exercises involving the Tai Chi-like movements are added as an option only at the end of each session to improve the participant’s balance, co-ordination, and leg strength to help minimise the danger of falls. When asked about exercise, most people will say: I go for a walk. The question is: walking is great exercise, but is it enough? Afraid not. There are plenty of marathon runners who struggle to get out of a chair, and certainly struggle to squat down on the floor and get up again. This is because a certain amount of muscle is needed to get out of a chair. In a marathon, or when walking, you need aerobic fitness; strength becomes irrelevant beyond a certain point. Your muscles adapt to your requirements. The bend in your knee when you walk is minimal (take a look at it), but when you get up from a chair it is a full 90 degrees. When we are down to a shuffle, there is no bend at all, and therefore not much work is being done by those once powerful thigh muscles. From there, it is a downhill slide to increasing immobility.
Having said that, there is no doubt that, apart from its cardiovascular value, walking is also a weight-bearing exercise, and as such, it will help to maintain bone density in the legs. For this reason alone, it is far better than doing nothing. However, people would not be struggling to get up from their seats, beds, and toilets if it was as simple as that. When you get up from a 90 degree knee-bend squat, you are lifting 80 per cent of your body weight to a standing position. The evidence is there that cardiovascular fitness, or ‘huff and puff’ fitness as I like to call it, will help you live longer, but there is also no doubt that weight-training or the ‘push and pull’ stuff will help you get to your feet and enable you to put the groceries on the top shelf. One of the problems arising as people live longer lives is the proportion of those years lived with the assistance of others. Doing both ‘huff and puff’ and ‘push and pull’ exercise along with exercise to improve balance and co-ordination will help you to live not only longer, but also more active lives. There is no single form of exercise that fits our body’s needs. As the eminent
HEALTH living longer than ever before. However, sad to say, in terms of active living, many older people are not so much living longer as dying longer. Without the muscle and the strength to maintain their independence, they are dependent on the help of others. And the length of their dependency has increased along with their lifespan. psychologist, Abraham Maslow, once said, “To the man who only has a hammer in his tool kit, every problem looks like a nail.”
THE BENEFITS OF EXERCISE FOR OLDER PEOPLE
Consider this: from our mid-thirties, if we are not doing resistance exercises, we lose approximately 150 grams of muscle a year. In terms of muscle mass, we are wasting away. So inevitably, we no longer have the strength to do the things we used to do, such as lifting objects from the floor or hopping out of bed in the morning. As we get older, we consider all this loss of muscle and associated strength to be inevitable. But it isn’t. Nor is all the associated bone loss. Nor is the loss of balance, nor the loss of flexibility. With age, we gradually do lose these things, but not at the rate most people are losing them right now – through lack of knowledge, lack of action, and lack of self-belief. The fact is you can lose muscle mass at any age. However, it is possible to slow – or better still – reverse these losses. The good news is not only can you maintain your strength at almost any age, but you can also increase it. So, too, can you increase your bone density and improve your balance and flexibility along the way. The more research that is done into the advantages of resistance exercise in those over 50, the more the benefits appear to be endless; not just the physical benefits but also the benefits to our mental health and our quality of life. The exercises with dumbbells have been selected to provide the best and safest way to maintain or increase muscle mass and strength. Because exercises with weights also help us maintain or increase our bone density, you get two health advantages for the price of one. In fact you get more advantages than just these two, but these are the two biggies in terms of bodily strength and function. Exercises with weights strengthen your muscles, your bones, your tendons, and your ligaments. In fact every cell in your body becomes more active. The outcome is greater bodily health. Add these “resistance exercises” to your exercises for co-ordination, flexibility, and cardiovascular fitness and you take your body out of reverse and put it into forward gear. Decreased strength and co-ordination increases the risk of falls and fractures. It could be said that people today are
causes confusion and fatigue. Urine becomes abnormally concentrated, and lack of water causes problems with digestion and normal bowel motions, and much, much more. As we get older, the fat content of our bodies will increase, and – if we let it – the muscle content will decrease, so that in old age the body may contain only 50 per cent or less water, as against the 60–70 per cent EATING WELL of earlier days. So, if we maintain or increase Exercise and diet go hand in hand and it is our muscle mass, we also store more water, important to keep healthy eating in check. maintain a more functional body, and burn We tend to eat less as we get older, and up more fat. although this may sound like a good thing in But whether our bodies are 45 or 70 per a time of increasing obesity, less food often cent water, they need topping up on a regular means less of the right kind of food. basis, because water is required to keep us at There are certain materials your body needs the right temperature and to move nutrients in larger quantities than others. You need and oxygen around the body and to remove protein for your muscles, you need calcium waste. Water also acts as a shock absorber for your bones, and you need carbohydrates around vulnerable areas, including our joints. and oils (preferably the good ones) as fuel Vitamin C is also important, but it and in maintenance of important areas of shouldn’t be a problem if plenty of fruit and your body chemistry. You also need fibre to vegetables are eaten on a daily basis. Whole move things along the supply chain. And fruits and berries are good sources of Vitamin then, of course, you need water to keep it all C. In winter, when the choices of fruit are afloat. limited, you may want to look at taking a Because protein is plentifully available in Vitamin C supplement. fish, lean meat, eggs, and milk products as Keep in mind that adequate protein, well in nuts and vegetable sources such as carbohydrate, calcium, and water are biggies, beans and tofu, it should be easy to get a and can’t be easily contained in a capsule or reasonable quantity, but everyone needs to tablet. There are some high-volume calcium examine their diets to ensure that theirs is supplements, but protein or carbohydrate adequate. supplements come in a form that requires When it comes to our calcium intake, it is spoonfuls at the very least. a bit more difficult. Milk products are great in this regard because not only do they supply A WORD ON VITAMIN D the protein you need, but they also provide Vitamin D is also something we need to the calcium. So, low fat milk, yoghurt, and think about. We need it to facilitate the low fat cheeses are good things to go for; use of calcium in bone building. We get cottage cheese is a particularly good choice. Vitamin D from the action of the sun on If you are a person who avoids or eats few our skin. So, we need to spend at least some of these products, then calcium-enriched time outdoors, preferably in the morning fruit juices and tinned sardines and salmon or evening when the sun is less intense. (which include bones) will provide calcium. Avoid sunburn. In our pursuit of healthier Some vegetables high in calcium content bodies, our outside activities, including our are broccoli, spinach, and other leafy green catch-up walking, can serve more than one vegetables. Nuts, particularly almonds, are purpose. There is also an increasing number also high in calcium. of products fortified with Vitamin D, When it comes to carbohydrates or oils, principally milk and milk products. You can most of us may in fact be overdoing it. also speak to your doctor about Vitamin D Complex carbohydrates are the best for supplements. prolonged energy, and we can get enough We also need Vitamin D to maintain the of these from a healthy diet of fruit and strength of our muscles, particularly fast twitch vegetables. Most of us include bread or muscle, which helps us stop ourselves from potatoes in our daily food intake as well. The falling. Without sufficient Vitamin D we lose best oils (fats) are derived from a few nuts fast twitch muscle faster as we get older. and good cooking oils such as rice bran oil, olive oil, canola, and grape seed. Omega-3 Gary Syme, the creator of Born Again Bodies, is a fish oils are also being promoted for their 75-year-old pharmacist who worked for 23 years health-giving properties. Apart from taking in the Public Health Directorate of the Ministry of these as a supplement in the form of capsules, Health. He has had an interest in health and fitness an occasional meal of salmon is a good source all his life. He has been a personal fitness instructor, of the Omega-3 components. a weight lifter, a runner-up light heavyweight Then there is water. The important point is wrestling champion, and he also has a black belt in that our bodies contain and use an awful lot Shotokan Karate. Gary is also a cancer survivor and of water. Water maintains normal blood flow a man with bilateral knee replacements – so he knows to the machinery of our body. Lack of water about some of the disadvantages that come with age. www.insitemagazine.co.nz | February / March 2013
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OPINION
On the soap box... Martin Taylor Aged care and premium charging
O
n December 11 the Government released a consultation document on premium charging in aged residential care. The consultation document is timely as the whole premium charging issue is coming to a head after nearly three years of disagreement between providers and DHBs. The point of contention is that DHBs assert a provider cannot refuse entry to a premium bed if the consumer cannot pay the premium. This means a premium service can be consumed for free. Most rational consumers would agree you should not get something for free as this means the incentive to provide the premium service is undermined. Therefore, the question arises: why should a consumer be entitled to a free premium service in aged care and not anywhere else in our market-based economy? The answer is because the premium itself is irrelevant, but the potential impact that premium may have on access to residential care for subsidy-only residents is not. For example, if too many facilities develop too many premium beds then the subsidyonly consumer will have little or no choice on where they can go. Even worse, a DHB may not be able to discharge a consumer when they
want or be forced to pay a premium in order to empty their wards in a timely manner. To quantify the level of this concern, it is worth referring to the facts as set out in the consultation document. In 2009, 44 per cent of facilities charged some of their residents extra – amounting to 15 per cent of residents in total. This means 85 per cent of all residents were in subsidy-only beds. Therefore, the DHB-perceived risk seems to be overstated on a national level, although in certain geographical areas it may be different. For example, there is one small community in the North Island with one aged care facility that has some premium beds. The issue for the DHB and provider is who should miss out on that last bed if it is a premium bed: the consumer who can pay or the consumer who cannot? This real example reinforces the point that the premium issue is about capacity and access and not about left wing ideology that asserts everyone must receive the same no matter what. It is also worth pointing out that any future capacity issues will have been caused by longterm underfunding of the aged care sector. The two main suggestions in the consultation document are (1) to allow a capped number of premium-only facilities, and (2) to have a four-week standdown period for subsidy-only consumers wanting to move into a mixed facility (one that has some rooms with premium charges
RESPONSE: CHRIS FLEMING “THE ISSUE OF premium-only and additional charging in mixed facilities (those with a mix of fully subsidised beds and additional charge beds) has been debated for many years, and it is pleasing to see that the Government is consulting with the public on some key issues pertaining to these issues. “Throughout the debate, New Zealand Aged Care Association (NZACA) has consistently resisted any constraints on the ability to determine whether any given facility is either premium-only (every resident in the facility must pay additional costs), mixed, or fully subsidised, arguing that the market will self- govern itself. Last year, through contract negotiations, NZACA threatened to put a surcharge on all residents if the price increases afforded by public health funding failed to meet their expectations. If that is an example of the market approach to self-governing, we would have good reason to be concerned. “It is also disappointing that NZACA has rolled the argument out that 85 per cent of residents were in subsidy-only beds as some form of justification to try to counteract District Health Boards’ concerns that unrestrained access to premium or mixed facilities is misguided. Many providers, if not the majority, take contractual obligations seriously (as I would expect the public would demand).
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“Changing the provisions in the contract to allow providers unfettered powers to determine what they will or won’t charge by way of premium-only or mixed additional charge facilities will undoubtedly have a significant influence on providers’ actions and decisions (particularly if they subscribe to Mr Taylor’s assertions that there has been “longterm underfunding of the aged care sector”). It is illogical to utilise statistics based on the current contractual environment to argue that if you fundamentally change the contractual environment, then historical practice and patterns will continue. “Addressing the points of whether there should be premium-only facilities and whether there should be constraints as to the number that are able to develop, and how rules for mixed facilities should operate, is long overdue, and it is great that the Government is consulting on this. It is time for providers, DHBs, older people, and their families to share their views to ensure that the Government is able to fully consider the idea, make policy decisions, and then expect us all to work within any policy- based parameters.”
Chris Fleming is lead chief executive officer for District Health Board Shared Services Health of Older People
and some without) that only has premium beds available. Suggestion one is well worth considering as it supports and promotes consumer choice, something we have an obligation to do and government policy should support. It is also hard to argue against giving operators that chance to see if a market for premium-only facilities really exists. Suggestion two is also well worth considering although it does still support the principle that a consumer can receive something for free – just after a certain amount of time. This seems a strange principle for a centre-right political party to protect. No doubt the tripartite negotiations (DHB vs Government vs provider) will be robust but one important condition has already been agreed – no consumer will ever be evicted from a facility if they genuinely run out of money and can no longer pay for their premium room. Providers agreed to that consumer protection years ago. Let us hope 2013 will finally resolve this outstanding issue. Consultation closes on 15 February; to read the full document go to: http://www.health.govt.nz/publication/ premium-only-aged-residential-carefacilities-and-stand-down-provisions-mixedfacilities-discussion Martin Taylor is chief executive of New Zealand Aged Care Association (NZACA)
RESPONSE: ASSOCIATE HEALTH MINISTER JO GOODHEW “I WELCOME Martin Taylor’s comment that the proposals in the discussion document on premium charging are worth considering. The Government would like to open up the possibility for some providers to operate premium-only facilities, if that is what they wish to do. We are not seeking to promote premium-only facilities in any way. Rather, we would like to allow them, but with safeguards. An important objective is for those who cannot afford to pay extra to have access to rooms without any extra charges. “Mr Taylor raises the possibility of someone being in a premium room without paying an extra charge. That possibility is an incentive for providers to aim for supply to meet demand. If they do so, it is unlikely they will have someone in a room they have not fully paid for. “Deciding rules that safeguard access for all residents if premium-only facilities are allowed is not straightforward. I will carefully consider all the submissions before deciding whether to proceed.”
DISABILITY
Spotlight on...
age-related hearing loss Audiologist INGRID DEKKER discusses the progression of degenerative hearing loss and steps that can be taken to treat it.
An audiologist taking an ear impression in order to customize the hearing instruments for the individual wearer.
Above: An audiologist verifying hearing aids so making sure they are capable of meeting the prescription set for the individuals hearing loss. Right: An audiologist completing a hearing test.
A
ge-related hearing loss, also known as ‘presbyacusis’ – derived from greek presbys meaning ‘elder’ and akousis meaning ‘hearing’ – is the cumulative effect of ageing on hearing loss. There are also other factors that may impact on an individual’s hearing, including lifestyle and environmental factors such as exposure to environmental noise, which can exacerbate hearing loss. Presbyacusis generally presents later in life – from age 50 onwards. It is usually in both ears (bilateral), progressive, and symmetrical in pattern, and its effects are permanent in nature. It is a common source of frustration for sufferers, as well as their family and friends, and studies have shown a link between hearing loss, depression, dementia, and Alzheimer’s disease. Presbyacusis affects an individual’s ability to detect high-frequency sounds such as indicators in a car, birds singing, and clocks ticking. Over time, the detection of highpitched sounds becomes increasingly difficult, affecting the overall clarity of sounds and chiefly affecting speech perception, particularly high-frequency consonant sounds such as ‘k’, ‘f’, ‘s’, and ‘th’. Hearing for low and mid pitched sounds is usually unaffected. Age-related hearing loss occurs microscopically where the sensory ‘hair cells’ of the cochlea (inner ear) degenerate. Common signs of a person experiencing presbyacusis include difficulty understanding
speech, often misinterpreting what others have said, and relying on other cues such as visual information from reading lips or body language or using the context from the rest of the sentence to understand conversation. They also have increased difficulty hearing in more challenging listening situations, such as hearing speech in background noise – in a restaurant, for example. There are other factors that can cause hearing loss and sometimes they may be difficult to distinguish from presbyacusis; these factors include: noise trauma and exposure to high-level noise over an extended period of time, smoking, general health, diabetes, and medications that can cause hearing loss (ototoxic drugs). The effects of presbyacusis on an individual’s hearing ability is easily quantified by a clinicial audiologist. An audiologist is a highly trained clinician specialised in testing and measuring hearing impairment and the treatment and rehabilitation of hearing loss with the use of hearing instruments. It is highly recommended to see an MNZAS audiologist as he/she is a member of the New Zealand Audiological Society (NZAS), which abides by regulatory protocols and procedures and has a high standard of care and conduct. If hearing loss is suspected either by the individual or family members/peers, a GP (general practitioner) can refer the patient to an MNZAS audiologist for testing.
Alternatively, one can see an MNZAS audiologist without a referral, primarily in the private sector, if a hearing loss is suspected or if a hearing health check is wanted. The audiologist will test and measure the hearing ability of the individual across the frequency spectrum (250 Hz to 8000) and identify if the hearing loss is sensorineural (permanent) or conductive (requires medical attention). Rehabilitative techniques in the form of hearing aids will be discussed according to the individual’s needs and listening environments. Presbyacusis is a sensorineural hearing loss and worsens over time during which the issues associated with it also increase. The first point of call is to see your GP or local audiology clinic. The hearing will then be tested and any other medical issues identified or referred on to further specialists if needed, such as an Ear Nose and Throat surgeon. Hearing loss resulting from presbyacusis can easily be treated with the use of hearing instruments that are programmed digitally by the audiologist/hearing specialist. The hearing loss configuration and pattern are entered into specific hearing instrument-related software, which helps programme the hearing aids to target specific areas of impairment and improve the sound quality. The prescription of amplification is very specific to each individual and each ear. Hearing aids in the treatment of agerelated hearing loss are the best method of rehabilitation and treatment for this common condition. Many individuals are treated each year with hearing aids, and although hearing instruments do not replicate ‘normal hearing’, hearing aids programmed correctly to an individual’s hearing loss provide a remarkable improvement in clarity, especially in improvement of speech detection and perception. The best recommendation with presbyacusis is to treat the hearing loss early. The longer a hearing loss is left untreated, the more difficult it is for the individual to acclimatise to the sounds they have missed. Hearing aids provide the best option in improving hearing ability for the presbyacusis sufferer and restore confidence and communication in the wearer. Although presbyacusis is an incurable condition, it can certainly be treated, and the benefits from treatment outweigh the negative aspects of leaving the hearing loss. Ingrid Dekker is a member of the New Zealand Audiological Society.
☛ GOT AN OPINION? Have your say online at www.insitemagazine.co.nz www.insitemagazine.co.nz | February / March 2013
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CONFERENCE
CONFERENCE CORNER
NEW ZEALAND HOME HEALTH ASSOCIATION CONFERENCE 2013
10-12 April 2013, Rendezvous Hotel, Auckland
Dr Kevin Woods
‘S
queeze, stretch and flex’: the theme for this year’s New Zealand Home Health Association (NZHHA) Conference 2013. It reflects the type of response community agencies are making to increasing demand and more pressure on spending. The conference will focus on questions such as what does integration mean for home and community agencies? Are we responsive to client need, client choice, and independence, and the cultural context? Service models are changing, and there is pressure on the public purse – what are the implications, what is the future? How can we value our workforce? How do we know that our work is effective? The conference will be opened by Dr Kevin Woods, the Director-General of Health. Two headline speakers are Associate Professor Walter Leutz, a guru on Integration, and Dr John Hirdes, who teaches at the University of Waterloo in Canada and is an international expert on interRAI. A/Prof Leutz wrote the seminal article ‘Five laws for integrating medical and social services: lessons from the United States and the United Kingdom’ in 1999. Since then he has continued to work on and teach about how to help communities improve services and supports for people with disabilities, particularly through stronger financing and better coordination of medical care and social care services. Dr John Hirdes will talk about interRAI, offering International Data Comparison and 18
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Associate Professor Walter Leutz
Dr John Hirdes
what we are learning from the use of this assessment tool. Dr Hirdes is Professor and Chair of the Ontario Home Care Research and Knowledge Exchange at the School of Public Health and Health Systems, University of Waterloo, Ontario, Canada. He is the senior Canadian Fellow and a board member of interRAI. Other presentations and the workshop sessions of the conference will follow three streams: Integration and flexibility; Workforce and future planning; and Measures, outcomes, responsiveness. Under these streams, sessions will be held on the latest data on case mix (a method of classifying patients, their treatment and associated costs); innovative rehabilitation programmes and future potential integration around ACC services. We will have reports on the paid family care and on ACC’s aims for further integrating care and bringing more of a rehabilitative focus to care. Other presenters will talk about residential-level care in the home; supporting disabled people’s choices in community living; working with older people who have disabilities; Pacific Island innovation in home support; consumer and support worker perspectives; and Government’s work on responding to complaints. The MC for the conference is Te Radar. Early Bird Registrations close 24 February 2013. A copy of the programme and registration information is available at www.nzhha.org.nz/conference.
Te Radar
>> CONFERENCE CORNER DATES FOR THE DIARY: • Thursday, 14 February
2013: The Business & Art of Human Happiness for Seniors workshop; Palmerston North
• Thursday, 21 March 2013, 5–7pm, Aged Care: Envisioning the future for workers seminar; AUT University Business School, Auckland TO ADVERTISE YOUR CONFERENCE CALL:
Belle on 04 915 9783 or email belle@apn-ed.co.nz
INTERVIEW
Up close and personal with...
Leigh Kelly
LEIGH KELLY shares the journey she took in establishing Clinical Update (NZ) Ltd and why she is passionate about providing training and education to nurses and caregivers.
I
am a registered nurse and have worked in aged care since 1974. I sort of drifted into aged care, working part-time as it fitted in with my family. I purchased my own dementia-specific rest home in Epsom, Auckland, in 1991 and owned that for almost seven years but unfortunately got “burnt out” and after I sold the rest home it took me a few years to decide what I wanted to do. In 2004, I broke my ankle and the forced rest gave me time to think about what I wanted to do. Clinical Update was born at this time. I started running some training courses and to my surprise, people turned up. This made me think, well maybe this is what I am meant to be doing. This further developed into in-house training for aged residential and home care organisations, so I put together a database of all the facilities in the country. I have continued to build this database and now have over 1500 facilities and individuals receiving regular communication from me via email and fax. In 2005, I ran the first Clinical Update for registered and enrolled nurses. It was around the time when the Health Practitioners Competency Act was launched, so it was timely. I gathered together experts in specific fields and put on four-hour training courses each month in Auckland. Being the first kid off the block was good for business but once other trainers started providing training, in addition to free study days from district health boards, the numbers started to dwindle, so I had to rethink a new direction for Clinical Update. In 2012, I changed Clinical Updates to three times a year, offering two full days of training. I discussed what I was doing with the Nursing Council and they said it met the Health Practitioner Competency requirements. My plan was to do it for 12 months and see how it went. These have proved to be very successful and continue to grow now. I believe offering conference-style training where people get comprehensive training over the two days – giving nurses 16 hours towards their mandatory training requirement – is very attractive.
However, because the updates are providing training that is relevant to practice, I am finding many people attend all the training days each year and are not just focusing on the hours. Online training has long been something I wanted to provide for the aged care industry but I didn’t know how to go about it. I have never been afraid to ask questions. However, it wasn’t until I asked for some help from Craig Dewe, Web Marketing Outlaw, that it started to take shape. I didn’t want to provide training where one person sat in front of a computer, did a worksheet online, and it spat out the results at the end. I felt computer literacy wasn’t particularly high and there was insufficient technology available in facilities for this to happen. My goal was to provide “mini classrooms” where I could provide the tools for managers to do their own training in-house so they could get 100 per cent of their staff receiving training that was easy to access, always available, relevant, and affordable. On top of this, it had to save managers, RNs, and educators time as they didn’t have to spend time developing programmes to fit this into their already busy day. So with the invaluable help and support of Craig Dewe, I set up Care Training Online. I also joined the New Zealand Association of Training and Development, which connected me with educators and trainers from many sectors, so I was able see what others were doing and keep up to date with current training methods. Care Training Online provides not only relevant training to the sector, it is also designed to be done is short segments – around 15 minutes in duration – so it can be easily fitted in around a caregiver’s day. I provide the work sheets, answer sheets, certificates, script, and attendance sheet for each topic – in essence, all the tools for facilities or organisations to facilitate their own training. The resources are in Word, so they can add in anything that is specific to their facility or organisation. Currently, there are 21 topics available online and there are more in the pipeline.
The most rewarding part of my job is that I am now facilitating training to get registered nurses, enrolled nurses, and caregivers upskilled with relevant applicable knowledge for them to be better carers, and most importantly, the people receiving the care will receive care from knowledgeable staff – staff who know what they are doing, not only clinically, but when looking at each client as a person. My dream is that people receiving care will be happy with the care they receive and my hope is it will reduce the amount of complaints received by management and save them time and money so they can better use their resources. My frustration is that many in the industry see training as an expense, not a benefit, and take the cheapest option – for free, if they can get it. All my training is affordable but still people complain it is too expensive. My other frustration is the expectations of some owners/providers who expect their registered nurses to be responsible for not only the clinical areas but also the training and often managing the facility as well. There are just not enough hours in a day for them to do everything. One of my biggest concerns is the lack of understanding of the Pākehā culture in New Zealand by caregivers. While we try to understand Māori culture and other ethnicities, we do little to try and understand Pākehā values and beliefs. So where to from here? The clinical updates will continue in Auckland three times a year, with two in Dunedin. Care Training Online is growing with over 70 facilities/organisations now using and getting up to 100 per cent of the staff receiving training. 2013 will see all the training developed to meet unit standards, so a qualification under Careerforce is in the pipeline. It will then mean that the one training programme will be able to be used for a relevant qualification and for ongoing professional development of caregivers. I also plan to bring on more contractors to write training programmes for me so there will be more topics available.
edward@activerehabequipment.co.nz
www.insitemagazine.co.nz | February / March 2013
19
LAST WORD
Last word... Rob Wilson A second letter from INsite correspondent ROB WILSON further questions the actions of the RVA in revising the code. TO THE EDITOR, RVA SLAMS CLAIMS OF “HYPOCRISY”
I am motivated to write again by the above headline on your website. A curious progression from my online comment. Perhaps this response will be accorded similar space. The RVA stated that my proposition was ...“incorrect”. Is that a “slam”? The 2006 Code of Practice came in to effect on 25 September 2007. As a result of the RVA court case, it was declared invalid on 19 December 2007. The Code was valid for 85 days before the RVA court action rendered the Code invalid. That is not “incorrect”. The RVA claim that the removal of the clause was not part of their intent, but it was certainly a consequence, even if unintended. Subsequent to the invalidation, the Department of Building and Housing, together with the Retirement Commission, called for further public submissions as required by the Act. During that process, despite submissions from resident groups and the Retirement Commission, the clause was not reinstated. It is not evident that the RVA made specific submissions on reinstatement of the clause until after the Christchurch disaster. To quote your original article: ‘The review of the Code started last year after the Christchurch earthquakes revealed several areas where the Code was deficient. Previously, if a village was destroyed and not rebuilt, the residents were only entitled to get back what was set out in the termination clauses in their occupation right agreement (ORA). The RVA felt this was
unfair and residents should get back 100 per cent of their original payment in such circumstances. “The revised Code makes things much fairer for residents and is something we’ve been advocating for a long time,” he says.’ The “long time” mentioned commenced after the Christchurch earthquake in 2011, when the RVA sought submissions from its membership and received responses from eight members, three associate members, and seven stakeholders (a very small representation of an organisation claiming in excess of 265 members). The residents were/are not protected by the Code from 19 December 2007 until 14 October 2013, a much longer period of time than the RVA claim advocacy. It is my perception that the RVA failed to address the clause under discussion until they were forced to by the Christchurch Earthquake disaster. This is validated by the first line of your printed quote above. It will be argued that the actual protection is detailed in the resident’s ORA. However, the protection minimum is legislated in the Code of Practice, and given the nonprescriptive vacuum, which has been in effect since 19 December 2007, there is no assurance for every resident that a repeat of the Christchurch experience will not occur. If you care to check the reality of residents’ concerns, a review of financial outcomes for insured Red Zone homeowners compared with financial outcomes for retirement villages residents in the Red Zone will give clarity. The present Code revision will be an improvement on the current situation when it takes effect.
RESPONSE: JOHN COLLYNS, EXECUTIVE DIRECTOR, RETIREMENT VILLAGES ASSOCIATION (RVA) We agree with Rob that the changes to the Code “will be an improvement” on the situation at the time of the Christchurch earthquakes. It’s worth noting that the RVA is running a series of seminars for members on the best practice way to comply with the changes to the Code and that already many operators are changing their ORAs to comply with the Code’s requirements around repaying residents the full amount should their village be destroyed and not rebuilt. Having persuaded, along with Resident Associations, the Government to change the Code in the residents’ favour, we take our role seriously and want to get everyone up to speed as quickly as possible. Regardless of all that, I repeat that the removal of the clause requiring a full repayment from the original Code was not a RVA initiative. It was the Government’s decision at the time following pressure from the Insurance Council. As far as consultation with our members is concerned, we spent a huge amount of time in informal discussion with the entire membership before we released our proposed Code changes for formal submission. The changes represented a significant change to the Code in the residents’ favour and we needed to make sure our members’ concerns were properly understood and reflected in the submission.
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February / March 2013 | www.insitemagazine.co.nz
AGED-CARE & RETIREMENT
NEXT ISSUE:
APRIL/MAY FOCUS ON:
LONG-TERM CARE NEEDS This issue of INsite focuses on issues surrounding long-term care. Looking across the spectrum from hospitals to home health, we seek to address the widely-held concern of providing quality care in the face of funding shortfalls. With opinions sought from all corners of the sector, including residents, caregivers, managers and policy makers, we strive to expose the real needs at the heart of longterm care. FEATURES: »» Challenges to providing a full continuum of care »» Age care workers - is fair pay within reach? »» Metlifecare's Stay At Home and Be Content model »» Dementia and leadership PLUS: THE REGULARS: ‘SPOTLIGHT ON ... ’ A section dedicated to relevant issues including education and training, therapies, falls prevention, infection control, palliative care, dementia and more. ‘A DAY IN THE LIFE ...’ An insight into the lives of everyone from caregivers to chief executives, residents to retirement village managers. ‘LET’S SNOOP AROUND...’ An insight into the operation of a village or aged care facility. ‘LAST WORD’ Giving sector leaders the chance to air their views on the current status and direction of aged care in New Zealand.
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WINNER
Staff enjoying the snow with a resident in the fountain garden.
AGED-CARE & RETIREMENT
INsite/NZACA Resident Wish competition SUMMERSET IN THE VINES RETIREMENT VILLAGE IN HAVELOCK NORTH WAS THE WINNING ENTRY.
A garden was converted into a Christmas themed park, with the reindeer made by the handy man and the snowman by residents with the help of the DT.
LAST CHRISTMAS STAFF at Summerset in the Vines in Havelock North went the extra mile for their Care Centre residents. An extra-special day was arranged that included staff dressing up and singing Christmas carols, a Santa cave in a hallway that was admired by residents and visitors (in fact, most of the independent retirement village residents came for a look), a winter wonderland in the fountain garden (complete with snow) a lovely Christmas meal, and the gardener and diversional therapist dressing up as Mr and Mrs Claus to distribute gifts and cheer to residents.
Staff rehearsing singing ‘The 12 days of Christmas’ prior to the Christmas concert performed for residents.
The gardener and diversional therapist (DT) dressed up as Santa and Mrs Claus for the residents, Christmas dinner.
The entrance to the dining room was transformed into a Santa cave, which was very popular for the grandkids particularly.
Residents sitting down to a special Christmas meal.
DESCRIPTION
COOKING METHODS
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Edgell Asparagus Cuts Cuts of asparagus in brine. Ideal for sandwich bars.
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