Aged Care Insite - Jun-Jul 2013

Election 2013: What it means for the industry Page 20

Issue 77 June–July 2013

Alzheimer’s research progress T he ongoing search for early indicators  Preventative diet

Page 10

TENS: here’s how to relieve pain without drugs Recommended by pain clinics throughout the world

TENS stands for Transcutaneous Electrical Nerve Stimulation. It is a drug-free method of pain relief that has been used to treat a wide variety of muscle and joint problems, as well as many other painful conditions.

TENS in Labour

TENS have proven itself to be a safe method to provide pain relief during labour, afterbirth pains and uterine contractions during beast feeding. Our labour TENS unit, illustrated below, has a plunger type control, the harder you press, the stronger the stimulation felt. These machines are available for sale to hospitals or hire to prospective mums.

TERI-TREDS™ Non slip slippers

Master Medical’s Teri-Treds™ non-slip slippers are a good alternative to non-slip socks for those after surgery, elderly people in aged care facilities and for wet areas like bathrooms, kitchens, laundries, pool areas and hydro pools.

• Our finest quality slipper • New high top knit cuff for added patient comfort • Improved super flex sole for maximum patient safety • Constructed of plush terry cotton/nylon upper • The ultimate in patient safety and comfort • Designed and sized to comfortably fit everyone from toddlers to adults

Address: PO Box 4063 Tregear NSW 2770 Phone: 02 9625 4924 Toll Free: 1800 621 335 Email: sales@mastersmedical.com.au Web: www.mastersmedical.com.au 2 | June-July 2013

Please see our website for information on Therapod Back Care Range and other products.

contents EDITOR Amie Larter (02) 9936 8610 amie.larter@apned.com.au

Journalist Aileen Macalintal aileen.macalintal@apned.com.au

production manager Cj Malgo

10

(02) 9936 8772 cj.malgo@apned.com.au

SUBEDITOR Jason Walker (02) 9936 8643 jason.walker@apned.com.au

Graphic Design Ryan Salcedo ryan.salcedo@apned.com.au

National SALES manager

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34 Dietary management

06 In for the WIN

Dealing with diabetes

Aged care providers to benefit from scheme

36 Nurse Naomi

Reducing the spread of norovirus

08 Three million reasons

clinical focus 38 Hygiene conscious

Campaign calls for more support

10 Alzheimer’s indicator

Survey results raise questions on brain plaque

Facilities standards improve

34

40 Screening essential

COPD and depression link

42 Standing strong

Secondary falls prevention trial

12 Diet matters

workforce 44 Opinion: Michael Fine

Nutrition underestimated as preventative measure

Workforce study provides big picture

14 Sing out loud

Program breaks down age barriers

46 Industry profile: Stephen

16 Virtual assistance

Muggleton

New website for chronic pain suffers

Leadership, business growth, future of care

48 Project focus

18 Tech alert

Watch connects elderly with carers

36

policy & reform 20 Election game plan

Major party policy breakdown

Australia’s first charity celebrates

technology 54 Opinion: Mary Casey

26 Preventative measures

Mental health research redirected

Benefits of real life experience

28 Call for reform

56 Life layouts

Increasing concern about oral disease

Design for dementia suffers Creating the right balance

community 50 World champion walker 52 200th Anniversary

Accommodation cost confusion continues

31 Design v. function

Study aims to champion skin integrity

Meet 86-year-old Heather Lee

24 Opinion: Bruce Bailey

construction & design 29 Navigating the home Audited 9,215 as at Sept 2012

Transitioning into aged care

The move to address a growing problem

Nurses evaluate carers input

(02) 9936 8703

24 practical living 32 Making the move

news 04 Elder abuse

09 ED expectations

Luke Bear

12

New website for elderly wins award

58 Managing rosters

50

Service delivery option

The latest in incontinence research and practice www.continence.org.au

w open o n s n o i t Registra ird closes Earlyb st 31 Augu

22nd National Conference on Incontinence Crown Conference Centre, Perth, WA

23 - 26 October 2013 www.agedcareinsite.com.au

June-July 2013 | 3

news

Elder abuse

‘prevalent’

Coinciding with World Elder Abuse Awareness Day, the National Ageing Research Institute has called for elder abuse to be placed on the national agenda. By Amie Larter

a

ccording to clinical associate professor at NARI Briony Dow, Australia should take elder abuse more seriously, and put in place more effective ways to prevent, detect and manage the range of abusive situations experienced by older people.

“We don’t exactly know what the extent of the problem is here, what types of abuse are occurring, and therefore what should be done about it.

“Unlike the UK, we’ve carried out no national prevalence study of elder abuse despite the obvious benefits of knowing more about the size and nature of this type of abuse.”

Leanne Groombridge, acting chief executive officer of Advocacy Tasmania, agrees that this is fast becoming a major concern – one that people are no longer prepared to hide behind closed doors.

In late 2012, the Tasmanian Elder Abuse Helpline – a Tasmanian government elder abuse prevention strategy – opened its lines to callers, followed shortly by a Tasmanian government initiative, the “Elder abuse is not ok” advertising campaign.

To date the helpline has received 173 calls – 35 per cent of which have been calls made directly from older people who are experiencing abuse. Another 35 per cent of callers were family members reporting alleged abuse of relatives.

The remaining 30 per cent was made up of service providers and friends.

“Given the number of elder abuse reports that we have received, and taking into account those which our colleagues interstate also report, it is clear that elder abuse is a significant issue …

“There is outrage within communities that the elderly find themselves a victim of abuse at a time when they should be able to feel safe and enjoy the remainder of their lives,” she said.

Around 3–5 per cent of Tasmania’s 4 | June-July 2013

elderly population experience some sort of elder abuse, a figure which Groombridge says will have a devastating effect both on individuals and community if not addressed adequately.

“The elderly are suffering and this is quite simply an intolerable situation.”

As government advertising campaigns, education for service providers and the elderly creates awareness, more pressure is being placed on authorities to have effective pathways in place to provide real assistance for those who are subject to abuse.

Describing elder abuse as a sad reality, COTA Australia chief executive Ian Yates called for a national zero tolerance approach to protect older Australians.

He said initiatives such as World Elder Abuse Awareness Day need to be matched by strong legislation and resources from government.

“It is time for the federal government to step up and take a leadership role to get a consistent approach across all states and territories including legislation, resources and advocacy and support services.”

Dow suggests education and awareness for health professionals is also important, so they know what exactly to look out for.

“I think it’s really important that [health professionals] don’t feel like they need to deal with it on their own,” Dow explained.

“They need training and supervisory support from managers because these can often be very tricky when you have an older person who is living in a situation where they are at risk of experiencing abuse but they may not want to do anything about it.”

Michael Wynne, spokesperson on behalf of Aged Care Crisis Centre, agrees that with more aged citizens and greater stress on communities, this is becoming a more pertinent issue.

However, he believes elder abuse is a reflection of the way the aged and their care is perceived in our culture. “The critical consideration is to change the culture within management and the facilities from that of a competitive business seeking to maximise profits, to that of a caring community.”

“Staff who entered the profession for altruistic reasons are disheartened and alienated by the pressure on them and the misdirected focus.

“There is too little positive cohesion and turnover of staff is too high. People who are likely to do these things are not identified and can get away with it.” n

2010 winners, left to right: 2012 winners, left to right: Chris McGowan Jan Wright and Raeline George representing Silver Chain, Rhonda Sawtell, Abby Dunnicliff and Shirley Nelson.

Meet Australia’s best in aged care!

Be there when winners in each of the following three categories are announced: Individual

Organisation

Team

Awards dinner Sunday 4 August 2013 Doltone House Jones Bay Wharf - Pyrmont Point, Sydney Visit hestaawards.com.au for more information. @HESTAACawards Winners announced on the evening will share in a $30,000 prize pool*

t i ck e ON sa ts le

NOW

*Generously provided by: Proudly presented by:

hestaawards.com.au Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No. 235249 Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321.

news

Aged are in to WIN O lder Australians of the future will be the beneficiaries of the recently launched: Aged Care Workforce Innovation Network (Aged Care WIN) – a lifeline for businesses struggling to cope with a rapidly changing industry.

The Aged Care WIN, delivered by Community Services and Health Industry Skills Council Australia (CS&HISC), plans to help aged care providers and business prepare for reform, innovate and remain viable.

Funded by $9.1 million from the federal government, through the National Workforce Development Fund, the Aged Care WIN will support organisations at a local level by reviewing business models and workforce skills in line with reform agenda.

Reform Ready Reviews will be available to around 200 organisations in ten selected regions, starting July 1 2013. The RRRs will help business identify ways to remain viable in a changing environment, focusing on the areas of preparedness for change, workforce and sustainability.

This will be reinforced by tailored grants of up to $15,000 to implement changes.

Businesses will also be supported at regional levels to identify and support opportunities for sustainable regional initiatives.

The ten regions will then come together to form a national network. Speaking from the launch, minister for higher education and skills Sharon Bird, said the network is about acting now to meet the workforce challenges of tomorrow.

“Aged care is not simply about medical care – it involves the whole community.

These regions will build better relationships between all organisations involved in looking after the older Australians, which will make aged care that much more effective.”

Rod Cooke, CEO of CS&HISC, believes that the Aged Care WIN will help strengthen the entire aged care sector including local aged care business as well as whole regions of Australia.

“Our read of the tea leaves of the future of aged care is that it is consumer-led, it is

6 | June-July 2013

A plan to keep aged care providers and related business viable while they prepare for oncoming change is winning support across the country.

By Amie Larter

Minister Bird (top left) with Barossa Valley CEO Phil Schmaal (l), CS&HISC’s Rod Cooke and Rob Bonner and residents

delivered in the home and the community and the workforce models will have a higher skilled workforce who is able to do more in fewer visits.”

He said the business model for the future is going to look different and that many will have review and change their fundamental business models.

“If existing providers don’t seriously look at ‘is my business model sustainable’, they could have some challenges in keeping their business,” he said.

The launch was welcomed by providers, hundreds of whom met in the Barossa Valley for the launch of the Aged Care WIN. Lucy O’Flaherty, chief executive officer of Glenview Community Inc in Tasmania, believes this will give providers an opportunity to participate in a process to improve service delivery and ensure that business systems remain competitive.

“Preparing the industry to make significant changes without support and systems in place could undo all the good work that has been done over decades.

“This gives organisations the opportunity to sit down and have an objective view and assessment of where we are at in the reform process.

“Not only in the context of legislative changes, financial impacts and the

changing demographics of clients buts also the impacts in our workforce and therefore the changing skills set that are going to be required.”

Heather Nicholls, regional general manager for the Royal Freemasons’ Benevolent Institution, looks after a range of facilities in Coffs Harbour, Bellingen, Urunga, Glen Innes and Armidale.

Two of these facilities fall within the NSW mid-north coast area – one of the ten regions chosen for the roll out of the WIN programs initiatives.

She has worked in the area for over eight years, and was part of the former Keep Australia Working program that saw five providers in the area come together to promote aged care as a career choice.

She sees the new rollout as an opportunity to continue and build upon previous work on a larger scale and reaching more organisations.

“I really hope that businesses will take the information from the reviews on board, as for many, especially those in rural and remote areas, this is an opportunity to help keep their businesses viable.

“It’s also about looking what we can do across the region because workforce, among others, is going to be a big issue for us all in the future,” she said. n

Images of dementia, love and family

• An internationally acclaimed photographic exhibition Love, Loss and Laughter: Seeing Dementia Differently is touring the nation, aimed at spreading the message that people with dementia remain human beings and should not be defined by their condition.

Launched by Alzheimer’s Australia, the exhibition showcases almost 100 photos taken by American sociologist and social photographer Cathy Greenblat.

Images were taken in the United States, France, India, Japan, the Dominican Republic, Canada, Monaco and more recently in Australia.

“Cathy captures the universality of the condition and the powerful emotions it creates,” said Ita Buttrose, Alzheimer’s Australia’s National President.

The exhibition will remain in Melbourne throughout June, then tour Canberra, Perth Adelaide, Brisbane and finally reach Sydney in November.

Researcher to probe B-12 Alzheimer’s link

• ARC Future Fellow and NHMRC senior research fellow professor Brett Garner has been awarded $430,000 to investigate whether a lack of vitamin-B12 could be associated with the development of Alzheimer’s Disease.

This was part of the $3 million announcement from the minister for ageing, Mark Butler.

Garner said it appears that in Alzheimer’s Disease, the vitamin-B12 becomes trapped with lysosomes; specialised compartments inside neurons.

“It is already known the lysosomes become dysfunctional with ageing and in Alzheimer’s,” he said.

“We have evidence this prevents vitamin-B12 from performing its normal function, which could lead to the over-production of toxic

metabolites, such as homocysteine and methyl malonic acid in the brain. This results in a vicious cycle, as these molecules contribute to further neuron death.

Enzyme blocking key to better wound healing

inbrief

news

• New international results from the University of Birmingham suggests that blocking a crucial enzyme which produces the stress hormone cortisol could lead to improved wound healing.

This could lead to health benefits for a range of patients, including elderly patients who have undergone surgery.

Results found that when an enzyme called 11ß-hydroxysteroid dehydrogenase type 1 gene (11ß-HSD1) was deleted or blocked wound healing significantly improved – meaning inhibitors of this enzyme were used to speed up wound healing.

Testing was conducted on a group of mice, and it was found that by removing the 11ß-HSD1 gene, age-induced thinning of the skin with a loose collagen network was prevented. This resulted in the aged mice having skin quality similar to young counterparts.

Xbox development Kinects elderly to carers

• A computer science student from Edith Cowan University (ECU) has developed an application that uses an Xbox Kinect to monitor the sick, the elderly, or those with a disability.

Developed for a student research project, Laurence Da Luz has created software which uses the infra-red camera and motion detection features of Kinect to observe a person’s movements while at home and to know more about the person’s regular habits.

The Kinect was personalised to detect if a patient missed a meal or didn’t get out of bed. It will then contact a family member via SMS or email.

Developer Da Luz said that that as 13 per cent of Australia will be over the age of 70 by 2021, there is a need for a low-cost home monitoring system that can be administered easily.

Adding a little extra into super can make a big difference

Many of us would love to save more for our future but feel like it’s all “too little, too late” to make a real difference.

While it may be hard to believe, it’s never too late — or early — to boost your super balance.

And it might be easier than you’d expect.

Consider Julie, a 50 year old personal care attendant earning $30,000 per year. Julie has $20,000 in her HESTA account and plans to retire at 66. She attends a HESTA education seminar at her workplace — available to her at no extra cost.

Interested in learning more about her options, Julie checks out the HESTA super calculator at hesta.com.au/calculate

She discovers that, if she makes no extra personal contributions to her super (above the contributions her employer makes on her behalf), she may have only around $141,758* ($88,339 in today’s dollars), including investment earnings, when she retires.

Reviewing her budget using the HESTA budget tool, Julie realises she can afford to add $20 per week after tax to her super account. The extra $20 per week means Julie’s super could reach around $178,858* ($111,458 in today’s dollars) by the time she’s ready to retire.

By contributing just $20 per week, Julie could be $37,100 better off!

There are many simple ways to contribute extra to your super. $10-$20 extra per week can

go a long way towards helping ensure your retirement is as comfortable as possible.

Use the HESTA calculator and budget tools at hesta.com.au/calculate to work out how much you might need, see how you’re tracking right now and the difference before and after-tax contributions could make to your super.

You can also attend the next Topping up your super presentation at your workplace, read our Make the most of your super guide at hesta.com.au/boostmysuper or free call 1800 813 327 to make an appointment with a HESTA Superannuation Adviser.

More people in health and community services choose HESTA than any other fund.

*Assumptions: Investment earnings of 6.25% net per year, inflation of 3% per year, and salary increases of 1% above inflation. Figures include the government cocontribution based on proposed income thresholds for the 2012/13 financial year. Figures calculated at 2 November 2012. This example is an illustration only and is not guaranteed. Investments may go up and down.

Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No. 235249, the Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321.

This information is of a general nature. It does not take into account your objectives, financial situation or specific needs so you should look at your own financial position and requirements before making a decision. You may wish to consult an adviser when doing this. Investments may go up or down. For more information, free call 1800 813 327 or visit hesta.com.au for a copy of a Product Disclosure Statement which should be considered when making a decision about HESTA products.

www.agedcareinsite.com.au

June-July 2013 | 7

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news

Millions

of reasons why

As more and more Australians are prevented access to age services, the government must fund more care and services. By Aileen Macalintal

E

very 71 minutes an Australian is denied age services. Since Medicare does not universally fund age services, Australians must rely on family as they are placed in a vulnerable position.

To address this, a campaign called Three Million Reasons has been launched in a move to secure a safety net for their health.

Retired general Peter Cosgrove launched the Three Million Reasons campaign in Sydney, promoting and supporting the age service workforce, as well as highlighting the need for critical planning and smarter funding of aged services.

Cosgrove is the chair of Leading Age Services Australia (LASA), the industry’s peak body.

“Three Million Reasons is based on the fact that there are three million Australians aged 65 and over,” said Cosgrove, quoting a statistic from the 2011 Census.

“As Australians live longer, this number will double by 2050. Despite age services being in the midst of reform, there is much more we need to do in order to meet the demands, today, let alone the looming liability,” he said.

LASA CEO Patrick Reid said support for the industry must triple in the next 30 to 40 years.

Reid said, “The age services workforce 8 | June-July 2013

must triple by 2050, and in last week’s budget $80 million was clawed back from Health Workforce Australia. This is a worrying sign, and does not suggest the government is taking the need to support and grow the workforce seriously.

“The numbers are real and they are quite sobering; 83,000 beds need to be built in residential aged care in the next nine years at an estimated cost of $17 billion,” he said.

The government has recently delivered a pay rise to age service workers who are receiving low wages, and this will be funded from the budget that provides direct care and services to older Australians.

However, LASA believed this is not a sustainable strategy and that the workforce deserves better.

Age services matter not only to current recipients but every Australian who in the future will need the services.

The Three Million Reasons campaign is also engaging politicians to ensure that the care of older Australians is taken into account in the lead-up to the September 14 election and beyond.

“In the lead-up to the election, this issue will again be highlighted and this campaign will publish the federal politicians committed to helping older Australians

to live well,” said Cosgrove.

“Despite age services being in the midst of reform there is much more we need to do in order to meet the demands today, let alone the looming liability,” he said.

During the campaign launch, Beth Cameron Cosgrove spent the day meeting with many elderly Australians and the carers, hearing their stories and the difficulties they encounter on a daily basis.

Beth Cameron, CEO of LASA WA commended Cosgrove’s campaign in support of better age services throughout Australia.

“Australia needs a significant increase in age services to meet the enormous demands of our ‘ageing’ population, which means more government funding that reflects the true cost-of-care,” Cameron said.

“The staff and providers of age services overcome enormous challenges in maintaining the standards of care we all expect.

“Three Million Reasons will highlight that our older Australians need more support which is placed squarely on the shoulders of our age services and their workforce,” she said. n

news

Carer

issues Carers, cognitive decline and complex health issues can make managing the elderly in an emergency department presentation a difficult situation to handle.

By Amie Larter

A

recent study has zoned in on the interactions between emergency nurses and older patients’ family and carers, as an increasing number of elderly people are entering Australian hospitals via emergency departments.

Prone to cognitive decline and the common presence of complex health issues, elderly patients who present to the ED generally require more immediate attention, have longer stays and are more likely to be admitted.

A team of researchers from the University of Technology, Sydney surveyed 27 nurses from a 550-bed emergency department in Sydney to explore experiences and expectations with family and carers accompanying older patients.

Published in the Nurses’ experiences and expectations of family and carers of older patients in the emergency department report, results suggested that “unvoiced and potentially unrealistic expectations” between ED nurses and family are resulting in conflict.

The study found carers were deemed to be helpful if they saved the nurses time; and obstructive if they cost time. Frustration was experienced with carers who invested little time with the older patient. Equally as testing were carers that were regularly present but demanded too much time with the ED nurse.

According to Robyn Gallagher, associate professor of chronic and complex care,

www.agedcareinsite.com.au

Faculty of Health, University of Technology, Sydney, it was clear that nurses were stressed and worried about getting things done in a timely way. “[Nationally] there has been a directive from the government that everyone should be in and out of the emergency department in four hours … that’s not going to work for older people that might have three different illnesses at the same time.”

Describing nurses expectations as “pretty tough”, Gallagher pointed out that in most cases, this was due to genuine concern about the rights of the elderly patients.

“Nurses did not tolerate family getting in the way of them communicating with their patients properly,” she said.

“It was very gratifying to find out how concerned nurses were with that, and that the older person was being heard and supported.”

In one instance, a nurse involved in the study reported the daughter of an elderly patient was adamant that she was the guardian of the patient – and all questions should be directed to her rather than the patient.

Nurses viewed situations like this as an “infringement on both the patient’s rights and the nurse’s duty to involve the patient”, according to the report.

Liz Cloughessy, executive director of the Australian College of Emergency Nursing believes that nurses do work very hard to

meet the needs both of the patient and their family or carers; however the ED is simply not designed for the elderly.

“It’s busy, it’s noisy, there is a lot of light, movement and increased stimulation. The actual environment itself is not designed for the older person – especially someone that is a little bit confused or a little bit frail,” she said.

Cloughessy confirmed that throughout NSW, most bigger hospitals have aged care nurses working with the emergency team, while medium-sized hospitals generally had access to aged care consultants.

“We refer them to come and see the elderly patient and do a determination on their home, cognition and where they are at, and we value their opinion in helping us to determine pathways we will take.

“This is a very important and heavily funded initiative.”

Gallagher agrees, suggesting what’s needed is specialist aged care nurses on rotating shifts. She also suggests that ED nurses require positive leadership role models.

“Nurses look up to senior nurses like educators and consultants. I think if those nurse behaved really positively then other people would model that.”

Gallagher says one of the next steps will be to develop brief workshops for emergency nurses on how to work with older people. n June-July 2013 | 9

news

Alzheimer’s indicator

too late

to help

New research shows brain plaque, the standard indicator of Alzheimer’s disease for decades, is not the main driver of neurodegeneration and memory loss first thought. By Aileen Macalintal

T

he discovery, made by two Sydney researchers, is set to fire further debate on the diagnosis and treatment of Alzheimer’s.

PhD student Amanda Wright and Dr Bryce Vissel from Sydney’s Garvan Institute of Medical Research are the lead authors of Neuroinflammation and Neuronal Loss Precede Plaque Deposition in the hAPP-J20 Mouse Model of Alzheimer’s Disease.

Wright and Vissel studied a mouse model of Alzheimer’s disease to identify early versus late disease mechanisms and markers.

Their data suggests that plaques occurred much later in the brain, well after significant memory loss. Thus, plaque may not be useful as an early pathological marker for Alzheimer’s disease.

The investigators found that significant nerve cell loss and inflammation began as soon as subtle memory problems appeared, which was early in the disease process.

Plaques are a build-up of a substance that does not normally occur in the brain, explained Wright and Vissel.

“To put into simple terms, the best way to imagine it is that under the microscope it looks similar to tooth plaque. However, it is a completely different substance,” they said.

In 1906, Alois Alzheimer first identified plaque in the brain and, many decades later, it was discovered that the plaque is made up primarily of a substance known as amyloid beta.

“In fact, amyloid beta occurs normally in the brain. However in Alzheimer’s disease, this substance clumps together to cause plaques. This is a gradual process and can take many years, even decades, for plaques to develop in the brain,” they said.

The role of plaque in Alzheimer’s disease is controversial, said the researchers.

“From our study we have concluded that plaques do occur in the brains of mice with Alzheimer’s disease, though they are not the major driver of neurodegeneration and memory loss,” said Vissel and Wright.

In other words, it shows that memory loss and neurodegeneration

10 | June-July 2013

news It is still controversial as to whether mild memory loss is necessarily a precursor to Alzheimer’s disease. may be early events in the disease.

If it’s not the plaque that marks the disease, what do the researchers regard as the conclusive marker of Alzheimer’s?

“It is still unknown what would be a great marker for early detection of Alzheimer’s disease. Our study has shown that inflammation occurs very early on in the disease process.”

“We hypothesise that one way to track Alzheimer’s disease is to look at particular markers of inflammation in conjunction with sophisticated cognitive testing.”

Vissel said their study supports the increasingly common view that treatment should start much earlier.

Various studies have pointed out that mild cognitive impairment may be another early predictor of the disease, he said.

He defined mild cognitive impairment as “a loss of memory without loss of cognitive function. This is detected by a general test for memory, mainly by what is called the Mini Mental State Examination”.

This involves thirty questions that test orientation, language, recall and repetition.

The score can indicate whether cognitive impairments are severe, moderate or mild.

“However, it is still controversial as to whether mild memory loss is necessarily a precursor to Alzheimer’s disease,” said Vissel.

The authors went on to explain that people with Alzheimer’s appeared to not have benefitted from recent clinical trials of drugs designed to prevent plaque buildup. Questions have already been raised about the best strategy for treatment.

Wright and Vissel said their research fits into this debate in three ways.

“First, it shows that disease occurs well before plaques have appeared which suggests that delivering treatment early in disease, even before plaques, might be sensible. In simple terms, we should probably start treatment before the horse has bolted.

“Secondly, it raises the question as to how to identify Alzheimer’s disease early since our study suggests that plaque is a last event in Alzheimer’s and as such is not a good indicator of early disease.

“Thirdly, it raises the question as to whether other therapeutic strategies besides targeting plaque may offer better approach to treating Alzheimer’s disease.”

Their findings may yet make previous research into the disease null and void, but it builds on the potential to develop future studies. “This study changes the way we think about Alzheimer’s disease,” said the lead authors.

The use of recent imaging agent to detect plaques for diagnosis, for instance, may change, said Vissel, as their findings provide implications for the way researchers may be able to detect and treat Alzheimer’s disease.

Dr Chris Hatherly, national research manager of Alzheimer’s Australia, said this study is an important development that builds on what is known about the diseases that cause dementia.

“It adds to a number of recent findings – including disappointing results from major drug trials – that suggest we need to look further than the amyloid protein to better understand and eventually treat Alzheimer’s disease and other forms of dementia,” said Hatherly. n

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ACN, Australia’s professional organisation for all nurses, is proud to work with the Department of Health and Ageing as the fund administrator for this program.

June-July 2013 | 11

news

Preventative

for

The need for closer attention to diet increases with age.

By Aileen Macalintal

G

rowing evidence shows people with early Alzheimer’s disease have low levels of certain nutrients compared to healthy individuals of a similar age.

People with Alzheimer’s, for instance, may need to particularly address low vitamin B12 levels that lead to fatigue and worsening of symptoms.

“As for people of any age and with or without a health condition like Alzheimer’s disease, a healthy and balanced diet is necessary for optimal brain function,” says Glenn Rees, CEO of Alzheimer’s Australia.

“If you already have Alzheimer’s disease or another form of dementia, good nutrition may help to mitigate physical health problems that would be difficult for a person with dementia to articulate.

“There is a considerable body of evidence that environmental and lifestyle factors including nutrition may help brain health and be protective against dementia, which is important for carers and family members,” Rees said.

He said the brain needs a range of nutrients, fluids and energy to work properly, but the relationship between food and dementia risk is not fully understood at this stage.

Evidence suggests that a high intake of saturated fats and sugars may increase the risk of developing dementia, he said, and “it is likely that a diet that includes a higher consumption of fish, fruits, vegetables and healthy fats in vegetable oil and nuts, and a lower intake of saturated fat in meat and dairy products can help in keeping the brain healthy”.

Alzheimer’s and other forms of dementia have a significant impact on the Australian healthcare system, and finding treatment and management is important.

Professor Michael Woodward, geriatrician, director, memory clinic and director of Aged Care Research, Melbourne says that nutrition, and its role in managing the early stages of Alzheimer’s disease, cannot be underestimated.

12 | June-July 2013

news

eating

Alzheimer’s “Medical nutrition is increasingly understood as a useful, and important, component in managing patient health,” said Woodward.

“Alzheimer’s disease is a devastating neurodegenerative condition, affecting memory, daily living and independence, causing substantial distress to family members and or loved ones who often become carers. Currently, effective treatment options for Alzheimer’s disease are limited,” he said.

One of the management options for the disease is the medical food Souvenaid, clinically proven to nutritionally support memory function.

After 10 years of research and development into the role of diet and nutrition and Alzheimer’s, Australian specialists and Alzheimer’s Australia support the multi-nutrient drink.

www.agedcareinsite.com.au

To achieve the nutrients provided by a once-a-day bottle of Souvenaid (125ml), in addition to their normal diet, a person would need to consume one kilogram of tomatoes, 1.2 kilograms of broccoli, 710g spinach, 100 grams fresh tuna (or four tins of tuna), 100 grams minced beef, four eggs, one orange, and a handful of brazil nuts.

The brain needs these nutrients in the processes related to learning and memory. This combination of nutrients may be difficult for people with Alzheimer’s to achieve at certain levels from normal dietary intake alone.

Aged Care Research has welcomed the introduction of Souvenaid as a new nutritional management option for those living with mild Alzheimer’s disease.

“Souvenaid is not a cure or preventative measure for Alzheimer’s disease,” Woodward said.

“It is however a significant advance to the nutritional management of memory function during the early stages of Alzheimer’s disease.”

Rees explains that “medical food” is a category of food product designed to provide some form of medical benefit, usually with minimal risks to the consumer.

“Souvenaid simply gives people with mild stage Alzheimer’s another option.

The research to date has only established that Souvenaid is helpful for people in the early stages of the disease, and it only acts to improve memory, not other aspects of the condition,” said Rees.

He said, “It does not stop the progress of the disease in any way, and it does not work for all or even most people, but for some (around 40 per cent, according to the research) it may slow down, and temporarily improve memory function.”

The multi-nutrient drink is now available nationwide.

“Since starting Souvenaid in February, my husband’s whole demeanour has changed,” said Suzane, who is caring for a husband with Alzheimer’s.

“His sense of humour is like it was when we were younger. He is more willing to fill his day with activities like gardening, whereas before he would mope around and not do much at all.” n

June-July 2013 | 13

news

Knox student Molly (left) and Pat Turner, 94, share a laugh.

Today’s youth

and yesterday’s

sing together A new installment in a program that brings together the elderly and the young to make music is breaking down the barriers of age. By Amie Larter

C

ontinuing its commitment to bring arts to the aged care environment, the Arts Health Institute (AHI) has launched its second round of their Sing Out Loud program – after a successful pilot in 2012.

The intergenerational program, which sees schools form a partnership with a local aged care facility, see primary school students build friendships with an “elderly buddy” over the course of eight weeks.

14 | June-July 2013

The two original schools involved in the pilot are back on board this year, joined by another five, and AHI CEO Maggie Haertsch confirmed they are hoping to see the program grow nationally.

“We felt that if there was a way that children could come and sing over a period of time – not just a once-off – then there should be some really good benefits in terms of building better relationships with the elderly,” she said.

“We really want to create neighborhoods’ that connect the school and the aged care facility ... and we felt that putting a choir together would really build that sense of community.”

The structured program sees school students visit their paired aged care facility weekly, where rather than coming to entertain the elderly, the students are coming into engage, socialise and sing with them.

The program uses music to promote social engagement, elicit positive emotional and behavioral response and stimulate cognitive functioning in both healthy elderly and people suffering dementia.

The elderly residents teach their buddies songs from their era and answers different questions for students writing and research tasks.

This culminates in a musical performance in the eighth week – where the elderly have the chance to sing with the students at the school hall.

Most recently, a group of primary students from The Knox School in Victoria’s Wantirna South partnered with residents from Australian Unity’s Victoria Grange Aged Care as part of the program.

Year 6 student Molly, who was partnered with 94-year-old Pat Turner, says she has seen that music brings back memories

news from when her elder buddy was young.

Her favourite parts of the program included getting to know Pat, and learning different types of music.

“The music is very different – they are simple songs but they are touching. Their songs are quite short but they are very moving because they show love, friendship, respect: just simple things.”

The students and buddies will join together on June 27 for the choir to perform, an event that Pat is very much looking forward to.

“I used to sing in choirs when I was younger so it will be good to perform again with the mixed group of residents and students,” she said. “[Molly] said she enjoyed learning all of the songs but she was not familiar with any of them.

“I told her that I knew all of the words and really didn’t need to look … when I was young it was common for families to sing around the piano every Sunday night. It was one of the main forms of entertainment in the home as there was no TV and no radio.”

Boyd Williams, Year Six teacher at The Knox School, said this is a remarkable program – one that helps students foster the value of respect, kindness, empathy and maturity.

“We certainly focus a great deal on these things in our class but to have the real life opportunity to watch these qualities grow is outstanding … students are able to see that there is more to life than One Direction, Justin Beiber or their iPad. “The program also enables some of the social aspects and values to develop as a consequence of the friendship formed with their new friend. Respect, dignity, trust are just three of the words that come to mind when I watch the interaction between the children and their new friend.”

The program integrates aspects of English, art music, HSIE and technology and forms part of the school curriculum and service learning unit.

Students at The Knox School reflect on their time with their elderly buddy by writing about their reflections on the experience, producing literature Williams describes as “revealing” and “heartfelt”.

For managers, senior managers and aged care workers looking to bring more creativity into their work, the Arts Health Institute is holding the first National Play Up Convention at Luna Park in Sydney on September 5 and 6.

The keynote address for the event will be Dr Stuart Brown, psychiatrist, author and Founder of the National Institute for Play in the United States. Brown authored the book Play: How it Shapes the Brain, Opens the Imagination and Invigorates the Soul. n www.agedcareinsite.com.au

Celebrating life and diversity Classic hits, dancing and fun were on the agenda for the elderly crowd that attended the 13th bi-annual Celebration of Life event last month.

V

ictorian aged care facilities joined together for a cultural themed afternoon of fun – aimed at offering a free-of-charge opportunity for residents to socialise with residents of other hostels and nursing homes.

Held at Northcote Town Hall – a popular meeting place for many of the elderly back in their younger days – the afternoon was opened by the people’s priest, father Bob Maguire, and entertainment included headlining senior’s band The Huffers and Puffers, as well as other ethnic musicians and a belly dancer.

Attendees were encouraged to dress in their national clothing or any type of traditional dress for the event, and the room boasted flags from over 30 countries.

Named “A Celebration of Cultural Diversity”, the Centre for Cultural Diversity collaborated with the Celebration of Life Group to host the event – celebrating cultural diversity in ageing.

“The biggest highlight of the event was looking around the ballroom and seeing people dancing, smiling and

hearing lots of laughter,” said Trish Crowe, lifestyle coordinator at Mary MacKillop Aged Care.

“When you see the positive impact these events have, it’s worth all the hard work.”

Staff, helpers and family were joined by primary school students and young adults – who not only assisted with the event but performed, as well as socialised and danced with residents.

Paul Brophy, manager of the Brotherhood of St Laurence’s Sambell Lodge residential aged care facility originally developed the idea to host the event back in 2006, and says it’s a way to show residents that living in a facility no longer means being cut off from your community.

“We are helping our elderly people who are living in aged care facilities to get out there, to get out into the world and enjoy life, and have some fun meeting other people in facilities in the community.

“We all like having something to look forward to, and our elderly citizens are no exception.”

Planning is already underway for the next event in October. n June-July 2013 | 15

news

Managing

persistent pain

For those struggling with chronic musculoskeletal pain, help is virtually at hand. By Aileen Macalintal

A

website has just been launched in collaboration with the Department of Health (WA) to help people manage chronic musculoskeletal pain.

Associate professor Helen Slater from Curtin’s School of Physiotherapy said the website – called painHEALTH – has the potential to help the estimated one in five Australians who suffer from this chronic pain.

“Musculoskeletal pain is basically pain that comes from muscles or joints or other soft tissues such as tendons and ligaments. It can include nerve pain,” said Slater.

Musculoskeletal pain may start in childhood, but the particular targets of

this website are adults, especially since the prevalence of this pain increases around 40–60 years of age.

Slater said a very substantial health burden related to persistent pain, of which musculoskeletal represents a sizeable proportion, prompted the website’s creation.

In 2007, the health economic burden for chronic pain in Australia was estimated at $34.3 billion or $10,847 per person, said Slater.

The National Pain Strategy reported that 20 per cent of visits to general practitioners are due to chronic pain and around 25 per cent of these persistent cases are for musculoskeletal pain.

A real gap exists in service delivery

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for consumers with persistent musculoskeletal pain.

She said there is a good evidencebased management, but despite that, only around 10 per cent are estimated to get this management.

“So in Western Australia, we wanted to try to close the gap and upscale consumers about the current evidencebased management and apply it, how they can get those treatments, and what they can do themselves,” she said.

The site will assist people with low back pain, neck pain, osteoarthritis, rheumatoid arthritis, osteoporosis and complex regional pain syndrome to better manage their pain condition.

Australians can benefit from painHEALTH in practical ways too. “It doesn’t just give current evidence and knowledge, but importantly, it also

news provides training module or skills that they can engage themselves,” said Slater.

The website features videos, meditations, and a comprehensive guide through seven different modules that can help people in pain integrate and get a more holistic approach to pain management.

One video shows a woman named Rose who said, “Life is hard … Don’t pretend that it’s not.

The power to overcome [pain] is in your head.”

Slater likes the fact that the website takes a whole personal approach.

Usually, a number of professionals are out there to give people advice, and it is left to them to try it, she said, “but in the website, we try to give a more holistic and personal approach. That’s really what the consumers, like Rose, want to talk about and find most beneficial.

“It’s going to be promoted through multiple mechanisms. It’s very, very important that we have all the health professionals on board,” she said.

They are promoting it through professional associations across Australia including the Royal College of General Practitioners, Australian Pain Society, Australian Psychological Association, Australian Osteoporosis Association, nursing bodies, universities and all worthwhile peak bodies. n View the website at painhealth.csse.uwa.edu.au

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June-July 2013 | 17

news

Who watches

the watch?

New steps in remote monitoring are leading toward more independent living. By Aileen Macalintal

R

emote caregiving will now be possible with the timepiece from family-owned company mCarewatch.

Aside from telling the time, the lightweight SOS mobile watch works as a phone, GPS locator and SOS emergency alert.

This technology allows the elderly to live independently and in their preferred environment. Paul Apostolis, director of mCareWatch, shared that the idea for the SOS Mobile Watch came after his family had a scare.

“My father became disoriented while out with my mother one day. He couldn’t speak properly and had difficulty driving but insisted that he was fine and by some miracle they made it home safely but it was clear that he wasn’t himself. As we later discovered, my father had experienced a stroke,” said Apostolis.

He said his elderly parents seldom use their mobile phones, often leaving the

TA R G E T I N G

YO U R

devices at home or uncharged. “Following market research and contacting leading aged care and community bodies, it became clear to both me and my brother Peter, that our family is not alone.”

Apostolis and company co-founder Peter Apostolopoulos have business experience in information technology, healthcare and personal care to create a range of solutions that free older people. The watch came out in their search of an alternative to the traditional emergency pendant alarms.

“There’s a whole ‘sandwich generation’ of Australians torn between the demands of work, caring for young families and caring for older parents or relatives,” Apostolis said.

He said not only will the elderly be ensured their independence, but carers too will have a peace of mind since the watch wearer can press a single button in an emergency to automatically call their nominated carers.

The carers can also locate via the wearer who may be incapacitated or unsure of geographical location of incident. The location of their loved ones can also be tracked anywhere, any time by using the GPS function via their smartphone using Google maps.

For Apostolis, the best features of the

M A N A G E M E N T

N E E D S

watch include the two-way communication at the press of a button and the SOS button that automatically dials up to three carers in an emergency.

“The other amazing feature of the watch is the SMS-command activated two-way communication if wearer is not responding and is incapacitated. The SMS command is sent from the carer’s mobile to the SOS Mobile Watch, which then opens up a channel to communicate and listen to the wearer without them having to press a button,” he added.

In addition, the wearer is not confined to a restricted monitoring area as SOS mobile watch works with Optus mobile digital network that covers 97 per cent of the Australian population.

“Technology is a great enabler to address issues and problems in aged care faced by families and service providers. By investing in technology, it will allow all stakeholders involved in the care of the individual to be conducted in more effective and efficient way, particularly with an ageing population and the pressures on our aged care/ health care workforce,” said Apostolis.

He said the next model will have features that include monitoring daily living patterns and the capture and sharing of specific health parameters. n

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18/02/13 8:25 AM

calendar

2013

• LASA National Congress 2013

JULY

• Nurses In Management Aged Care (NIMAC) Conference and Trade Exhibition 4–5 July Queensland qld.lasa.asn.au

• National Diabetes Week

14–20 July Nationwide diabetesaustralia.com.au

15–18 July Adelaide Convention Centre hisa.org.au

5–6 September Luna Park, Sydney NSW artshealthinstitute.org.au

NATIONAL CONGRESS 2013

Leading Age Services Australia

INVITATION

gratefully acknowledges the support of our sponsors to date:

On behalf of the LASA National Board I invite you to join us in Sydney in August for what will be the premier industry networking event.

Our industry understands we face considerable challenges and yet continues to provide high quality care and services to older Australians. With challenges comes opportunities and that's exactly what Congress 2013 will explore. New Frontier: New Focus will hear from trailblazers who have succeeded against considerable odds; inspiring individuals who have changed cultural thinking, business operation and ingrained their approach within the Australian psyche. Age services can learn much from Mark Bouris, Jon Dee and Todd Coates. Our industry will also be informed and inspired with assistive technology practices that will greatly enhance human capital and the ability to focus on care. This Congress also includes innovative study tours and a special master class. We're delighted to introduce a number of new innovative partnered sessions with the Australian College of Nursing, Better Boards Australasia and the Australian Institute of Management. The 2013 Congress will be facilitated by two expert master of ceremonies, Andrew Klein and Toby Travanner, with specialist audience participation technology allowing you to guide discussion. This is a Congress not to miss!

• Daffodil Day

23 August Nationwide daffodilday.com.au

• Hearing Awareness

Platinum Sponsor

Platinum Sponsor

caresystems

o

• National Stroke Week

Platinum & Congress Dinner Sponsor

Bronze Sponsor

Lanyards Sponsor

Massage Booth Sponsor

Welcome Reception Sponsor

9–15 September Nationwide strokefoundation.com.au/ national-stroke-week

CONGRESS PLANNING COMMITTEE Patrick Reid – CEO, LASA Charles Wurf – CEO, LASA NSW­ACT Cynthia Payne – CEO, SummitCare Robert Orie – CEO, Sir Moses Montefiore Jewish Home Deborah Key – Director of Nursing, St Luke's Care Steve Gordon – Director, Gordon Group Jacqueline Murkins – Projects Manager, LASA Justine Caines – Government Relations & Communications Manager, LASA Kay Richards – National Policy Manager, LASA Stuart Bicknell – Manager Member Services, LASA NSW­ACT Laura Barnes – Events and Administration Coordinator, LASA NSW­ACT Barry Neame – Congress Manager, Consec – Conference Management

CONGRESS MANAGERS

Week 2013 25–31 August Nationwide 25-31 hearingawarenessweek.org.au Patrick Reid Chief Executive Officer Leading Age Services Australia

• Health Informatics

• National Play Up Convention

5–7 New Frontier: New Focus August Sydney Convention & Exhibition Centre, Sydney NSW lasa.asn.au/events/

2

Consec – Conference Management As agent for Leading Age Services Australia PO Box 3127 BMDC ACT 2617 Australia T: +61 2 6251 0675 E: lasa@consec.com.au

Pressure Weights For no; one-Educating Patients and Families The Best Care for older People Everywhere Toolkit

Creating Champions for Skin Integrity to Reduce the Prevalence of Pressure Injuries Within Residential Aged Care The Implementation of a Hospital Wide Wound Care Program

Responding to the Challenges Created by the different Shapes of the obese

• World Hepatitis Day

• Jean Hailes Women’s Health Week

25–26 July accreditation.org.au

28 July Worldwide hepatitisaustralia.com

AUGUST

• Better Practice 2013 – Adelaide 15–16 August Hilton Adelaide, SA accreditation.org.au

Australia | Pressure Ulcers | Royal Darwin Hospital | QUT Wound Healing Service | The Wound Centre | Alfred Health

Translating Research into Clinical Practice Change Pressure Injuries & the Indigenous Community in the northern Territory

DO NOT MISS!

The Post Conference Workshop: Wednesday 18th September 9.00am –12.30pm Putting Pressure Injury Prevention into Practice for Hospital, Community and Residential Aged Care Facilities Led by Debbie Blanchfield, Wound Care Clinical Nurse Consultant, Surgical Stream, Wollongong Hospital

• Dementia Awareness Week

SEPTEMBER

• Prostate Cancer Awareness Month

Prevention Project Group | The Prince Charles Hospital | Western Health |

Melbourne Health | Australian College of Critical Care Nurses | Prince of Wales Hospital | University of Western

Wound Champion Program – A network of Far-Reaching Tentacles

www.deafnessforum.org.au

• Better Practice 2013 – Sydney

Sutherland Hospital | St Vincent’s

Health Network | Australian Bariatric Innovations Group | The St George Hospital | ACI/ICCMU Pressure Injury

The Prevention of Pressure Injuries in People with Spinal Cord Injuries

design-edge.com.au

22–28 July Nationwide chronicpainaustralia. org

With key contributions from:

Pressure Injury Prevention during the Surgical Patient Journey Pressure Injury Risk Assessment in Intensive Care

www.hearingawarenessweek.org.au

• National Pain Week

Th loo e on kin ly co g n of sole fere pre ly n ss at th ce in ure e A inju pre ust ries vent ralia ion

Meeting Standard 8, our Experience

Best Practice Guidelines for Pressure Injury Prevention in the Adult Intensive Care Patient

Notes

Office of Hearing Services

2nd Annual

A comprehensive case study led program covering:

• ACHSM: Asia Pacific Congress on Health Leadership 28–30 August 2013 Rydges Lakeside Canberra, ACT achsm.org.au

Reducing Avoidable Pressure Injuries Conference 16–17 September Novotel Melbourne on Collins, Victoria Healthcareconferences.com.au 16–17 September 2013 | Novotel Melbourne on Collins

To Register visit: www.lasacongress.asn.au

August 2013

• 2nd Annual

1–30 September Nationwide prostate.org.au

2–6 September Nationwide jeanhailes.org.au

• 12th Australian

Palliative Care Conference 3–6 September National Convention Centre, Canberra, ACT dcconferences.com.au

16–22 September Nationwide fightdementia.org.au

Australia’s leading healthcare conference provider

This conference is endorsed by APEC No 090810001 as authorised by Royal College of Nursing, Australia (RCNA) according to approved criteria. Attendance attracts 12 RCNA CNE points as part of RCNA’s Life Long Learning Programme (3LP). In addition, by attending the postconference workshop you will earn an additional 3 RCNA CLE points.

Endorsed by:

The Wound Centre www.thewoundcentre.com

TO REGISTER: VISIT: www.healthcareconferences.com.au/pressureinjuries T: +61 2 9080 4090 E: info@iir.com.au

• Better Practice 2013 – Melbourne 19–20 September Hilton on the Park, Melbourne, Victoria accreditation.org.au

• World Alzheimer’s Day 21 September Worldwide fightdementia.org.au

• Parkinson’s

Awareness Week 25–30 September Nationwide Parkinsons.org.au

beyondblue training for BOOK community care staff NOW! World Hepatitis Daybeyondblue 2012 has released its latest

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Professional Education to Aged Care (PEAC) Program targeting care staff working in the community.

Page 1 of 16

The workshop – Understanding depression and anxiety in older people in the community – will help care staff improve detection and management of depression and anxiety in community settings.

It also looks at a number of wellbeing and prevention strategies, such as meeting social needs of clients and the power of reminiscence.

To find out more about the training, visit www.beyondblue.org.au/peac

To find out more visit www.beyondblue.org.au/PEAC www.agedcareinsite.com.au

June-July 2013 | 19

e b i r c s b u S today  Comprehensive and diverse range of topics  Independent and insightful articles making our publications essential reading  All our websites feature interactive areas where users can comment directly on the conversation and debate the topics that face your industry, today and in the future  D elivered free of charge, and you will also receive weekly online updates and special content.

APN Educational Media is a division of APN News and Media, serving the education and health sectors. It has a stable of publications, which combine to cover all aspects of secondary, tertiary and further education, together with a range of related professions and careers.

Using the latest technology to address this range of niche publishing markets, the company has access through its books, magazines, newspapers and the internet to virtually every teacher, university student, academic and health professional in the country.

APN Educational Media has identified the importance and dynamism of the education and health sectors and is growing and adapting with these industries, working in successful partnership with a large range of educational and health institutions and industry bodies.

APN Educational Media is not just covering the education and health industries - it is a part of them.

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policy & reform

Federal election 2013 What’s on the

aged care agenda?

The major parties look like relying primarily on existing policies to spruik their aged care credentials.

Fiona Marsden reports.

20 | June-July 2013

W

ith this year’s election coming just a few months after the federal budget and a senate committee inquiry, Labor is pinning its aged care policy hopes on the passage of its $3.7 billion Living Longer Living Better (LLLB) package.

The LLLB’s key reforms include increasing the number of home and residential care places, revamping fee arrangements, and boosting wages and training for aged care workers.

“I have been determined to give the aged care sector the funding certainty it has sought for decades,” says Mark Butler, minister for Mental Health and Ageing.

“Not only does Living Longer Living Better articulate the government’s intentions and funded commitments for the 2013–14 budget, it lays out our commitments between now and 2016–17.

“That allows providers to plan for the future of their organisations, and provides peace of mind to Australians that the right care will be available as they get older and require aged care services.”

Although LLLB was announced in April 2012, the legislation wasn’t introduced until March this year. With the package’s home care changes and dementia supplement set to take effect from July 1, this left parliament little time to consider the bills.

In mid-March, the senate referred the bills to the Community Affairs Committee, which reported on May 31.

The report’s 13 recommendations include calls for

policy & reform

One major part of aged care that has been sadly overlooked by this government’s so-called reform [is] any commitment to reducing the administrative burden that plagues the sector. close monitoring and evaluation of the effects of the LLLB legislation on care providers—particularly low-care-only, small and rural/ regional providers. At time of writing, the government was yet to respond to the recommendations.

The Coalition’s model

The Coalition’s central policy platform is a four-year Aged Care Provider Agreement, to be negotiated in consultation with providers and other stakeholders within the first year of government.

“The implications of an ageing population, including an increasingly larger culturally diverse ageing population and the need to increase aged care services, means it is important that we formulate policies that can actually be delivered on,” says shadow minister for ageing, senator Concetta FierravantiWells.

www.agedcareinsite.com.au

“There is growing and alarming evidence that the aged care sector cannot provide the care that Australians expect. Until there is structural reform of the sector, the care and wellbeing of senior Australians is at risk.”

Senator Fierravanti-Wells says that, like the agreements that provide the framework for the pharmacy profession, the Aged Care Provider Agreement will act as a game changer for the aged care sector by providing certainty and flexibility.

“These two factors have been the standout complaints that many in the sector say [desperately need addressing].”

The senator also says the agreement will reduce the current administrative load facing aged care providers.

“One major part of aged care that has been sadly overlooked by this government’s so-called reform [is] any commitment to reducing the administrative burden that plagues the sector,” she says.

“Every hour a staff member spends meeting regulatory reporting requirements, is an hour less spent on providing handson care and support for an older Australian.

The Coalition’s plan is to work with the sector to remove this cumbersome burden, without reducing the quality of care. This will be a key feature of our Aged Care Provider Agreement.”

The breakdown

When Aged Care Insite asked the Coalition for more specific comment on how its proposed agreement would address key areas of aged care provision, senator Fierravanti-Wells said she did not want to pre-empt the outcome of any negotiations a Coalition government might undertake with the aged care sector.

Nonetheless, we have done our best to break down the major parties’ aged care policies into three key areas – home and residential care, dementia care and workforce sustainability – to help you work through the potential implications for your roles as aged care providers and workers.

Home and residential care

Labor’s LLLB package provides $955 million for home care services, including 40,000 new packages over five years to help people remain in their own homes.

The Home Care Packages Program is scheduled to begin on July 1 2013. It will replace Community Aged Care Packages, Extended Aged Care at Home, and Extended Aged Care at Home Dementia packages.

LLLB also allocates $660 million for residential aged care; including more than 30,000 new places over five

June-July 2013 | 21

policy & reform years, changes to means testing for fee payments, and trials of consumer directed care in residential aged care settings.

The Coalition has not yet elaborated on the kinds of funding arrangements for home and residential care places it might seek to negotiate as part of an Aged Care Provider Agreement.

Within this context, the CEOs of two of Australia’s leading aged care sector organisations (which have been extensively involved in the LLLB consultations) are broadly supportive of Labor’s package in regards to home and residential care, while saying it does not go far enough in some critical areas.

“The aged care market has a rationed supply,” says John Kelly, CEO of Aged and Community Services Australia, which represents more than 1100 church, charitable and community-based providers.

“The government controls who can have beds, where they go and exactly how they can operate.

“As long as aged care [remains] an artificial market, it’s very hard for providers to plan services appropriately in terms of community demand, and put offerings on the table to address different levels of demand.”

While acknowledging that the LLLB package includes provision to review the

supply issue after five years, Kelly believes that’s too long to wait. “Lead times for planning and capital expenditure on aged care facilities are quite long,” he says, “and the pace of change in the over-65 demographic is such now that five years is too far away.”

Ian Yates of COTA Australia, which represents older Australians as consumers of aged care services, says the LLLB’s commitments to home care and Consumer Directed Care are significant, but says a future government (be it Labor or Coalition) must address the issue of entitlement.

“The largest single thing COTA wants is a move to the end of rationing and the introduction of entitlement, whereby entry into aged care is [based on] a rigorous assessment of need.

“On the basis of that assessment, the Commonwealth would accept that you as the consumer are entitled to an amount of money – not something that can be cashed out, but a voucher, if you like – that you can spend on resources as you choose.”

Dementia care

The LLLB earmarks $268 million for dementia funding. This includes a dementia supplement for home and residential care

to apply from July 1, 2013, in recognition of the higher costs involved in caring for people with severe dementia.

At time of writing, the proposed supplement is $16.15 per day for people in residential care, and 10 per cent funding in addition to the basic subsidy level for the relevant Home Care Package.

Opposition spokesperson senator Fierravanti-Wells declined to detail any dementia-specific measures the Coalition might unveil. However, she pointed out that the Howard government committed $320 million in the 2005 budget to help fund the Dementia Initiative—Making Dementia a National Health Priority.

“Despite this initiative proving invaluable in helping dementia sufferers, and a St Hospital government evaluation of October 2009 Mary Smith finding the initiative successful, LaborRN Div 1 Nursing deliberately dropped this program,” she says. “Labor ... has only recently made up some lost ground with its $268 million package.

“The Coalition remains committed to addressing the growing numbers of [people with] dementia in Australia, and, without pre-empting the negotiations of our aged care agreement, I would envisage that such matters would be covered.”

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policy & reform Workforce sustainability

A centrepiece of Labor’s LLLB package is $1.2 billion to shore up the aged care workforce. This includes an Aged Care Workforce Development Plan, which will be developed during 2013 to improve: • career structures and pathways • training and education • career development opportunities • work practices • workforce planning.

The package also includes a Workforce Supplement payable to eligible employers from July 1 this year; starting with 1 per cent of the amount of the basic subsidy/ funding agreement in 2013–14, and rising to 3.5 per cent in 2016–17.

To be eligible for the Workforce Supplement, employers must be approved residential aged care providers who are eligible for the payment of a basic subsidy in respect of a resident, under the Aged Care Act 1997. Providers must pass on the supplement in the form of higher wages.

“Labor’s plan to grow our workforce has been developed in consultation with consumers, providers and unions, and is fully costed and articulated,” says minister Butler, “unlike the opposition’s ‘policy’ which appears to be little more than business as usual, [and will] not deliver the better pay

and conditions we need for our workers.”

His counterpart senator FierravantiWells is a strident critic of the Workforce Supplement. “We all accept wage rises are needed,” she says, “but they need to be affordable and sustainable.

“With only 40 per cent of providers operating in the black, many will be unable to pay the wage increase and meet the associated on-costs. These cost pressures will further erode their viability, especially [for] smaller providers in regional and rural areas.”

In their dissenting report attached to the Senate Community Affairs Committee’s report, participating Coalition senators recommended removing all provisions in the LLLB Bills that refer to the Workforce Supplement. The overall committee, however, did not support this.

As for how she plans to address workforce sustainability, senator Fierravanti-Wells says, “Whilst the Coalition does not want to pre-empt the contents of any formally negotiated agreement, we do envisage that it will contain measures to address concerns in regards to wage and staff retention.” n

A negotiation nightmare?

Given that Labor’s LLLB package was developed through extensive consultations with the aged care sector, neither John Kelly nor Ian Yates believes that the sector will want to change it substantially if a Coalition government is elected this September.

Both say they welcome the Coalition’s plan to negotiate with the sector in developing an Aged Care Provider Agreement, although Yates believes such negotiations may be more complex than the Coalition anticipates.

“Their proposed agreement is based on the one negotiated between the pharmacy industry and government,” he says.

“However, that agreement is with the Pharmacy Guild, which is a membership body representing the vast majority of pharmacists in Australia. They have given the Guild the authority to negotiate on their behalf.

“The nature of the aged care sector is much more complicated than what a pharmacist delivers in their community; and the sector doesn't have the same kind of [cohesive representation].”

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June-July 2013 | 23

policy & reform

Aged care:

Who pays?

The confusion over changes to the daily accommodation charge continues, but the real story is, there are likely to be high increases in the cost of care.

By Bruce Bailey 24 | June-July 2013

policy & reform

F

rom July 1, 2014, the payment made in lieu of a daily fee will be known as a “refundable accommodation deposit”, and providers will have greater flexibility in setting these charges for other than supported residents. While you may think this is essentially a change in name, the reality is very much more than this.

As the RSM Bird Cameron aged care team worked through the proposals to understand the new daily accommodation charge and the lump sum equivalent rules, it soon became evident that the new system will be as difficult to understand as the current one and there is a real risk that this will cause accommodation charges to increase. In the example below the increase could be as much as 74 per cent.

The money or the box

Subject to the residents’ preference operators can either have the money (daily fee) or the box (lump sum). Where the lump sum applies to beds currently not bonded, it is essential that operators understand the impact of this choice on the operating surplus of their facility.

If you take a lump sum and the money is invested (under the permitted use rules) the operator will earn an investment return (say 4 per cent). So the first issue is to consider the investment return relative to the forgone current accommodation fee (accommodation charge).

Currently, the maximum daily accommodation charge is $33.29 ($12,150 p.a). At 4 per cent, this is equivalent to a lump sum of $303,780. If the money is used to reduce debt with an interest rate of 6 per cent, the bond equivalent would be $202,500.

In order not to see pressure on operating surplus, operators will need to fully understand the use to which they will put lump sums and the return that is appropriate from aged care facility as a rental stream.

Setting a daily accommodation charge

$33.29 per day may convert to $303,780 but for a provider lump sums are a function of daily charge and the maximum permitted interest rate (MPIR).

This means that providers need to set their accommodation charge based on the notional income they expect to derive from the invested lump sum. In the above example, and using the current maximum permissible interest rate, the operator has to set a daily accommodation charge at $58.00 to achieve a lump sum of $303,750 or $38.64 to achieve a lump sum of $202,500.

Therefore, to be sure of replacing the lost daily accommodation charge of $33.29 an operator has to set a new daily charge at $58.00 which is a 74 per cent increase.

Of course, the new fees will also replace existing bonds and the retentions the operator was entitled to. Looking only at the impact

of the loss of retention demonstrates a further complexity. The present retention is $323 per month. Using rates of 4 per cent for investments and 6 per cent for borrowings to replace this income requires a bond increase of between $64,600 and $96,900.

The actual rate is dependent on the liquidity ratio maintained by the operator. The new daily charge to replace the lost retention is between $12.33 and $18.50.

The numbers just keep changing

Another challenge for operators arises because the lump sum is based on the maximum permissible interest rate; these amounts are interest rate sensitive in a way that the existing bonds were not. As the MPIR declines, the bond goes up unless the operator drops the daily charge and as the MPIR rises, the bond comes down unless the daily charge is increased. The MPIR has changed every quarter since March 2008 ranging from 11.75 per cent to its current rate of 6.95 per cent so this is another significant issue to be considered.

Pensions with limited means

Currently, a pensioner with their own home and no other income is a supported resident and the operator receives the maximum daily accommodation fee of $33.29. Under the new means test arrangements, this person will now be asked to contribute $49.86 to the cost of their accommodation. However, with no income other than the pension they will be unable to do this until they sell their home, so this raises the prospect of increased bad debts to operators.

Conclusion

While sustainability in aged care requires a move to a ‘user pays’ system there are many traps for unwary or unprepared operators as they seek to develop their pricing models. Not only are they faced with changing the system for existing bonded places they also have to introduce a lump sum alternative on places that were not previously involved in those payments. This all adds to the complexity and risk: operators who fail to prepare for the change will ultimately see higher costs for residents’ accommodation or an increase in financial pressure on their operations.

RSM Bird Cameron has been working with clients to assist them in developing pricing models that ensure they are not disadvantaged by the changes. We often recommend operators look at airlines as an example. By having flexible pricing to suit both the needs of residents and operators, they end up with average accommodation revenue per bed equivalent to the current combination of resident fees investment income and interest savings. n Bruce Bailey is a director of aged care for RSM Bird Cameron.

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June-July 2013 | 25

policy & reform

An ounce of

prevention

The prevalence of mental health illness remains high, regardless of the amount of money dedicated to research and treatment.

Now, professionals are looking for new ways to direct mental health research.

By Amie Larter

26 | June-July 2013

M

ental illness has seen an increased profile over the last couple of years, featuring heavily in the 2010 election campaign, as well as being made a health priority in the recently released federal budget.

Despite increased exposure and spending, mental health issues are still on the rise, with mentalhealth related services costs rising to $6.9 billion in 2010–11, an increase of approximately $450 million from the previous year.

A recent survey of stakeholders in the field revealed that research priorities are now turning towards prevention. “Prevention is the Cinderella of mental health, not receiving the same attention as treatment and services, even though it has greater potential to reduce human suffering in the long term,” said professor Tony Jorm, professional fellow at the University of Melbourne.

“In Australia, we have made great strides in providing primary and specialist care for people with mental disorders. However, prevention is the missing element that remains neglected.”

CEO of Australian Rotary Health Joy Gillet agrees, suggesting that if the nation continues spending money on treatment at the same rate, we will go broke.

Convening at a symposium last month, a group of Australia’s top mental health researchers agreed that

the billions Australia spends on mental health could shrink significantly if greater emphasis was placed on prevention.

The group considered mental disorders across fives stages of life including prenatal and early childhood, childhood, adolescence, adulthood and old age.

Dr Nicolas Cherbuin, director, Neuroimaging and Brain Lab at ANU College of Medicine, Biology and Environment was one of the speakers specifically addressing prevention for the elderly.

He said there were a lot of risk factors for mental health in older age; but confirmed the major challenge was dementia.

“We have tried to develop treatments for dementia for two decades, there have been billions invested in these types of research projects and they have all failed.”

Risk factors for dementia later in life however have been identified, with effects often accumulating across the lifespan – some starting in childhood or teen years.

“We already know a lot about modifiable risk factors, and projections from the World Health Organisation suggest that if we could reduce exposure to the major modifiable risk factors for dementia and Alzheimer’s [education level, obesity, cholesterol, social engagement, depression, anxiety,

policy & reform Prevention is the Cinderella of mental health … even though it has greater potential to reduce human suffering in the long term.

exposure to pesticides, fish consumption, physical activity, cognitive activity, alcohol, smoking] it would lead to an annual decrease in dementia cases of 3.3 per cent while a decrease of 25 per cent would reduce dementia cases by 10 per cent annually,” Cherbuin said.

“Given the incidence of dementia in Australia it would lead to thousands of people being spared from the disease nationally, and many more internationally while saving billions of dollars.”

Cherbuin, along with professor Kaarin Anstey also from ANU, have progressed with research into prevention of cognitive decline using a three-pronged approach that began with the identification of risk factors for brain ageing and dementia.

The second step was to identify people at risk of developing dementia later in life by developing a risk assessment tool called the ANU-Alzheimer’s Disease Risk Index – which has been built into a website that will be made freely available later in the year.

The third step is the development of an intervention called Body, Brain, Life or BBL. The purpose of this third element, according to Cherbuin, is “to decrease www.agedcareinsite.com.au

exposure to known modifiable risk factors for dementia in middle age individuals”.

This intervention is currently the focus of a randomised controlled trial that will be completed by September 2013.

Dr Lee-Fay Low, senior research fellow, Dementia Collaborative Research Centre at the University of New South Wales, put forward a preventative measure that involves encouraging people to start thinking about mental health as part of their retirement plan.

“People plan for the first five or ten years of retirement, which is when you are travelling and looking after the grandkids.

But what actually happens when you are frail – even if you don’t get dementia? How are you going to protect yourself from negative consequence of physical frailty?”

Low suggests there are two elements that should be considered as part of this approach. First is for the individual to realise that ageing generally comes handin-hand with losing some physical health – so it should really be addressed as part of one’s lifestyle.

Main considerations include locality of residency to public transport, friends, and family, the size of the building – how will you maintain it?

Second is looking at communities, and how at a societal level we can protect peoples’ mental health by everyone being aware of ageing issues.

Currently, WHO is doing work around creating aged friendly communities, and Low believes that models presented at the symposium could work her in Australia, as long as they were implemented at community/ council levels.

At this level, she suggests schools, libraries, cafes etc can run special promotions or events for the elderly to reduce stigma and keep elderly involved within the communities.

“It’s about not just doing things for older people, but giving them opportunities to be part of society.”

An alliance on prevention of mental health disorders was formed at the event, which will advocate, promote and lobby to make prevention a key policy focus for health and government entities. n

Risk factors According to beyondblue, a notfor-profit organisation aiming to promote awareness and understanding of depression and anxiety in the Australian community, risk factors that can increase an older person’s risk of developing depression or anxiety include: • an increase in physical health problems/ conditions e.g. heart disease, stroke, Alzheimer’s disease • chronic pain • side-effects from medications • losses: relationships, independence, work and income, self-worth, mobility and flexibility • social isolation • significant change in living arrangements e.g. moving from living independently to a care setting • admission to hospital • particular anniversaries and the memories they evoke.

Change and illness The health and social changes experienced by elderly people, including death of loved ones, illness and isolation, can often lead to mental health issues later on in life.

According to the 2012 Mental Health Services In Brief in 2010/2011, there were 13.9 million mental health-related GP encounters in year 2010-11 – one in four of which were for patients aged 65 and over.

Furthermore, depressive symptoms affect in between 10-15 per cent of people aged 65 and over, with just over 10 per cent of the same age bracket affected by anxiety.

For those living in aged care facilities, the figure jumps much higher – with in excess of 35 per cent of residents believed to suffer from mental health issues.

June-July 2013 | 27

policy & reform

Preventive

primary dental care

Oral disease contributes to both poor dental health, and negative healthcare outcomes. By Patrick Shanahan

O

ral disease is one of twelve chronic diseases identified as National Health Priority Areas (NHPA) by the Australian Institute of Health and Welfare (AIHW). In 2006, AIHW estimated over seven million Australians had a chronic disease, four million a disability, and three million required care assisted by over two and half million carers. About fourteen million of the population go to the dentist annually. Those most likely not to go are those with chronic disease.

Oral disease almost always affects chronic diseases. Medical research has strongly linked many medical complications with untreated dental infections. The associated bacteria can be transmitted via the blood stream, ingested, or aspirated, causing an inflammatory response, which then has to be treated.

The absence of teeth or dentures does not reduce the bacterial risk. The palate and the tongue can harbour bacteria that are a risk factor for aspiration pneumonia particularly with stroke affected swallowing and respirator use.

According to AIHW, half of hospital admissions were for chronic disease complications, most of which were amenable to prevention. In a very large study, the US Institute of Health found treating post-operative complications caused by untreated dental infections increased health costs by $100 million (10 per cent) when treating these dental infections pre-operatively would have cost only $16 million (1.6 per cent).

In WA, an emergency extraction not carried out for $34 resulted 28 | June-July 2013

in a bacterial endocarditis that cost almost 700 times more to treat.

Treatment of chronic disease almost always affects the mouth too, the most common being dry mouth, where the mouth becomes sore, extremely sensitive, prone to injury, infection, and delayed healing. This can affect eating, swallowing, and sleeping, and result in digestive disorders, weight loss, depression, and pneumonia. Medicare legislation arbitrarily excluded dental services, even those which are medically necessary.

Medicare dental was introduced to deliver better health care and save money. In 1998, the US Congress passed Medicare dental into legislation (HR1200). It determined medically necessary dental care was health care; Medicare would fully meet the cost of diagnosis and treatment of clinically evident dental infection, but excluded restorative dentistry, and limited the conditions covered.

In 2004, Tony Abbott, as health minister, introduced Australia’s Medicare Chronic Disease Dental Scheme (MCDDS). It lacked clarity and had limited support. Just before the 2007 election, it was radically amended.

Unlike the US legislation, which was precise in who and what it would cover, the 2007 legislation was imprecise and did not deliver. Labor considered MCDDS flawed policy and committed to closing it before the 2007 election, but did not till July 2012, and nothing replaced it. Medicare dental was sound health policy, but it could have been much better. Despite its cost, it delivered health savings, benefitted over a million people, and transformed their lives. Few programs achieve that. Instead of closing MCDDS, it should have been retained and amended to: • protect the $2.5 billion already invested in MCDDS • focus on those most in need, their needs, and carers • operate within the health system • confine conditions covered to the NHPA’s • focus on health care outcomes • restrict access to expensive cosmetic dental items • promote prevention, wellness, and holistic health • target changing health behaviour and enhancing self care • develop a diagnostic capability and referral system within medical practice to facilitate treatment of ‘medically necessary’ dental care • provide for developing competencies in HACC and at the community level • include an outcome and evaluation process.

If these amendments were implemented, Australia would lead the world in this neglected area of health care, and improve the quality of life of millions of people. n Dr Patrick Shanahan BDSc (WA), DipPH (Syd) has a background in clinical dentistry and developing programs and national health policy.

construction & design

Creating

living space for dementia sufferers

Dementia residents require highly specific living arrangements that help reduce confusion and frustration if they are to effectively negotiate their later years. By Genevieve Brannigan

D

ementia is the single greatest cause of disability in Australians aged 65 years or older, with more than 321,600 Australians currently living with the disease. There are approximately 1700 new cases each week, which is expected to grow to 7400 new cases weekly by 2050.

According to the latest census, there is a need for significant investment in aged

care. Residential aged care is moving towards providing ‘ageing in place’ so that people don’t have to move accommodation as they progress from low to high-level care.

Residents who enter care with dementia are initially quite mobile but can exhibit agitated and aggressive behaviors borne out of frustration and confusion with unfamiliar surroundings.

private space refuge + identity

living area relationships

Smith+tracey architects, who specialise in aged care design, recently held a think tank to explore how design can better cater for dementia sufferers. Ten concepts were developed, which focus on improving the quality of life of dementia sufferers.

Dementia specific accommodation requires a very human approach to design, with therapeutic elements integrated into secure indoor and outdoor spaces that help ease behavioural issues, said smith+tracey’s interior design expert Fran Curtis.

She suggests that design should focus on aiding communication and connection, providing health professionals with appropriate spaces to solve issues.

observation interaction

front door transition

path circulation + navigation courtyard ventalation + cueing

dining memories + communication

external activity space connection to everyday needs

out-door space relationship visual + physical connection

kitchen sensory messages + activity opportunities

www.agedcareinsite.com.au

June-July 2013 | 29

construction & design The ten design concepts formed at the think tank follow the theme of making navigating the home easier, a focus which Curtis believes is “especially important because confusion and disorientation is a major source of agitation for people with dementia”.

Navigating signs include personalised visual cues at a bedroom’s entrance and in private spaces. “Placing objects and images familiar to residents, which have personal meaning from their home or childhood helps them navigate their way around and remember where their bedroom is,” she said. Transitions from one room to another are eased with individual front doors, which enable easy differentiation.

Curtis explained that even as a person with dementia loses their ability to communicate through language, they maintain their sense of smell, taste and touch.

“Two-thirds of home care residents are women from a generation that was generally responsible for running the home and getting meals ready for the family. Spaces should be designed to provide scope for activities, like a kitchen that is not just a serving space, but a place people gather around and engage in normal activities that

they have been doing for years. This helps continue their daily life routines.”

Eat-in kitchens offer opportunities for interaction between staff and residents and provide a permanent and useful area to run activities, such as baking groups, using space within the facility that is often redundant between meal times.

One of the strengths of people with dementia is the wealth of memories they possess that can be accessed if the right opportunities present themselves.

The layout of the kitchen/ dining area provides a direct similarity to a normal domestic home which, when partnered with everyday activities such as cooking will improve quality of life for residents.

The internal courtyard garden enables residents to experience the elements from inside, and offers those unwilling or unable to venture outside the opportunity to interact with nature. It will also act as a source of natural ventilation.

Outside healing gardens act as a place of refuge and renewal, the landscaping will include paths with clear destination points to curb aimless wandering.

Covered external activity spaces will provide areas for events and group gatherings, while also offering space for

a men’s shed, picnicking, potting and food growing areas.

Centralised staff areas allow maximum discrete observation and passive interaction across the entire communal floor, from the entrance to the garden areas.

Although effectively designed as open plan, the relationship between the bedrooms, central courtyard and dividing wall create the feeling of individual areas.

Communal living areas are designed to help carers create spaces that facilitate connection and engagement for residents with their surroundings. “Rooms and zones should have single functions so that residents can choose the activities they want to be a part of, and can tailor sensory information to improve recognition of what is going on,” said Curtis. “Furniture and spaces can be moved around to make cosy corners or to create rooms of purpose, like a library.

“Understanding a person and understanding dementia are integral concepts that need to be used to inform design which provides the right type of care for all residents.

“These concepts have been developed with ease of interaction and improved quality of life in mind, not only in regards to those suffering from dementia, but carers and other aged-care facility residents.” n

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construction & design decorators to interior designers, draftsmen to architects, family members to the discerning power of attorney and aged care facilities promoting an ambience, character and atmosphere of a home.

The aged care room is frequently the final living room for person requiring care and this third phase of life holds many changes, ones that often are accompanied by a new type of consciousness in one’s personal environment.

In order to meet the solutions of the patients, it’s important to take into account the major stakeholders. There are three points of view to consider:

Loving child

For the son or daughter of a dementia patient, this will be one of the most difficult decisions a family member will have to make. Of course, the level of care always takes precedence, but small features around the ambience and feel of the facility, in my experience, make the biggest difference.

Leading architect

Building homes for the aged

In designing aged care facilities, there are many considerations to be made, not least of which is finding the right balance of design and function.

By Samuel Dwyer “We need products to be less institutionallooking ... less visible metal work ... softer, home-like tones.”

This is the repeated request coming from key decision makers in aged care, and has been the case for at least the last 25 years.

When first asked this question many years ago, it was taken as rhetorical. But it wasn’t. This was repeatedly a genuine request from serious forward-thinking professionals striving to improve the ambiance of the industry and comply with clear compliance regulation.

Over the years both professionally, and personally, we have all observed both the finest and poorest examples of patient www.agedcareinsite.com.au

care being delivered in the aged care environment.

Those involved with the industry have learnt that care encompasses the comfort and feel of our patient’s surroundings.

Thankfully, we are now seeing more and more of our industry leaders, investing abundant volumes of money in architecture and interior design.

Sadly, through lack of options, our key equipment decision makers have then been obligated to accept a compromise when selecting the most important items in our care facilities.

We are watching an amazing transfer from nursing home to aged care, independent/ low care to high care, interior

“I am tired of designing these beautiful facilities, then seeing on completion, they have dumped these stupid beds in there.”

This was said by one leading architect when speaking with an equipment consultant. A very pertinent point, considering aged care providers go to huge lengths to promote and build a state-of-the-art facility, yet they continually restricted to institutional, cold-looking bed selection. Considering the rising demand for aged care placement and Australia’s ageing population, invest into aesthetically pleasing beds and surroundings may well be the guarantee to 100 per cent occupancy. The aged care bed is considered the most significant item in any equipment budget and is certainly one of the most critical components to providing quality aged care.

Care giver

Pride in the workplace is everything. And in aged care, we are fortunate to have some of the most caring people in our society. They do what they do because of their selfless motivation to loving to care, not by the level of pay.

When our dedicated carers give in an environment with an ambient atmosphere and character, it will easily improve workplace moral. We either make things happen, watch things happen or don’t know what happened. n Samuel Dwyer is acting marketing director of Ambient Care Interiors Pty Ltd, the national import/ distribution division of Active Medical Supplies.

June-July 2013 | 31

practical living

The

transition to home

For some older Australians, living in care is not an option, but even the most independent spirits may eventually have no choice. By Amie Larter

M

aking the decision to move from living independently in the community into an aged care facility can be daunting – most older people prefer to remain at home for as long as possible.

According to the recently-released The desire to age in place among older Australians bulletin from the Australian Institute of Health and Welfare, many older Australians prefer to ‘age in place’ – that is, “remain in their current accommodation, compared with moving into specialised care, or even moving at all”.

Data included in the bulletin confirms that in 2009–10, 75 per cent of those aged 65–74 and 82 per cent of those aged 75 and over, own their own home. It is among this group, it suggests, that the “desire to age in place is found to be the strongest”.

However with an ageing population 32 | June-July 2013

care

and forecasts from the Global Burden of Disease (GBD) 2010 study revealing that Australians’ life expectancy is increasing, the reality is that this will be a decision faced by an increasing amount of elderly and families in the near future.

Australia is currently ranked 5th in the world for life expectancy – with a newborn girl living until 83.3 and a boy to 79.9 years of age on average.

Aleksandra Wawrowski, who passed away last year, was one of those people determined to never leave her home in Geelong, Victoria. She loved her house, friends and gardens – for Aleksandra, there truly was no place like home.

However, after suffering an aneurysm and realising that she needed around-theclock care – Aleksandra, her daughter Halina Bone and family decided upon moving her to Sydney to be closer to

relatives, placing her into care at Holy Family Services.

“When mum said she didn’t want to stay in her home anymore, I was in complete disbelief – I was panicked, sad and devastated,” Halina said.

“I felt guilty that I couldn’t look after her, and I just wanted her to be happy. But it wasn’t possible to have her living with us because of the stairs and she needed 24-hour care.

“I knew she was homesick and missed her friends in Geelong.”

Halina said that support from staff during that original transition was important – and made the process much easier to cope with.

According to Kevin Rocks, CEO of Holy family Services, offering support to families in addition to their clients must be a priority for aged care providers.

He said that when clients come in families they have generally spent a lot of time grieving and are generally carrying a lot of unjustified guilt about putting their parents into an aged care facility.

practical living

Many have carried the burden of being a carer for quite some time – a role that can be a challenging and emotional experience for the carer and extended family.

As Rocks explained, “Caring for a family member is a very emotional experience that can affect the dynamics of an entire family as it takes up most of the carer’s time, energy and even financial resources.

“Aged care providers shouldn’t only meet the care needs of their residents, but also extend the support to their families … We convey this to our staff and volunteers and train them as part of a support network for our residents’ families.”

From the first interview, Rocks believes it is important to talk to families about what they are going to feel, what the resident is going to feel and the reality of what is going on and how they are feeling.

“It gives them permission to suddenly realise that this is normal, and then they can start dealing with stuff and you can work with them,” he said.

Support is particularly crucial when working through and discussing advanced care planning and advanced care directives. Halina suggests that working with a collaborative and understanding team during this phase of the process in vital. www.agedcareinsite.com.au

“Although it was a difficult time, I felt some weight drop off my shoulders because I knew they were sharing the load with me,” she said.

Good communication will foster good relationships from the onset, and plays a large role in demystifying what life is like at aged care facilities.

“It is terribly important that you try and get the family united in the care and support because it really is a partnership – a three way partnership between the facility, the family and the resident,” Rocks said.

“Anyone who attempts to just provide good care to an elderly person who comes into a facility is really shortchanging everybody.”

To make sure the physical move from old to new home goes smoothly, more organisations are picking up on the valueadded service provided by transition companies to streamline the move from the community to an aged care facility.

Non-for-profit and for-profits in Queensland’s aged care sector including RSL Care, Blue Care, Churches of Christ Care, Tall Tree’s Care Communities have joined with provider Golden Years Home Transitions to minimise stress and distraction and ensure residents have a smooth move into their new home.

Golden Years Home Transitions assists with everything from property valuation and selling a home, to arranging removalists for the final move into their new aged care home and cancelling any utilities and subscriptions from a client’s old address.

“In our experience – it’s a very stressful time. Not only with the fact that the conscious decision has already been made to pursue moving into a carebased facility but then what’s next?” said managing director Cameron Early.

He believes that once the decision has been made, clients want to make the move as quickly as possible. However, the need to sell the house in order to realise the asset to enable them to get into the care-based environment often prevents this.

“There is a lot of anxiety associated with choosing a real estate agent, how to go about it, what’s the property worth, how do we coordinate the move and so on,” Early said.

“What we have found is that it is the merging of all of the tasks that becomes overwhelming.

“All of the tasks in and of themselves are probably not difficult or unmanageable for the client and or the family – the combination of them all can become too hard – and cause a delay into moving into the new home.” n June-July 2013 | 33

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practical living

Managing

diabetes in aged care Older diabetes sufferers are at risk of many problems, including malnutrition, but best practice is to balance blood glucose levels and quality of life.

By Philippa Cahill

34 | June-July 2013

D

iabetes is a growing health problem, characterised by the body’s reduced capacity or inability to control blood glucose (sugar) levels.

Poorly-controlled diabetes can result in: • Chronic infections • Poor wound healing • Weight loss • Fatigue.

Diabetes can also lead to long-term health problems, such as: • Heart disease • Nerve damage • Vision impairment • Kidney failure.

The increasing prevalence of diabetes has meant that residential aged care facilities are

facing the growing burden of caring for, and managing clients with diabetes.

With the high risk of malnutrition in this population group, managing residents with diabetes can be challenging for many nurses and aged care kitchens.

Best practice diabetes management in the elderly population has evolved immensely. There is now a better understanding of the disease and its implications for the frail elderly.

And there have been many improvements in diabetes medications and insulin therapies.

This progression has led to a movement away from a restrictive ‘diabetic diet’ to a more relaxed approach.

The priority for diabetes management in aged care is to achieve a balance between controlling blood glucose levels and promoting

practical living quality of life for residents.

For the dietary management of residents with diabetes, residential aged care facilities should consider the following:

for residents with diabetes. Foods with large amounts of added sugar such as soft drinks and lollies are of low nutritional value so should be kept to a minimum.

1. Menu planning

4. Suggested servings

A separate diabetic menu is not required.

If the standard menu is well balanced, there is no need to provide alternative diabetic options. An even distribution of carbohydrate-containing foods at each meal and snack ensures the regular menu can be applied for all residents. Input from an Accredited Practising Dietitian (APD) will assist in this aspect of menu planning.

5. Fibre

2. Artificial sweeteners

Diet products such as diet cordial, diet jams and artificial sweeteners are not necessary for residents with diabetes.

These products can be expensive, and when consumed regularly, may result in gastrointestinal upset in some residents.

Residents who have been using these products at home may choose to continue to use these upon entering the facility.

Kitchens should be able to provide these at the resident’s request, however a review by an APD to explain the decreased need for these to the resident or their family, may be useful.

3. Sugar

Standard serve sizes are important for residents with diabetes. Although the standard menu can be offered, second servings of high-carbohydrate foods such as potato, rice, pasta, bread, desserts, fruit and cakes, should be discouraged. This decision should, however, be made by the resident.

Sugar added to tea or coffee, or a thin spread of jam on toast can be included as part of a healthy diet for residents with diabetes. A spoonful of sugar in a drink between meals is unlikely to impact greatly on blood glucose levels. Likewise, regular desserts such as fruit crumble and custard, milk-based mousses and ice-cream are acceptable to include as part of the menu

A higher-fibre menu is a benefit to all residents, not just those with diabetes.

Higher-fibre foods slow the release of glucose into the blood, assisting in balancing blood glucose levels. Ways to ensure enough fibre in the diet include: • Offering porridge, bran-based cereals or muesli at breakfast.

• Providing wholemeal bread as a standard item on the menu.

• Ensuring two serves of fruit and five serves of vegetables are offered each day.

• Offering higher-fibre snack options, such as cakes and biscuits with added dried fruit, bran or wholemeal flour.

• Offering fresh cut-up fruit.

• Adding legumes to soups.

6. Meal frequency

Regular meals and snacks are important for all elderly residents to ensure enough food and fluids are consumed. Although this is also important for residents with diabetes, these residents are often unnecessarily provided with extra snacks, often plates of sandwiches, to avoid low

blood glucose levels.

Not all residents with diabetes are at risk of low blood glucose. Only those receiving insulin, and some on oral hypoglycaemic medications, are at risk.

For these residents, a substantial supper snack should be given to avoid blood glucose levels dropping overnight.

Appropriate snacks may include a milkbased drink, yoghurt, a sandwich or dry biscuits with cheese.

Those residents with diabetes who are ‘diet-controlled’ are not normally at risk of low blood glucose levels and are likely not to require anything additional to what is provided to other residents.

7. Dietary advice

Residents with consistently high blood glucose levels need individual dietary advice and support by an APD in combination with a review of medications and/ or insulin by their doctor.

8. Weight control

Being overweight can have a negative effect on blood sugar control. However, overweight residents need to be managed with caution and a referral to an APD for individual advice is encouraged.

In many cases, the aim should be for weight maintenance rather than weight reduction, as the risk of malnutrition poses a much greater threat to the health and wellbeing of the resident.

All residents with diabetes should be referred to an APD on admission to a residential aged care facility. APDs play an important role in ensuring these residents receive a healthy, individualised diet for optimal health and wellbeing. n

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June-July 2013 | 35

practical living

Dealing

with norovirus The elderly are at even greater risk than ever of contracting gastroenteritis. But this pandemic can be averted with the help of health professionals. By Naomi Cook

T

he so-called ‘Sydney 2012’ strain of norovirus is behind the recent gastro-pandemic in the UK, with around 750,000 cases of acute vomiting and diarrhoea. The virus, which caused such havoc in the UK has already caused outbreaks in Australia.

The virus is a hybrid of two separate strains of norovirus, and it’s likely to cause widespread illness this winter, due to its novel presentation to the immune system.

Text book descriptions of norovirus call it a ‘mild and self-limiting illness’, and for the normally healthy population this may well be so, but for more vulnerable groups, such as those with pre-existing health conditions, the very young and the very elderly, the opposite may be true.

Stopping the norovirus

It should be much easier to limit the spread of norovirus than colds and flu due to the 36 | June-July 2013

shorter, more intense duration of the illness.

However, there are some key factors to be aware of, in order to prevent major outbreaks.

Most state guidelines recommend a 48-hour window after the last symptom of diarrhoea or vomiting before returning back to work, school, day-care and so on.

The ‘48-hour’ guideline is in accordance with most international guidelines, however some states only recommend a 24-hour window.

It is also important to note that the Centre for Disease Control and Prevention in the USA actually suggests that the period of high infectivity can continue for up to 72 hours post-symptom resolution, and specifically requires food handlers to wait for 72 hours before returning to work.

Virus particles may be excreted for some time post-symptom resolution in faeces, particularly in those that have trouble

‘clearing’ the virus – usually those with compromised immune systems, the very young and the elderly.

How this applies to aged care • Health care staff working in aged care will need to wait 48 hours before returning to work if they have had vomiting and or diarrhoea. Any symptoms of vomiting and diarrhoea must be assumed to be norovirus unless laboratory studies prove otherwise.

• It might be prudent to put up signs in aged care units alerting visitors to protocol of visiting soon after symptoms of norovirus, before an outbreak has a chance to occur.

• Bearing in mind food is a prime vector for norovirus transmission, any personnel who have recently been sick with norovirus that return to work after the 48 hour window must still take extreme care when preparing food for others.

• Hand washing is key to reducing norovirus transmission, both within places of work and the local community.

A vigorous hand wash for at least 15 seconds is recommended.

practical living Alcohol-based hand sanitisers, although effective in killing other forms of gastroenteritis-causing pathogens such as rotavirus, haven’t shown significant efficacy in killing norovirus, but are recommended in the absence of an alternative.

• Thorough cleaning of an environment where there have been cases of norovirus is important, once symptoms have resolved. Water and detergent, followed by a wipe with diluted bleach is considered the best practice. Since the virus particles can be aerolised during a bout of vomiting or during a toilet flush, surrounding areas must be cleaned well. Norovirus particles are highly environmentally stable and have been shown to persist for long periods of time (lasting for weeks on some surfaces).

Closing thoughts …

All health care workers are in an excellent position to reduce the spread of norovirus in their place of work, and in their local community this winter.

But to really limit spread of the virus, cooperation of other community members is crucial. Reading up on ways to reduce the spread as well as actively engaging in dialogue with friends, family members and other work colleagues are ways to do this, helping to ensure that our elderly patients and family members are protected. n Naomi Cook is a registered nurse and author.

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clinical focus

Keep it

clean Hygiene improvements in the last two decades have improved the lot of those living in aged care, but as research shows, the rise in multi-resistant bacteria is still a major concern.

By Louis White

F

or 20 years, Christina Kenneally, a now-retired nurse, has worked in aged care facilities throughout Australia.

During that time she has seen a wealth of changes including a sustained and renewed focus on hygiene.

“The change has been remarkable in aged care residences around Australia,” Kenneally says.

“Twenty years ago you wouldn’t have hand sterilisers in bathrooms and constant messages telling you to be aware of spreading germs and to continually wash your hands.

“We had multiple people stacked in one room that would lead to the spreading of the flu and other minor diseases very quickly as you went from one resident to the next.

“Now, we have very clean residences, proper medical care and generally only one person to a room that ensures not only privacy for the resident but greatly reduces the chances of any spread of infections.

“That is not to say that illnesses and infections won’t be an issue now or in the future, but the standards and regulations have improved vastly and everyone is far more conscious of the need to keep things clean and be respectful of others.

38 | June-July 2013

clinical focus “While no system is perfect, I think we have made great inroads throughout my time of working in aged care facilities.”

According to statistics from the Australian government, more than 180,000 Australians receive permanent residential care with more than 70 per cent of those falling into the high care category. There are in excess of 2500 residential aged care providers across the nation with approximately 75 per cent falling into the private not for profit category. There are another 350 government facilities.

But the real figure is that 40 per cent of Australians aged between 65 and 73 require assistance with everyday and physical activities. Whether these people choose to enter an aged care facility voluntary is another matter but with a country like Australia where our population is ageing faster than we are giving birth, the care of the elderly will only increase.

“Residential aged care facilities are people’s homes but they are also public places as well that see hundreds if not thousands of visitors come through every week,” Patrick Reid, chief executive officer of LASA, says.

“Maintaining the health and wellbeing of residents and demanding staff standards is somewhat easier to achieve than when dealing with visitors, especially when relatively unknown. Facilities do remind staff and visitors in relation to general health, for example not to visit when sick but it is not possible to guarantee compliance from visitors.”

But while every measure is taken to keep aged care facilities clean and disease free, it is not possible to maintain or prevent illnesses spreading from time to time.

A survey published in the Medical Journal of Australia in 2011 assessed more than 100 residents across three aged care homes and found 12 per cent of the study group tested positive for E. Coli infection.

Dr Timothy Inglis and Dr Christopher Bear, wrote an article in the Medical Journal of Australia entitled ‘Multi-resistant Escherichia coli in aged care: the gathering storm’:

“The challenges of aged care are many and will continue to grow as the number of people in need of residential care expands.

There are many potential contributors to the emergence of multi-resistant bacteria in residents of aged care facilities: multiple hospital admissions, excessive use of antibiotics (in terms of courses, duration and antimicrobial spectrum), incontinence, dementia, venous stasis ulcers, and difficulty implementing infection control practices in institutions where residents are free to move outside their rooms and mingle with others.

“A control method for multi-resistant bacteria that relies on surveillance and targeted infection control measures may seem appealing, but in reality is likely to be costly, impractical and ineffective.

An alternative strategy is to use multiple measures targeting improvements in the skilled nursing care of those at identifiably higher risk of multi-resistant bacterial infection, without prior surveillance culture.

“But with an estimated multi-million dollar annual cost of multi-resistant bacteria control measures, and a residential aged care sector facing many challenges, we will be forced to explore all options. This should include considering a more public healthbased approach, as long-term care facilities lie outside the remit of conventional hospital infection control.”

E.Coli can cause an elderly person serious health problems. The infection can easily be passed from person to person via unwashed hands after going to the bathroom. The reality is that simple hand washing can stop the spread of many diseases.

“Aged Care Standards administered by the Aged Care Standards and Accreditation Agency encompass regulatory compliance that insists organisations have systems in place to identify and ensure compliance,” Reid says.

“This is coupled with additional measures in specific areas around clinical care, specialised nursing, medication management, nutrition and hydration continence management, oral and dental

care. There is a specific standard covering the physical environment and this standard encompasses fire and emergencies, infection control, laundry and catering.

Additional to this there are specific standards covering occupational health and safety and education and continuous improvement for staff.”

Damien James, founder and chief executive officer of Aged Foot Care, has also been working extensively in aged care residences across Australia since 1997.

After graduating with a podiatry degree and losing both his grandparents, he was keen to work with the elderly. His business has expanded to the point where he is now working with 327 facilities and employs 47 staff across Australia.

“From my own experiences, the industry has changed a lot for the better,” James says.

“We take great care working with the elderly to ensure that they feel safe and ensure an efficient, healthy and clean treatment. What I have also seen is the change in regulations regarding hygiene.

“When I first started, there was always a musty smell in aged care facilities and a lot of people crammed into one room with only a curtain separating them. Thankfully, you don’t see that anywhere anymore and there is a lot more emphasis on cleanliness and hygiene.

“I think everything has improved from the circulation of age in the facilities, the quality of the meals to the re-enforced emphasis about washing your hands at all times. Of course, nothing is foolproof but we have seen a lot of improvements which can only benefit the quality of life for aged care residents.” n Inglis TJ, Beer CD. Multiresistant Escherichia coli in aged care: the gathering storm.

Med J Aust 2011; 195(9):489-490.

Copyright 2011 The Medical Journal of Australia – reproduced with permission.

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June-July 2013 | 39

clinical focus

Screening for COPD

depression

link

Research has found that depression and anxiety adversely affect prognosis for COPD patients, and even lead to increased mortality.

By Aileen Macalintal

T

he connection between chronic obstructive pulmonary disease and depression could point to better health outcomes.

Research has suggested that given the adverse relationship between COPD and depression and anxiety, screening simultaneously for both disorders could be of great advantage to patients.

The study by Dr Evan Atlantis and colleagues has found that patients diagnosed with COPD and depression or anxiety consistently had worse outcomes including exacerbation and increased mortality.

The researchers’ report in Chest, the online journal of the American College of Chest Physicians, said COPD patients with comorbid depression had an 83 per cent higher risk of mortality. Data suggested that chronic bronchitis alone may increase the risk of anxiety as depression or anxiety worsens COPD prognosis, possibly interfering with effective COPD management.

COPD patients had also been found to have a much higher chance of being diagnosed with depression, as 40 per cent of COPD patients had depression and anxiety compared to the general population’s figure of less than 10 per cent.

40 | June-July 2013

clinical focus

Dr Evan Atlantis

Kate Carnell

Many people across Australia suffer with COPD, especially those who are in the later stage of life.

“The Burden of Obstructive Lung Disease study estimates that the prevalence of COPD, defined according to the Global Initiative for Chronic Obstructive Lung Disease criteria as stage 2 or higher, was 7.5 per cent among Australian people aged 40 years or older in 2006–10,” said Atlantis, senior research fellow from the University of Western Sydney.

“The prevalence of COPD was highest among people aged 75 years or older,” he said, adding that treatments should be prioritised according to COPD guidelines.

Depression among COPD patients can be addressed through multidisciplinary care plans for COPD. He said screening for both diseases at the same time can become a common practice by increasing awareness of the best available evidence through publications.

“Screening for these disease combinations would identify patients who have both COPD and depression/ anxiety, and provide clinicians the opportunity to treat both problems at the same time – potentially delivering a better overall health outcome,” he said.

He said depression leads COPD patients to disregard pulmonary rehabilitation and cut on the exercise, resulting in lost productivity.

Currently about 10 per cent of the world’s population aged 40 years and older have COPD, he said, and COPD rates increase with age, independently of smoking history.

“So, an aging world population will increase the rates of COPD and undoubtedly cause significant stress on healthcare systems in high-income countries, and may threaten economic growth in developing countries,” he warned.

Beyondblue believes in raising awareness of both the general public and health professionals on the link between these two great health challenges.

“First and foremost, health professionals should understand that people with COPD are significantly more likely to experience depression and anxiety,” said CEO Kate Carnell.

Carnell said Beyondblue has recently produced a document that they are sending out to hospitals and GPs, to alert doctors to the issues surrounding people who have had a major health problem, and expounding the importance of taking note of other health issues such as mental health when diagnosing patients.

She said doctors need to appropriately treat chronic conditions and how likely the patients of such conditions are to experience depression.

“What unfortunately happens with conditions like COPD is doctors focus on COPD but don’t look for other issues in the patient’s life. So if the issue is, say heart attack or heart disease, they treat heart disease, and don’t actually ask the appropriate question look at the patient’s mental health issues.”

A doctor, she indicated, needs to ask how the patients are feeling as well as how their mental health is faring. Patients, on the other hand, need to talk to their GPs about how they are feeling.

Carnell believes it is important to speak to your GP if you are “feeling sad having trouble sleeping or organising their lives, starting to becoming or feeling disconnected with friends and family, not going out, not doing the things that used to make them happy”.

She advised COPD patients who are experiencing depression and anxiety to get around, continue as normal as life is, and continue to stay in touch with their family.

“It’s hard anyway with COPD if the person has depression,” she explained, adding that the situation can make the patients withdraw from society.

Those with COPD and depression may have lifestyle problems, “ … not getting the exercise that they should do, not eating or sleeping properly, which makes their general health and COPD worse”. Carnell says treating the depression early is imperative, in order to avoid a downward cycle.

She also emphasises the importance of nurses in general practice, who she believes are well-trained in this area. Often patients see doctors busily going around, thinking they don’t have time to listen, but patients shouldn’t think that way. Talking to the general practice nurse or to other health professionals such as social workers or occupational therapists may be of great help. n

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June-July 2013 | 41

clinical focus

The fall-out

from

falls

A $1.5 million research trial to prevent falls hopes to keep elders standing firm. By Aileen Macalintal

A

mid current concerns about the impact of falls on the ongoing health of older people, research is being conducted via a patient-centred program to prevents falls, subsequently reducing injury and hospitalisation.

RESPOND, the innovative postemergency department discharge program designed to reduce secondary falls in older people, will bring together health departments, service providers, researchers and clinicians from Victoria, WA and NSW. To extend current research and practice on falls prevention, patientcentred education will be incorporated with behaviour change strategies that are proven to be effective in the secondary prevention of cardiovascular events.

Associate professor Glenn Arendts from the the University of Western Australia’s School of Primary, Aboriginal and Rural Health Care said the trial’s strategies include ensuring adequate surveillance of ED patients and participation of as many eligible patients as possible.

“This is a trial testing secondary falls prevention. To be eligible, the patient must have already had at least one fall requiring

42 | June-July 2013

ED attendance and recruitment will occur in the participating hospitals,” Arendts said.

He said falls are the leading cause of ED attendance in older people, and healthcare costs associated with falls are double those associated with motor vehicle trauma.

Very few people that attend ED with a fall have access to appropriate interventions to prevent further falls. In addition, some programs may not meet the requirements and preferences of the patients so participation is poor.

Thus, falls and ED attendances with often serious injury are common. Currently, 50 per cent of older people who come to ED with a fall will return within six months.

“We believe that many if not most secondary falls are preventable, providing two fundamental principles are applied,” said Arendts.

“Firstly, falls risk factors must be identified and addressed using best available evidence. Secondly, it is the patient, supported by falls specialists, that drives risk factor modification through informed choice and targeted goal setting tailored to their circumstances and preferences,” he said.

Dr Anna Barker of Monash University

said the research aims to reduce ED presentations and admissions. “The increasing burden on hospitals as a result of the persistent rise in emergency service demand by older patients is unsustainable,” said Barker.

ED demand in Australia has increased 32 per cent beyond that expected by population changes over the last decade, she said.

“Our prior studies show the fastest demand growth is in older people,” she said. “It provides a unique opportunity to strengthen research and policy collaborations. It will build both research and clinical capacity, and targets issues at the forefront of the reform agenda.”

She said the practical, rigorous design of the plan will ensure translation of sustainable research outcomes for maximal impact.

RESPOND’s partner institutions and organisations across Victoria and Western Australia will be coordinated and led by the School of Public Health and Preventive Medicine at Monash University.

Patient recruitment at the Alfred Hospital in Victoria and Royal Perth Hospital in Western Australia will start later this year, she said.

The National Health & Medical Research Council (NHMRC), Australia’s peak body for supporting health and medical research, funded this Partnership Project on preventing secondary falls.

“Partnership Projects like the one led by Monash University’s Dr Anna Barker are an important part of NHMRC’s action plan to accelerate research translation so that healthcare and the prevention of illness is based on evidence and achieves tangible health benefits for Australians,” said a spokesperson for NHMRC. Funding under the scheme supports researchers to work with those who deliver health services to investigate and address specific ‘on the ground’ problems.

“Dr Barker’s RESPOND project aims

clinical focus

Glenn Arendts

Dr Anna Barker

to prevent patient falls and reduce the strain on the health system. Older patients who present to emergency departments after falls often re-present within six months again because of falls. This project will help these patients access health services that are known to prevent falls,” said the spokesperson.

Patient falls could drop by facilitating patient access to health services such as vision and medication assessments and exercise programs, which in turn will help reduce demand on emergency departments.

As part of the Partnerships for Better Health initiative, $7.9 million in Australian government funding has been allocated for 11 NHMRC’s Partnerships for Better Health Projects.

These partnerships are a joint initiative between NHMRC and partners including Commonwealth and state agencies, hospitals, medical research institutes and patient advocacy groups.

Partners are contributing an additional $3.46 million in funding plus $6.25 million in-kind support. A key benefit of this work is encouraging alliances between partners who deliver health care services, partners who make decisions about health practice, and researchers who can offer tailored, evidence-based solutions.

“As highlighted in the NHMRC Strategic Plan 2013– 2015, research translation is a vital part of health and medical research. The ‘on the ground’ partners will take up the knowledge and solutions that are uncovered through these collaborations to improve health policy and practice, and reap improved health outcomes for our community,” he said. n

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workforce

Good news for the aged care work force Change has been slow in coming, but it has arrived.

A government report on the industry is giving us the most comprehensive picture yet.

By Michael Fine

10% 90%

44 |June-July 2013

I

n the midst of uncertainty, it is reassuring to learn that the aged care workforce has been growing strongly over the past five years. And it looks set to continue to grow well into the future to meet the needs of the ageing population.

The Australian government has just recently released its report, The Aged Care Workforce, 2012. Produced by the National Institute for Labour Studies (NILS) at Flinders University, this is the most comprehensive picture we have ever had of those who work in aged care.

The study, which covers both residential and community-based aged care, found that altogether, there are over 350,000 paid employees working in the industry. While the number employed in residential care continue to exceed those in community care, the proportion working in the community is increasing. In 2007, 33 per cent of all staff worked in the community, but by 2012, this had increased to 43 per cent.

At this rate of increase, the majority of aged care workers will work outside of residential care settings within the next five years.

Direct care staff now makes up 69 per cent of the total, also an increase over the proportion in 2007. Personal care attendants are the mainstay of the residential direct care workforce, making up 68 per cent of the total.

Community care workers, 81 per cent of the total, make up an even greater proportion of community direct care workforce.

But not all staff provides direct care, of course. In residential care, the largest group of staff not providing personal care are those with responsibility for ancillary care, such as cooking, cleaning, maintenance and transport.

In community care, the largest group are care managers and service coordinators, closely followed by administrators and management staff.

It won’t be a surprise to ACI readers to learn that the majority of age care staff don’t work full-time. While a high proportion is casual in both residential and community care, the most common form of employment is permanent part-time. About one in two direct care staff in each sector work between 16–34 hours per week.

Although there has been a slight increase in the proportion of direct care workers employed full-time (35 hours or more per week), aged care is mainly based on part-time employment.

Similarly, there has been a slight increase in the proportion of staff born overseas. While there are quite high concentrations of staff born in non-English speaking countries in capital cities across Australia, migrant staff are still approximately the same proportion as they are the in the general population.

workforce

There is some other good news hidden in the report. Gone are the days when aged care was an unskilled job suitable for those who lacked qualifications. There has been a big move towards increased qualifications over the past twenty years and now, more than 85 per cent of direct care workers have a post-secondary qualification. This is above the national average.

There is an increasing number of staff pursuing further education. Interestingly, the workforce is also an increasingly older one, with a higher proportion now aged 55 or older.

The proportion of staff aged 35 and under has not significantly changed in recent years, so the increased in older staff is for a large part a result of staff staying on.

But perhaps the single most outstanding characteristic of the aged care workforce is the fact that most workers are women.

There has been an increase in recent years in the proportion of men, up from 8 per cent to now just over 10 per cent of the total. But this is still a small proportion of the total, and aged care is one of the last bastions of single-sex employment. Many think this helps explain the low pay and the lack of opportunities relative to comparable areas of employment.

The increase in demand for care, arising from population ageing as well as from the new policies enhancing access to support, mean that for staff, aged care workforce will remain a relatively secure occupation.

Will there be a change in the makeup of the workforce to help meet future demand?

Might there be more men attracted to this field? One possibility to help make that more possible would be a shift away from a culture of nursing care to an approach in which aged care increasingly began to open up to the large numbers of qualified personal fitness coaches.

But while it might be a good thing to see more males learn to provide direct, hands-on care, it’s difficult to see how such a culture change in aged care might come about in the aged care field. And while the pay remains low, it’s difficult to see how more men might be attracted to work in the industry. n

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workforce

Muggleton’s

passion

An enthusiasm for management and health, coupled with concern for the elderly, saw the young Stephen Muggleton move from hospital management to a career in the aged care sector. By Amie Larter

A

lways interested in contributing to making a difference to people’s quality of life, it was during his time managing teaching hospitals that professor Stephen Muggleton became increasingly concerned with the amount of elderly patients he saw trapped in hospitals. This fact he put down to insufficient community care and residential support.

“This is when I decided to move out of hospitals and be more involved in managing organisations that were caring for the aged, vulnerable and disabled,” he said.

In 2003, Muggleton stepped into his first CEO role for Blue Care – the residential and community care division of UnitingCare Queensland.

Over the eight years he served the company, Muggleton oversaw the strengthening of the brand and its investment into its retirement living division Azure Blue, with his efforts contributing to the company being recognised with a Premier’s Award, as

46 |June-July 2013

well as Q150 icon status.

“I really enjoyed the ability to transform an organisation and increase it and improve its ability to care for people,” Muggleton said of his time at Blue Care.

Muggleton was also professionally recognised for his business acumen, being awarded the inaugural AIM Award as Queensland Non-for-Profit Manager of the Year.

Today, Steve is heading up not-for-profit healthcare agency RDNS, which provides 24-hour, seven-day specialist and general home care to people throughout Australia and New Zealand.

Leadership

Muggleton was fortunate enough to be mentored through the early stages of his career by professor Robert Burton, who went on to do ground breaking work on cancer control with the World Health Organisation.

“Despite not being a medico or a medical researcher he used to challenge

me to apply the same discipline to health management decisions.”

Burton’s advice: “Without valid data you are just another person with an opinion” stuck with Steve, shaping the way he made decisions throughout his career. He has never executed change just for the sake of it, stating “there has to be a strong case for change and measurable positive outcomes for staff and consumers”.

Recognised in the industry as an innovative and transformational leader, today Muggleton describes his leadership style as being based on servant leadership.

He believes that to properly serve the mission of the business, it’s imperative to align all the organisations efforts to support front line staff and care.

Anything more complicated, he states, turns “leadership into unnecessary and distracting bureaucracy”.

“As leaders in a tough sector we must create a culture where there is a bias for action, where staff are trusted and encouraged to trial new ways of delivering care,” he said.

“I strongly believe that people who choose to care for vulnerable and frail people should be empowered as an invaluable resource and not be made to feel that they are being micromanaged as a cost.”

Growth and rebrand

It is no wonder that a businessman who “hates orderly inaction” – has been able to make so many changes to the business

workforce staffed by nurses 24 hours a day, seven days a week. So, if we are looking after people that are palliative or that have quite serious conditions – they get reassurance by just being able to link in with the nurse at any time of the day or weekend.”

Another element that enticed Muggleton to the position at RDNS was the “degree to which the provision of care is underpinned by research”.

RDNS’s Research Institute undertakes original research, evaluates community nurse programs and provides support to clinical leadership groups.

“Our research institute specialises in dementia, wound care, medication management and telehealth and its lead by Susan Koche – who is currently the chair of the minister for ageing’s expert advisory committee on dementia,” Muggleton said.

“In 2011–12 the RDNS Institute’s research team managed 10 major projects, presented at more than 30 conferences here and overseas, and published 20 peer reviewed articles.” in such a short time.

Since stepping into the role of CEO at RDNS just over 21 months ago, Muggleton has rejuvenated the business, extending its footprint both nationally and internationally, as well as revamping the brand and image.

It was this opportunity for expansion, in conjunction with RDNS’s reputation as an iconic Victorian provider that originally drew Muggleton to the role.

“It’s a position that doesn’t come up very often – the previous CEO had been in the role for 17 years and done a terrific job.

“But after discussion with the board, I realised they wanted to expand the expertise and had the constitution and vision, which is very attractive to a CEO – to expand both the variety of services that you offer as well as your geographical footprint.”

Before Muggleton joined the company RDNS had a well-established client base of 37,000. This has increased by over 21 per cent, rising to approximately 45,000.

This rise can be attributed in part to the negotiation of a number of large contracts from national aged care services company KinCare, effectively buying RDNS a footprint in every Australian capital city and the eastern seaboard.

On an international scale, RDNS also picked up a major Home and Community Care contract with the Southern District Health Board in New Zealand, as well as two Accident Compensation Commission contracts and expanded their core services in Auckland.

Aware that change is inevitable – in regards to the customer, the industry and the pathways by which clients choose providers – RDNS also underwent a complete image overhaul. www.agedcareinsite.com.au

Muggleton said the revamp has been an exercise in understanding what people want from a provider and creating a brand that is fresh, more visible and modern.

“We are about more than just delivering a functional service to people: we are about sharing their journey with them ...

“Our new brand reflects this sentiment; it captures not just the things we do but the way we do it, and the overall experience we undertake to provide to our clients and customers.”

This complete transformation can be firstly attributed to “the support of an incredibly capable and engaged board”, according to Muggleton.

Secondly, he said, was aligning that support and vision into a series of steps that have been and are continued to be executed by a smart and energetic leadership team.

Tech and research

Although quick to stress it’s never a substitution of care, Steve confirms that if used correctly technology can help supplement and better support clients.

RDNS recently took home one of four major awards at the first Asia Pacific Eldercare Innovation Awards in Singapore.

Video conferencing is high on the agenda, with the company having just completed a successful trial with medication management.

Under Muggleton’s direction, the company has most recently gained the largest grant under the NBN Enabled Telehealth Pilots Program – clear evidence of their commitment to being at the forefront of research in the area.

“We have got a call centre which is

The future of care

According to Muggleton, the shortterm plan for RDNS is to consolidate the business as it stands now, with the possibility of diversifying its services throughout Australia.

He would like to see movement into chronic disease programs and more primary care centres. Like many similar organisations, the company is also looking into home-care packages and providing good service solutions for residential aged care and retirement living.

RDNS will also continue its strong history of dedication to technology, by heavy investment into telehealth.

“I am delighted with the growth, but we are really only matching increasing demand as the Australian population ages – and we think there plenty of potential to continue growing to provide more innovative response to people’s needs,” he said.

Muggleton’s message to other providers: “There is no doubt that the funding environment is tough but it’s been tough for a long time and it’s always been changing. It’s important not to feel trapped or helpless by the situation.

“Above and beyond the opportunities presented by an increased Home care packages and NDIS there is plenty to be excited about. Good providers should easily adapt to consumer directed care principles – it should be part of their fabric anyway.

“They have the possibility of expanding their primary care offerings, doing more to ameliorate chronic disease, develop healthy ageing programs and reduce pressure on hospital beds.” n June-July 2013 | 47

e b i r c s b u S today  Comprehensive and diverse range of topics  Independent and insightful articles making our publications essential reading  All our websites feature interactive areas where users can comment directly on the conversation and debate the topics that face your industry, today and in the future  D elivered free of charge, and you will also receive weekly online updates and special content.

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Using the latest technology to address this range of niche publishing markets, the company has access through its books, magazines, newspapers and the internet to virtually every teacher, university student, academic and health professional in the country.

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workforce

Championing

skin inte

Want to become involved in helping the elderly look after their skin?

This article is a first step toward becoming a champion of skin integrity.

By Kathleen Finlayson

i

n managing and caring for skin injuries, there is now substantial documentation to prove that evidence-based wound management is making a world of difference in aged care.

Residential aged care facilities (RACFs) now have the opportunity to participate in a national dissemination and implementation of the Evidence Based Champions for Skin Integrity (CSI) program and associated resources.

The program and resources were first developed in 2008–10 as part of the Department of Health and Ageing’s Encouraging Better Practice in Residential Aged Care (EBPRAC) program.

This first stage of the CSI Program was implemented and evaluated by a consortium of seven RACFs across Qld and NSW and the School of Nursing, Queensland University of Technology, led

by professor Helen Edwards, program leader for the Cooperative Research Centre for Wound Management Innovation.

The impetus for the project was the recognition of the increased incidence of wounds in older adults, the significant pain and decreased quality of life caused by chronic wounds, and the burden on carers and health system resources aggravated by evidence-practice gaps in appropriate assessment and timely use of best practice treatments.

While there are a large number of evidence-based guidelines addressing differing aspects of wound management and/ or different types of wounds, very few guidelines cover all aspects of wound management.

This contributes to the difficulties faced by clinicians trying to quickly locate appropriate evidence based information on wound care, exacerbated by the multiple

guidelines available on the same types of wounds, increasing confusion for clinicians and carers in deciding which to follow.

To address this, the project team developed a suite of guidelines summaries which provided a simple summary and consistent rating of evidence based guidelines from multiple documents.

The guidelines’ recommendations were grouped into assessment, management and prevention sub-headings.

Following this, all education and resources for the project were based on these summary documents.

The aim of the project was to preserve skin integrity and increase implementation of evidence-based wound management

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workforce

egrity

through implementing the CSI Model in RACFs, where the incidence of skin tears, pressure ulcers and chronic leg or foot ulcers are a serious issue.

This model incorporated multiple evidence-based strategies for promoting the uptake of evidence into practice, including: a supportive environment with local Champions, easy access to education and information resources, use of audit and feedback cycles, hands on skills development Care Insight 67Hx 185W BB 20130614 OL.pdf 1 and clinicalAged decision making support systems.

The initial audit and feedback cycles found a significant decrease in the prevalence and severity of wounds following implementation of the CSI model, particularly in the area of pressure injuries.

The figures indicated that the CSI model was able to facilitate the implementation of evidence-based prevention and management strategies, with positive outcomes.

There has been overwhelming demand for access to the project resources, with requests received from many organisations across Australia and overseas, including residential aged care facilities, community nursing associations; hospital in the nursing home programs, GP practice nurses, and the acute care hospital sector.

The success of the first stage in increasing implementation of evidencebased wound management and developing an evidence based resource kit has highlighted the value of strategies which focus on stakeholder involvement and a focus on prevention.

These strategies have the potential to improve the quality of life of people with, or at risk of developing chronic wounds, while also reducing the burden on their carers.

In addition, and of considerable importance in the current climate of the strain being experienced by the Australian aged care sector, is the potential reduction of the burden on health system resources.

As a result of evaluations and discussions, it was concluded that the dissemination of the CSI Model and project resources on a national scale would be beneficial. The project team will soon extend an invitation to all RACFs across Australia to participate in the dissemination of the project and resources throughout 2013 and 2014.

The pivotal requirement would be to identify a clinical leader with strong commitment to supporting dissemination and implementation of evidence-based practice in skin integrity and wound care, to 14/06/2013 9:58:52 AM become a Champion and CSI trainer.

This Champion would be given the opportunity to attend a “train the trainer� workshop given by the project team on the CSI Model and use of the resource kit, with the expectation that skills and knowledge acquired at the workshops would be used to train a team of Champions within their RACF, lead a small project on evidence based wound care, and engage with the project team in the few months following the workshops to provide feedback on the project activities.

It is envisaged that the Champion and their new team of CSIs would act as a resource person for advice and be the first point of contact to contribute to education and change management strategies for promoting evidence-based wound care.

This might seem like a daunting prospect, and might well be – were it not for the support provided for Champions.

This includes a comprehensive resource kit, with evidence based guidelines summaries; brochures for health professionals, clients and carers; tip sheets; flow charts; a self-education DVD, with eight modules, self-assessment quizzes and all resource files; a wound dressing information guide; role descriptions for Champions at all levels; role descriptions for wound care networks and link clinicians; a data collector (clinical auditor) training file; skin integrity audit tool; support tools for meetings and education, with template files (e.g. evaluation tools, fact sheets, discussion group resources); and link information to sources of evidence based guidelines in wound management.

In addition workshops will provide guidance on change management strategies, targeted goal setting activities, and formation of long-term support networks. n Dr Kathleen Finlayson is a research fellow at the Faculty of Health at Queensland University of Technology and can be contacted at k.finlayson@qut.edu.au

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June-July 2013 | 49

community

Talking of

walking

Grief compelled her to walk, but the pleasure and sense of achievement keep this octogenarian legend moving ever faster. By Aileen Macalintal

T

here is little standing in the path of world champion 86-year-old competitive walker Heather Lee. Lee, a competitor in the 41st Australian Masters Athletics Track and Field Championships, is the winner of numerous gold medals, national walking awards, and two world records, leading to her own web TV series and a dedicated YouTube Channel about her training and achievements.

“I’ve been walking in events since 2001, but took up race walking in 2011,” said Lee. “The Adelaide Masters Games was my first experience in race walking but this 50 | June-July 2013

did not deter me and determination to succeed seems to be a part of my psyche.

Core strength probably played a part in managing to beat the other competitors,” she said.

Getting two world records are achievements that she considers the best in her life, but another part of her success is that she could be an easy source of inspiration in every race.

“I’ve inspired other people to walk, to have a better lifestyle,” she says proudly.

To stay competitive, she said she maintains an 8-minute per kilometre benchmark, as she competes not with people outside her age group, but against

her own performance level.

The Gold Company of Sydney manages her website, uploading her YouTube channels. Lee said they consider her to be worthy of public notice and the recognition they think she deserves.

The octogenarian shares her exercise, meal plan, sleep habit, and what drives her to walk in races.

“What drives me to race: always the adrenaline rush at the start and the feeling of achievement at the finish line,” she said.

After losing her husband to cancer, she began walking for pleasure and charity events to cope with grief. When she saw what she could do at events like Relay For Life and the Sydney Bridge Walk, where she walked past participants half her age, she and her supporters knew she had to try racing with professionals.

“I took up walking in a more serious way

community after my husband died, and I felt a compulsion to walk. It was therapy and gave me solace.”

She said she has discovered since then that walking is an excellent way to keep fit as one grows older. “It sharpens the mind as well. This is very important to me, that feeling of well-being.”

Lee gets up early to train and she does this regularly, at least four times a week, “with a sensible diet including fresh vegetables and plenty of fruit, meals prepared and cooked at home.”

She said she is fresh and ready to go after 6-7 hours of sleep. “To prepare for a major walk, I train well beforehand, taking infinite care with diet and fitness in mind,” she said.

Before a race, she will eat a healthy breakfast. “I usually have mostly blueberry, banana, a few extra nuts, yogurt, and milk, of course. That’s my usual breakfast because I find it energising and healthy,” she said.

When she was younger, she didn’t play competitively but she said she played tennis and hockey,

and was engaged in swimming, cycling and walking.

“I had a very active life and that’s the secret, I think: stay active, keep active,” she said.

In the book What I Talk About When I Talk About Running, novelist Haruki Murakami, also a runner, shares that he’s always asked what he thinks about whenever he’s running long distances at long stretches of time.

What does Lee think about while she is in her own company during a race?

She said she’s concentrating on the important leg action in race walking, lap times and the enjoyment she gets from exercise.

Thinking about these matters helps keep her focused.

As for her message to the young people who say they can’t find time to join walk races or do regular walking exercises, she says, “Young people should remember that one day they will grow older and regret their lack of exercise that will then have an impact on their quality of life. It is then too late to remedy this.” n

What Do Hospitals And Aged Care Providers Find So Appealing About Their Companion?

That’s obvious. When delivering the best possible outcomes in medication management is a priority, more and more establishments from both sectors of the health care industry have chosen to make AMH Aged Care Companion Online available throughout their facilities. They have come to rely on this electronic resource to reap health benefits for the residents and harness cost benefits for the facilities.

AMH Aged Care Companion Online is produced by the same team that publishes Australian Medicines Handbook, and designed specifically for industry professionals – that is reassuring to anyone aiming to achieve QUM through delivering quality care.

The content is carefully organised for speed and ease of reference. It contains information on more than 70 specific conditions common in older people, including: dementia and management of behavioural symptoms, cardiovascular diseases, fall prevention, osteoporosis, palliative care issues, COPD, insomnia, depression as well as some broader concepts. Drug choices are ranked as first line/other options or arranged by disease severity or symptoms, with dosing information specifically for the older person.

With more hospitals and aged care facilities adopting this tool for sharpening their competitive edge, other health professionals, including those in general practice, have also integrated it as an essential part of the quality framework of their organisation.

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June-July 2013 | 51

community

A force for

benevolence

The story of Australia’s first charity spans the nation’s history, and in a storied 200 years, has received support from the likes of Prince Charles and Princess Diana, and Elvis Presley.

I

magine an Australia without free legal aid, child protection laws, the old age pension or maternity care and you’ve just imagined Australia without The Benevolent Society,” CEO Anne Hollonds said.

Hollonds said The Benevolent Society holds a unique role in the nation’s history, helping people of all ages change their lives by breaking the cycle of disadvantage.

She said the society was really Australia’s welfare system for most of the 1800s. “When we were formed in 1813, the colony was a harsh place for the growing number of destitute children, single mothers, and elderly ex-convicts who were not considered deserving of help.

“Our founders were a small group of visionary people who established the first home-grown philanthropy and volunteering in Australia,” she said.

One of their best known attributes is their establishment of the Royal Hospital for Women in Paddington, which ran for almost a century and became known for its medical breakthroughs, including the first reliable test for pregnancy in Australia and the first cancer detection clinic for women.

In the late 1800s, they also campaigned for the age pension and the abolition of child labour.

Despite having come a long way since 1813, the society still needs to do more. One in six children lives in poverty, one in five children is developmentally vulnerable when they start school, and more than 30,000 kids live in foster care since living with their parents is unsafe.

“Now we help people before they get to crisis point – to prevent and reduce the cost of social problem. We help struggling families to provide a better start for their kids, so they don’t get left behind.

We support older people living at home to have a better quality of life, and much more,” she said.

“With our legacy of experience, we know that the earlier people get help, the more effective it is for them and the less it costs the community – so everyone benefits.”

The Benevolent Society’s milestones include governor Macquarie becoming the first patron, which became a legacy that successive NSW governors have carried on since 1818.

In 1968–69, Elvis Presley became life governor after an Australian charity tour of his gold Cadillac raised the equivalent of $1 million in today’s money. And in 1983, prince Charles and princess Diana supported the Benevolent Society by attending a royal charity ball during their royal tour of Australia.

Prime minister Julia Gillard has extended her best wishes to The Benevolent Society.

In her message, Gillard recognised how the founder, Edward Smith Hall, arrived from England with a reputation for religious and social zeal. “Hall was a farmer, bank founder, coroner, public servant and turbulent newspaper proprietor who Macquarie once called ‘a Useless and discontented Free Gentleman Settler’.”

52 | June-July 2013

She remarked Hall’s sense of justice, which led him to build the NSW Society for Promoting Christian Knowledge and Benevolence, now known as The Benevolent Society.

“The Benevolent Society is Australia’s first charity and one of its finest,” she added, “the society has been a voice for compassion and reform – always accomplishing in its own deeds what it asked of others. Thanks to the society, thousands of Australians have found comfort, dignity and the tools for empowerment and self-reliance.”

Other well-wishers included opposition leader Tony Abbott and NSW governor Marie Bashir, who said, “For two centuries, the Benevolent Society has provided a safe haven for the poor and dispossessed, enriching the lives of thousands of Australians of all ages and backgrounds.” n

community

Queensland

Baptist Care C

rebrands

arinity is the new name of non-profit organisation Queensland Baptist Care, as the group expands its services throughout Queensland.

CEO Jon Campbell said Carinity represents care and a sense of belonging, which they strive to give clients every day.

The organisation began in 1949 as an aged care provider and it now offers a comprehensive range of community services, including aged care, retirement living, education, and support for communities and youth.

“For those in need of support, we provide communities of care, compassion and respect in which people feel secure and valued – a place where they feel they belong,” said Campbell.

“By walking alongside those in need, we seek to ensure that no one is denied the chance to reach their full potential because of adverse circumstances.

“Our organisation offers caring services at 29 locations throughout Queensland, assisting over 11,500 people each year. After a great deal of consultation and consideration, we believe our new name reflects both our mission and identity,” he said.

After recently acquiring Kepnock Grove aged care centre

www.agedcareinsite.com.au

in Bundaberg and John Cani in Mount Morgan, Carinity is expanding across Queensland with new services planned for the Gold Coast, Toowoomba and Townsville.

Campbell said the expansion plans and new name indicate “the dynamic evolution of the organisation” over the past few years.

“Our organisation’s positive reputation in the not-for-profit industry is based on its Christian mission and values which remain firm and a long history of listening to customers’ needs and meeting their expectations,” he said.

“Our clients throughout the state can be assured that under the new name ‘Carinity’, our caring staff will continue to provide the same high quality compassionate services and dedicated support, making a real difference to those in need.”

Carinity also offers support and accommodation for homeless youth and help families and young people dealing with domestic violence and abuse.

It also secures lifestyle communities for people over 65, supports those with disability, gives chaplaincy support for people in hospital, and provides an alternative education for teenagers who struggle in traditional schools. n

June-July 2013 | 53

technology

Sim City Mary Casey reveals the benefits of education in a simulated environment.

S

imulated training is an educational concept that all nursing and allied health colleges should be offering students. Teaching multiple objectives in a ‘real life’ environment can grow confidence, encourage knowledge retention and be highly beneficial for the student, employer and patient.

It has been proven that the essential bases of adult learning theory is through experiential learning and I have witnessed this firsthand with our students.

I have also noticed a far higher level of knowledge retention when adults learn through experience, opposed to standard classroom education whereby they only get to listen and hear how it is. Whether it is community or hospital based, simulated training is a combination of assessment and clinical decision-making through communication, hands-on, teamwork and management to care for the patient.

At Casey College, students are taught in a simulated environment, and for a portion of the lesson, learn what it’s like to be a patient. This method of simulation provides perspective on the patient’s needs.

When the student is immobilised by being in a wheelchair for a period of time, they quickly develop an understanding 54 | June-July 2013

technology not only for the patient’s physical needs but also for their frustrations. It is at this point that students see the bigger picture and suddenly what they’ve learned in the classroom clicks into place.

When working in health, you’re responsible for the wellbeing of your patient and therefore confidence in your ability is a must. You’re required to feel at ease with the method and technique that you’re using and the patient must trust that you know exactly what you’re doing.

This confidence grows when students are exposed to ‘real life’ situations and this training positively impacts an individual’s skillset as well as boosts professionalism in their career as a nurse or allied health worker.

It’s true that we learn by our mistakes and in healthcare it is important that these mistakes happen before working with a patient.

Debriefing is an essential part of simulated training as this is where areas that require growth can be highlighted and praise on positive skill can be given. This training environment provides the benefit of consistent, constant and immediate feedback.

If the simulation is designed to offer feedback at various points throughout the timeline, participants can take the

feedback, make corrections, and move forward.

Feedback can be personalised and in some cases the instructor may choose to film the student to show them directly what they need to be working on. In teamwork, students feed off the debriefing that other students receive and when an individual witnesses another making a mistake, they too learn from it. This also applies to when an individual does something well, they then lead by example and more often than not the others follow.

I have also witnessed students who may fly under the radar when it comes to the theory aspect of the course. These students may be mothers who have been out of work for over a decade and putting pen to paper is something that they have been out of practice with for a long time.

Their life experience however makes them soar through the practical sections of the program by showcasing their life skill and understanding for a patient. Providing a balanced program allows students to shine in their strongest area.

A well-designed simulation can also be an enjoyable and exciting experience for both the participants and the instructor.

When students are enjoying what they do, they retain more information and have a far

better application of knowledge. Instructors also feed off the positive energy in the classroom and therefore provide a more upbeat and fun way of learning.

Progressing from education to the workplace is far less daunting when the student has worked hands on in the past.

In addition to knowing how to perform tasks the new employee also has a sense of how long each task should take and the expectations that they have to meet.

A student who has graduated from a program with this form of training is far more likely to be picked up by an employer than someone with next to no experience with patients. These students will be able to approach patients straight out of college and the learning curve is less likely than someone who has not had hands on training.

While simulated training is talked about widely in the media today, it’s not something new. Learning through experience is a taught to us from the day we begin kindergarten therefore there is no logical reason why this too shouldn’t be part of our adult teaching programs.

I encourage all education facilities to consider this option. n Dr Mary Casey is founder and CEO of the Casey Centre.

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Aged Care

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Nursing

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June-July 2013 | 55

technology

Writing down

your life

H

ow does one design a life?

An online repository for memories, called On My Life has won at RMIT University’s annual Design Challenge focused on ageing.

The idea for a website that stores life stories came up during a seminar about a palliative care biography service.

Cameron Rose, representative of the winning team and lecturer at Monash University, says that the service collects the stories of people as documented at the end of their life. The stories would then be transcribed and copies would be given to the family and the organisation.

“There was a metal cabinet of these biographies just sitting there, unread.

In fact, there were so many that the organisation had stopped collecting them.

It seemed to me that biographies like these should be facilitated online, making it easier for the biographers,” Rose said.

He said the seminar had revealed the possibility of taking these memories to the general public. “It also occurred to me that there was no reason to wait for the end-of56 | June-July 2013

life to record these stories. Surely it would be of benefit to those who still had many years to live,” he said.

Photographs, documents and other digitised memorabilia can be stored in On My Life, enabling elderly residents to easily and intuitively store and share their histories, even if they have little experience using the internet and computers.

On My Life was designed to empower a largely disempowered community in medicalised aged care, and engage family members and care workers in a richer comprehension of who they are, said the winning team.

The project offers many benefits.

Reminiscence and life review has been shown to improve mental health, underlining the importance of making this activity readily accessible. Through online activities, aged care staff can also improve their understanding of those in their care by learning more about the resident’s background – as well offering new staff the chance to familiarise themselves with residents by simply browsing their histories.

A planned website that allows the elderly to set down their life story for future generations has won the RMIT annual Design Challenge award.

By Aileen Macalintal

“On My Life is a proposal to develop a website to record the biographies and reminiscences of residents in aged care homes. It is designed particularly for use by aged care organisations as an addition to their activities,” said Rose.

Gene Bawden, head of visual communication at Monash University, designed the templates. His research, which involves designing family histories, is enhanced by his use of image and typography. These templates, said Rose, add value to the experience and a sense of fun and creativity for the user.

“It is designed to be simple to use, and encourages the participation of family members and visitors in the creation of the resident’s stories,” Rose said.

“Ideally, the elderly would co-create their biography with a family member, visitor or staff member,” he said. Tech-savvy younger family members are hoped to have a meaningful activity to share with their elderly relative while also learning about their family history.

“Most users of the internet are familiar

technology with multiple options and have the ability to toggle through different software to complete their task, but the elderly are inexperienced and can be intimidated by too many options, he said. However, the ‘six steps to story’ design will make the task easy.

The steps to create a story start with choosing any place in the map of the world, where they like to begin their story. Next, they select the year of the event. Based on the place and year, a selection of images will spring from a reputable image database that the users can add to their ‘photo box’ for the design. Family members can also upload their own. The users may then enter the narrative of their story. Once the story is finished, formatting templates can be tried on. The last step is to publish the story, which family and friends can access freely.

There is also a time-capsule option, where the resident can record their story, without sharing it with the whole world until a later date.

Design challenge jury member David Napier said On My Life stood out among other competitors because of the project’s simplicity and ease of application.

Napier, who is executive director of Digital Harbour, said this project is innovative because it provides the elderly an access to an enduring record of a life-long range of experiences, images and documents for the benefit of their family and loved ones.

“On My Life provides the opportunity for the elderly to have an interest, a target and a goal with the ongoing benefit of adding to and extending the breadth and depth of the collated information,” he said.

This project is one of those “simple but immediately identifiable innovations that we can all relate to,” he added. “It is relatively easy to participate, can be accessed by people of all ages and is of particular benefit to the ageing. This innovation should be encouraged.” n

Above: Cameron Rose (left) and team member Gene Bawden, head of Design, Monash University.

Right: Design Challenge jury member David Napier

At Bunzl, we are working closely with our preferred and trusted healthcare suppliers to deliver market leading brands to professionals in hospitals, aged care facilities and other organisations. We offer product supply solutions and a service oriented consolidation and distribution service, by means of one order, one delivery and one invoice. Our team of clinical specialists can support staff with outcome-based education to optimise patient and resident care.

Major partners include:

One Order, One Invoice, One Payment.

Visit www.bunzl.com.au or call 1800 655 152 www.agedcareinsite.com.au

June-July 2013 | 57

technology

Asking the

right

questions Determining a service delivery strategy requires leadership, education and funding.

So it’s important to get all your ducks in a row.

By Manolo Yanes

I

recently participated in an aged care industry event, and had a conversation with a CEO from a large community care provider that manages over 1000 carers. I asked my usual questions about the event – whether he was enjoying it, and what he thought of the overall issues being discussed.

His response surprised me. He described how the event still looked at the in-home care and aged care providers with issues that his organisation had already moved on from years ago.

He also pointed out that it seemed the industry had the wrong focus. In his view, the event reflected what the industry was asking for, as opposed to what clients and the government were now demanding. “We should be talking more about efficiency, transparency and communication in the service delivery process,” he said. “My people spend most of their time sorting issues with the service delivery over anything else.”

So what’s missing? Is it leadership? Better education of service delivery managers? Better funding? I believe that this all plays a role when determining a service delivery strategy.

However, perhaps the real reason is that these organisations are not aware that there are solutions in the market that can improve and optimise their service delivery strategies. The CEO I spoke to intimated that the problem was in service delivery and in his view, his employees spent most of their time managing and creating a ‘schedule’ of work for their clients.

The toughest issue facing service delivery organisations is managing the day to day tasks that are part of a client schedule, and trying to fit those requirements against an employee roster.

Issues arise when managing the roster for carers, or client schedules are broken due to exceptions such as clients cancelling appointments, carers calling in sick, priority of tasks and many others. If they failed to deliver services as agreed with the client, then they start seeing poorer care outcomes for the client.

So what is out there for service delivery organisations?

Five years ago, if you wanted to put a mobile device in the hands of a carer the cost would have been in the thousands, just for the hardware. Currently, an Android smartphone can be purchased for well under $300. In some cases, carers will already have a smartphone as most mobile providers only sell smartphones.

So what can you do with a smartphone in your hand? With the 58 | June-July 2013

The government has recognised that even though the goal of service delivery organisations is a better outcome for their clients, organisations providing community care and aged care may not always have the level of transparency clients are asking for.

current HTML5 technology, it is possible to deploy mobile solutions to most mobile devices on the market. These mobile applications can be used to update carers about their rosters, appointment details, client information relevant to their visit and obtain proof of service from the client via signature or location aids, e.g. A-GPS. However, the obvious questions with any technology whether new or entrenched, arise in relation to security, information privacy and mobile infrastructure. So let’s look at my next topic: the cloud.

Service delivery organisations are not IT experts and setting up expensive infrastructure for IT systems is costly and not the focus of a service delivery organisation. Cloud services can minimise a lot of the IT costs associated with setting up mobile workforce management solutions by avoiding heavy capital expenditure. This approach frees up service delivery organisations to continue to focus on what they do best, and leave the cloud service provider with managing the IT systems.

The most pertinent question that arises with cloud services in aged care and community care service delivery is around security and privacy of client information. Protecting this data is important and there are plenty of safeguards offered by cloud providers that can be put in place to address privacy and security issues. Is it a good reason to stop an organisation from going ahead with a better service delivery model that is more cost efficient?

I remember when I got my first BlackBerry, and how the same arguments on security were used by people within my company not to use BlackBerrys. Six months later, no one had any issues with it, seven years later and people put their corporate emails on many devices. It can be done with the right safeguards in place mitigating any potential risk.

Transparency is such an important issue that it goes to the heart of everything an organisation in delivering aged care or community care is trying to achieve. The government has recognised that even though the goal of service delivery organisations is a better outcome for their clients, organisations providing community care and aged care may not always have the level of transparency clients are asking for.

The government has addressed this issue with Consumer Directed Care (CDC). CDC packages ensure that clients will have a say on their budget allocated to their care, have a say on the schedule, the make-up of their appointments and even choose different providers if necessary.

How do you provide such transparency? By taking control of your service delivery to the point that clients can re-book, update and change appointments where necessary without having to pick up the phone.

There are tools available by organisations that address the points raised by the CEO in the aforementioned conversation. Perhaps the introduction of CDC will be the catalyst for a change in strategy across the sector. n Manolo Yanes is a senior solutions consultant with ClickSoftware.

technology

IEC 60601-2-52

AutumnCare launches

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Telephone: 1800 987 870

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Has your clinical system grown?

June-July 2013 | 59

2010 winners, left to right: 2012 winners, left to right: Chris McGowan Jan Wright and Raeline George representing Silver Chain, Rhonda Sawtell, Abby Dunnicliff and Shirley Nelson.

Meet Australia’s best in aged care!

Be there when winners in each of the following three categories are announced: Individual

Organisation

Team

Awards dinner Sunday 4 August 2013 Doltone House Jones Bay Wharf - Pyrmont Point, Sydney Visit hestaawards.com.au for more information. @HESTAACawards Winners announced on the evening will share in a $30,000 prize pool*

t i ck e ON sa ts le

NOW

*Generously provided by: Proudly presented by:

hestaawards.com.au Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No. 235249 Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321.