INsite March 2015

March/April 2015 | $10.95

AGED care & retirement

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

TerraNova exclusive: both sides speak out

Aged Care

End of an era: Martin Taylor leaves NZACA

clinical

Fear of falling – friend or foe? retirement

The arrival of Arvida

focus

Retirement Villages: Ask the experts – industry

trends, legal matters, mergers and acquisitions, exit strategies, investor advice, and more

serving suggestion

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AGED-care & retirement

INsite magazine March/April 2015 Volume 9/Issue 1 Editor: Jude Barback @INsite_NZ T: 07 575 8493 E: editor@insitemagazine.co.nz Advertising: Belle Hanrahan T: 04 915 9783 E: belle.hanrahan@nzme-ed.co.nz General Manager & Publisher: Bronwen Wilkins Production: Aaron Morey David Malone Subscriptions: T: 04 471 1600 E: gunvor.carlson@nzme-ed.co.nz Publisher’s note: © Copyright 2015.

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

Editorial & business address Level 1, Saatchi & Saatchi Building, 101-103 Courtenay Place, PO Box 200, Wellington 6140, New Zealand T: 04) 471 1600 ISSN 2324-4755

INsite is distributed to key decision makers in the aged care sector and its distribution is audited

by New Zealand Audit Bureau of Circulation (ABC).

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In your expert opinion...

Ed’s LETTER I read something recently that appalled me.

In the United Kingdom, the elderly and disabled are being put up for auction by local councils on Trade Me-style websites, allowing care organisations to bid to offer them a bed.

According to The Daily Mail, the bidding is sometimes open for mere hours, and the cheapest offer typically wins. The councils participating in this practice are apparently listing anonymised details of people, including their ages, care needs and medications, on the sites. Bidding care homes then ascertain whether they want Mrs Bloggs, or not. Or more accurately, decide how cheaply they can provide her care. Talk about a race to the bottom.

This so-called ‘granny auctioning’ means that the person or their family often does not get to see the care home before they arrive, nor do those at the home get to meet the person. What should be a carefully considered choice for an important stage of life is essentially reduced to a unilateral cost-saving decision. One council has boasted of reducing care costs by almost a fifth using the system.

In this issue...

FOCUS:

Retirement villages as a business

2

In your expert opinion...

6

TerraNova v Bartlett case – both sides speak out

9

‘New kid’ Arvida takes a fresh approach

10

Up close and personal with ...

Martin Taylor

12

Highlighting the link between loneliness and dementia

14

A good place to Be

15

Fear of falling: friend or foe?

17

Never too old to clown around

19

Let’s snoop around ...

Acacia Cove

21

New quals ready for launch

22

Conference preview: HCHA 2015 Conference

24

Last word ...

Hon Peseta Sam Lotu-Iiga

It’s disturbing, but it’s on the other side of the world, right? We would never auction off our older people in such an uncivilised manner, would we? It couldn’t happen here... could it?

Ros Altmann, a government advisor in England, says the auction sites “highlight the funding crisis for elderly care”. These words sound all too familiar. To deny the existence of a ‘funding crisis’ in New Zealand residential aged care is to overlook the issue at the heart of the TerraNova v Bartlett pay equity case – that providers cannot afford to pay their staff adequately while simultaneously providing a high level of care.

It was interesting talking with Martin Taylor for his ‘exit interview’ as he prepares to leave the NZACA after 10 years at the helm. He describes New Zealand’s residential aged care service as ”world-class” and challenges anyone who thinks differently to visit other countries and see what they are offering in comparison.

While I haven’t the depth of Martin’s knowledge of aged care systems around the world, I certainly agree that standards are high here in New Zealand.

But if we don’t sort out our own ‘funding crisis’ soon, we could be on a slippery slope to ‘granny auctioning’ before we know it.

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

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

www.insitemagazine.co.nz | March/April 2015

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Management

In your expert opinion...

INsite asks experts in the retirement villages sector about industry trends, business decisions, investor information and legal advice.

Issues and trends

What are the current key issues for retirement villages?

JOHN COLLYNS, Executive Director, Retirement Villages Association (RVA) When it comes down to it, the single key issue for retirement villages is keeping pace with success. And while success brings its own rewards, it also brings challenges.

Residents’ satisfaction with their decision to live in a village is the most important ingredient of the industry’s success. A survey of residents undertaken by the Retirement Commissioner back in 2007 gave the industry a 99 per cent “satisfied” or “very satisfied” rating, and individual surveys by operators reinforced that finding.

The RVA wanted a more current and industry-wide measure of residents’ satisfaction of their decision to live in a village, so at the end of 2014 we commissioned McCrindle Research, a leading Australian market research company, to undertake a survey of 3,000 randomly-chosen retirement village residents across the RVA’s membership. We also asked a number of questions about residents’ sense of security and wellbeing in a village.

The results found that residents reported better mental and physical wellbeing, with two in three residents surveyed reporting a greater feeling of security and confidence after moving into a retirement village, as well as high satisfaction with retirement village living in general.

More than 67 per cent of residents aged 79 and over also indicated their social lives had improved after moving into a village.

Meanwhile, residents overwhelmingly stated they would decide to move into a retirement village if faced with the same choice again.

The research used the Net Promoter Score (NPS) to measure retirement village residents’ perceptions and attitudes across New Zealand and benchmarked it with Australia’s retirement village industry and other sectors. NPS is a common method to evaluate sector performance and loyalty from customers.

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The findings highlight that residents in New Zealand are more satisfied with retirement village living than their Australian counterparts by a factor of almost double.

Valuers Jones Lang LaSalle’s (JLL) annual review of the retirement village industry as at the end of 2014 shows continued growth in the number of villages and the number of residents choosing to live in a village. In the 12 months ending December 2014, an additional 12 villages were registered with the Registrar of Retirement Villages, increasing the total number of villages to 363.

There are now 25,300 units that are home to around 32,850 residents, an increase of around 5500 people over the previous 12 months. While the numbers of people aged 75 and over are steadily growing each year, so too is the percentage choosing to live in a retirement village. The industry’s penetration rate (i.e. the percentage of people aged 75+ of the total population who live in a retirement village) has risen from 10.5 per cent at the end of 2013 to 12 per cent at the end of 2014.

JLL also identify 76 registered villages and a further 51 villages yet to be registered with a total of almost 12,000 units that are in the resource consenting or construction phase of development.

This avalanche of retirement village development means that the industry has had to address how councils incorporate retirement villages in their planning system.

The traditional approach has been that villages are a ‘discretionary’ activity in residential zones, and this means that the development can often be slowed through local opposition. Retirement villages draw their residents from a 15km radius and there is no doubt that they are ‘residential’ in nature, allowing people to realise equity and free up their family home for another family to live in.

The RVA has been working with councils to allow retirement villages as a ‘permitted’ activity in residential zones, with appropriate safeguards around height, bulk and traffic movements. Our objective is to ensure that villages are acknowledged by council planners as being appropriate developments in residential areas.

Allied to this is the challenge in finding suitable land for village development.

Operators are on the lookout for the right location, but finding it is getting increasingly difficult, which is why it’s important to be able to get developments sorted reasonably quickly once suitable land has been identified.

New Zealand faces challenges around housing affordably and supply, as well as issues such as social isolation and mental health. Retirement villages can provide answers to these questions, and we look forward to another successful year doing so.

Mergers and acquisitions (M&A)

What advice would you give operators considering entering a major transaction?

CAM ANSELL, Managing Director, Ansell Strategic The M&A scene in Australia has reached dizzy heights over the past 12 months, fuelled by three aged care groups on the Australian Stock Exchange.

While activity has also been buoyant in New Zealand, the early signs are that 2015 will be a big year for new aged care and retirement living transactions.

Buying and selling in aged care is intrinsically unique, due to the sensitive nature of the transaction and the complexity of the industry. Gaining adequate information about a target, without breaching confidentiality, can be a difficult process.

Historically Kiwis and Australians have tended to manage the sale of rest homes more like real estate than businesses and this can result in underselling the real value of the offering.

Last year we facilitated the sale of around 30 aged care homes and observed that there were some very clear differences in the approach taken by buyers. Here, we explore the characteristics of an efficient and effective due diligent process, and the pitfalls of dealing with other aspects of the transaction process.

1. Running a professional sale process This is a sellers’ market and the only way of determining the market value of your service is through a competitive process.

This is true whether you have one home or a dozen. Make sure you are dealing with specialists that understand the business and know who the genuine buyers are.

The process should be structured to ensure that your requirements are understood (timelines, price, qualifying

Management bidders etc.), and that there is a clear communication plan so you know where you stand throughout the process.

A professional Information Memorandum should be prepared with sufficient information to enable an interested party to make an indicative offer. Detailed due diligence should be managed through a data room under tight protocols (see below).

2. Have a clear mandate There have been a number of sizeable transactions in Australia that have failed because management teams did not have a firm mandate from the owners (or financiers).

It is not uncommon to find owners with cold feet or mixed expectations – but it’s a catastrophe to uncover the problem at the last minute.

Your advisors should ensure that their vendors are genuinely prepared to sell and are aware of the limitations and qualifications attached to that position.

Buyer due diligence is a resource intensive process – any attempts to test the market without genuine intention to sell risks the reputation of the service and the owner.

3. Manage confidentiality An aged care service is more than a business; it’s a home to your clients. The value of your goodwill is tied into your reputation and the stable environment provided to your clients, employees and the community.

Most vendors elect to keep the sale confidential until a sale agreement has been signed. Although more difficult, some will elect to keep the sale confidential until completion/settlement.

Open sale arrangements can compromise value and be unsettling for residents and staff. If a sale does not occur, the goodwill of the business can be permanently eroded.

Your advisors should have a communication plan ready for the announcement as well as a contingency strategy in the event that the process is leaked ahead of planned announcements.

4. Dealing with consultants and advisors Interaction with consultants and advisors can be one of the most critical elements for buyers and sellers. Professional advisors that understand aged care and the sensitive nature of the sales process will balance the requirement to obtain sufficient information on the target with the need to maintain confidentiality. A risk-based diligence process will reveal any major issues without asking copious irrelevant questions.

From the sellers’ perspective, you also need to manage the buyers’ approach to their diligence work. Their advisors are often paid by the hour, so they may be

motivated to throw more resources at the process than required, particularly if they don’t have clear instructions from their client.

Your own advisors should carefully scrutinise information requests and site access to make sure that the prospective purchaser is operating efficiently and not wasting your resources or compromising confidentiality.

5. Integrity and transparency As with many sales transactions, there can be a temptation to focus only on the positive side of the business. However, the importance of openness and integrity extends beyond your reputation and conscience – misrepresentations are costly!

A prospective purchaser will usually provide indicative pricing based on a limited amount of information and generally has limited time to do so. If they are selected based on the pricing, their detailed due diligence process will provide them with a much better insight into the business. This is where misrepresentations start costing you money – just about every material exaggeration or omission will be uncovered and the buyer will be justified in revisiting their original price or may even withdraw from the process.

Any good lawyer will make sure that the warranties in the contract provide recourse for the buyer, just in case they did miss something important.

Although it is essential to highlight the strengths of your business, it is equally important to ensure that you (and your advisors) are transparent about the negatives.

6. Run a formal process and do it professionally I’m always struck by the amount of effort real estate agents make when they sell a single residential property, and yet a rest home or hospital, worth perhaps 10 times the value, is often sold on the back of a valuation submitted to a single buyer.

Ansell Strategic adopts some fundamental

principles when preparing a home or portfolio of homes for sale: 1. Never hide your light behind a bushel – the value of the business is much more than bricks and mortar and its strengths should be presented in a professional document (the Information Memorandum).

2. In the current competitive market the opportunity should be canvassed to more than one prospective purchaser (and they should know that the process is competitive), unless there is a specific limitation, in which case the pricing should be benchmarked.

3. Manage the information exchange through a data room. Make sure you have a professional, experienced administrator responsible for the management of uploading information and monitoring data room activity.

4. Ensure the lawyers are brought along for the journey, from preparing confidentiality agreements all the way through to settlement.

5. Make sure the vendor is always engaged and made aware of progress and issues material to the transaction.

7. Know when to cut and run During a number of transactions, we’ve witnessed the key objective shift from securing a strategic acquisition or sale to just achieving completion. That is, the buyer or seller starts to compromise their position, purely to bring an end to what can be an intensive and stressful process.

In a heated market, with a number of operators acquiring aged residential care facilities for the first time, participants are often nervous about committing to a transaction and will make attempts to completely de-risk their position.

This often results in protracted and unnecessarily intensive due diligence.

A client recently reminded me: “Sometimes winning means letting the deals go”.

In extreme cases, the process could drag on until the due diligence process itself starts to damage the value of the business.

If the remainder of the process has been well managed, and confidentiality has been maintained, there should be avenues for the vendor to terminate the process and recommence with another bidder.

The acquisition process can be an exciting and highly beneficial activity when it’s done right. A successful transaction is one in which a vendor achieves a fair price for an asset that adds value to the purchaser’s business. Through a wellmanaged, professional process, and with mutual respect between buyer and seller, there is every reason your transaction will be a success. www.insitemagazine.co.nz | March/April 2015

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Management

Privacy compliance What advice do you have for villages and facilities when dealing with privacy compliance issues?

MICHAEL MOYES, Partner – Corporate Advisory, Anthony Harper

The laws protecting an individual’s personal information are tighter than ever, and with stronger enforcement measures. But effective authorisation can change the rules.

People care about their privacy – and they are wary about organisations that misuse their personal information. Personal information (any information about an identifiable individual) is protected by our Privacy Act 1993, which – together with codes of practice such as the Health Information Privacy Code and the Credit Reporting Privacy Code – governs the way that ‘agencies’ (almost everyone holding personal information about others) may deal with such information.

At the core of the Privacy Act are the 12 rules or ‘Privacy Principles’ which guide agencies on how to safely deal with personal information. Generally speaking, an agency can comply with privacy law by adhering to the Privacy Principles. However, it is also possible to comply with privacy law without adhering to all of the Privacy Principles.

The importance of authorisation

The 12 Privacy Principles govern the collection, storage, use and disclosure of personal information.

Principle 3 is important. When an agency collects personal information directly from the individual concerned, it must take reasonable steps to ensure the individual is aware of: »» the fact that the information is being collected »» the purpose »» the intended recipients »» the names and addresses of who is collecting the information and who will hold it »» any specific law governing provision of the information and whether provision is voluntary or mandatory »» the consequences if all or any part of the requested information is not provided »» the individual’s rights of access to and correction of personal information.

Principle 10 is also important – personal information obtained in connection with one purpose must not be used for another.

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These principles assume that agencies can, at the time they first collect personal information, foresee all relevant uses of that information – which is not always the case.

Fortunately, because our privacy laws are consent-based, agencies do not have to comply with those principles if noncompliance is authorised by the individuals concerned.

In this way, an agency may collect information from an individual without making them aware of the information set out in Principle 3 in circumstances where the agency believes, on reasonable grounds, that the individual has authorised collection on these terms.

Similarly, an agency that holds personal information that was obtained in connection with one purpose may use that information for another purpose if the agency believes, on reasonable grounds, that the use of the information for that other purpose is authorised by the individual concerned.

Essentially, the individual and agency can agree to a different set of rules – rules that you can create to fit with your business. Typically, those rules are contained in a privacy policy or a privacy statement.

Effective authorisation

Authorisation is stronger than consent.

Authorisation requires a positive action or decision by an individual, and they have to understand reasonably clearly what they’re agreeing to.

This is why the documentation governing your initial collection of personal information is all-important. It must make your ‘new rules’ clear, and require a positive action (such as signing a form, or clicking ‘I accept’ on your website) to confirm acceptance.

Timing of the authorisation is also important. Because it is not always easy to obtain authorisation at the same time as the personal information is initially collected, the law allows some flexibility.

Each individual must authorise the particular way in which you collect, store, use and disclose their personal information at the time that they provide that information – or as soon as possible afterward.

In the majority of cases, authorisation will be effective if: »» the appropriate positive action or decision by the individual is recorded at the same time that they submit their personal information; and »» your privacy policy (or other rules that the individual is agreeing to) is clearly referenced in the document the individual signs or accepts.

The first steps to compliance

The first steps to privacy compliance lie in your privacy officer reviewing your documentation, particularly those documents that collect personal information.

With ever-increasing public awareness of privacy breaches, now is the time for businesses in the aged care, retirement and community care sectors to review their privacy compliance regimes, as well as their standard form agreements, websites and forms that apply to the collection of personal information.

This article is necessarily brief and general in nature. We recommend that you seek our professional advice at Anthony Harper before taking any action in relation to the matters covered here.

Exit options

What should owners wanting to sell be considering?

MARTIN GRAY, Executive Director - Transaction Advisory Services, Ernst & Young The decision to sell your facility is one of the most important an owner will make. The aged care and retirement village sector has evolved significantly in recent years and the market is segregating around service offering, target market and expertise. It is important to carefully consider which parties are the best and most logical buyers for your business that will: »» be able to complete a purchase »» maximise the value you achieve »» limit the disruption on the business and staff »» ensure confidentiality »» continue the legacy of the business you have built.

EY has been actively involved in a large number of transactions in the sector and we have advised many owners through the exit process. We take the view that it is better to fully research potential buyers before approaching them, and come up with a short list that can be matched to your particular facility.

The aged care and retirement village sector has achieved far greater recognition in recent years due to more information on the sector being publicly available, more visibility from additional listings on the Stock Exchange, and greater public awareness of operator performance, as well as demographic changes spurring demand and the number of available facilities.

As a result, understanding of the business models has improved and a greater number of investors and buyers are interested in the sector, while liquidity from the banks is more

Management readily available for good assets/operators. The range of buyer/investor groups that are active in the market include: »» existing groups seeking add on acquisitions »» Australian corporates looking for an entry point acquisition »» investors looking to ‘roll up’ a number of facilities »» New Zealand and Australian private equity groups and family offices »» iwi »» institutional investors »» offshore sovereign and private funds.

All the investor groups have different objectives and seek different assets, so identifying a shortlist of potential buyers with the best fit with your facility is fundamental to a successful outcome.

It is important to present your business in the best light to the particular buyer/investor and ensure that the business is exit-ready.

Some of the issues that should be considered when preparing information to be provided to potential buyers and highlighted in your offer include: »» full assessment of the potential of future development property opportunities »» assessment of future demand and the demographics/penetration in the catchment area »» the benefits of offering a continuum of services »» GST and other tax issues »» the mix of services that could be offered and the financial impact »» property prices in the catchment area »» consideration of different ORA (occupation right agreement) contractual arrangements or premium charging structures »» ongoing management availability or how the business may perform under alternative management/group structures »» tax, structuring and estate planning.

We leverage our extensive sector knowledge and transaction experience with New Zealand and Australian retirement village and aged care operators and investors to develop a discrete buyer group. We then ensure that the value proposition is well developed and articulated. It is more than just looking at a rule-of-thumb price per bed.

Rather than present a one-year budget, we think it is important to develop a cash flow model over the life span of the facility to help guide your value expectations that takes into account: »» entry age, occupancy, length of stay and mix »» growth in revenues from property price increases; subsidies, premium charges and weekly fees »» operating and construction costs »» hybrid care and RV models and service offerings

»» unit entry price/ current unit prices and volumes »» GST and other tax considerations »» an appropriate discount rate »» maintenance and capex requirements »» property price growth »» demand and penetration rates in catchment area »» resident contracts and DMF realisations »» ORA structures – both current and local market norms »» tax implications of the sale and appropriate structuring and estate planning considerations.

Not all the information needs to be presented to potential acquirers, but you need to know how buyers will assess your business and what value they see from acquiring your business.

If you are armed with this information, the chances of maximising the outcome for you are significantly enhanced.

The market is currently buoyant and high prices are being achieved for well-presented businesses where the right competitive tension is achieved.

Investor information

What is the investor’s perspective of the retirement and aged care sector?

MARK LISTER, Head of Private Wealth Research, Craig’s Investment Partners From an investor’s perspective, the retirement sector has changed markedly over the past few years. Five years ago, Ryman Healthcare was really the only company that was on the radar of most investors, and Ryman therefore got most of the attention. That all changed in 2011 when Summerset Group listed on the sharemarket, and when Metlifecare merged with Vision Senior Living and Private Life Care Holdings the following year.

Summerset had considered floating on the sharemarket a few years earlier in 2007, although changed its mind as market volatility increased ahead of the looming global financial crisis.

Metlifecare has actually been listed for much longer, since 1994 in fact, although the company’s chequered history saw it largely ignored by investors until a few years ago when some of the issues were ironed out.

Late last year we saw smaller operator Arvida list on the NZX and Oceania Healthcare is also looking at its future options, of which a sharemarket listing is one.

All of a sudden, investors looking to gain an exposure to the sector have a number of options, something which has had an impact on the retirement sector operators themselves.

Having multiple companies in a sector means that analysts, investors and fund managers find it a lot easier to benchmark companies against each other. This could mean comparing the levels of disclosure about their businesses, quality of management and governance, as well as operational performances.

We also tend to see the profile of companies increase when they are under the listed area. The media takes a little more attention, and it becomes much harder to fly under the radar.

Ultimately, company share prices will respond immediately to any changes in the outlook, as well as due to changing perceptions about the strategy and progress of each company in the eyes of the investment community.

On many occasions I have asked CEOs of recently listed companies what the key difference is between being a private company and having listed on the sharemarket, and the answer is always the same – scrutiny.

This added attention from a much wider, highly informed and engaged group of people is positive for the industry and for the companies themselves. It forces them to sharpen their game, become more efficient and innovative, work harder on customer satisfaction and focus their strategy.

One thing that hasn’t changed as a result of a much broader range of listed entities has been the stellar performance of the sector.

Ryman remains the standout, having returned a stunning 29.5 per cent annual return over the past decade (compared with the broader market, which delivered 6.2 per cent). An investor who put $1 into Ryman shares 10 years ago would today have $13.26 if they had re-invested all their dividend payments.

The others haven’t been too shabby either, with Summerset up 18.3 per cent per annum over the last two years, and Metlifecare having returned 22.7 per cent.

Whether returns of this calibre will continue is difficult to say. We are coming off an exceptionally strong period for the sector and the market, so it is likely we will see some moderation in the pace of gains for these companies.

However, with demographic trends still as supportive as ever, a robust economy and plenty of growth options, the sector remains well-placed to deliver excellent long-term earnings and dividend growth.

Mark Lister’s disclosure statement is available free of charge under his profile on www. craigsip.com. This column is general in nature and should not be regarded as specific investment advice.

www.insitemagazine.co.nz | March/April 2015

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Funding

TerraNova v Bartlett case

INsite exclusive:

– both sides speak out

TERRY BELL of TerraNova Homes & Care and ALASTAIR DUNCAN of the Service & Food Workers Union sit on opposite sides of the TerraNova v Bartlett pay equity case. Yet here, in this rare feature, both appeal for the same thing – an increase in government funding to put an end to inadequate pay levels of care staff.

TerraNova: An opportunity to address fundamental wrongs in aged care TERRY BELL, executive director of TerraNova Homes & Care, the organisation at the heart of the ongoing pay equity case, breaks his silence.

I

often reflect that ‘losing’ the Equal Pay test case stands to benefit residential aged care providers more than it will the caregivers taking the case!

Clearly the courts have shifted the wellsettled understanding of ‘Equal Pay’. It is also easy to see that a definitive ‘loss’ in the yet-tobe heard substantive case will see caregivers’ pay being mandatorily moved towards a ‘living wage’ but materially lifting pay rates will also allow providers to retain loyal staff, demand more skilled caregivers generally, and to invest more in training them.

However, I believe there are many complex factors that ultimately determine pay and conditions in any industry and that it is overly simplistic to believe these can be discovered, balanced and delivered by a court acting along the one-size-fits-all principle.

TerraNova does not intentionally discriminate against anyone on basis of their sex. However, I do accept that neither does it set out to address perceived wrongs in society’s employment structures. We work with what we are given. We are vitally interested in the skills, qualifications, aptitude and attitude of our 300 or so staff.

However, it is unrealistic to expect increasing standards and accountability from providers whilst our funding streams decline in real terms.

Because our fees are fixed and capped by regulation at marginally uneconomic levels, the sector lacks the mechanism to rationally invest in improved or extended services. An 6

March/April 2015 | www.insitemagazine.co.nz

analogy would be trying to imagine a hotel operator deciding to provide a 5-star service in an environment where the government decrees they are only allowed to charge a 2-star fee.

Providers should be expected to provide a high standard of care at all times, but they are not magicians; either the state needs to pay fairly for those services, or it needs to act to rebalance the regulations so that those who can and do choose to pay for ‘premium’ services are encouraged to contribute more towards those cares. Alternatively, real standards of care will continue to stagnate, or perhaps even decline over time.

The courts did NOT find that TerraNova discriminated against Kristine Bartlett, or indeed any of its female staff – that question is set to be investigated through the next set of court proceedings (probably taking a further two years) – but what it did find was a new way of interpreting the Equal Pay Act. It has determined that the court can look beyond the employer and even beyond the particular sector in question to find what it considers is an appropriate comparator to decide if an employer has discriminated against its predominately female staff. It then has the power to effectively set the pay-rate for all participants in those industries – akin to the old Awards mechanism that existed at the time (1971) when the Equal Pay Act was introduced.

Clearly the court does see the ‘smoking gun’ of historic and systematic underfunding of ‘women’s work’ in the residential aged care sector, but it must be noted that the court’s decisions are not limited to this sector.

This makes the case significant for almost every industry and a major headache for any government.

People often confuse the frequently reported commercial success of retirement village operators with a solution for residential aged care. Whilst it is true that retirement village operators are increasingly providing care facilities on-site as their clients demand a pathway into care, they are cross-subsidising this investment from the capital and fees paid privately by their residents. But NZ Inc. is simply not wealthy enough to rely on this approach to provide the facilities needed for our rapidly ageing population. Village lifestyles would suit many

but are beyond the ability of most to afford them.

By contrast, residential aged care is not a lifestyle choice; our role is increasingly as palliative care/end-of-life specialists. As length of stays shorten in residential care (often down to days, typically only months) the cycle of admission, decline and dying increases the stresses on both staff and systems.

Regardless, providers are basically unable to charge more than the daily rate set by government for core services. These rates are ‘unsustainable’, allowing operators to barely ‘make do’ within the existing environment and denying any latitude to build for a larger or better service. From our perspective, inadequate funding underpins the current mess.

In any instance, this test case has not been about ‘equal pay’– i.e. ensuring an employer does not differentiate between the amount it pays men and women for doing the same job. Instead it has shifted focus to the more vexing issue of ‘pay equality’ – paying people the same amount for similar jobs performed under similar terms and conditions, despite those people potentially working in different industries for different employers. Thus the guidance provided by the courts has enormous ramifications across the entire New Zealand economy – both on what people get paid and who sets and how those wages are set.

People often ask me why TerraNova was ‘picked on’ by the Service & Food Workers Union to showcase this industry problem. I usually respond that it doesn’t matter; that we are beyond guessing, and we are far more interested in ensuring we use the opportunity to address some fundamental wrongs in residential aged care. Nonetheless, I do find it bizarre that it seems the only way for society to resolve such an obvious and endemic problem is by taking one small business through the courts for years on end so as to establish a mechanism to address an industry-wide problem that was clear to everyone at the beginning.

Government policy has led us to focus on the most complex ‘hospital’-level cares, ultimately providing end-of-life services to residents and their families. We don’t mind this at all; the work is technically challenging and rewarding beyond words. What we do, what our teams do, really does matter.

Funding TerraNova provides end-of-life care to about two per cent of all the elderly in hospital-level care – and we have a reputation for doing this well. Currently, we are the final home for around 300 frail, often confused and sometimes frightened people. We look after them and support their loved ones through some very difficult times. Sadly, we say goodbye to around twice that number every year, so we are forced to be efficient – but without losing the desire to find love and affection for each and every one of our guests.

When we started in aged care, an indepth study of the sector by PricewaterhouseCoopers found it was significantly underfunded (in the order of 15-20 per cent) so it would be comic, if it were not so tragic, to read in Grant Thornton’s report, commissioned by the Government and the sector a decade later, that the sector is now similarly underfunded – that is, unsustainable. Put simply, this means that providers find themselves having to make mean-spirited choices around basic cares and services because of inadequate funding.

But should that really be a surprise? For about the price of a moderately-priced 3-star hotel room, we are required to provide: »» bed, bathroom and common room facilities »» all meals, snacks and drinks »» regular doctor’s visits »» 24/7 clinical nursing oversight and cares »» all the regular activities of daily living (mostly delivered by our caregivers) »» medical transport »» all scripted pharmaceuticals/dressings and the like »» a full laundry service »» a balanced programme of entertainment and activities.

Yet providers don’t have trouble finding staff. There is a constant line of unqualified

and inexperienced hopefuls ready to jump into aged care. Sadly, many are ill-suited to caring: they don’t have any experience to deliver challenging cares well; their English, education or drive to learn lets them down; they have little awareness of the demands that helping people live out their remaining days and die with dignity will place on their own emotional stability; OR they are using residential aged care as a stepping stone to something better. Once they have some job experience or have improved their language skills, many are off to a career in an industry that can provide them with a living wage – a wage that allows them to live their life sustainably.

TerraNova can’t be responsible for the nationwide ramifications of the court’s activism but we can and do feel a duty to address the parlous pay rates the sector has been cornered into paying its caregiving staff.

We hear the call from the wider community to address the fairness of caregivers pay; we hear the call from Kiwis to improve the skills and stability of the aged care workforce.

Accordingly, we applaud Kristine Bartlett/ SFWU for taking this case. Now the court has shown how the Equal Pay Act is to be read today, we are keen to work with the union to discover what an equitable pay rate would look like.

We know we could not, and we understand many providers could not, operate for long if the court awards a significant increase in caregiver wage rates and the Government does not fund that uplift – or alternatively does not provide the mechanism for you and me to contribute more towards the costs of our care.

At the same time, TerraNova refuses to be defined by this one issue. Our team is doing all it can to maintain and even improve the service to our residents. We have intentionally

created a group of homes to combine our resources and to develop and share systems and benchmarks for great care. We have, for our modest scale, ‘over-invested’ in technology to allow our nurses and caregivers to work more effectively and spend more time with our residents. We have used those same technologies to standardise our services across the group and to alert us when things are going wrong (and I assure you they do go wrong on occasion – which is unsurprising when providing a 24/7/365 service whose basic purpose is helping people with complex unwellness and end-of-life needs).

In the meantime, we deal with the hand we are dealt; thus one of the few ways we can control costs, make ends meet, balance the books and provide a (modest) return from investing our savings into TerraNova is by paying the market rate for our unregulated care-giving staff (who make up the bulk of our workforce).

Yes, we would like to pay them more because then the skilled caregivers would stay in the sector, and others out there who have the skill, the empathy, the x-factor might give caregiving a go. And if all that happened, we would probably sleep easier.

The ageing of our population is not a unique, new or little-understood issue.

Governments have done much to prepare the country and the sector for more demanding cares delivered in more complex environments over much briefer timeframes.

At the same time, the sector has consistently lobbied successive governments to increase the real funding so that we can meet those expectations in an orderly manner.

So when people ask me, I tell them that my wife and I, plus my talented managers and our incredible team of dedicated staff, Continued over page >>

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www.insitemagazine.co.nz | March/April 2015

7

Funding are delighted to have the opportunity to help address a major failing in aged residential care that otherwise threatens the sector’s stability. And if our bit-part in this exposes and addresses historical and structural wrongs that have been inflicted on those members of our workforce who happen to be female, then so much the better. Just don’t let that get in the way of what we do, because in-house, we are working harder than ever on the things that will improve the quality of the experience of the last days, weeks and months of my mother-in-law, someone’s dad – and one day, perhaps even you or me.

NZACA is the voluntary peak body for the Residential Aged Care Sector. TerraNova has agreed for the NZACA to represent it (and the industry) on this issue in exchange for support with legal costs and one of six seats on a Litigation Committee. Accordingly, the foregoing is necessarily the personal opinion of Terry Bell, TerraNova’s executive director.

SFWU: Let’s get on with it ALASTAIR DUNCAN, strategic industry leader for the Service & Food Workers Union (SFWU), says it’s time to get on with resolving the TerraNova v Bartlett pay equity case.

I

n a few weeks the Employment Court will sit and decide how to determine the worth of an aged care worker. Whatever the outcome, the decisions will change the face of residential care – and potentially affect hundreds of thousands of other working women. It’s been a long time coming.

For decades, Lower Hutt carer Kristine Bartlett has worked to support the elderly. She is one of an estimated 30,000 carers working hard behind the scenes in what has become one of this country’s growth industries. By bravely agreeing to be the test case for the 1972 Equal Pay Act, Bartlett was challenging not only the perceived interpretation of a 43-year-old statute but also the endemic undervaluation of jobs largely done by women.

The response from the sector was as varied as the players. Early on, the leadership of the Aged Care Association determined to fight the case – ultimately and unsuccessfully all the way to the Supreme Court. That strategy may or may not have reflected its members’ views, as INsite reported at the time. Other employers stood aside and at least one corporate sought to intervene. Curiously, the 8

March/April 2015 | www.insitemagazine.co.nz

funders, DHBs and the Ministry of Health were nowhere to be seen. Not until the case reached the Court of Appeal in early 2014 did the Government finally decide it wanted to be heard on the legal issues. The rest, as they say, is history. On 22 December the Supreme Court ruled in Bartlett’s favour and confirmed the 1972 Act was about both equal pay and equal value. Now the case heads back to the Employment Court for the substantive hearing.

The court will now invite the parties to determine the mechanisms to decide what a carer should be paid. The method is not new. Determining the relative value of any jobs involves analysing the respective skill, effort, responsibility and working conditions of differing jobs. For decades management companies have used the method to set executive level pay. Now gender and the weighting of its impact is a matter for the court. In 2012, Bartlett was alone. Today nearly 3,000 other women have joined the case – perhaps enough to dissuade the Government from changing the law.

New Zealand is finally catching up.

Thirty years ago, Julie Hayward, a cook at the Cammell Laird shipyards in Britain, challenged gender bias in pay. Her case went to the House of Lords, who ruled in her favour. Julie argued her work as a cook was at least as skilled as a shipwright and her case sent off a wave of others. In 2012, one of the last acts of Australian prime minister Julia Gillard was to sign off the funding that revalued carers across the Tasman. Gender and pay also featured in acceptance speeches at this year’s Hollywood Oscars – the focus being that an actor’s rating on the A or B list should be irrelevant.

For any employer, litigation is a serious issue but for aged care providers the settlement, when it comes, will be cushioned by the knowledge that the funder, the state, will foot most of the bill. One way or the other the added cash flow will certainly contribute to the bottom line. With aged care, a classic example of the public private partnership approach, employers may finally get the support they need to do even better and that’s music to shareholders’ ears.

Since Bartlett started the case, the world has changed for funders, providers and residents.

In real dollar terms the DHB funding continues to decline, while the expectations of both staff and residents continue to rise.

In some respects, the Government has been fortunate. In last year’s budget Bill English listed the case as a contingent risk to the state. But by fighting the case all the way to the Supreme Court, the NZACA brought two years of delay – two years in which the Government could have, but chose not to, engage effectively with providers and the worker force.

While the unions – SFWU and NZNO – led the industrial and legal challenge,

the Human Rights Commission brought together and maintained an extraordinarily effective lobby group of employers, unions and community. Sadly, its tripartite recommendations, which go beyond wages and include staffing and skills development, have been ignored.

In that time the sector moved on.

Summerset floated, Ryman and Metlifecare reported record profits, and BUPA took over from Oceania as the largest provider. Small providers continued to struggle – perhaps they were the ones driving the NZACA strategy?

Collective bargaining saw most, but not all, providers move from a position of reluctantly handing over the DHB funding to a situation where nearly all are now working more closely with the unions to find ways to lift pay for the staff who are, quite rightly, the backbone of any successful hospital, village or apartment.

With the Supreme Court decision the case looks set to expand beyond residential aged care. Next in line will be homecare and home support staff and after that community support workers, such as those working for the likes of IDEA and CCS. That’s the sector Gillard targeted and involves at least another 30,000 women.

In its 2012 report Caring Counts, the Human Rights Commission estimated that simply matching the DHB pay rates with those in the private sector would cost $140 million. Pay equity is going to cost even more. How much more will depend on the comparators chosen. Ironically Bartlett’s son is a corrections officer, one of the groups referred to in the judgement. Whatever the cost of fixing this inequity, it is long overdue and will be a lot less than the cost of the South Canterbury Finance bailout or the long-term cost of the Iraq deployment.

And what a return there will be. Good, well-paying jobs in the parts of this country that most need them. In provincial and metropolitan New Zealand. In the heart of small towns and in the suburbs of large cities.

A mature and skilled workforce valued for the first time in decades with the commensurate reduction in turnover and a rise in self respect.

But there are risks. Will the Government try and change the law? Will they actually deliver the funding needed? Will the NZACA continue to fight a now lost argument? And will the new CEO realise the target was always the funder?

Radius Residential CEO Brien Cree told the Caring Counts report: “I fundamentally believe that care workers should be paid more.

What that ‘more’ is, is difficult to say.” Brien Cree is a board member of the NZACA and a major employer. The Employment Court can now help Cree and Bartlett and thousands of others work out what ‘more’ means. That work could have started two years ago. So let’s get on with it.

Retirement

‘New kid’ Arvida takes a fresh approach JUDE BARBACK talks to Arvida Group chief executive Bill McDonald about the formidable task of getting the retirement and aged care sector’s newest player up and running.

I

’m told the name ‘Arvida’ is a play on words: the ‘Arv’ stands for ‘A Retirement Village’ and ‘vida’ means life, vitality. It’s clever. I like it.

But then, I’d quite liked the group’s earlier temporary name, ‘Hercules’, too. Apparently, during initial discussions one of the chaps from Forsyth Barr had described getting the concept off the ground as “a Herculean task” and the name stuck.

As chief executive Bill McDonald gives me a quick précis of Arvida’s origins, it becomes clear that it has indeed been a big job.

McDonald credits the concept to the late Grant Adamson, one of the drivers of New Zealand’s retirement village industry.

Although Adamson passed away soon after the group’s first meeting, director Michael Ambrose and McDonald were keen to fulfil Adamson’s vision and 18 months later, All Black and Arvida investor Dan Carter rang the bell at the sharemarket listing ceremony for the Arvida Group Limited. Shares began trading on the NZX Main Board in December last year, following an IPO (stock market launch) that raised $80 million in new capital.

Navigating initial obstacles

McDonald says whilst it has all been fairly plain sailing since then, it was getting to the IPO that was the main challenge.

He says there were “innumerable barriers and issues” standing in the way of successfully merging the 17 villages into one entity ready to list on the stock exchange.

“It took the combined commitment from a very determined team to push through and get this thing finished.”

McDonald says the 17 villages, scattered throughout New Zealand, came together through a combination of the group approaching the village, and villages approaching them.

There was a due diligence process in which they ascertained which villages were suitable, and negotiations were held with the owners.

“The merger and acquisition process was quite intense and complicated,” he says.

However, from the outset the group had a clear idea about the sort of village that would fit the mould; they took into account the quality of the operation, building, cash flow, and the mix of care and independent living. McDonald says they were also keen to include villages that had ‘brownfield’, or redevelopment, potential.

“I think that the market … has fairly accurately identified that we’re not necessarily akin to the other players, and that we are offering something a little different.”

McDonald says Arvida is more biased towards providing care than other village operators, and describes it as a “key differentiator”. Approximately 50 per cent of the residents across its 17 villages are accommodated in aged care beds.

McDonald says there are opportunities to expand the care facilities at some of the villages, and there are various development projects in the pipeline.

Arvida intends to get bigger, too.

“Acquisition is a core part of our strategy,” says McDonald. “But – and it’s a big ‘but’ – we want to identify acquisitions that are genuinely earnings accretive to the bottom line.

“We’re not about growth for growth’s sake,” he adds.

Integration all-important

McDonald, an Australian, confirms Arvida has no plans at this stage to expand across the Tasman. For now, he says, the focus is on consolidating the 17 villages.

“The integration task to us is of critical importance – it’s our number one priority at this stage.”

He says the villages Arvida has acquired have been running very well and independently for some time, so rather than centralise operations across the board, they intend to provide greater support and governance instead.

“We’ll provide support services, as opposed to a classic M&A approach, where the old guys are out and the new guys are in; it’s more of a collaborative approach.”

McDonald says having 17 effective villages under one umbrella lends itself to capitalising on their various strengths.

“We’re identifying strong synergy areas that we’re focusing on at the moment. We’ll try and draw good examples from specific areas and cross-pollinate to enhance good practice.”

McDonald says Arvida hopes to streamline the auditing process and establish benchmarking across the villages. They intend to take a more understated approach to branding, with the individual villages retaining their name but with the addition of words

along the lines of ‘Part of the Arvida Group’.

“We’re very keen for the villages to maintain their own identity and character,” says McDonald.

A point of difference

Arvida views itself as somewhat different from the big corporate players currently dominating the market, like Ryman Healthcare.

“I think that the market, from a customer point of view and also from an investor point of view, has fairly accurately identified that we’re not necessarily akin to the other players, and that we are offering something a little different.”

He says there were some initial concerns from the villages about being corporatised, but these fears were quickly allayed once they understood the group’s vision and goals.

McDonald says interaction with the villages – the staff and the residents – has been great so far.

In terms of how Arvida’s entrance has been received by the wider sector, McDonald says that while they haven’t really had much opportunity to interact with other villages, they feel welcomed by the sector.

“We’ve been so darn busy we haven’t had a great deal of time really to get off the road and do some observations. Certainly the general perception is that there is room for another operator, particularly one that has more of a focus on residents’ wellbeing and providing a holistic approach.”

In any case, McDonald is aware of the scrutiny. He says the group is the first of its kind for the retirement village sector.

“I think we will have quite a few eyes watching us,” he says a little wryly, referring not only to the sector, but to the investors as well.

Certainly, Arvida’s entrance onto New Zealand’s retirement and aged care landscape has created a fair amount of interest and speculation since the group made itself known publicly last September. Six months later, with a successful IPO under its belt, integration well underway, and development high on the agenda, the group appears to be off to a fine start.

The 17 villages currently comprising Arvida are: Glenbrae, Bay of Plenty; Molly Ryan, New Plymouth; Olive Tree, Palmerston North; Waikanae Lodge, Waikanae; Oakwoods and The Wood, Nelson; Ashwood, Blenheim; Ilam, The Maples, Mayfair, Park Lane, Rhodes on Cashmere, St Albans, St Allisa and Wendover, Christchurch; and Bainlea and Bainswood, Rangiora. www.insitemagazine.co.nz | March/April 2015

9

Management

Up close and personal with...

Martin Taylor JUDE BARBACK interviews exiting chief executive Martin Taylor about his 10 years at the helm of the New Zealand Aged Care Association.

W

hen I hear the news that Martin Taylor is leaving the New Zealand Aged Care Association (NZACA) to work for the Labour Party, I express to him my surprise, having pegged his political allegiance a little more right of the line.

However, he is quick to put me straight.

“Not the Labour Party,” he says emphatically, “I’ll be working for the Labour Party leader’s office.”

Taylor will start his new role as director of research and policy for Labour leader Andrew Little in April. He says he has long held aspirations to work in a Prime Minister’s office, and this opportunity was “too good to miss”.

He also felt it was time to move on. After 10 years as chief executive of the NZACA, it was time for a change.

Taylor says 10 years ago the association, then called HealthCare Providers NZ (before it merged with the Association of Residential Care Homes in 2009), was a very different organisation from the one it is today. They hadn’t made any big political gains in quite a long time. There was no lobbying. Even the commissioned PricewaterhouseCoopers report hadn’t generated any real changes.

“And these were in the days when the Government had surpluses,” says Taylor, somewhat incredulously.

Taylor has been through four general elections during his 10 years with the NZACA, and used each as a chance to lobby for various political gains for the aged care sector. In 2008, for example, they successfully fought to increase nurses’ pay – a particularly hard-won victory considering it was first year of the Global Financial Crisis.

And in 2011, they brought about an increase in funding to rest home rates.

He’s quick to point out that elections are just “points in time” and that discussions with the Government are happening all the time. The ongoing A21 contract negotiations and discussions surrounding interRAI are certainly testament to that.

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Taylor speaks ‘aged care’ with perfect fluency. It is a subject he knows inside out.

Despite three years of journalistic exposure to the sector, I still feel intimidated by his grasp on the various policies and issues.

Which is why I am mildly relieved to hear that he hadn’t always been so familiar with the sector and its nuances.

In fact, Taylor describes his first year at NZACA as “really hard”.

“I understood very little about the aged care sector when I arrived,” he said. “It was a very steep learning curve.

“At the first meeting I went to when I arrived, one of the members said in front of everyone, ‘I don’t pay my fees to employ a schoolboy’. I was momentarily speechless.

“It took six months to scratch the surface, and a year to fully understand how the sector worked and all the issues.”

Since that time, he’s accomplished a lot. Ten years is a long time from which to cherry-pick the major ‘wins’, but there are several points that stand out to Taylor as he reflects back. Redefining the sector’s relationship with the DHBs was pivotal,

he believes, as was getting the Grant Thornton Aged Residential Care (ARC) Service Review off the ground in 2010. The report provided the evidence that there will be a shortage of beds by around 2019, and ultimately gave the sector more credibility going forward. While they’re in the process of updating parts of the report, it seems unlikely the Government will be prepared to pay for another report any time soon, so in that sense it was a major feat.

Despite his successes, there are certain projects he wishes he could see through – like interRAI, for example.

“I would love to see interRAI fully established, robust, doing what it is meant to.”

Taylor describes the assessment system as “a game changer”. He believes interRAI would help remedy the current dearth of clinical statistics in aged care and create a clearer picture of residents’ needs.

He seems frustrated by the resistance towards interRAI demonstrated by some, yet remains “hopeful” that the issues surrounding interRAI will be resolved.

He mentions other things that he would like to have achieved. Small things like reinstating funding for pressure-relieving mattresses. And bigger things like sorting out a fairer and more consistent system for palliative care funding.

He would also like to have initiated a more formal collaboration between the NZACA and the Retirement Villages Association. With an increasing number of villages now offering care on site, the interests of villages and care facilities are becoming more closely aligned.

For the most part, however, Taylor is rightly pleased with what he has achieved during his time at the NZACA. He describes it as the “most efficient and effective association in the health sector”.

Taylor truly believes in the provision of aged care in New Zealand. He describes it as a “world-leading service”, a far cry from the 12-bed government-run geriatric units of 30 years ago.

Management “I challenge anyone who thinks differently to go and travel and see what I’ve seen,” he says.

“I firmly believe that aged care people should be paid more. They should be able to make a good living out of aged care as they provide a good service to people in their last years of life.”

I sense that his comments are perhaps directed more towards the smaller aged care providers, than the larger operators.

However, at the suggestion that the sector is divided between the ‘big corporates’ and the ‘little guys’, Taylor says that regardless of size, all providers tend to share the same concerns.

“It has never been that hard to reach consensus.”

He bristles slightly when I allude to the NZACA’s U-turn on refusing to sign the ARC contract last year, brought about by pressure from some of the larger providers not willing to fall out with Government.

“That was the first and only time that’s happened,” he says, and he makes the point that the correct outcome was reached in the end.

“Aged care in New Zealand is a world-leading service and a far cry from the 12-bed government-run geriatric units of 30 years ago.”

He maintains all providers are on the same page with respect to the TerraNova v Bartlett case. I detect a slight weariness when he talks about the case, and I ask whether he’ll be sorry to leave it behind.

“I’m not particularly sorry to be leaving that,” he admits.

He also won’t miss attending the vast number of government forums, which he likens to “watching paint dry”. He says dealing with Health Workforce New Zealand is particularly painful owing to its slowness in reaching any outcomes. He finds being involved with certain legislative areas also to be tedious; he describes dealing with issues surrounding the Food Safety Act, for example, as “mind-numbingly soul destroying”.

But, moreover, has he enjoyed the last decade?

“I have,” he says, decidedly. He feels very privileged to have held his position with the

association and has been grateful for the loyalty, support, friendship and respect that it has granted, he says. He has particularly enjoyed the four election campaigns, and 10 really great conferences.

“Ten years sounds like a long time, but it’s never dragged,” he says. “Now I’m older, greyer... possibly wiser. When I look back at the last 10 years, when I arrived, I was unmarried, with no kids, no mortgage, my father was still alive... I’ve done a lot of living in that time.”

Finally, I ask Taylor if he has any advice for the person filling his shoes.

“Don’t worry about the first year – it’s really hard,” he says. “Get to know everyone.

Spend some time trying to understand people and what motivates them and you’ll find that, by and large, they’re a great set of people delivering a really high-quality service. We’re genuinely lucky to have such great people doing it.”

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Dementia

Highlighting the link between loneliness and

dementia

CAROLINE BARTLE says it’s time to stop talking and start acting on funding a campaign to tackle loneliness in older people – ultimately delaying, or even preventing, the onset of dementia.

A

couple of months ago, Alzheimer’s Disease International (ADI) produced their annual report focusing on risk factors and dementia. The report reflects a shift in research and public policy from cure to prevention. Taking a life course view, the report identifies a number of factors over the course of a person’s life that may increase their chances of developing dementia.

The ADI report makes for very interesting reading. However, I was disappointed to find that it did not give psychological factors the prominence that it deserves. This may be because of the difficulties in researching a subject that has so many complex variables, or perhaps because of the dominance of the medical model in society.

In my social work practice, I observed many individuals develop dementia following a life event, such as the death of a partner or another form of loss, sometimes material or physical. This has always made me curious as to the relationship between how we feel and the onset of dementia. Similarly, in my training and consultancy work, I often feel moved by the powerful impact that good emotional care has on an individual’s wellbeing. The impact is far-reaching, often impacting on physical health as well as emotional wellbeing. Many studies reflect

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this correlation: one study, for example, showed that narrative self-disclosure can significantly improve wound healing (Wienman, 2008).

In trying to understand these links, my research has taken me deep into the realms of neuroscience, biology, psychology, sociology, and the complex and fascinating world of psychoneuroimmunology (PNI) – a topic well researched at AUT. I discovered an interesting body of research on loneliness and its impact on wellbeing, and in particular, its relationship with dementia.

Health impacts of loneliness

Social isolation is used to describe the absence of social contact, whereas loneliness is the dissatisfaction with the quality and/or quantity of social relationships. Loneliness is a subjective experience and may be influenced by a number of other demographic factors. A quality of life survey carried out by Statistics New Zealand in 2010 of over one million people identified a strong relationship between poor economic status and feelings of loneliness in older people. A New Zealand study of 332 people (La Grow and Neville, 2012) found correlations between an individual’s self-reported health and feelings of loneliness. Cultural factors may also influence the prevalence of loneliness.

There is a growing amount of generic research showing that loneliness is harmful to our health. One study claims that loneliness and isolation has a greater impact on mortality rates than obesity (Holt and Lunsted, 2010). Loneliness could also increase the risk of high blood pressure (Hawkley et al., 2010), and has also been linked to more rapid motor decline (Wilson et al., 2010).

Similarly, and unsurprisingly, there have also been a number of studies exploring the impact of loneliness on our mental state; individuals who are lonely are more prone to depression (Cacioppo et al., 2006).

Depression may be a major risk factor to developing dementia (Byers et al., 2013), and some researchers have hypothesised that depression may even be an early part of the pathology of dementia, while others maintain that the links between loneliness and dementia are independent of depression (Holwerda et al., 2012).

There have also now been a number of studies researching the link between loneliness and dementia. The AMSTEL study (Holwerda et al., 2012) concluded that individuals with feelings of loneliness have a 64 per cent chance of developing dementia.

However, disentangling the complex overlapping issues is difficult.

Dementia In this research, several questions are explored: »» Could loneliness be a behavioural reaction to early cognitive decline impacting on our ability to maintain social relations?

Social cognition can be impaired early both in Alzheimer’s and frontal temporal dementia. This also may be the case in vascular dementia, dependent upon where the incident is in the brain. »» Could it be that when someone is living alone, they have less access to social stimulation and sensory engagement, which may lead to physical changes in the brain, reducing cognitive reserve? »» Could it be related to certain personality traits? For example, there are a number of research studies linking neuroticism to increased mortality rates (Huppert 2009). »» Could there be a more novel neurobiologic mechanism involved?

Prolonged psychological distress will create a physical response along the HPA axis, meaning that distress causes the body to release cortisol, which can lead to a number of physical responses impacting on vascular, immunologic and metabolic systems. While some studies have found no correlation between cortisol and onset of dementia (Schrijvers et al., 2011), others have linked cortisol to hippocampal damage (Lupien et al., 1998) – the hippocampus being where our memory is located.

Resilience can be developed

Whatever the biological process, psychological distress is not good for wellbeing. However, the level of distress may be mediated in some way with an individual’s personality, specifically one’s ability to be resilient. Resilience is a quality that can be developed. One of the main personality types is neuroticism – these individuals have a tendency to experience negative feelings

“Individuals with feelings of loneliness have a 64 per cent chance of developing dementia.” more and may be less resilient when dealing with emotional distress.

Loneliness exists all over the world and poses significant challenges to health and social care systems. In New Zealand, more dispersed rural communities may mean that individuals could be living alone in areas that are much harder for services to reach. However, as social isolation and loneliness are not the same thing, this may not necessarily correlate. Similarly, a person may live within a care facility or receive home-based support services and still feel lonely. This highlights that it is quality, not quantity, that service providers need to consider.

The challenge exists for home care providers to think quite broadly about the outcomes of their work; to consider how they are improving not just physical outcomes but also meeting important psychological needs. This needs to be driven, in part, by the infrastructure in place organisationally.

A quality infrastructure needs to include perspectives of a range of stakeholders and needs to be implemented from a position of shared vision. Jacobs (2010) found that there is often a disparity between the policy makers and funders and individuals at front line service in the interpretation of government directives. The scope of the assessment process will also either highlight or minimise the importance placed on addressing issues of loneliness. The question has to be asked: how effective is InterRAI at highlighting these issues?

Home-based support services are key

Addressing feelings of loneliness as a key outcome should be not only the domain of voluntary services such as Age Concern, but also a key responsibility of homebased support services. To achieve this, services need to consider what drives this both on a macro and micro level. On a macro level, what measures can be put in place to convince funders that this is an issue worth funding? On a micro level, it is about enabling the support work not to just be there, but to connect with the person they are supporting. Homebased support services should also have a good understanding of a whole range of approaches so that they might utilise, advocate, and campaign for them – for example, accessible, flexible transport, using social media to connect people, assistive technologies that support communication, and befriending schemes.

The time is right to campaign for funding to tackle loneliness as a way of moderating risk factors and ultimately delaying the onset of dementia. The research is far-reaching and highlights the potential impact of loneliness both on our mental and physical state. Failing to recognise loneliness as a major area for preventative work will have an extensive impact economically. Tackling loneliness is going to take a cohesive approach and a shared vision of what government policy is trying to achieve, so that we may reach beyond the rhetoric to the reality.

Those currently researching all things dementia, individuals and family carers living with dementia, and front line staff are invited to join us on Twitter every Wednesday at 7pm GMT for an opportunity to influence research in this area. Look for #demphd.

Aged care news, views, trends and analysis If you want to know what your colleagues are thinking or doing in the aged care and retirement sector, subscribe to INsite.

Multimedia format includes: »» Four print editions per year »» In-depth website, newsfeed, opinion pieces and sector updates.

www.insitemagazine.co.nz/subscribe www.insitemagazine.co.nz | March/April 2015

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Management

A good place to Be JUDE BARBACK talks to Guy Eady about life after Oceania and the rise of his new venture, the BeGroup.

I

meet Guy Eady for coffee at the trendy BeGroup offices in Parnell, Auckland. As we sit on the sunny terrace overlooking Parnell, I reflect on how different this must feel from his former workplace, aged care provider Oceania Group, where he was chief executive for two and a half years.

Eady agrees. He’s gone from heading up 3,000 staff at Oceania to 10. And he seems pretty happy about the change.

But it is in talking about his vision for the BeGroup that Eady becomes particularly animated. The whole notion of Be is focused on creating environments where residents can Be happy, Be part of the community, and Be themselves.

“It’s a straightforward industry,” he says. “It’s essentially about looking after people.”

Getting started

The BeGroup, so the website tells me, was established by Eady and Pencarrow Private Equity Fund. Eady, an accountant, was introduced to Pencarrow towards the end of 2013 by Rod Gethen, a connection made during his days at Deloitte, and the BeGroup concept materialised fairly quickly from there. By April 2014 Eady had tendered his resignation to Oceania and by July he had left.

Pencarrow’s current fund (Fund IV) of $124 million is split over five investments, the BeGroup being one of them. Eady tells me Pencarrow’s investors include some of New Zealand’s largest institutional investors, including NZ Super, ACC and Trust Waikato, as well as some high-net individuals.

It’s exciting being at the start of a new venture.The Falls Estate in Whangarei was the first BeGroup acquisition. Eady says he instantly liked the vibe there, but also spotted some development potential for adding a care facility or around 30 more villas.

The second acquisition for the BeGroup, at a cool $8.1 million, was the former Rawhiti Bowling Club on Rangitoto Avenue in Remuera, Auckland, which will be redeveloped as the Rawhiti Retirement Village. There was a small amount of resistance from locals who sought to keep the land for recreation.

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Eady dismisses this. After all, he was once a local, too. The site is just down the road from where he grew up.

“I knew the location well, and believed it had great potential for a retirement village,” he said.

The land was sold via a tender process, a process which Eady describes as “stressful” as it forced them to get organised very quickly.

Eady tells me that in addition to independent retirement villas, Rawhiti Village will include a full range of care options, including dementia care. It will include approximately 50 care beds and 20 independent living dwellings.

While an increasing number of village operators are incorporating care facilities into existing villages, some prefer to keep independent living separate. Eady says he can understand such reservations.

“Care isn’t majorly profitable,” he says, somewhat cautiously, “however, from a longterm view it is beneficial to a village to be able to offer a continuum of care.”

USP is crucial

The concept for Rawhiti Village couldn’t be more different from The Falls, but this doesn’t faze Eady, who says the important thing for a village is to “find its place in the community”.

“There’s always got to be a point of difference. For example, the USP [unique selling point] for Rawhiti is location. For each site it will be different.”

He’s also keen to identify what is working well in one facility and incorporate that in others.

“I’d like to replicate the culture of The Falls into other sites,” he says, by way of example.

Beyond Rawhiti, Eady says the BeGroup is currently looking at two other greenfield sites and doing due diligence on those.

“We may even look in Melbourne,” he says, in obvious reference to Ryman’s move across the ditch, but I can’t tell if he is being serious.

But he is earnest on the subject of growing the business.

“We are looking to grow to a point where we don’t need to bring in new capital and we can reinvest back into the existing and future sites,” says Eady.

Eady thinks it is a good time to be in the retirement and aged care industries.

“Thirty years ago banks didn’t understand the model. Investors didn’t understand the model.

Now they do.”

Size matters

Eady thinks being smaller gives the BeGroup certain advantages over competing organisations.

“We can move faster – the tender process was a test of that – and we can be innovative and offer more unique bespoke products and services.”

Innovation is set to become a key hallmark of the BeGroup. Eady feels there is a lack of innovation in the sector at present, partly due to an ‘if it ain’t broke, don’t fix it’ mentality.

The sector appears to be content with playing it safe. He says that the bigger players are not being pressured into changing or experimenting with new ideas.

“Their investment is being refunnelled into what they’ve been doing before,” he says.

It is interesting hearing Eady discuss the big corporates, as I am used to associating him with Oceania, one of the largest aged care providers in the country.

He says his time at Oceania gave him a wealth of experience in building, developing and selling, and helped him to build important relationships with lawyers, bankers and other people with expertise in areas relevant to his new venture.

Eady has been entrenched in the aged care industry for a long time. His own rest home business was bought by LifeCare Residences and he subsequently joined the Macquarie Group, which formed the Oceania Group. He has served on the board of the New Zealand Aged Care Association for 10 years, during which time he has “enjoyed getting an insight into the way Wellington ticks”.

I sense Eady is pleased to be on a different track now, with the BeGroup. He talks about the sense of relief that comes with having a clean slate from which to start.

Indeed, the swish white Parnell offices, the modern business cards with their contemporary fonts and colours, the transparent enthusiasm that Eady shows when talking about his new venture, all give the impression that this is a good place to Be.

“Thirty years ago banks didn’t understand the model.

Investors didn’t understand the model. Now they do.”

Clinical

Fear of falling: friend or foe?

SHELLEY JONES looks at recent research on actual risk of falling and perceived risk, and the implications for older people.

F

ear of falling ranks higher than other fears, such as burglary or financial trouble, according to several studies of older people.

Fear of falling can be protective if it prompts a positive or proactive response – or it can create a downward spiral of physical inactivity and social withdrawal that actually increases the risk of falling.

Commonly cited findings in research on falls in older people are that fear of falling can exist even in those who haven’t had a fall, and that 12 to 65 per cent of older people living in their own homes (community-dwellers) have a fear of falling, with higher rates in women than in men.

What we know about falls and fall-related injuries confirms that falls are a fact of life in older age and that there are indeed reasons to fear falling: »» Over the course of a year, among generally healthy people aged 65-plus living in their own homes, approximately one in three will take a tumble. Although most will not have a serious injury, about one in 20 of those who fall will have a fracture or other injury requiring hospital admission, with the likelihood of injury increasing with age. »» People living in age-related residential care fall more often than those in their own homes and their falls are more likely to result in harm. The severity of fall-related injuries is higher, with up to one in four falls resulting in serious injuries such as lacerations, fractures or head injuries. »» People living with dementia fall twice as often as those who are cognitively intact, and are more likely to have injurious falls. »» After age 75, hip fractures are the most common fracture – and the most unfortunate. Figures from the New Zealand Health Information Service tell us that within a year, 27 per cent of people who’ve had a hip fracture will have died (and just under two-thirds wouldn’t have died if they hadn’t fractured their hip).

However, since it’s generally held that falls are not an inevitable part of ageing, and considering the extensive publicity about ways to prevent falls in older people, these figures are less a losing score than a challenge to do the right thing by those in our care. A significant part of that challenge is not to cause anxiety or avoid the issue, but to encourage older people to take relevant and practical actions for themselves to prevent falls.

Being concerned about falling, or worrying about possible outcomes of a fall, is functional if it means taking appropriate actions to reduce one’s personal risk of falling. Fear of falling is by definition a dysfunctional”ongoing concern that ultimately limits the performance of daily activities”, according to falls researcher Mary Tinetti and her colleagues.

Limiting activity to reduce the risk of falling makes sense on one level, but unintended consequences can actually increase the risk of falling. For example, inactivity leads to a loss of strength and condition; avoiding or dropping activities that involve being ‘out and about’ reduces social interaction and quality of life.

A shift in perspective

The opposite of fear of falling – rather than an absence of fear – is a sense of confidence in being able to undertake everyday activities without falling. This ‘fall-related self-efficacy’ allows an older person to maintain the participation and activity that helps prevent falling.

One study showed that improvement in depressive symptoms is associated with increased falls efficacy.

A recent study followed the number of falls (with and without injury) in 500 men and women aged between 70 and 90 over a year. It measured actual physiological risk of falling (through a series of physical tests and questionnaires) and perceived risk of falling (according to the falls efficacy scale). Almost a third of the sample overestimated or underestimated their risk of falling, and the researchers suggested that attention to the disparity between physiological and perceived risk would be useful in preventing falls.

Drawing from this study, the framework below matches possibilities of actual risk and perceived risk, and identifies relevance for different sub-groups in the retirement village and aged residential care populations. Actions for organisations, professionals, families and carers to take in supporting older people are also suggested.

Common sense tells us to ensure hazard-free environments that enable everyone to get about safely, irrespective of falls risk.

Evidence for effective falls prevention directs us to identify and address an older person’s modifiable risk factors for falling, and to facilitate involvement in exercise programmes and activities targeted particularly to improving balance and strength.

Continued over page >>

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Clinical

High

Moving on from thinking that ‘fear of falling’ is something that many older people have, to a more nuanced understanding of what their concerns are – or should be – helps us to find a point of motivation that can lead to positive action. While fear of falling may be a ‘foe’ to those whose actual risk of falling is low, for many older people, a shift in perspective could make their concerns about falling a useful ‘friend’.

”The opposite of fear of falling – rather than an absence of fear – is a sense of confidence in being able to undertake everyday activities without falling.”

Shelley Jones RN BA MPhil works independently in training and development and has an advisor role in the Health Quality & Safety Commission’s national programme, Reducing Harm from Falls.

Low actual risk and high perceived risk About 10 per cent of the study sample had perceived their falls risk as high – inappropriately in relation to their actual physiological risk. However, they had performed poorly in a dynamic balance task and were classified as ‘anxious’. Although they weren’t less active than the group with low actual risk and low perceived risk, just under half of this anxious group had multiple falls or injurious falls in the follow-up year.

Perceived risk of falling

What we can do: »» Be aware that a small proportion of older people will have a high level of concern about falling (not related to actual risk), and are also quite likely to fall. »» Respond in ways that acknowledge and allay concerns about falling, rather than heightening anxiety. »» Involve these older people in activities targeted to improving balance and confidence in performing daily activities.

Low actual risk and low perceived risk Older people living in their own homes usually agree falls are a problem in their age group, but believe that falls happen to other people – even when they themselves have had a fallrelated injury requiring hospital admission.

Those living in their own homes (including in retirement villages) may benefit from a reality check: ‘One in three people over the age of 65 falls each year... it could be me’. Keeping active, improving balance, attending to hazards around the house, choosing safe footwear, checking eyesight and taking extra care when getting used to updated glasses are all effective ‘fall-proofing activities’: ‘If I do these things, I reduce the chance of it being me that has a fall’.

Low

What we can do: »» Heighten awareness that normal ageing processes increase the risk of falling in even generally healthy, active people. »» Promote ‘fall proofing’ actions and support uptake through motivational interviewing.

Low 16

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Please contact the editor at editor@insitemagazine.co.nz for a version of this article with references and acknowledgements.

High actual risk and high perceived risk The frail older person and those with one or more risk factors for falling (such as problems with mobility or balance and strength, painful feet, medical conditions predisposing to falls) have realistic concerns about the possibility of falling, perhaps because they have already fallen.

What we can do: »» Shift the focus from ‘preventing falls’ to involving the older person and their family/carers in positive confidence-building actions for ‘moving around safely’, keeping physically active, and staying as independent as possible. »» Support older people who have risk factors for falling in practical preparation for the possibility of a fall (such as having a personal alarm, and learning how to get up after a fall or what to do if they face a ‘long lie’).

High actual risk and low perceived risk Older people living with cognitive impairments have higher rates of falling – perhaps related to lack of insight into their own capabilities, risk-taking and impulsivity. One study found global cognitive impairment to be strongly associated with low levels of concern about falling, despite these people also having low levels of physical functioning.

What we can do: »» Make the care environment as safe as possible for those who are unaware of their actual falls risk and unable to compensate for it. »» Consider technologies that alert staff or carers to assist with mobilising safely. »» Provide tailored prompts for using mobility aids where needed. »» Using a person-centred approach, support physical activities that are meaningful and motivating, and encourage involvement in exercise programmes tailored to risks.

Actual physiological risk for falling

High

Aged care

Never too old to clown around Clown doctors show that sometimes laughter truly is the best medicine.

CAMERON TAYLOR, of Clown Doctors New Zealand Charitable Trust, reports.

“W

hat an invaluable service.

They bring joy, community and lift the spirits of patients and staff, all of which helps healing.

Thank you.”

These were the heartfelt words of Lena Robertson, a nurse from Christchurch’s Princess Margaret Hospital, referring to a drug-free service that aids the recovery process, while supporting patients and hospital staff across Christchurch, Wellington, and Auckland; a service provided by Clown Doctors New Zealand.

Clown doctors aren’t real doctors dressed as clowns. They are professional performing artists who receive an academic education from the International Institute for Medical Clowning, Steinbeis University, Berlin.

This programme involves studying a variety of age-related conditions, health science, psychology, social and cultural studies, as well as compassion and spirituality.

“Medical clowning is a serious business,” explains founder and chief executive of Clown Doctors New Zealand, Professor Thomas Petschner, “because you’re visiting

people in hospital and you have to be sensitive to what they are going through.

There’s potential to cause real damage if people think they can just turn up in a ward, juggle and tell a few jokes.”

Clown doctors are also trained to provide distraction during difficult treatments and to give psychological support and motivation for physical therapy.

“Clown doctors are very different from other types of clowns,” says programme director Rita Noetzel. “They’re interacting with people in various states of sickness – entering their rooms, their personal space – so they can’t be too over the top.”

Clown doctors don’t wear coloured wigs, big shoes or have painted faces. Instead, they look more like slightly eccentric hospital staff. They may have colourful shirts, bright knee-high socks, or a large handkerchief in their top pocket. Of course, the red nose is a dead giveaway.”

Bringing back good memories Currently, clown doctors visiting the elderly all wear white lab-coats with the Clown

Doctors logo on the back. But as Rita explains, “In our work with the elderly, we are moving towards using costumes reminiscent of a specific era in patients’ pasts. This helps trigger memories and avoids the possibility of being mistaken for a medical doctor.”

The Clown Doctors New Zealand Charitable Trust was founded by Professor Thomas Petschner and Rita Noetzel in 2009. “We met while working together at a medical centre,” Rita says. “Thomas told me he’d come across clown doctors in Europe, said there’s nothing like it in New Zealand and asked, ‘would you be crazy enough to try and do this with me?’ and I said ‘yeah, sure’.”

Shortly after that pivotal conversation, Noetzel and Prof Petschner presented the idea to the board of Princess Margaret Hospital, the Christchurch hospital with dedicated aged care wards. Director of Nursing Kathy Peri thought it was a great idea and wanted to know when they could start.

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17

Aged care arrived to provide their highly artistic and humorous work to the older people who are currently patients in the hospital,” says Peri.

“We sincerely embrace the clown doctors as being part of the interdisciplinary team at Older Person Health and look forward to the ongoing working relationship we have with the Clown Doctors service.”

“When you laugh, there is a chemical reaction inside the body that actually makes you feel better.”

Scientific backup

Devil-may-care persona notwithstanding, the clown doctor premise is supported by 40 years of solid scientific evidence proving the positive effects of smiling and laughing on the human body and mind. “People still ask me if there really is a connection between laughter and health,” says Prof Petschner.

“That’s like asking if the Earth is actually flat!”

“When you laugh, there is a chemical reaction inside the body that actually makes you feel better,” explains Rita. “The endorphins and hormones released alleviate fear and pain, relax the muscles, and lower blood pressure, along with a host of other benefits.”

These benefits include improvements to the cardiac and respiratory systems, a boost to the immune system, and the reduction of stress hormones, all of which leads to a more pleasant hospital stay. Medical staff also smile and laugh during their interactions with clown doctors, in addition to enjoying the benefits of happier and more relaxed patients. Families of patients benefit from knowing their loved ones are nurtured and happy during their hospital stay. The entire community benefits because patients recover more quickly and require less medication, providing more efficient use of our health resources.

“Patients have been very sad and stressed from the earthquakes and the clown doctors totally changed their emotional state,” says a nurse from Princess Margaret’s Ward 1A. “They joined in singing and smiling.

A very significant and much needed transformation.”

Eleanor Wilson, a visitor to Ward 1B agrees. “You’re a great team, a real pick-meup. Such a blessing for my grandma-in-law.

She got up, sang, jiggled and danced, when she had been so blue and in tears when I first saw her this afternoon.”

Prof Petschner’s vision is that everyone in hospital should enjoy these benefits.

“It’s our aim to start visiting a new hospital each year, and we’re proud that we don’t charge hospitals for our service. But clown doctors are professional artists and must be reimbursed for their outstanding work. The challenge in expanding our aged care programme to other centres is finding funding. That’s where we rely on our generous donors and sponsors, and hope we can also count on your support.”

Case Study – a visit to Princess Margaret Hospital Clown doctor Exami-Nation saw an elderly woman with a nurse coming down a corridor.

He had a small pouch with speakers and an iPod, so he played some music, took the woman’s hand and invited her to dance.

She replied, “You have no clue who I am.”

“No”, he agreed, “but will you dance with me?”

“Yes, let’s dance,” she replied, and the two of them began to dance to the music from

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his iPod. Later she said, “I danced to this song with my husband at our wedding.”

Afterwards, Clown Doctors received an email about this encounter from head psychologist, Dr Chris Collins: “I wanted to let you know how much I appreciate the clown doctors’ visits to the ward where I work. Sometimes the clowns can reach patients and lift their spirits in a way that our usual treatment cannot. For

example, one elderly woman had been very slowed up, glum, and unresponsive for weeks. When the clowns visited she smiled and paid attention, and even got up to dance.

This seemed to be a turning point in her severe depression; she went on to improve slowly and eventually recover fully. Many thanks for bringing the clown doctors to our hospital!”

Retirement

Let’s snoop around...

Acacia Cove JUDE BARBACK finds a cheeky bunch of residents on her visit to Acacia Cove retirement village.

“W

hat sort of magazine is INsite?” enquires an Acacia Cove resident, when I ask permission to take his photo for this article. “Is it a bit like Cleo?”

“Just like Cleo,” affirms manager Bruce Cullington. “And they want you to be the centrefold.”

It’s like that the whole way around my tour of Acacia Cove – jibes and cheekiness and general banter between Bruce, the staff, and the residents.

I chat to a group of ladies in the lounge; one – Barbara – has just returned mere hours ago from a trip to Patagonia.

“Can you sort out your hair first, Barbara, before we get a photo?” jokes Bruce.

Prior to my tour of the village, Bruce had told me that it was its vibrancy that set Acacia Cove apart, so it was gratifying to see it for myself.

Despite his background in real estate, Bruce doesn’t go in for the hard sell with the villas. He tells prospective residents to make a shortlist of three villages and then visit them each at happy hour to gauge the atmosphere.

Acacia Cove sprawls over 10 hectares on the Wattle Downs peninsula, a part of Auckland with which I’m not overly familiar,

but I can understand why the village is appealing to residents. Next to the golf course, overlooking the peninsula, it has a touch of resort lifestyle about it. The village entrance way, with gardens and flag, leading into a pristine foyer, beautifully decorated for Christmas, adds to the initial first impressions.

Family ties

The village began in 1998 as a partnership between Prime Care and the Kimpton family with just 57 residents and 23 empty villas.

Today there are 108 single women, 28 single men and 87 couples.

There are 223 dwellings – 213 houses and 10 apartments. Bruce came on board in 2000 and the Kimpton family acquired full ownership in 2006.

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Retirement The family-owned element is another key selling point for Acacia Cove.

“All the residents know the Kimpton family. And my family,” he adds. “They see them almost every day and they like that.”

I meet Bruce’s daughters along the way, repainting outdoor benches. “How about a photo of child labour?” he suggests.

Bruce says the biggest advantage of being privately owned is that any problems can be resolved on the same day, without the hassle of consulting head office and gaining consent.

There is also a strong sense of being a “community within a community”. Acacia Cove liaises closely and regularly with their local council and MPs. On occasion, the village gets involved with political issues, with residents putting their submissions forward on issues such as rates remissions and stormwater tariffs.

I agree, based on my brief tour, that “vibrant” is a good word to describe the residents here. They are an active, witty bunch. They range in age from 57 to 97, with 20 residents over 90. The average resident age is 79 years, and the average age of entry is 72. There isn’t an activities coordinator at Acacia Cove – the residents run their own activities. Golf, tai chi, bowls and swimming are all popular pastimes.

Care facility question

“… “vibrant” is a good word to describe the residents here.”

However, for all the emphasis on independent and active lifestyle, it is interesting to note the absence of a care facility at Acacia Cove. Driving down Wattle Farm Road earlier that morning, I’d noticed a large construction site wrapped in Bupa branding, advertising retirement village living and aged care. My initial conclusions that the Bupa neighbour would be competing with Acacia Cove were dispelled when Bruce told me the land had been sold to Bupa by the Kimpton family for the purpose of providing a care facility lacking at Acacia Cove.

While Bruce concedes that if Acacia Cove were built today, a care facility would most likely be included, but the layout doesn’t lend 20

March/April 2015 | www.insitemagazine.co.nz

itself to incorporating one now.

He also suggests, somewhat cautiously, that a care facility would perhaps spoil the vibe of the village.

“We canvassed residents and they said they didn’t want a care facility,” says Bruce. “Mind you, they said the same thing about walking frames 15 years ago, too.”

I tend to agree with him – I can’t envisage the inclusion of a care facility into Acacia Cove as it stands, however I think the complementary Bupa facility across the road is bound to be appreciated by residents when the time comes and they are granted priority access.

Bruce admits that he now spends more time dealing with health and welfare issues than time on sales. There has been an increase in home cares, with most accessing this through the DHB needs assessment programme. The village also offers a free daily check service and a resident-run helpline to assist with things like transport to doctor appointments, or help to hang the washing after an operation.

New trends emerging

When I ask what other trends he noticed emerging, he says he has noticed increased demand for larger villas, high-quality finishes. He’s also noticed a trend towards dogs and campervans.

“We interview the dogs as well as the prospective residents,” he says. Where possible, they try to place new residents in streets with simpatico others nearby. Dogs certainly have a bearing on such a placement – and neighbours are consulted.

My tour takes me round a big loop of the village, giving me a small taste of the maze of tidy, pretty streets filled with villas: some being renovated, some in full festive cheer mode, most being enjoyed by happy, active residents.

We wind up back at the entrance way and I reflect, as I drive off, that gleaming as it is, the real sparkle, the real vibrancy, lies with the village’s residents and management.

Education & training

New quals ready for launch With the first set of new qualifications for the aged care sector ready to launch, INsite talks to Careerforce’s Penny Rogers about what the qualifications review process has identified so far.

I

Image supplied by Careerforce and Rannerdale Veterans’ Care.

t doesn’t feel that long since the qualifications review was announced, but thanks to much hard work behind the scenes, Careerforce is poised to roll out the first new qualifications to the sector.

The review process

Of course, the qualifications that are being revamped for the aged care sector comprise just a small proportion of all the qualifications that have undergone a major review.

In 2009, the New Zealand Qualifications Authority (NZQA) undertook a targeted review of its qualifications, which revealed that the system was not easily understood by learners or employers, and that the pathways to further education and employment were not clear cut. It also identified that there were too many qualifications and much duplication.

This led to a much-simplified New Zealand Qualifications Framework that ensured the reduced number of qualifications were fitfor-purpose and relevant. They were based on workforce needs, with clear employment pathways and graduate outcomes.

Following on from this work, the NZQA established a health and disability, social services and whānau ora cluster. Led by Careerforce, with input from Health Workforce New Zealand, a review of the qualifications in these sectors was launched, with the aim of ensuring all the qualifications meet the skills and training needs for their future workforce.

First quals ready

Following a lot of hard work and collaboration with the sectors, Careerforce is ready to launch the first batch of new qualifications this April.

The new qualifications include the New Zealand Certificate in Health and Wellbeing at both Level 2 and Level 3.

The Level 3 certificate has strands in health assistance; support work; orderly services; whānau, kin and foster care; vision and hearing screening; and newborn hearing screening. Also among the new qualifications ready for launch is the New Zealand Certificate in CleaningLevel 2.

Penny Rogers, transition manager at Careerforce, says that the review process uncovered many synergies between the various roles across the sector.

“The review process identified that while there are unique aspects to every role and context, there is a clear set of core skills that are valued across the sector,” says Rogers. “The qualification recognises these shared skills, which will allow people to move into new

“We receive feedback from employers, assessors and trainees about how gaining a qualification for some trainees has been life-changing.” roles while having their previous experience recognised.”

Rogers says they wanted to look beyond a ‘tick-box’ approach to gaining the qualifications.

“When we developed our new learning and assessment material, our focus wasn’t just on helping trainees to understand the requirements of their role; we also wanted them to gain the skills they’ll need to improve the health and wellbeing outcomes for those they support.”

This is exemplified by the Health Assistance and the Support Work strands of the qualifications, which focus on developing carers who can work with others to support people using a person-centred approach.

“The qualification suite as a whole will allow employers to develop experienced staff and provide them with further opportunities for skill development and recognition,” says Rogers.

Next steps

With the launch of the first set of qualifications complete, Careerforce will transfer its focus to developing further opportunities for skills recognition and development. This will include the launch

of the New Zealand Certificate in Health and Wellbeing (Advanced Support) Level 4 and creating assessment tools that will better recognise the existing skills and knowledge of experienced workers.

Rogers agrees that this is bound to make a difference to the personal and professional development and job satisfaction of many aged care workers who relish the opportunity to continue to learn and grow in their roles.

“We receive feedback from employers, assessors and trainees about how gaining a qualification for some trainees has been lifechanging. Holding the qualification validates their skill and experience.

“It is sometimes the first formal qualification a trainee has achieved and that pride shows on the faces of the graduates and their families at the graduations that Careerforce supports across New Zealand.”

Careerforce is launching the first suite of qualifications during April with a series of expos across the country and encourages anyone who wants to view the new products and discuss workplace training to get full details and register via our website www.careerforce.org.nz.

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Conferences

Conference previews: HCHA 2015 Conference Home & Community Health Association 2015 Conference 28–30 April 2015, Auckland

T

he HCHA Conference 2015 will explore the challenges and opportunities of changes occurring in home and community services – as a result of consumer and cultural needs, demographics and choices; and as a result of strategy around workforce, community supports and integration. It will include consumer and carer perspectives and look at what is going on overseas, as well as economic and social perspectives at home.

Minister for ACC Hon Nikki Kaye will give the opening address at the conference.

Among the keynote speakers is Professor Nicholas Mays, a professor of health policy at the London School of Hygiene and Tropical Medicine. Professor Mays also directs the Department of Health-funded

Policy Research Unit in Policy Innovation Research. This is an innovative venture that began in January 2011 aimed at involving a multidisciplinary team of researchers in the very earliest stages of national policy development and evaluation of innovative programmes and policies across health services, social care and public health.

Mays has a background in social policy, policy analysis and health care policy evaluation. He has experience as a policy advisor in government, having been principal health policy advisor in the New Zealand Treasury from 1998 to 2003. He continues periodically to advise Treasury and the Ministry of Health on health system strategy. Overall, he has 30

years’ experience in health services research and policy evaluation.

Mays will give a progress report on the 14 ‘Pioneers in England’ projects, which bear a strong resemblance to various integrated care initiatives in New Zealand, all of which rely heavily on the strength of the home and community care sector.

Dr Ganesh Nana will also take the podium as one of this year’s keynote speakers. Dr Nana is chief economist at BERL (Business and Economic Research Limited), a privately owned, independent economic research consultancy. He has 30 years’ experience in the field of economics since first working as a researcher at Victoria University and joining BERL in 1983. His experience includes a variety of contract

RVA 2015 Conference Retirement Villages Association 2015 Conference 15–17 June 2015, Melbourne

T

he RVA Conference makes its way to Melbourne this year and promises an outstanding programme of presenters, study tours, and social activities.

The theme of the conference is “Looking outwards” with speakers from around the globe – Brazil, England, Scotland, the USA, Australia and of course, New Zealand.

The opening keynote speaker is Professor Alexandre Kalache, described last year by the Australian media as “the international academic rock star of ageing well”.

Dr Kalache is a specialist in matters of population ageing and has been a leading pioneer in ageing issues for 40 years in various roles – as academic, international civil servant and advocate. His was one of the very earliest voices to articulate the global nature of population ageing, together with its enormous potentialities and the inherent risks through inaction. He directed the World Health Organisation (WHO) global ageing programme for 12 years. During this time he conceived and launched the WHO Active Ageing Policy 22

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Framework and the WHO Age-friendly Cities Project, among other enduring initiatives.

Wednesday’s opening keynote speaker is Rod McGeoch, who continues to enjoy a remarkable career at the forefront of business, sports administration and the legal profession, uniting exemplary senior level management experience with an unparalleled commitment to achievement.

Perhaps best known as the leader of Sydney’s successful Olympics 2000 bid, he is chairman or director of a wide range of major corporations and past chairman emeritus of Corrs Chambers Westgarth, one of Australia’s largest law firms.

The closing keynote speaker is Dr Michael Henderson, who will be talking about “above the line” culture. This address, drawn from Michael’s latest book Above the Line, is a no-nonsense, powerful overview of what it takes to create a high-performance culture. Every culture eventually falls into one of two categories – what Michael refers to as above or below the line.

A team from Melbourne University’s Masters of Ageing programme will be talking about the role retirement villages play in the health and wellbeing of older people; the economics and risks of an ageing society and the policy implications; how to age healthily; and innovations in retirement village design and construction.

Kiwi travellers and village managers Andrew Joyce and Martin Oettli will share what they learnt on a study tour to the US, including lessons applicable in New Zealand villages.

The MC, broadcaster and presenter Sean Plunket, will provide a political overview and insights into the Government’s thinking for this parliamentary term, and Michael Voges, the executive director of the British Retirement Villages Association, will take a look at what’s happening in the UK. Late last year many RVA members took part in the RVA’s first Net Promoter Score (NPS) survey (an internationally recognised measure of consumer satisfaction) of 3,000 randomly selected residents.

Conferences Pictured left to right: »» Professor Nicholas Mays »» Dr Ganesh Nana »» Liz Forsyth »» Merepeka Raukawa-Tait

project work for BERL; research, tutoring and lecturing at Victoria University; as well as macroeconomic policy analysis and forecasting during a four-year stint in the UK, using the IMF MULTIMOD model.

Despite his passion for numbers, Dr Nana believes economics is about people: their jobs, incomes, opportunities and futures. He strongly believes robust economic analysis is critical to ensuring informed choices and policy decisions are made – decisions that have positive effects on the lives and prospects of New Zealanders.

Another keynote speaker is Liz Forsyth, KPMG’s sector leader for health, ageing and human services. She is also deputy chairman of KPMG Australia, and until recently was on the board of the health sciences faculty at Sydney University. Her driving passion when working is health and social policy

reform. Her work predominantly focuses on issues related to disadvantage, disability and vulnerability, covering the many and varied aspects of the health, human services and aged care portfolios at both state and national levels. Forsyth will talk about consumer directed care (CDC) – a new direction for delivery of Australia’s aged care services.

KPMG is working with a range of providers to adapt their core systems, processes and operating models to give effect to the CDC philosophy and practices.

This presentation provides an overview of these evaluations and key findings and recommendations, as well as insights into some of the practical challenges and opportunities that providers will confront in moving towards a CDC model of service delivery and support.

Also among the keynote speakers is Merepeka Raukawa-Tait. A Rotorua district councillor and an elected member of the Lakes District Health Board, Raukawa-Tait is well known as the former chief executive of Women’s Refuge. She holds an MBA in international management and now spends much of her time encouraging Māori women into leadership positions. She will give her perspective on whānau ora.

Many other excellent speakers will also take the stand to discuss an array of interesting topics. There are sponsorship and trade display opportunities and, of course, the conference dinner to look forward to as well.

More information including how to register can be found at the HCHA website: www.hcha.org.nz/conference-2015

Pictured left to right: »» Professor Alexandre Kalache »» Rod McGeoch »» Sean Plunket

Mark McCrindle, one of Australia’s foremost market researchers, will explain what the results mean for the sector.

In addition, Mary Wood, from the Retirement Living Council, will look at the council’s research programme and what can be learned from it.

The Arvida float late last year generated a huge degree of interest from both the investing community and the retirement village sector and Michael Ambrose and Bill MacDonald, who put the offer together, will talk about the trials and tribulations of preparing a group of villages for the stock market.

Thanks to Ernst and Young, our conference app has been upgraded to include the opportunity to win a $5,000 travel voucher. The app will revolve around the 25-booth trade show, with lunches sponsored by Crombie Lockwood.

No conference would be complete without a study tour of local villages

demonstrating best practice examples of design, business models or resident welfare.

This year’s offering includes a new village (Selandra Rise) with a 7-star energy rating and the first village to be awarded a 4-star certification from the Green Building Council of Australia. The visit also includes one of Australia’s largest (by area) villages – The Village Glen at Rosebud West – as well as an intergenerational village in inner-city Carlton, and two well-designed villages on relatively small city sites but with all the amenities of far larger establishments.

Melbourne is home to the world’s only virtual dementia laboratory and the RVA has secured up to 45 seats over three sessions for delegates to experience the world through the eyes of a dementia patient and learn how villages can make that journey easier.

And of course, the social programme! The Programmed Property Golf Tournament for the Grant Adamson Memorial Golf

Trophy will be the highlight on Monday, while non-golfers can take part in a Lanes and Arcades walking tour, visiting corners of the city that even the locals don’t see.

The Trade Me Property opening cocktail function formally kicks proceedings off on Monday evening. The ANZ Gala dinner will be on Tuesday night as usual, and this year Melbourne band Cloud Nine will be providing the music.

The RVA has also obtained a limited number of tickets to Wednesday night’s big game at the Melbourne Cricket Ground – the second State of Origin league game between Queensland and New South Wales.

Alternatively, you can see the awardwinning musical Anything Goes at the Princess Theatre, or try out Melbourne’s hundreds of restaurants and bars.

To register, go to the RVA’s website: www.retirementvillages.org.nz/Site/Events/ conference_2015/default.aspx www.insitemagazine.co.nz | March/April 2015

23

POLICY

Last word...

Hon Peseta Sam Lotu-Iiga The recently appointed Associate Minister of Health shares his vision for aged care in New Zealand.

A

s Associate Minister for Health with responsibility for aged care, it is my honour to work with you to ensure that our precious senior citizens are well looked after, healthy and comfortable.

Aged care services aim to support older people so they can be as strong and independent as possible. They include home and community support as well as residential care.

The number of New Zealanders aged 65 years and over is currently 650,000, and is projected to climb to more than one million by the late 2020s. Those aged 65 years and over will then account for between 20 and 22 per cent of our population, compared with 14 per cent today.

At present there are about 31,000 people in aged residential care and 75,000 people receiving home support.

Older people generally have a wide range of conditions that make integration of care particularly important. This is why the Ministry of Health is supporting the implementation of comprehensive assessments of older people’s health and support needs.

Since my appointment as Associate Health Minister last October, I have already overseen the publication online of full audit reports for all rest homes in a reader-friendly format. This is so that older people and their families can make betterinformed decisions about their care and living environment.

Audits are conducted regularly to ensure our rest homes meet necessary standards. All rest homes are independently audited against 50 standards and require certification to ensure they provide safe and effective care. The audit reports identify any risks and areas where the homes need to improve. Audit information is available at www.health.govt.nz/resthomes.

Another initiative aimed at improving the lives of older New Zealanders is the recently announced Ageing Well National

24

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“Aged care services aim to support older people so they can be as strong and independent as possible.

They include home and community support as well as residential care.”

Science Challenge, with initial funding of $14.6 million.

Hosted by the University of Otago, this will bring researchers from seven New Zealand universities together to determine how science can reduce and moderate the impact of dementia, strokes, depression, impaired vision and hearing, and physical disability. By studying innovations in housing, transport, and care services, the researchers intend to develop new techniques and technologies that better enable older people to live more independent lives.

In other good news, the latest quarterly health target results, released last month,

show that district health boards are continuing to improve their performance on the Government’s health targets.

Almost all DHBs are now exceeding the number of elective surgeries they had planned.

DHBs carried out 5,441 more elective surgeries than planned in the last three months of 2014. DHBs have also focused on reducing waiting times for elective first specialist assessments and treatment, such as hip replacements.

Another exciting development is a cross-agency collaboration to improve the delivery of services to older people and meet the needs of our ageing population.

This is being led by my colleague Hon Maggie Barry, Minister for Senior Citizens [see “Last word”, December/January issue].

Four projects within the collaboration aim to improve the wellness of older people. The projects will lead to greater prevention of injuries in the future and will better integrate injury prevention services and interventions across agencies. They will also review the rehabilitation journey from hospital to home for injured older people and ensure that it is highly effective. In addition, they will improve data integration across agencies to streamline services.

The Government recognises that there are challenges to be met with an ageing population and is committed to supporting and improving aged care services now and into the future. I am pleased to be part of that change.

By way of background about me, I was elected to parliament in 2008 as the MP for Maungakiekie in Auckland. As well as being Associate Minister of Health, I am the Minister of Corrections, Minister for Pacific Peoples and Minister for Ethnic Communities. I live in Onehunga with my wife Jules and four-year-old daughter Hope. My interests include playing rugby, spending time with my family and being out and about in my local community.

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