INsite October 2014

October/November 2014 | $10.95

AGED care & retirement

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

Person-centred care nice concept but what actually is it? conferences

NZACA Award finalists

retirement

The Abbeyfield Alternative focus

Wound care & infection control

• Outsmarting the outbreak • New pressure injury guideline • rise of multi-resistant organisms

Tacera

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

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

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

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

Graphical user interface

Our range of Nursecall Systems provide;

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

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

Infection control

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

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

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

www.austco.co.nz

info@austco.co.nz

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

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

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

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

0800 287 826

PERTH • MELBOURNE • AUCKLAND • SINGAPORE • TORONTO • DALLAS • LONDON

Austco

AGED-care & retirement

INsite magazine October/November 2014 Volume 8/Issue 7

2 Ed’s LETTER

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

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

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

Very sadly, my grandmother passed away recently.

She had been in a rest home for the last 10 years of her life, and it was really touching to see a huge number of the rest home staff in attendance at her funeral, and to witness just how much she had meant to them.

We tend to define caregiving in physical terms, as in attending to residents’ and clients’ needs, but as I watched the grief-stricken carers at the funeral, it struck me that their role extended far beyond these terms. My grandmother was someone they not only cared for, but cared about.

The caring about is an aspect of the job we too often overlook. We are too flippant about the notion of caring, and the role caregivers and other support staff play in the lives of their clients, our loved ones. If you read the death notices in the paper – morbid hobby of mine! – you will see many tributes and votes of gratitude to care staff who made such a difference in those final years. The emotional burden that comes with the job needs to be better acknowledged.

In this issue...

FOCUS:

WOUND CARE & INFECTION CONTROL

2

Person-centred care – nice concept, but what actually is it?

4

News and opinion

5

Sweet as honey

7

A new global guideline for pressure injuries

8

The rise and rise of multi-resistant organisms

9

Outsmarting the outbreak: pandemic management and control

10

The Abbeyfield alternative

12

Social integration of older New Zealanders

14

On the soapbox ... Martin Taylor

15

Spotlight on ... adverse Drug Events

16

Let’s snoop around ... Ranfurly Village

18

NZACA Award finalists

19

Up close and personal with ... Frances Denz

20

Last word ... Care Association New Zealand

Caregivers, whether working in the community, public hospitals, or rest homes, are a vital piece of the puzzle in looking after our rapidly ageing population.

I was thrilled for the home and community support sector for finally reaching agreement with the Government on the issue of payment for community support workers for time spent travelling between clients. This ‘win’ marks a big step forward in terms of improving employment conditions and making things fair and consistent for community support workers across the country.

We are still some distance from where we need to be in terms of raising the profile of caregiving, so that the full extent of what carers and community support workers do is fully appreciated. But the wheels are certainly in motion.

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

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

www.insitemagazine.co.nz | October/November 2014

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aged care

Elizabeth Knox Home & Hospital resident with one of the facility's many volunteers

Person-centred care – nice concept, but what actually is it?

JUDE BARBACK discovers the ingredients of the truly person-centred approach taken by Elizabeth Knox Home and Hospital.

I

t is Election Day. There is a buzz at Elizabeth Knox Home and Hospital as staff and residents watch voters come and go from the polling station across the road.

I’d love to quiz the residents on which way they will vote, or have voted – especially as Knox is located in the strategic Epsom electorate – but I refrain; although from my experience, older people are usually very forthcoming on their political views.

I get the sense from Knox chief executive Jill Woodward that the residents here are not shy of an opinion, either. Woodward clearly thrives on this.

“The resident is at the heart of everything we do here,” she says, and she outlines the Knox organisational structure for me, which is like a circle with the resident and family at the centre, the care partners on the next layer, the nurses, physiotherapists, occupational therapists, and other support staff on the next, the clinical mentors on the next, and the board and management on the outermost layer.

Woodward likens it to a district nursing model, calling on expertise when needed, but more focused on the day-to-day relationships 2

October/November 2014 | www.insitemagazine.co.nz

between the residents and care partners.

It is not the first time I’ve heard facilities talk about putting the resident in the centre.

Ever since my involvement began with INsite and the aged care sector, I’ve heard the term ‘person-centred care’ used frequently. It’s a nice concept, the idea that care delivery is tailored to the specific needs of an individual.

However, the more facilities I visit, the more I realise that person-centred care is much easier to talk about than it is to actually deliver.

This year’s New Zealand Aged Care Association’s conference is all about the delivery of person-centred care. It is a timely topic. The funding for aged care is failing to keep step with the increasing ageing population and older people’s rising expectations of residential care. The conference will look at how providers can create an environment that supports choice and flexibility in spite of the regulatory and financial constraints to meet the changing needs and wants of residents.

It feels like they have achieved such an environment at Knox. It is as close to personcentred as I’ve seen in a rest home.

Creating this sort of environment is no easy task. Many factors come into play – a clear organisational structure and vision for a facility is certainly a good place to start – but it needs to translate into its day-to-day operation. Good management certainly plays a big part, but much of this comes down to the staff and the physical environment.

“The best care could be delivered in a tent,” says Woodward of the latter, although she acknowledges the role that the design and layout of Knox plays in achieving an environment that is person-centred.

Although construction is still underway, the new “household” set-up at Knox is exemplary.

Fifteen residents share what is essentially an open-plan kitchen-dining-living area.

Woodward would love to take the household concept a step further and have the bedrooms feeding directly into the living spaces, to reflect a layout that is homelier still. Fire regulations currently forbid this, but Woodward says she is prepared to take the council on over this matter.

As things stand, meals are served in the household dining tables, where the residents

aged care eat together. Woodward expects the large communal dining room will eventually not be used for meal times, as the household set-up is proving to be so effective.

But what catches my eye are the full working kitchens with plenty of bench space and modern appliances. The fridges are filled with food, all labelled with the residents’ names. It is reminiscent of a student flat.

“Imagine being restricted to only the food that is cooked for you,” Woodward says disdainfully. While all meals are provided, sometimes a resident may fancy cooking something for themselves.

On weekends, a breakfast buffet lasts all morning, and residents can eat at their leisure.

Care partners often eat with the residents.

Certainly, the household set-up seems to lend itself to closer staff-resident relationships.

In one household I visit, there are some residents watching TV, a couple having a cup of tea with the household’s home maker, and a care partner sitting with them at the dining table writing her notes.

The care partner’s presence in the room does more then she is possibly aware. She chats away while she’s writing, in much the same way a student would complete her homework in the kitchen. Instead of being tucked away writing notes in the nurses’ station, she is contributing to the room’s warm, relaxed atmosphere.

In the same way, the home maker – “we don’t call them cleaners,” Woodward informs me – is clearly a vital part of the household, ensuring it is a nice place to be.

Woodward sees the home maker role maturing into eventually assisting residents to do their own laundry if they wish.

It seems the model of anchoring care partners and home makers to households has not only enabled the relationships between staff and residents to really blossom, but has empowered the care partners to be more proactive, to use their initiative more, and feel more confident about making decisions.

That is not to say the model is without its challenges. Woodward says anchoring care partner teams to households has been “jolly difficult”, mainly due to unforeseen things like staff illness or parental leave.

Staffing can be a complex issue, particularly in this sector. The aged care workforce, in general terms, remains burdened by low wages, a lack of mandatory training, and in many cases, high turnover. Consequently, many facilities find their staff stretched, with nurses and caregivers overseeing large numbers of residents. A facility might have every intention of personalised care, yet finds itself operating most days in survival mode.

The goal changes from finding out what a resident needs or wants or feels that morning, to simply getting them up and dressed in time for breakfast.

Woodward says it is difficult to completely avoid operating in an institutionalised way.

“The tyranny of the clock exists all the time,” she says. The point of difference at Elizabeth Knox, she feels, is that there is a pressure to help get residents up as early as the residents want to be up, such is the residents’ desire to get stuck into each day.

Woodward tells me it is “positively frenetic” during the week, but even on the Saturday I am there, the place is humming. There are people coming and going to vote, families visiting, a movie in progress, (a resident-run activity every Saturday), volunteers making drinks and chatting with residents.

The volunteers also play an important part in the Knox environment. There are a staggering 600 volunteers in the programme.

The youngest is 12 and the eldest in their 80s.

Woodward shares with me a beautiful card from a volunteer given to a resident with advanced dementia. It describes how much her friendship with the older lady has come to mean to her and helped her to come to grips with living in a new place.

Knox has a strong relationship with Languages International, and many of the volunteers come from there. Like the author of the card, many are a long way from home, and Knox offers a respite from their loneliness and a chance to improve their English in a safe environment.

Girls from nearby St Cuthbert’s College are frequent after-school volunteers, too, often making biscuits in the kitchens with the residents.

It is very difficult to imagine a resident being bored or lonely here – especially when there is the opportunity to alleviate another person’s loneliness. The principles of the Eden Alternative hinge on combating loneliness, helplessness, and boredom, and I am not surprised to learn that Knox is the first care

provider in New Zealand to achieve full Eden Alternative Registration.

Woodward says they have trained over 135 team members as Eden Associates, and for the past two years have held weekly Eden sessions for residents, family, and staff, which have helped the whole Knox community engage in decision-making, not only in terms of care delivery, but in the strategic decisions related to the ongoing site redevelopment.

Woodward gives the example of how one resident suggested the kitchen bench tops and appliances were lower to accommodate those in wheelchairs, which has been a very practical modification to the plans.

I’ve often heard caregivers, nurses, and managers say they aim to treat their residents how they, the carer, would like to be treated – which is certainly admirable – but really, the emphasis should be on treating residents how they, the residents, like to be treated. No one has the same needs and wants.

As I leave Knox, I think about how I would like my life as a resident to be. I like to cook. I like to read and write. I like to exercise. I like to be social sometimes, but reclusive at others.

While my capacity to cook, write, and exercise may wane, I can’t envisage a day when I won’t want to do any of these things. So when the time comes for me to go into a care facility, if it is to be truly person-centred, it is going to need to accommodate these things.

I see Knox residents returning from casting their vote. They look happy. Indeed, there is something satisfying about choosing your preferred party and candidate from a list of options. Choice and flexibility are fundamental to their lives at Knox, thanks to a person-centred approach that hasn’t been achieved by a single change or variable but a raft of factors stemming from a common vision.

www.insitemagazine.co.nz | October/November 2014

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News

New Zealand 10th best country for older person wellbeing New Zealand ranks tenth out of 96 countries in a global index measuring the wellbeing of older people.

HelpAge International used the recent International Day of the Older Person as the launch date of the Global AgeWatch Index, which ranks 96 countries according to the wellbeing of older people.

New Zealand has been given an index ranking of 10, ahead of United Kingdom (11th) and Australia (13th), and just trailing USA (8th) and Japan (9th). Norway topped the charts, closely followed by Sweden, Switzerland, Canada, and Germany.

According to the new index, New Zealand performed best in the capability domain with a high employment rate of older people (73.3 per cent).

This comes as no surprise to Human Rights Commissioner Dr Jackie Blue.

“Over 21 per cent of over 65-year-olds continue to work. Over 30 per cent are volunteers, and the majority live independent ,productive lives.”

However, Dr Blue emphasises that elder abuse in still prevalent in New Zealand.

“While clearly our senior citizens are valuable contributors to our society and economy, sadly, elder abuse in New Zealand is a growing and serious concern.”

Dr Blue highlights the International Day of the Older Person as an opportunity to not only celebrate our senior citizens, but also to acknowledge the need to protect our kaumatua, or older people, from abuse and neglect.

“Seventy five per cent of abuse of elderly people comes from a family member and can range from neglect, physical and psychological abuse, to financial abuse. Like family violence, there is often deep shame by the victim in admitting what is happening, particularly when it is financial abuse by a family member.

“From a human rights perspective, clearly local and central government policy development must include specific consideration of our ageing population and their right to a decent standard of living and protection from harm,” Dr Blue said.

Dr Blue pleaded New Zealanders to check in on older people in the community and not to assume that they are living in an abuse free environment.

Age Concern New Zealand chief executive Robyn Scott says that she is thrilled to see New Zealand ranked at number 10 in the

Global AgeWatch Index. She says that the ranking should encourage the future government to ensure that the good policies that thave led us to this ranking are not eroded.

“I believe this high ranking is a testimony of good policies of the past. Older people in New Zealand have access to appropriate housing and a good public health care system.”

“The report shows us that strong policies that support older people such as education and employment opportunities as well as subsidised transport are of great importance to older people.”

Mrs Scott says that at Age Concern the focus is strongly on creating an enabling environment for older people, although she believes there is room for improvement in the area of public transport.

“Many rural areas in New Zealand have limited options for public transport, resulting in increased social isolation for older people in these areas.”

Check out www.helpage.org for more information on the Global AgeWatch Index 2014.

New retirement village group Hercules set to flex muscles A new player has emerged in New Zealand’s retirement village and aged care sectors. Nineteen privately owned retirement villages and aged care facilities are considering a proposal to amalgamate ownership under a corporate entity, Hercules Ltd. The group is not prepared to release the names of the “established and well performing” facilities. However, it has emerged that Park Lane Retirement Village in Christchurch is among the group. Eight villages or facilities are from the Christchurch area and two in Nelson, with others in Hibiscus Coast, Auckland, Tauranga, Palmerston North, New Plymouth, Waikanae, Blenheim, and Rangiora.

The concept has been in the pipeline for some time, with Hercules director Michael Ambrose crediting the vision of the late Grant Adamson, one of the drivers of New Zealand’s retirement village industry.

The group would have more than 2000 residents, with 48 per cent accommodated in aged care. Ambrose says providing a continuum of care will be a key focus of the Hercules group.

Facility owners will meet in October to approve the transfer of ownership to Hercules in exchange for shares in the company.

Hercules spokesman John Draper confirms the villages and facilities have been given valuations by property company CBRE and that the next step involves the owners approving these valuations.

It is anticipated that the proposed group will go ahead, due to the potential benefits for the current owners. As shareholders, they will have an investment in an enlarged group of villages and a public company. Under the new model, there is likely to be greater scope for maintaining and improving the villages and facilities and better opportunities for employees.

Draper says the villages will likely adopt the branding of the new group. However, the final name of the group is yet to be decided, as Hercules is the provisional name.

Hercules will seek to complete an Initial Public Offering and listing on the NZX. At this stage, it is envisaged the offer will seek to raise $50 million to $100 million through the issue of new shares, the proceeds of which will be used to pay down debt and provide funds for future growth.

It is unclear what impact the Hercules group will have on New Zealand’s village and aged care sectors. The dip in New Zealand shares of some listed retirement village operators following the announcement of Hercules’ entry onto the market suggests the new group could pose a competitive threat to those already listed.

Got an opinion? Have your say online at www.insitemagazine.co.nz 4

October/November 2014 | www.insitemagazine.co.nz

FOCUS

Sweet as honey As resistance to antibiotics strengthens, it is more important than ever to look for alternative treatments.

When it comes to wound care and infection control, mānuka honey is proving to be a strong contender.

By JUDE BARBACK.

I

t seems hard to believe that something we spread on our toast also occupies an important place in the medicine cabinet, but research and clinical trials suggest that honey is every bit as useful now for treating wounds and fighting infection as it was in ancient times.

History lesson

Much of medicinal history relates to treating battle injuries. In Mesopotamia (2100 bc), after cleaning a wound with beer, a bandage with wine and turpentine was applied. In Ancient Egypt, after irrigating a wound with wine, physicians would then cover the wound with fat and honey. In Ancient Greece, wounds were covered and treated with herbs; infected wounds were healed with scrapings from bronze spears. Four hundred years later, Hippocrates taught that wounds should be washed with wine, bandaged, and then saturated with more wine. Vinegar, boiling oil, egg yolk, and turpentine also made it into the annals of medicine, as time and knowledge progressed.

Not all ancient natural remedies have retained a place in modern medicine.

However, honey appears to be a notable exception.

Mānuka honey – a national treasure

Not all honeys were created equal, however.

Leptospermum spp. honeys, known as mānuka honey in New Zealand, is one type that is lauded the world over for its medicinal properties.

All honeys, to some degree, have antibacterial properties due to their high sugar content and lower water content. They produce hydrogen peroxide when diluted, making them antibacterial. But most are very unstable, are typically affected by heat and light, and are only activated by water.

Cliff Van Eaton’s new book Mānuka, the biography of an extraordinary honey recounts the story of how research led by scientist Peter Molan in 1980 at the University of Waikato, resulted in an important discovery about what set mānuka apart from other honeys.

Molan was supervising a small experiment carried out by a high school teacher in his lab, testing some local honeys against

bacteria. One of the samples yielded a confusing result, prompting Molan to investigate further. He had read that some honeys exhibited non-peroxide activities, so he set up an experiment with blackberry, clover, and mānuka honeys in which the hydrogen peroxide was knocked out.

While the blackberry and clover honeys had no effect, the mānuka honey proved to be very effective against the bacteria.

The subsequent research showed that some strains of mānuka honey have a powerful, naturally-present, unique antibacterial activity not found in any other variety of honey due to its non-peroxide activity. It is also more stable, proving to be resistant to heat and light. But due to the variations within mānuka honeys, the Unique Mānuka Factor (UMF) rating was established to help identify those that contained these particular attributes.

The rise of medicalgrade honeys

Van Eaton’s book describes the amazing experience of Aaron Phipps in 1999, whose extensive wounds resulting from meningococcal septicaemia completely healed within nine weeks with the help of mānuka honey – after nine months of trying more conventional treatments. Phipps’ story, and others’, helped support earlier arguments for mānuka honey to be used in a medicinal context. As the clinical research started to stack up, it became clear that this medicinal honey was not to be overlooked.

The UMF rating and antibacterial properties are not alone sufficient to classify mānuka honey as a medical-grade honey.

When collecting honey, like any natural

product, there is the likelihood of minor contaminants entering the product. While our stomachs can easily digest these, it is necessary to remove the bacteria completely from a honey product that is to be used in the treatment of wounds. Therefore, honey used for this purpose is collected in a vastly different manner, ensuring it is cleaned and sterilised by gamma irradiation, which does not affect its antibacterial properties.

Medical-grade honeys are making their mark all over the world, and perhaps the best known example emerges from New Zealand: Comvita’s Medihoney brand, which incorporates a range of first-aid and www.insitemagazine.co.nz | October/November 2014

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focus skincare products that are now used in hospitals and clinics around the worldand are challenging the reliance on synthetic medicines and treatments. It is one of the first medically certified honeys licensed as a medical product for professional wound care in Europe and Australia.

The Medihoney brand has withstood the rigour of clinical trials, with its first trials started under its Australian ownership and subsequent trials undertaken since Comvita took on the brand. Comvita provides a reference list that currently includes 129 articles or posters published in scientific or medical journals that reference Medihoney.

Heidi Darcy, a clinical advisor at Comvita, says there has been a big growth in the medical-grade honey market. She agrees that the growing resistance to antibiotics has the world looking for alternative treatments, and medical-grade honey can provide answers.

“Even over thousands of years, bacteria still hasn’t been able to develop resistance to mānuka honey,” she says.

Fighting MRSA

A similar argument for honey over antibiotics is emerging around its use as a treatment for the superbug MRSA (methicillin-resistant Staphylococcus aureus).

Eradication of MRSA from colonised wounds following topical application of mānuka honey has been reported in patients with leg ulcers, and new research shows it could have a place in eliminating nasal MRSA as well.

New Zealand infection control specialist and peri-operative nurse Elsie Truter, a lecturer at Rotorua’s Waiariki Technical Institute, says it is only a matter of time before resistance develops to the antibiotic currently used to eliminate nasal MRSA.

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October/November 2014 | www.insitemagazine.co.nz

“We are working with an ever-shrinking arsenal of antibiotics that can be used to treat infections. If we could develop new products that still have bactericidal ability that would be really good. Hopefully, mānuka honey will do it. It is showing some interesting results.”

Some scientists claim that significant advantages can be found from combining mānuka honey with other formulations.

Mānuka honey expert Dr Lynne Chepulis, also of Waiariki Institute of Technology, says combining mānuka honey with CycloPower™ has been shown in the lab to be even more effective in inhibiting the growth of MRSA. The mānuka honey with CycloPower™ nasal cream product was developed by New Zealand biotechnology company Mānuka Health, which commissioned The University of Auckland to conduct this research. It is soon to be clinically trialled.

Very seldom do natural products make such an impact in the world of modern medicine. What is exciting, from an economic perspective, is that the potential for medical-grade honey is huge. The worldwide market for products to treat advanced wounds is over US$5 billion per year and growing annually by 10%. As we start to comprehend the realities of a postantibiotic age, longer life expectancy and increasing diabetes rates, we are bound to see mānuka honey products taking everincreasing bites out of this market.

Exisle Publishing is pleased to offer INsite readers 15% off the newly published book Manuka, the biography of an extraordinary honey by Cliff Van Eaton, which normally retails for $34.99.

Please contact editor@insitemagazine.co.nz for details.

Saving Daylight Metlifecare’s The Poynton has made use of one of nature’s most readily available ingredients – daylight. The Auckland retirement complex recently added the latest in natural daylighting technology.

The apartments on the top floor of Metlifecare’s The Poynton complex had Solatube daylighting systems installed in the kitchens to enable maximum daylight optimisation. The internal ensuites and bathrooms also had the systems installed to provide natural light to areas that would otherwise be reliant on electric lighting all day.

International studies have shown that a living environment lit predominantly with natural daylight improves people’s sleep patterns, circadian rhythms and mental health.

Healthcare providers have also found exposure to daylight decreases a patient’s length of stay in hospital, lessens agitation among dementia patients, and helps to ease pain.

There’s also the ‘green’ advantage of reducing electricity consumption.

The daylighting systems are also more thermally efficient than traditional skylights, and therefore, cost-effective as well.

focus

A new global guideline for

pressure injuries

As the Guideline Development Group representative for the New Zealand Wound Care Society (NZWCS), PAM MITCHELL was pleased to be involved in the creation of the 2014 International Guideline: Prevention and Treatment for Pressure Ulcers: Clinical Practice Guideline.

R

epresentatives from the New Zealand Wound Care Society collaborated with colleagues from around the world in creating the 2014 International Guideline, Prevention and Treatment for Pressure Ulcers: Clinical Practice Guideline. The new guideline was launched at the European Pressure Ulcer Advisory Panel (EPUAP) conference in Stockholm on 27 August this year by chairperson of the Guideline Development Group Dr Lisette Schoonhoven.

It provides the best practice evidence for the implementation of preventative strategies in regard to pressure injury.

Building the Guideline – a global effort

The 2014 International Guideline, Prevention and Treatment for Pressure Ulcers: Clinical Practice Guideline, is the culmination of two years of work.

The invitation in 2012 by the NPUAP/EPUAP (North American and European Pressure Ulcer Advisory Panel) group to update their guidelines opened the door for Pan-Pacific Pressure Injury Prevention (PPPIP) members to work on these from a global viewpoint.

Pressure injuries (also known as pressure ulcers, bed sores, or decubitus ulcers) create a cost of millions of health dollars per year internationally.

In Australia alone, the cost in 2005 was $285 million nationally. New Zealand does not hold national database figures. Therefore, the costs associated with pressure injuries and the extent of the problem is largely unknown. A number of New Zealand District Health Boards do conduct prevalence and incidence studies but data collection tools, as well as reporting the findings, are inconsistent.

There should be little doubt that New Zealand’s pressure injuries are comparable with those in Australian care facilities. Some estimates for acute and sub-acute healthcare facilities are between six and 48 per cent, and around 26 per cent for longterm care.

Pressure injuries have a profound physical and psychological effect on their recipients, aside from the pain, anxiety, loss of income, and limitations in function that the person may experience. They can also cause death.

The New Zealand Wound Care Society began to work more closely with our Australian and Pan-Pacific colleagues. This aim climaxed in the publication of the Pan Pacific Clinical Practice Guidelines for the Prevention and Management of Pressure Injury Guidelines (PPCPG) in 2012.

EPUAP Conference, Stockholm, Sweden. From Left: Margaret Goldberg (NPUAP president), Dr Lisette Schoonhoven (EPUAP president-elect & chair of Guideline Development Group), Professor Amit Gefen (president EPUAP) and Pam Mitchell (NZWCS representative of PPPIA)

Highlights of the new Guideline

The new 2014 International Guideline builds on the evidence base surrounding pressure injuries.

It contains many new recommendations and new sections. Some address the specific needs of special populations, including obese individuals, critically ill individuals, older adults, paediatric individuals, palliative care patients, and patients in operating rooms. These chapters will support us in our daily practice and improve our knowledge and management of these vulnerable groups.

Each recommendation has both strength of evidence (evidence base indicating volume and quality of evidence) and strength of recommendation (the extent to which one can be confident that adherence to a recommendation will do more good than harm) which are based on rigorous methodological standards and will support health professionals in their decision-making.

Contemporary issues such as biofilms, the use of prophylactic dressings, microclimate control, the development of medical-device-related pressure ulcers, and the use of low-friction fabrics are also covered. This new research and technology will challenge us, increase our knowledge, and provide innovative ways of addressing these issues that will benefit our patients.

The NPUAP/EPUAP International Pressure Ulcer Classification system is complete with category/stage descriptions and illustrative photography is included.

Implementation can be challenging, and to this end, there are four chapters to assist in the implementation of the guideline within organisations.

The guideline is relevant to all clinicians, consumers, administrators, educators, researchers, policy makers, and industry. The section for consumers is a demonstration of its versatility, written in lay language, to further increase the guideline’s use.

Stop Pressure Injury Day The new guideline is just part of a wider campaign to increase the profile of pressure injuries and optimise the care of people most at risk. Another strategy, The International Stop Pressure Ulcer/ Injury Day, is aimed to raise awareness and is held annually on the third Thursday in November, this year on 20 November.

The NZWCS encourages facilities to organise activities around this day, making use of the resources available for download on its website (www.nzwcs.org.nz), to help increase the profile of pressure injury awareness.

References are available on request.

For a full list of everyone involved in the establishing the new guideline, please see the online version of this article at www.insitemagazine.co.nz

www.insitemagazine.co.nz | October/November 2014

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focus

The rise and rise of multi-resistant organisms Bug Control New Zealand Ltd Infection Control Advisory Service discusses CRE, the next big bug about to hit New Zealand, and what care facilities can expect.

Risk factors for acquisition (colonisation or infection)

M

ulti-resistant organisms (MROs) are on the rise, and we are seeing them enter into residential care facilities from both the acute care sector as well as the community. MROs such as extended Beta lactamases (ESBLs) are on the rise every year.

A new and emerging MRO is carbapenem-resistant enterobacteriaceae (CRE). While there are no reported cases of this MRO in New Zealand to date, there are many reported cases in Australia, and given the countries’ proximity and the frequency of travel between the two, it will only be a matter of time before cases start to appear here. The main thing to remember is not to overreact. There are standard and transmission-based contact precautions to be followed that can minimise risk following a comprehensive risk assessment for each case.

What is CRE?

Enterobacteriaceae are a family of bacteria that are found in the normal human intestinal tract. Sometimes these bacteria can spread outside of the bowel and cause infection – e.g. urinary tract infection, wound infection, and pneumonia. Carbapenems are powerful antibiotics used to treat serious infections. Some enterobacteriaceae have become resistant to carbapenem antibiotics, and these are referred to as carbapenemresistant enterobacteriaceae or CRE. The occurrence of antimicrobial resistance in these and other gram-negative bacteria is increasingly reported worldwide and has 8

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become a major threat to the provision of healthcare. In recent years, infections caused

by CRE have become more common in overseas hospitals.

The carbapenem group of antibiotics (imipenem, meropenem, doripenem, ertapenem) are considered last resort antibiotics as they offer broad spectrum antibiotic cover, enabling safe and effective treatment for severe infections. CRE occur due to the acquisition of carbapenemase enzymes (i.e. carbapenemase-producing enterobacteriaceae or CPE) or less commonly arise via other mechanisms, such as porin loss. Within the enterobacteriaceae family, carbapenemases have been found most commonly in escherichia coli and klebsiella pneumoniae, although they have also been reported in other gramnegative bacteria, such as pseudomonas and acinetobacter species.

Carbapenemase-producing enterobacteriaceae pose a particular infection prevention and control risk to any healthcare or residential care facility, as they are difficult to treat, and they can more efficiently be transmitted between patients and residents within a facility. CPE have caused a number of healthcare facility outbreaks overseas.

Recently in Australia, a number of cases of CPE have been reported in people who acquired the organism overseas. Following the detection of a CRE by the pathology laboratory, the confirmation of CPE requires specialised molecular testing in a referral laboratory, which may take several days.

In New Zealand, the major risk factor for acquiring CRE is recent hospitalisation in a healthcare setting overseas. Hospitalisation in the Indian subcontinent, Israel, Greece, Eastern Europe, China, North America, and South East Asia appears to confer the greatest risk.

Within healthcare facilities in countries where CRE are endemic, risk factors include prior antimicrobial use, length of hospital stay, severity of illness, mechanical ventilation, intensive care, the presence of wounds, prior surgery, and recent transplantation.

The majority of people who acquire CRE are colonised rather than infected.

The primary site of colonisation is the lower gastro-intestinal tract. The duration of colonisation is unknown but is possibly lifelong. CRE can survive on environmental surfaces and equipment.

Risk factors for transmission

Certain CRE-positive patients and residents are more likely to contaminate the environment, together with the hands of healthcare workers. These include: »» patients and residents with diarrhoea or faecal incontinence, enterostomies, discharging wounds »» catheterised patients and residents with CRE colonisation of the urinary tract »» patients and residents who are incapable of maintaining their own personal hygiene.

Caregivers providing direct care to these patients and residents are at increased risk of transient acquisition of CRE on their hands if standard and transmission-based contact precautions are not strictly followed.

The routes of transmission from patient or resident are either by direct contact through carriage of CRE on the hands of caregivers or indirectly via contaminated environmental surfaces or shared equipment.

Want to know more? ‘Simple Solutions to Managing Multi Resistant Organisms’ is the topic of a series of education sessions that are being run around New Zealand by Bug Control Ltd to help your knowledge about how to manage CRE and other MROs. Most facilities over-manage residents with MROs and therefore spend valuable time and money unnecessarily.

focus

Outsmarting the outbreak:

pandemic management and control INsite talks to the Emergency Response team at Counties Manukau District Health Board (CMDHB) about the processes involved with preparing for and managing major virus outbreaks.

INsite: What processes does Counties Manukau DHB take in preparing for a potential outbreak?

CMDHB: The Counties Manukau Health Pandemic Plan was developed by the Emergency Response team working in collaboration with services across the organisation in a multi-disciplinary team effort. In the instance of a potential outbreak, such as Ebola or Norovirus, a technical advisory group (TAG) convenes to plan any specific protocols and processes required for the specific outbreak and an incident action plan developed. This information is communicated to services managers and hospital staff via an organisational email.

Counties Manukau Health has a flu planning group that convenes annually prior to and during winter to plan strategies for the management for influenza-like illnesses.

The Counties Manukau Health Emergency Plan on the website is due to be updated.

In terms of preparing for a specific outbreak, such as Ebola virus, Norovirus, or a particular strain of influenza, what additional steps are taken?

In terms of DHB planning, standard infection control business precautions are in place. Strategic planning is put in place when there is an increase in infectious patient numbers or an unusual/particular strain of virus by senior management and technical advisors regarding specific requirements for the response.

In terms of regional planning, the northern region DHBs (Auckland, Waitemata, Northland and Counties Manukau) are all part of the governing

Health Coordinating Executive Group (HCEG) and are responsible for coordinating regional-based emergency management planning activities across the northern region (as defined by the Civil Defence Emergency Management Act 2002). This group collaborates to ensure the effective coordination of health emergency management and includes risk reduction, readiness, response, and recovery planning for the northern region.

What is done to educate and inform staff about health emergency procedures?

The emergency services (Police, Fire, Ambulance, Civil Defence, and relevant agencies) all use the same CIMS structure to manage incidents, enabling staff to form the Incident Management team. Health CIMS training (two hours) is provided for charge nurse level up and Auckland Civil Defence CIMS 4 training (two-day) is provided for service managers and general managers.

Are there any measures taken to educate patients and the wider public?

Depending on the scale of the incident, communication is disseminated via public health messages using posters, leaflets, websites, 0800 number, radio, TV.

In the event of an outbreak/health emergency do you find you usually adhere to the plan, or is there more ‘thinking on feet’ involved, depending on the severity of the incident?

Counties Manukau Health has emergency plans that include the management structure, processes, and procedures. These plans are flexible enough to meet the need to respond

to any eventuality. The Major Incident Plan (MIP) is the overarching plan, the Pandemic Plan links with the MIP, and each service has their own Service Specific Emergency Plan that also links to the MIP. These plans include roles and responsibilities, actions required and task cards.

Can you give an example of an incident or outbreak where valuable lessons were learned and fed back into the planning and procedures documents for another time?

The lessons from the 2009 outbreak of H1N1 required the Counties Manukau Health Pandemic Plan to be reviewed extensively as there were plans in place that did not eventuate at the time needed – i.e. setting up of community-based assessment centres.

What advice would you give to the managers and lead clinical staff of aged care facilities and retirement villages for being prepared to deal with a pandemic or outbreak?

Each aged care facility is responsible for developing their own pandemic/outbreak procedures. Standard precautions represent the minimum infection prevention measures that apply to all patient care delivered in any setting at all times. The procedure objective would be to provide a framework to reduce the risk of transmission of microorganisms from both known and unknown sources of infection to protect healthcare personnel and patients and their families and to emphasise the responsibilities of staff with regard to implementing infection prevention and control measures. www.insitemagazine.co.nz | October/November 2014

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retirement

The Abbeyfield alternative

INsite’s recent articles on retirement villages and care facilities prompted BEATRICE HALE to consider alternative forms of senior housing. Here, she examines the Abbeyfield model.

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ome move into senior housing from physical necessity; others because they want smaller premises and maybe some relief from home maintenance; and others because living alone becomes depressing. If we want to move for these social reasons, there is the choice between a unit in a retirement village or supported living in an Abbeyfield house, representing a home within a home. The number of residents is important to many seniors. Small and intimate, family-like, with the chance of making good friendships – that’s what makes Abbeyfield so attractive to many.

Origins

Abbeyfield began in London in1956 as the vision of former British army major Richard Carr-Gomm who left the army, after hearing evangelist Billy Graham, to work as a volunteer home-helper with people in need. He was appalled by the isolation and loneliness of older people when he began visiting. So he bought a small house in Bermondsey and invited two local residents who’d been living alone to join him.

There are 11 Abbeyfield houses in New Zealand, with two more under construction in Christchurch. Each is 10

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managed by a local committee of volunteers and has a committee of residents, meeting regularly, to air issues and ideas and solve any problems. There is a resident housekeeper to maintain the house, make the meals, and to help solve problems.

Practicalities

Some homes give potential residents the chance to try Abbeyfield by living in a guest room for a week or two. Once accepted, the resident furnishes and cares for their own room, lives independently and as privately as they wish, but socialises with other residents for main meals. They must have a personal advocate or friend who can assist in any emergency.

If a resident is sick, the resident housekeeper will provide meals for short periods of time. Otherwise, it is up to family and friends to help. If a resident has a disability requiring home care, their carer is still in attendance, and other services, such as district nursing, will visit.

Charges vary from house to house but the rents, which include main meals, are below national superannuation, with a living-alone allowance for single residents and a meanstested accommodation supplement to help.

Dunedin Abbeyfield

Dunedin Abbeyfield is a two-storey brick house with a platform lift, surrounded by a small garden, where residents can and do continue gardening. Many of the residents are from nearby suburbs. What prompted their move? Some felt they needed support living alone, that things were getting on top of them. Others said they had been in hospital and hadn’t wanted to return home.

For others, a bereavement had prompted the need for change.

Fiona, resident for seven years, said Abbeyfield “couldn’t be better”; she describes it as her home. She enjoys the warmth and the cooked meals, the company, and the support of people in the house. She also maintains her many friendships in the community. She continues to garden in the small patch surrounding the house.

Margaret moved in with her husband seven years ago, and has remained there, despite her husband’s move to a care facility and subsequent death.

“It’s suitable,” she says, “Near old neighbours who visit regularly, and I could carry on gardening.”

retirement Rosalie, resident for three years, finds it “like a family”. She had already visited an Abbeyfield house during a trip to the UK and decided that that was what she wanted – friendly and private, independent but supported.

Gordon was cautious. He enjoyed the warmth, the friendship, the support, but said should he become frail and unable to look after himself, he would have to move on.

Margaret repeated how much she and the others enjoyed the convenience of bus stops nearby, doctors and physiotherapists in the vicinity, as well as the regularly visiting library bookbus. There’s a hairdresser and a new prepared-food outlet nearby; even a vet!

“Not that we need that,” said Margaret, “but often friends who take their animals to the vet will drop in and see us.”

Robyn, housekeeper for eight years, says her role is to “look after the welfare of the residents”. This involves house care and also cooking two meals a day. As Robyn is a qualified chef, the meals are appetising.

‘Welfare’, for her, includes “being a listening ear” for residents who might want to discuss personal concerns, and to ensure that residents feel well supported.

However, hands-on care is not part of Robyn’s role, nor of the Abbeyfield philosophy. For people with frailties, their home carers will continue to come as needed.

However, occasionally people needed more care and had to move.

An issue, she believes, is the absence of government funding. Like many in the social services, she believes that support for social wellbeing and alleviating loneliness should attract government funding.

often maintain the resident’s health for longer than independent living.

Abbeyfield, he emphasises, is a unique accommodation model, being smaller and more companionable than other places. Not everyone wants to live in a larger complex; some prefer smaller places, “like a family”.

Each of the Abbeyfield houses has different traditions: some have more organised events, others prefer to have greater privacy for their residents.

Supported living

Centralised Abbeyfield

Alan Somerville, chairperson of the management committee, reiterates “the essence of Abbeyfield is security and companionship” and that “security is for families as well as for residents”. Anxiety about a mother or father who is alone in a large house, maybe cold, maybe isolated and lonely, and maybe getting inadequate nutrition, can be alleviated by a move to Abbeyfield. This is a planned move, for social and welfare reasons, rather than a move made for medical urgency.

Somerville acknowledges the concerns over a move from Abbeyfield, in cases of increasing dependence, but says that the supported living provided by Abbeyfield will

Somerville is keen to see a strengthened New Zealand Abbeyfield, to which all Abbeyfield houses will belong. A stronger central body will help consolidate standards and allow for large-scale funding applications.

Being part of Abbeyfield New Zealand gives access to manuals of advice and procedures, other advice when required and financial planning assistance. Abbeyfield New Zealand helps keep standards consistently high.

So is Abbeyfield a major contender in the social housing field? Undoubtedly. The Dunedin residents emphasise the positives – supported living and pleasant companionship, care and consideration, someone on hand to turn to for support. www.insitemagazine.co.nz | October/November 2014

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research

Social integration of older New Zealanders Massey University’s Health and Ageing Research Team (HART)’s Independence, Contributions, and Connections (ICC) study reveals that working longer and socialising through the internet are related to social and health benefits for older people. PROFESSORS FIONA ALPASS and CHRISTINE STEPHENS looks at some initial findings.

In New Zealand, the population of people aged 65 and over is projected to double over the coming 30 years. Those over 65 will constitute 25 per cent of the population by 2040, while the number of oldest-old (those aged 85 and over) will expand more than fivefold to constitute five per cent of the population.

The Health, Work, and Retirement study (HWR) is a longitudinal study that was initiated in response to the challenges of population ageing. It is a population-level study that aims to identify the health, economic, and social factors underpinning successful ageing in New Zealand’s community dwelling population. The first HWR postal survey was conducted in 2006 with a representative sample of older New Zealanders aged 55 to 70 years.

Since then, four more waves of in-depth data have been collected using postal questionnaires and interviews to investigate quality of life within three broad areas: economic participation (e.g. meaning of work, employment, retirement); social participation (e.g. family support, social capital, participation); and resilience and health (e.g. physical, emotional, cognitive). We are presently about to go into the field for a sixth wave of data collection with our participants who are now aged 63 to 78 years old. ministry of Business, Innovation and Employment, focused on three issues: independence, contributions, and connections (ICC study). Here we will outline some initial findings from this study in regard to work, retirement, internet use and social connections.

Work and retirement

Extending people’s working life is seen by policy makers as a key element in addressing the rising social costs associated with an ageing population. Engagement in paid employment is also considered an important factor for the health and financial wellbeing of older adults. Over one third (35 per cent) of the ICC study participants aged 61 to 77 years were in paid employment, with half of these working full-time. Being in paid employment was associated with higher quality of life and better physical health than non-workers, but workers and retirees shared similar levels of mental health.

In 2013, over three quarters of the sample said that they expected to retire in the next five years. Age was by far the strongest predictor of their intended age of retirement. However, work-related factors also played a part. Those reporting lower job satisfaction and higher job stress intended to retire earlier. Those in poorer health were also more likely to plan earlier retirement. The strong relationship between poor physical health and lower workforce participation in general in the sample suggests that workers’ health must be taken into account when policy promotes more economic activity among older workers. To retain workers in the workforce, more consideration must be given to working conditions and their appropriateness for older workers.

In our previous data waves, entitlement to New Zealand superannuation has played an important role in shaping work and retirement intentions and behaviour. Reaching age 65 has been by far the most common reason for retirement. In the ICC study, among 12

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those aged 65 and under, only 32 per cent intend retiring before or at the age of eligibility for New Zealand Superannuation. Of the 68 per cent who intend retiring after 65, one quarter plan to retire at 70 years of age.

The ICC findings reflect international data that shows increasing labour force participation by older workers over the past three decades. New Zealand has the highest participation rate in the OECD with 40 per cent of 65-69-year-olds in the labour force.

The New Zealand Positive Ageing Strategy stresses the benefits of prolonging workforce participation and policies that support “productive lives in the economy and society” are to be encouraged.

Extending the working lives of older adults has the potential to benefit the individual through health and wellbeing gains and by improving material standards of living. Benefits to society are also possible as older workers contribute their skills and experience to the workplace and make contributions to economic growth through taxes and reduced dependence on social care.

Internet use and social connections

Social networks and social connections are an important contributor to the health and longevity of older adults who are also more likely to experience loneliness and depression as they age. As computer networking becomes increasingly dominant in our society, it is important to examine how this technology is used by older generations and whether it contributes to the development of supportive social networks. The ICC study specifically examined the nature of older people’s participation in cyberspace and the ways in which communication using computers contributed to their social integration.

We began this aspect of investigation by giving participants a choice of their usual postal questionnaire or an online option. There was a remarkable lack of response to the internet questionnaire.

Perhaps the familiarity of the postal questionnaire was a factor here; remember that these same people had already responded to five earlier questionnaires. Although the numbers were too low to generalise, the first indications were that older and poorer participants were less likely to use the online option. This fits with the rest of our findings about internet use.

There was no difference in internet use between males and females, but in terms of ethnicity, Māori were less likely to report using the internet. Older people were less likely to use it, and those with higher living standards were more likely to use the internet. The most common use of the internet among the whole sample was seeking information, closely followed by keeping in touch with friends and family. Eighty per cent of the sample agreed that the internet enabled them to keep in touch with people.

Social networking on the internet was related to both keeping in touch in your local area and to connecting with people outside the neighbourhood. Interestingly, people were nearly as likely to use the internet for local personal contact or for information about local events as they were for more distant connections. Furthermore,

research people who were already involved in Some cautions about wider community networks were more positive findings Encouraging older people to remain likely to use the internet than those who in the workforce and to participate had restricted social networks. These socially are two examples of current findings suggest that people who are social policy aimed at keeping older already well integrated socially are also people healthy and productive as more likely to use the internet to keep they age within an ageing society. up their connections.

Our findings – that working longer From a different perspective on the and socialising through the internet same issue, the ICC findings showed are related to social and health that those who used the internet less benefits for older people – support often were also more likely to report international findings and policies higher levels of isolation and feelings to encourage such participation. of loneliness. Thus, lack of internet use However, without attention to more could compound already existing social nuanced aspects of participation, isolation. such policies are also in danger of Overall, these results show that oppressing those who are already active participation with friends and disadvantaged. family online may contribute to the In regard to encouraging people to strengthening of participation in local extend their working lives, chronic Professor Fiona Alpass (L) and Professor Christine Stephens or long-term health conditions, communities and the broadening of lack of qualifications and skills, and caregiving responsibilities the social networks of older people. Those participants who use the pose considerable barriers to those wishing to remain in the internet more are more likely to belong to beneficial social networks workforce. Ageing workers in physically demanding or manual jobs and less likely to report isolation and loneliness. may be unable to continue functioning effectively in their roles.

Social engagement is well established as a reliable predictor of Ageism remains an obstacle and many older workers experience physical and cognitive health and protective against early mortality discrimination in regard to recruitment, training, and promotion. among older adults. So the development of internet use has the Interventions to extend working life must recognise the diversity potential to contribute to increased wellbeing. In particular, of the work and life experiences that older workers bring as they developing the capacity for internet use among those at risk of navigate the transition to retirement. isolation and poorer health may be a useful intervention.

As we discover the social benefits of internet use, it also becomes One aspect to be aware of is the potential for an increasing digital apparent that access to this tool is easier for those who can afford to divide. Socioeconomic status (assessed by variables such as income, run computers and for those who are already socially well connected. education, and living standards) is already a strong predictor of The digital divide is a new concern in the area of inequalities, and health and mortality in all populations and among older people. any moves to encourage older people to use the internet will need to Our study results show that, as we might expect, socioeconomic take access into account in many different ways including education, status also predicts internet use. While the use of digital media wealth, and location. and the internet have great potential for enhancing the social life Socioeconomic status, disability, and lifelong exclusion remain of some older people, there is also a danger that the privileged important considerations to be included in future research, access to digital media may result in widening inequalities in social intervention, and social policy aimed at promoting the wellbeing of older people. engagement and health outcomes.

www.insitemagazine.co.nz | October/November 2014

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aged care

On the soapbox ...

Martin Taylor

Election 2014: Not such a surprise

While the National Party’s ability to govern alone is a surprise, the outcome of the election is not such a surprise. The polls always had them well ahead so they were always going to be the next Government.

The assumption was they would need coalition partners, but in the end, this was not necessary.

Perhaps the most significant outcome of the election was Labour’s complete and comprehensive failure. Their proportion of the party vote went down to its lowest result since 1922. The question is whether a failure of this magnitude will result in an honest appraisal. National did that when they got their worst outcome under Bill English in 2002, and by 2005, they almost snatched the election away from Labour under Brash. But by 2008, they were and still are a real force.

It took them six years.

My guess is Labour do not have the ability to rebuild in three years. Structurally, they have kneecapped themselves by letting the wider membership and unions select the leader over their MPs. This has created a situation where David Cunliffe does not have the support of his own caucus – and it shows. Also, their continued focus on promoting diversity (labelled the “man ban”) means they are slowly disassociating themselves from mainstream New Zealanders, which has proven to be electoral suicide.

Labour also thought the 2011 loss was caused by ‘their vote’ staying at home and that by getting these 600,000 people out in 14

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2014, they would reverse their fortunes. That didn’t happen and the question is whether two consecutive elections with ‘their vote’ staying home is enough of a wake-up call to refocus on middle New Zealand.

Perhaps the most interesting left excuses for failure relates to the Dotcom impact.

Apparently, it is his fault as voters didn’t believe the left was an alternative to Key, and Dotcom took so much media time that the left could not get their message across. If anybody truly believes this, they are kidding themselves. National’s greatest asset is really brand Key. This brand was attacked mercilessly for weeks by a run of international and local conspiracy theorists, but in the end, it had no impact.

The reality is Key might well have done better in a normal campaign, without the Dotcom distraction, as Labour’s and the Green’s failures and faults would have been even more evident.

But what does this mean for the next three years in health? My guess is a continuation of what we have seen under Tony Ryall. No great reform and issue-by-issue tinkering to address risk with the quiet merging of DHBs into more sensible units. Probably the biggest issue for the new Minister will be the baby boomers impacting on health in general and aged care in particular from around

2017. When you look at the numbers, just maintaining the current subsidy rates will cost hundreds of millions extra in volume growth alone.

Overall, health is very important in a political sense and the left will need to make it a battle ground if they are going to have any hope of stopping Key roll into a fourth term. Tony Ryall, like him or loathe him, has been the most politically successful Minister of Health in modern times. For six years and two straight elections, under his micro-management, health has not been an issue. This is a remarkable achievement.

In many respects, health is a good political barometer; the more issues that come up, the worse the Government looks. So the question is, can the left organise themselves enough to be a credible opposition by testing and pushing National in the health portfolio? Time will tell, but at this stage, it does not seem likely. The new Minister of Health – whoever this will be – has big shoes to fill; it will be interesting to see if his or her approach will be more of the same or a focus on reforms necessary to meet the challenge of increasing numbers of demanding baby boomers.

Martin Taylor is chief executive of the New Zealand Aged Care Association.

clinical

Spotlight on ... adverse drug events Dr ANECITA GIG LIM backgrounds adverse drug events for the elderly and how to avoid them.

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dverse drug events are prevalent and can lead to serious or potentially fatal outcomes for older adults.

This is a particular concern because we are seeing a rapid rise in the proportion of older people in our population.

However, to date, there is only limited research that addresses drugs and related adverse drug events that is specific to older people*.

Older adults are increasingly susceptible to adverse drug events.

Generally, the older population will have a greater number of co-morbidities, with the implication that they will be polymedicated with many different kinds of drugs. There will also be age-related changes in the physiology of the body that will alter the pharmacodynamic and pharmacokinetic mechanisms through which a particular drug affects the body or conversely the way in which the body deals with the drug.

It has been suggested that almost 50 per cent of adverse drug events in older adults are preventable, and so appropriate pharmacovigilance may well serve to avoid such unnecessary harm**. Understanding the early signs of adverse effects would allow for earlier detection of an inappropriate medication and serious adverse drug events could be avoided as a result. Moreover, the initial dosing of medication and subsequent monitoring and evaluation of the given therapy is crucial to the safer management of the older patient and awareness of these various parameters is essential as an appropriate preventative measure.

A project was undertaken in 2010 by Tony Lee (3rd year medical student) to re-examine those medications that most commonly cause problems when prescribed to the elderly. Specific criteria were drawn up from the information gathered to inform current research on psychotropic drugs and their use in the older population. The purpose of the review was to enhance the understanding of drugs that are highly likely to cause adverse drug effects in the older adult population.

The results of the literature review identified a group of medications that most commonly cause adverse effects in the older population.

These are antidepressants, atypical antipsychotics, cholinesterase inhibitors, benzodiazepines, and statins (see diagram). Each class of medication had a specific set of common adverse effects and more serious adverse drug effects such as falls, cerebrovascular adverse events and rhabdomyolysis were associated with some medications.

The review found that there are a range of adverse effects that are associated with each class of drug. These adverse effects are more likely to occur in elderly patients. As older patients tend to have poor functioning liver and kidneys, they are highly susceptible to develop these adverse effects. Nurses must therefore ensure that they monitor the older adults for these adverse effects.

Overall, for many of these drugs, dosing should be carefully initiated within the ranges recommended for older adults and limited to the smallest effective dose particularly with benzodiazepines and statins. Also critical to safe care is appropriate prescribing of medications depending on patients’ renal and hepatic status and close monitoring of medication levels when renal and/ or hepatic function is impaired. It is therefore important that nurses in particular are aware of these factors. *Giron, M. S., Forsell, Y., Bernsten, C., Thorslund, M., Winblad, B., & Fastbom, J. (2001). Psychotropic drug use in elderly people with and without dementia. International Journal of Geriatric Psychiatry, 16(9) 900-906. **Beers M, Baran R, & Frenia K. (2000). Drugs and the elderly, Part 1: The problems facing managed care [Review] American Journal of Managed Care, 6 (12), 1313-1320.

Anecita Gigi Lim, RN PhD is a senior lecturer at The University of Auckland nursing school and co-ordinates three prescribing papers.

Dr ANECITA GIG LIM

“It has been suggested that almost 50 per cent of adverse drug events in older adults are preventable, and so appropriate pharmacovigilance may well serve to avoid such unnecessary harm� www.insitemagazine.co.nz | October/November 2014

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aged care

Let’s snoop around ...

Ranfurly Village JUDE BARBACK visits Ranfurly in Auckland and gets the low-down on the home’s foray with Campbell Live.

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nce upon a time there was a war veterans’ rest home called Ranfurly.

It seems apt to begin in this fashion.

I’ve written about Ranfurly Home and Hospital before, and in fairly glowing terms.

Indeed, the idea of breathing new life into a dilapidated war veterans’ home has a certain romantic quality.

However, this was all PCL. Pre-Campbell Live. Some seven months after that piece was published, the fairy tale was to take some darker turns.

In October last year, TV3’s Campbell Live ran a damning report on Ranfurly, claiming that standards had slipped since Retirement Assets Limited had taken over the operation of the rest home.

It was to be the first of three attacks on the facility. The second report targeted a resident with dementia who allegedly lost his way returning to Ranfurly, and the third a resident who fell from his power chair in public view.

Campbell Live’s treatment of each incident was one-sided and loaded with

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pre-agenda. Six months after the television treatment, I meet with manager Helen Martelli and hear the other side. I hear how the Campbell Live crew and the nurses’ union NZNO unlawfully gained entry into the secure dementia unit at 6.30am one morning – a move that later prompted a formal written apology from NZNO. I hear about sincere apologies of families who appeared on the show. I hear how a breach of the broadcasting standards was filed with the Broadcasting Standards Authority but frustratingly took nine months for the Authority to uphold the complaint as to accuracy and fairness; little comfort for Ranfurly after such a long time. I hear many facets of the incidents that make it clear Ranfurly was unfairly dealt a rough hand by the media.

But actually, none of this is particularly relevant anymore. I am more interested in how Ranfurly has emerged from the fray, and in what I will find on my tour of the facility.

It is what one would expect from a Retirement Assets Limited product – classy, modern, immaculate. Even on a rainy Auckland day, the place is bathed in natural light. It is spacious, tasteful, yet practical.

From the $56,000 hydrotherapy bath, to the state-of-the-art kitchen headed up by professional executive chef Terence, I cannot fault it on appearances. Martelli shares with me how they have already introduced a variety of technological innovations, including residents selecting their meals via an iPad and the introduction of electronic patient records.

Of course, a facility’s operation runs much deeper than shiny surfaces and bells and whistles, and so I ask to see the resident satisfaction surveys. The last one, with 56 per cent take-up, being over twice previous responses, reveals a 98 per cent satisfaction rating.

I then visit Shirley, a resident. While I am absorbing the dramatic view of Auckland from her window, I realise she has ducked into her ensuite. I wonder if I have unnerved

aged care her in some way, but no, she is simply aching to show off her personal bathroom. “You’re missing the best part!” she says.

I also meet Bob, who has just turned 100.

His room is equally impressive, with views spanning across Auckland, but it is the signed Blues jersey hanging above his bed that takes my eye. He was lucky enough to attend the All Blacks versus English test match at Eden Park, something that Ranfurly staff helped arrange. He can barely hide his disdain when I tell him I am a Chiefs supporter, but he softens as he spreads his many birthday cards out on his bed, including one from the Queen and one from Prime Minister John Key, whom Bob refers to as “the old boy”.

I meet several other residents along the way and their endorsement of Ranfurly echoes the high level of satisfaction indicated by the survey. I catch the last of the residents enjoying their lunch – fish and chips day, served out of paper like the “old days”, with salad and even a beer to wash it down with.

It is all very impressive. So how did Ranfurly find itself so lambasted by TV3?

Four years ago, aware that the existing Ranfurly War Veterans’ Home was in need of a major overhaul of its facilities and operation, the Ranfurly Trust partnered with Retirement Assets Limited, headed by director Graham Wilkinson, to take over the management and operation of the home.

And so the facility underwent a massive transition. Staff wages were found to be elevated far beyond industry norms and contributed to the unsustainable model upon which Ranfurly was operating. Consequently, it was proposed to adjust wage levels unless staff undertook industry training to justify the remuneration, and although they still

remain higher than the industry average – “in the top five per cent” Helen informs me – the fall-out from this particular change was significant.

Negotiations with the union were difficult, particularly because the restructure came at a time when the campaign for ‘fair share for aged care’ was gaining momentum. Martelli declares her support for fairer wages for aged care workers but is appalled at the way NZNO went about pursuing the cause.

The other controversial aspect of the overhaul was the activities programme.

Martelli describes the previous arrangement as an 80/20 programme, whereby 20 per cent of the residents were benefitting from 80 per cent of the activities. However, changing this to a more inclusive and varied programme again attracted criticism.

While Wilkinson and Martelli were aware from the outset that such a transition was never going to be easy, nothing prepared them for the media’s misrepresentation of the changes.

It was damaging for Ranfurly. Martelli describes how it affected the facility’s reputation, and she shares some of the scathing comments she received by people who only had half the story via Campbell Live. She describes staff too embarrassed to wear their uniforms out for fear of criticism from the public.

Yet they have emerged from the experience stronger and more resilient. Martelli shows me a picture of an enormous bouquet of flowers on her desk – a vote of gratitude and confidence for her leadership through the ordeal. Then there is a pic of Wilkinson, cooking a morale-boosting breakfast barbecue for the staff.

These are the photos that will never see the light of day on Campbell Live, and more is the pity, for they represent a certain tenacity and tenderness that lies at the true heart of this organisation.

There have been lessons learned along the way as well. For example, Martelli admits there was room for improvement in the way that changes to activities were communicated with residents and families, and communication has since vastly improved.

There has also been some upside. Ranfurly Trust, as a major stakeholder in the complex, asked what it could do to assist, and as a result provides funding for specialised occupational therapy, physiotherapy, and even bought a new Mercedes minivan for resident use. The Auckland RSA has also assisted with its connections with Eden Park and Sky City.

In light of the publicity, it would be reasonable to expect that Retirement Assets Ltd is eager to prove itself, but in reality, the facility – its happy residents, united staff and sound leadership –speaks for itself.

As I drive out the gate, I set eyes on the construction of phase two of the Ranfurly development – the first of several planned retirement apartment complexes due to open in November this year, of which over half have been sold already. I think about the lengthy waiting list for the 60 beds in the hospital. I think about Bob and Shirley and the men enjoying their fish and chips and Tui beer. I decide that in spite of the difficult journey they’ve had, Ranfurly has achieved its ‘happily ever after’ ending after all. www.insitemagazine.co.nz | October/November 2014

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conferences Presbyterian Support South Canterbury.

NZACA Bidvest Excellence Other 2014 NZACA Award in Food Award

for Care Homes and Hospitals Ranfuly

Ranfurly has been announced as one of this year’s finalists for the NZACA Bidvest Excellence in Food Award for Care Homes and Hospitals. As outlined in the previous article, the introduction of a professional executive chef and an innovative iPad meal selection system for residents has seen a vast improvement to the quality and choice of meals.

“The changes made revolve around having staff and management take ownership of the delivery of food and instilling in them a pride that they now get when the meal is served to the resident. The tangible benefits are represented in better quality, nutrition, choice, presentation, cost, and of course, resident satisfaction. Essentially we asked ourselves what and how we would want to eat and charged the executive chef and all staff to deliver at that level.” says Graham Wilkinson, director of Retirement Assets Ltd.

Presbyterian Support South Canterbury

The other finalist is Presbyterian Support South Canterbury (PSSC). Led by food services manager Linda Hogan, PSSC has made many changes to its food service for its three facilities to incorporate the principles of the Eden Alternative, thereby providing residents with not only enjoyable food but also opportunities for a more enjoyable life.

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Residents’ breakfasts underwent the first major change, with a buffet breakfast now on offer to those who preferred to get up for breakfast than have it served to them in bed. The buffet allows residents to enjoy the company of staff and other residents and has proved so successful that one of PSSC’s three facilities has now adopted buffet dining for all three meals.

More crockery was also purchased so staff could slacken tight schedules for the turnaround of dishes, thus enabling residents to enjoy a meal at their own pace and enjoy more conversation at the meal table.

The menu has been varied to incorporate different type of meals including finger food, barbeques and picnics, as well as more traditional meat and three-veg options.

Residents are more involved in their food as well, growing their own vegetables, and making cups of tea for other residents. A volunteer comes in on a weekly basis to assist the residents in baking something different for morning tea.

“You can actually feel the difference,” says Carolyn Cooper, PSSC Eldercare manager.

“It doesn’t have to cost more. It is just a matter of looking at things from a different angle, the resident’s angle, a bit of a no-brainer really.”

The winner will be announced at the NZACA Conference gala dinner, Thursday 16 October.

Finalists

Medi-Map Community Connections Award Finalists: Aria Gardens Home and Hospital – The social integration of residential aged care facilities.

Wharekaka Aged Care Facility – Connecting with our community.

Highly commended: Shalom Auckland and Radius Fulton Care Centre.

Health Ed Trust Training and Staff Development Award Finalists: Nurse Maude Hospital – An innovative training programme for hospital aides.

Oceania Group – Therapeutic moving and handling training package.

QPS Benchmarking Innovative Delivery Award Finalists: Mercy Parklands – Spark of Life Centre of Excellence.

Presbyterian Support South Canterbury – Our Eden journey.

Highly commended: Summerset Holdings.

Jackson Van Interior Built and Grown Environment Award Finalists: Oceania Group – Eden Lifestyle Care and Village.

Bethlehem Views.

The 2014 NZACA Conference: ‘Facing Tomorrow’s Challenges Today’ will be held from 15–17 October 2014 at Shed 6 and TSB Bank Arena, Wellington. Visit www.nzaca.org.nz for more information.

retirement

Up close and personal with ... Frances Denz INsite meets Metlifecare Senior New Zealander of the Year, FRANCES DENZ. INsite: Earlier this year you were awarded Metlifecare Senior New Zealander of the Year. Did this come as a surprise?

Denz: Both the nomination and the win were a real surprise. My friends are obviously good at keeping secrets!

The title of Senior New Zealander of the Year puts you in a position to inspire and motivate others. What is your main message to older New Zealanders as to how they can get the most out of life?

Don’t stop doing new things, making new friends, and learning how the world works, today, tomorrow, and in the future. Life is too special to waste it.

I understand the Senior New Zealander of the Year title joins an array of other awards, including a Member of the New Zealand Order of Merit for services to business.

What do you feel has been your biggest contribution to the Tauranga/ New Zealand business sector?

Taking the longer view, my contribution to the business sector has been the 6,000 people I have trained in the art of running a business, with 4,000 of them doing so. To the best of my knowledge, only five have gone bankrupt. And also the fact that about 800 of those people had a disability, usually major, so that employment was difficult or impossible. But running their own business gave them a focus on life, a reason to keep going, and independence from the state. They are amazing people.

My work now is with those who want to be excellent company directors and trustees.

Being a director or trustee is wonderful as the board is responsible for the values and vision of the organisation and making sure that it achieves what it sets out to do.

You’ve also received an Exceptional Adult Educator Award and a Tertiary Teaching Excellence Award, despite having no formal tertiary teacher education – you must be doing something right! What is the difference between a good teacher and an excellent one?

A passion for the topic and real life experience helps. To be able to communicate

using language and imagery that participants understand is critical to their learning and to treat them all with respect as adults who can take responsibility for themselves.

You serve on a number of boards.

New Zealand boards are well known for their shortage of women directors. Why do you think this is the case? Do you think a woman’s perspective, even presence, adds a different tone to a board room? What do you think should be done to get more women on boards?

In part, the problem is because boards use the ‘old boy network’ to select their boards.

This is understandable as board members do need to trust each other and know how they will behave in any given situation. By and large, the people they trust are like them – usually suited older men who have experience in directing. They don’t feel challenged and uncomfortable when they are with like-minded people.

Does a woman’s presence make a difference? I personally don’t know! You would need to ask a man. What I do know is that when I open my mouth and use a woman’s example of an issue, or a female illustration, the men stop listening to me. I have learnt to use male-related examples.

Getting more women on boards means that women have to upskill themselves in the arts of governance and have proof of learning and ability. The Certificate in Governance can provide that. Unfortunately, to break into the market, we have to do it better than the men.

We also need to pick a niche and learn everything about that niche, network properly at the highest level, write articles that demonstrates knowledge, and become an expert in a technical area! That is the minimum we have to do.

We should not be elected/selected because we are a woman, just as we should not be rejected because we are a woman, either.

We do have to present visibly as the best in the market, and have (male) champions and mentors to support us into the system.

You have written several books. When do you find the time?! Any more on the way?

I have published four so far and have another

one on the way. This one is more technical than the others in that it is a text on our new model of governance, ‘the Director’s Chair™’ that I have designed to meet the governance needs of the small and medium sized business and NFP sectors, which existing models do not necessarily provide for.

I love writing. and my problem is not finding the time, but disciplining myself to do income-generating work and not get sidetracked into the self-indulgence of writing.

Who inspires you?

I am inspired by people who overcome huge obstacles to achieve success and change their world. As a girl, I had two heroes. One was Florence Nightingale, who overcame the army’s incredible inefficiency to provide nursing care to the soldiers, when she was very unwell herself. The other was a local woman, June Opie. Her book Over My Dead Body about her battle for life when she contracted polio on her big OE was inspirational to me.

Both these women demonstrated that being a woman or severely disabled did not stop them being successful and making a difference to others. What bigger legacy can you leave than that?

When you’re not doing all of the above, where can you be found?

Truth to tell, probably in bed, watching telly!

I am always very tired by week’s end, and I spend my weekend repairing my soul by not doing anything significant at all. I also love shopping at op shops, and tiki tour those for entertainment. www.insitemagazine.co.nz | October/November 2014

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aged care

Last word ...

Care Association New Zealand A

fter reading the article ‘United we stand, divided we fall’ in INsite, it is evident that those outside the sector are not conversant with the enormity of the situation that the aged care sector has been battling for decades – this is the chronic underfunding that was identified in the Grant Thornton report, Aged Residential Care Service Review, 2010. A much earlier report by Price Waterhouse Cooper identified the level of underfunding at 32 per cent.

Despite continued underfunding, the Ministry of Health and the DHBs continue to amend the contract and more expenses are expected to be absorbed by the sector at a time when delayed entry means that the level of acuity is rising steadily. The cost is to the provider who must continue to expend more income to provide more incontinence products, greater levels of transportation, more ambulance costs, more dressings – many of which are extremely expensive for complex wounds – more doctors’ visits, a new and compulsory assessment system (interRAI), more costs for KiwiSaver, higher costs for certification and other compliance requirements.

Costs have escalated so much without a

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consequent, proper increase to funding that many of the smaller stand-alone aged care facilities are forced either to close down, or if they are able, to convert to hospital or dementia facilities.

Anecdotal evidence suggests that some facilities do not always accept residents who are deemed to be high-cost as it is not viable for a facility to continue to pay for such costs in view of the low level of funding.

All this flies in the face of the Grant Thornton report that found that there is a need for more, not fewer, facilities with the over-65 population increasing by 84 per cent by 2016. The number of facilities need to increase in this period by between 78 and 110 per cent to accommodate this increasing number of aged people. The return on investment is, however, too low to support an increase in building more capacity. Most of the recent growth in investment has been targeted at those who have the financial capacity to make private contributions.

The workforce is predicted to increase by at least 50 per cent by 2026. Many highly qualified RNs continue to leave through stress and to seek better wages elsewhere. All providers desire

to pay staff more and would definitely do so if the sector received the same funding that the DHBs receive – there is currently a $3 per hour differential. Apart from religious and welfare homes and retirement villages, the majority of facilities have no other additional or alternative funding or income stream to provide better wages.

Providers and the aged in their care would benefit immensely from increased pay rates through improved staff morale and reduced staff turnover – but this can only happen with better funding.

In addition to an already stressed sector, interRAI, whilst in theory a great system, is in practice crippling the sector by increasing the RN’s workload and taking the RN away from the ‘hands on’ approach. Though some costs have been met by the funders, the real cost of interRAI implementation is far greater than the funding allocated to date. With the interRAI funding currently inadequate, the sector has yet again been pushed in a corner and expected to come up with the goods and take on board a system that the Government wants for the data it can generate.

We hear time and time again from families who are denied access to long-term aged

residential care and are seriously concerned about the longer delays to entry to care. Families express anxiety at having aged parents at home alone, where they are lonely or fearful at night, or parents not drinking enough fluid for fear of going to the toilet too often, or not mobilising and losing muscle strength, or not eating nutritious and regular meals – the list is endless.

To protest is the sector’s only way of bringing their desperate plight to the fore so that those in a position of power are aware of just how inequitable it has become to expect the aged care sector to provide quality care with so little funding year on year. This is not a recent problem but one that has been compounding through never having been addressed, and it is now taking its toll on a much undervalued sector. The sector initially united and decided that they needed to bring their desperate plight to the attention of the Ministry by not signing the increase for one per cent.

However, it was a catch-22 situation, hence the change of direction. If an aged care facility didn’t sign, they would not get any increase for a whole year and would have to sign to the changes in any subsequent increase in the following year.

Many facilities also wanted to take advantage of the ‘premium charging’ clause that was part of the Variation. Though this problem has been partially alleviated by the announcement of the 5 per cent increase for rest homes from 1 October, it is almost too little too late. Last year, rest homes received a 0.89 per cent increase.

Pleas for better funding have unfortunately fallen mostly on deaf ears. With successive governments ignoring the dire financial situation, the sector is left to find alternative ways of surviving despite increasing compliancy, operational costs and rising inflation. Every increase thereafter has been way below what is acceptable for the sector to be expected to provide the very best for our elderly. The premium charging clause will assist some of the sector to

charge more to incoming residents but not all are in this happy position.

Many providers do this job because they are passionate about the elderly, not because it is financially rewarding. We wonder how much more the aged care sector has to do before its pleas are heard. The evidence is very real and the Ministry does not need interRAI to determine the level of funding required when evidential reports have been submitted in the past and totally ignored by successive governments. Many of New Zealand’s longest serving residential aged care providers are not retirement villages. This group includes privately owned and operated facilities along with charitable trusts whose focus is on providing care to the most frail in our communities. As they are not retirement villages, they have no alternate revenue stream, so any expectation of cross-subsidisation by the Ministry is inappropriate and erroneous. These providers are left to fund a service that cannot break even from resources that do not exist. What does this mean in terms of impact on capacity to deliver service to the community?

In the greater Auckland region alone, there are 211 residential aged care providers. Of that total,

“To protest is the sector’s only way of bringing their desperate plight to the fore so that those in a position of power are aware of just how inequitable it has become to expect the aged care sector to provide quality care with so little funding year on year.”

71 are also retirement villages but 140 are not. So 66 per cent of the Auckland residential aged care providers are unable to tap into alternate revenue streams to cross-subsidise what is already seriously underfunded. Why then is the Ministry listening to the ‘Big 10’ when 66 per cent of the market providers aren’t being listened to?

What does this mean in terms of impact on capacity to deliver service to the community?

The 71 providers who are also retirement villages hold 2488 of the total 9046 aged care beds (27 per cent). The Ministry interpretation that residential aged care providers are able to cross-subsidise service costs from their retirement village activities is placing 72 per cent of the total care capacity significantly at risk.

The public need to be aware of this. The Ministry’s perception is flawed, and because of it, more than 70 per cent of the service capacity in the community is being placed at risk due to underfunding.

We all know the sector as a whole goes way beyond the call of duty to provide premium care to our elderly, and there can be times when it is a thankless job, yet we all soldier on with a smile on our face and grin and bear any unjustified negatives. Stand-alone facilities, as much as the corporate, provide a standard of care that can be exceptional. Clients should still be given a choice of going to either a small or larger facility as one size does not fit all. Therefore, dealing with the corporates to advocate for the good of the entire sector is not the answer as we need representation from both sides.

Although there is now no real ‘quick fix’ for the sector, someone must take responsibility for ensuring that the sector does not go backwards any further. Enough is enough!

CANZ is the Care Association New Zealand. This article was written by the CANZ Executive with input from members.

News and opinion is covered on the INsite website.

Visit www.insitemagazine.co.nz for these stories and many more: »» ‘Win-win’ agreement for home support sector: The home and community support sector has welcomed the Government’s announcement to support an agreement, that will see community support workers paid for time spent travelling between clients and fairly reimbursed for travel costs. »» New retirement village group emerges: A new player has emerged in New Zealand’s retirement village and aged care sectors. Nineteen privately owned retirement villages and aged care facilities from Auckland to Canterbury are considering a proposal to amalgamate ownership under a corporate entity, Hercules Limited. »» New research reveals Kiwis fear dementia: In new research released by Alzheimer’s New Zealand, more than a third of New Zealanders state that dementia is one of the things they fear most about getting older, with 15 per cent fearing dementia more than any other condition, second only to cancer.

www.insitemagazine.co.nz | October/November 2014

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