Aged Care Insite - Aug-Sep 2013 by Racs Salcedo

Issue 78 Augustâ&#x20AC;&#x201C;September 2013

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

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

production manager Cj Malgo (02) 9936 8772 cj.malgo@apned.com.au

news 04 NACA’s pre-election push

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Study investigates benefits and participation rates

Aged-care rationing system failing elderly

36 Modified meals

Tasty, nutritious options

06 A new way to track meds

Who’s managing medications?

08 Caring concerns

Panel calls for improved advocacy services

10 Industry recognition

Awards highlight best in aged care

SUBEDITOR

34 Yoga limits falls

11 Crisis looming

44 Breathe easier

Why it’s all in the brain

Researchers improve efficiency of lung treatments

13 Dementia and education

UTAS launches two world-first initiatives

policy & reform 16 Challenging perceptions

LGBTI-inclusive aged care

27 Lessons from overseas

© Copyright. No part of this Study tour visits Europe and UK publication can be used or facilities reproduced in any format without express permission in writing from APN Educational Media. The mention practical living of a product or service, person 30 Engagement via art or company in this publication, Cognitive stimulation for dementia does not indicate the publisher’s endorsement. The views expressed sufferers in this R Spublication M B 0 0do 1 not 3 necessarily 1 2 0 1 3 - 0 8 - 1 5 T1 0 : 1 1 : 0 2 + 1 0 : 0 0 32 Capturing the experience represent the opinion of the publisher, Alzheimer’s photo exhibit tours its agents, company officers or Australia employees.

Providers face workforce challenges

Tips to look after your financial health

22 Opinion: Jude Comfort

PUBLISHER’S NOTE

50 Rural recruitment and retention

55 Money matters

Funding and regulation won’t fix care system

Tailoring layout to improve outcomes

ACI’s Top 5 Inspiring aged-care professionals

Increasing workforce efficiencies and effectiveness

20 Opinion: Michael Fine

construction & design 24 Rethinking hospital design

workforce 46 Winners revealed

54 Opinion: Barry Williams

Close bonds at aged-care residences

APN Educational Media (ACN 010 655 446) PO Box 488 Darlinghurst, NSW 1300 ISSN 1836-1501

Elderly emergency presentations challenge staff Proper management avoids prolonged use

12 Understanding pain

Cart connects residents and specialists

Ways to improve healing

40 Protocol rethink

42 Psychotropics risk

Nation’s healthcare spending needs attention

14 Video-conferencing pilot

clinical focus 38 Wound management

community 56 History in the making

Over 80s tennis champ to attend world championships

57 Sensory gardens

Dementia-specific spaces improve well-being

technology 59 Opinion: Jeffrey Soar

Emerging technologies improve quality of life

61 Senior Techies

Kids give tech tips to elderly

Audited 9,215 Looking for certainty through change as at Sept 2012 in accommodation charges?

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August–September 2013 | 3

news

No reason

for rations

NACA leads call for end to scheme that ‘limits choices and independence’ of seniors. By Amie Larter

any people are simply not receiving care or are getting an inappropriate form of it that does not meet their needs due to Australia’s aged-care rationing system, according to nursing peak body and education provider the Australian College of Nursing. Forty members of the National Aged Care Alliance, including ACN, have joined forces for a pre-election push to bring an end to the aged-care rationing system they say is leaving many elderly Australians without care. The group, which consists of aged-care advocates, health professionals and workforce representatives, called on political parties to review the system. Under the present scheme, the number, type and location of beds and services available per 1000 people is restricted by planning ratios, forcing some elderly onto waiting lists or to move away from loved ones. ACN CEO Debra Thoms said this “mismatch between the services people need and the services they are able to access removes or limits the choices and independence of older Australians”. She suggested that Australia needed “significant investments in our health and aged-care workforces, including attracting and training aged-care nurses”. Only 116 out of every 1000 people over the age of 70 get the care and services they need, CEO of Alzheimer’s Australia Glenn Rees said. “Recent reforms will lift that to 125, but what happens to

numbers 126 and beyond?” he questioned. “Chance plays a huge role in whether or not you can get help to keep living in your own home or access a place in an aged-care facility when you need it.” Adjunct professor John Kelly, CEO of Aged Care Services Australia, said service providers are forced to operate in a system that can’t keep up with demand. “Providers of aged-care services are put in a position where they have to constantly turn older people in need away,” he said. The group supports the abolishment of aged-care rationing, a recommendation of the Productivity Commission in 2011. Lee Thomas, federal secretary of the Australian Nursing and Midwifery Federation, said the industry had seen some of the PC’s findings but a commitment to the whole package is needed. She called for the federal government to end the aged-care lottery by: • Providing a level of resources for eligible individuals to meet their needs however they choose to do so – in their own home or at a residential care site • Removing the regulatory restrictions on the quantity and type of services providers can offer, enabling services that are more responsive to older people’s needs and preferences • Committing to an independent cost-of-care study to support better informed decisions about how we fund aged care in the future. n

Kit up for dementia care

linders University will roll out a dementia care training program in aged-care homes throughout Australia with the help of a $1.45 million federal government grant. The grant will fund the university’s distribution of the Personalising Practice Resource Kit to every aged-care facility over the next three years. This e-Learning resource will be launched through a series of 30 workshops across all states and territories, with additional assistance through web-based support. Acting head of the Flinders’ Palliative and Supportive Services Discipline, Dr Sam Davis, said the kit was designed to help staff improve dementia care by putting their knowledge into practice. “A lot of staff recognise there are things they could do better but they don’t know

4 | August–September 2013

how to facilitate those changes, so these tools will help make their jobs a bit easier and empower them to enhance the care they already provide,” Davis said. The kit, which Flinders researchers created in conjunction with seven nursing homes in Victoria, includes: • A CD of practical information and tools to help aged-care staff improve dementia care across 19 themes, including strategies to enhance independence, well-being, meaningful activities and simple environmental changes • A CD with 26 short video messages about person-centred care, as well as an accompanying training manual • A video featuring the experiences of aged-care staff who have used the kit. n

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e b i r c s b u S today C omprehensive and diverse range of topics  I ndependent and insightful articles making our publications essential reading ll our websites feature interactive areas A where users can comment directly on the conversation and debate the topics that face your industry, today and in the future elivered free of charge, and you will  D 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. SUBSCRIPTIONS Aged Care INsite

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news

A closer eye

on medicines

A new software function can help check antipsychotic drug use in residential aged care. But it raises questions about just who’s managing medications. By Aileen Macalintal

PS MedicineWise has teamed up with Webstercare to develop a new reporting mechanism that reviews the use of antipsychotics for the behavioural and psychological symptoms of dementia, potentially increasing the role of pharmacists and other staff in monitoring use. Lynn Weekes NPS MedicineWise CEO Dr Lynn Weekes said that whilst there is a role for psychotropic medicines in residential aged-care facilities (RACFs) there is evidence to suggest that there are instances where they are being used improperly (see “Mind the mind drugs”, page 42). Antipsychotics should be used with deliberate caution Gerard Stevens and only when the benefits outweigh the risk of harm, the CEO said. “Antipsychotics are a type of psychotropic medicine that can be used to manage behavioural and psychological symptoms of dementia,” Weekes explained. “They have modest efficacy for treating such symptoms, but also have a range of potential adverse effects and are associated with an increased risk of death – primarily from cardiovascular events and pneumonia – compared with placebo. “Their use also requires careful monitoring.” In 1995, the Senate report Psychotropic medication in Australia, recommended that 6 | August–September 2013

pharmacists become involved in the review of psychotropic medication, Weekes said. There has recently been renewed focus on this issue amidst a media spotlight and parliamentary scrutiny. Webstercare CEO Gerard Stevens said the new reporting mechanism it has developed with NPS MedicineWise includes quality use of medicines (QUM) reports, which automatically extract medicine usage data from dispensing records for review. “The design … provides the ability for retrospective analysis of antipsychotic usage over time in facilities,” Stevens said. “Webstercare’s software records … dosage changes, ceased medications or new medications.” Stevens said pharmacists – along with aged-care staff and medication advisory committees – may benefit from this new reporting mechanism. “Reviewing and actioning the reports may assist an RACF in meeting expected outcomes of the Accreditation Standards for Residential Aged Care related to continuous improvement, medication management and behavioural management,” Stevens said. “The new reporting mechanism for antipsychotic use in aged care enables ongoing analysis of antipsychotic medicine usage in a timely manner - which is also easy to use and

works at the click of a button.” It should be noted that the new software function is designed to extract data on the dispensing of antipsychotics automatically and identify which residents may be using them. As Weekes explains, this means staff will have to take care to analyse the data in the proper context. “While all residents taking antipsychotics need regular review, the information in this report is primarily to assist the review of antipsychotics used for behavioural and psychological symptoms of dementia,” Weekes said. “Indications need to be checked from the care plans or resident notes if the health professional does not know why a resident is using an antipsychotic.” Stevens said the reporting mechanism should encourage the use of data and educational resources to achieve and maintain best practice. Lastly, it should also help quickly identify and prioritise residents who may benefit from review. Leading Age Services Australia (LASA) CEO Patrick Reid saw the advantage of the new functionality but emphasised the role of doctors in prescription. “The new reporting mechanism will enable pharmacists to provide information to staff working in residential aged-care facilities and aid them in understanding, analysing and effectively managing the appropriate use of antipsychotic medicines for their residents,” said Reid, who is also a pharmacist. He noted, however, that “doctors prescribe, pharmacists dispense”. “It is the doctor who prescribes the use of these medicines and it should be the doctor who monitors the ongoing use, in collaboration with the professional staff in facilities, including the pharmacist.” Reid said the announcement of the MMS function generating QUM reports seemed to indicate that the staff would be responsible for managing the use of the medicines. He questioned such a system. “Will the report highlight against a baseline? Is the use high, low or average? How does a pharmacist know the use is appropriate, as there is often no indication given with the script as to diagnosis – so how does the pharmacist or care staff judge appropriateness?” Reid asked. “The Pharmacy Guild has called for prescriptions and medication charts to have indication for us on them for years but this has been resisted. This would then be meaningful for off-label use. “Unfortunately, NPS MedicineWise and Webstercare have neglected to contact LASA for input,” he said. Reid added that any review of medicines was important, “but this area should be approached from a care team level and not in isolation”. n

news More milk, please

• Ita Buttrose has called on politicians to fund an increase in research to address what she described as “the dementia epidemic”. In a speech at Edith Cowan University, the Alzheimer’s Australia national president said dementia research was underfunded in comparison with work on other chronic diseases. She said this was not linked to the quality of dementia researchers in Australia, but that there were simply not enough working on the challenges of Alzheimer’s disease and other causes of dementia.

• Further weight has been added to evidence of dairy’s beneficial role in protecting bones. A study recently conducted by the Dairy Health and Nutrition Consortium linked higher dairy intake to “greater whole body mass, better physical function and a trend of lower prevalence of falls in older women”. Researchers from the University of Western Australia monitored 1456 Australian women between the ages of 70 and 85 to investigate the effects of different amounts of milk, yoghurt and cheese on muscle mass, mobility and risk of falls. Muscle mass and mobility were higher for women who had more than two serves a day, compared with women who had fewer than 1.5 serves a day. The study also showed the rate of self-reported falls tended to be lower in women who had more dairy foods, after adjustment for non-dairy protein intake.

Market stress a reminder • The recent fall in interest rates has prompted COTA Australia to remind Australians of the importance of the elderly having access to sound independent financial information. Chief executive Ian Yates said the fall would make older Australians re-assess how their funds were invested as income from cash investments continued to fall. The organisation believes that older Australians would be better served with a ban on all commissions and third-party payments to all financial advisers, including accountants.

Highest accreditation standards yet • A new retirement living accreditation scheme has been launched that will attempt to give residents peace of mind by making owners accountable and responsive. The Lifemark Village Scheme contains higher standards than ever seen in the industry, measuring aspects of life including services, respect of dignity and safety. Accreditation under this scheme is not compulsory, it is voluntary and industry driven. The plan will be run by BSI Australia – one of the nation’s largest auditing organisations.

inbrief

Buttrose: more research funding

AHHA online course a hit • The Australian Healthcare and Hospitals Association (AHHA) has announced that their Palliative Care Online Training Program has reached 2000 participants. The free online training program is sponsored by the Department of Health and Ageing and is available to anyone interested in palliative care. The program was introduced in June to promote the use of the department’s Guidelines for a Palliative Approach for Aged Care in the Community Setting. An assessment has shown positive satisfaction rates from participants and a significant reach across Australia. After completing the online program, 81.5 per cent of respondents reported an “excellent” or “greatly improved” understanding of the published palliative approach guidelines. Participants said the program had helped them be more effective in their practice.

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We are at the forefront of super innovation. HESTA was the first Led by CEO, Anne-Marie Corboy, our role is to inform you about your options — so you can build a better retirement savings balance, major super fund in Australia to introduce a sustainable investment option – Eco Pool – and assess fund managers on their after-tax whether you’re 25 or 65. investment returns. HESTA now has more than 750,000 members, 119,000 employers and more than $22 billion in assets. For more information visit hesta.com.au or free call 1800 813 327. HESTA’s size means we can offer many benefits to members and employers. These include: low fees, a fully portable account, easy administration, access to low-cost income protection and death Issued by H.E.S.T. Australia Limited ABN 66 006 818 695 AFSL No. 235249, Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. 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.

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August–September 2013 | 7

news

Candidates

pledge advocacy

Opponents praise, criticise aged care on election panel. By Bina Brown

etter advocacy services for older Australians is an area of personal concern and one where improvements can be made, the minister for health and ageing senator Jacinta Collins has said. Speaking as part of the election panel at the recent COTA Australia National Policy Forum, Collins encouraged the industry to suggest changes to how the aged-care system deals with concerns about the treatment of residents, including where care plans are ignored. “My own thoughts … go to how we improve what I think is a fairly strong and resilient system, to better identify better advocacy services for people so we don’t see conditions we should not tolerate in care for aged Australians,” Collins said. “I intend to spend a bit more time looking at existing schemes but I would like to see a more proactive element to advocacy within the system, particularly as we will have more ageing Australians on their own”. The former social worker and carer for her elderly parents said that where the system might work for people with families, the real concern was for those without relatives to advocate for them. “Any feedback on how to strengthen our current system would be gratefully received,” she said.

8 | August–September 2013

Collins said that whilst the accreditation and systems outlined in the government’s Living Longer Living Better reform package were “reasonably robust” it was important to increase the investment and support for people needing care as the population continued to age, so further changes could be expected. She said that as well as moving to eliminate scarcity in the aged-care system, the government would focus on fostering diversity within it. The shadow minister for seniors, Bronwyn Bishop, said that only when people stopped “obsessively categorising” people according to age or sex or work would Australia be a truly inclusive society. “An aim I set down very firmly is I want it to be just as offensive to be ageist as it is to be sexist,” she said. Bishop said it was important to stop using ‘aged’ as a broad brush term, particularly when it came to talking about care. She said that although the Productivity Commission report Caring for Older Australians implied that everyone aged over 65 needed help, in reality only the “frail aged” needed assistance. “Only 8 per cent of people aged over 70 will ever need residential aged care,” she said. “Another 12 per cent will need some sort of care at home and the other 80 per cent will have a damn good time until they fall off the perch.” She added that if the Coalition won the next election, she would be a cabinet

minister for seniors and a voice for the 40 per cent of the population aged 50 and above. She said there was a range of concerns for Australians in that age group, including: employment issues, from staying in the workplace longer to not having to meet discrimination when trying to find work; superannuation; private health insurance and its impact; cost of living pressures; social issues and the roles senior Australians continue to play within a household. Bishop said she also wanted to “get rid of the doom and gloom language” associated with the country’s ageing population and amend the laws that continue to discriminate against people aged 65 and above. “Living longer is something to be celebrated rather than lampooned,” she said. “It is a great cause of celebration and joy that we all live longer and longer lives. The concept of seniors is not one of ageing or aged. It is not one of lampooning people and putting them all in the same category. It is about adding aspirations for people, to value their contribution and see they are able to keep adding value and most of all to have their voice heard.” The Greens spokesperson for ageing, Rachel Siewert, said key areas of concern for the aged remained exclusion from the workforce, the low level of Newstart allowance and extending the National Disability Insurance Scheme to people aged 65 and above. n

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news

Aged Care Awards

celebrate champions

Best people and organisations honoured. By Amie Larter

ifteen finalists over three categories were celebrated by peers and industry in early August during the 2013 HESTA Aged Care Awards at Doltone House, Jones Bay Wharf in Sydney. The event, hosted by Jean Kittson, highlighted and celebrated our nation’s best in aged care, recognising professionals who work tirelessly to improve the quality of life of ageing Australians. Lifelong volunteer Helen Williamson beat four other outstanding finalists in the Individual Distinction category, acknowledging her tireless efforts and commitment to the well-being of residents at Bankstown City Aged Care in NSW. The 78-year-old Williamson, who has raised more than $100,000 for the Bankstown facility since 1995, oversees the running of its kiosk – selling food and goods to residents and visitors. Earlier this year, she was appointed to the board of directors for the centre, to help mould its future. The Better Together Cottage Team from Wahroonga Aged Care Victoria, represented by Mary Fromberger, received the Team Innovation award for its pilot program designed to give residents of long-term facilities more independence in a homey environment. As part of the Better Together Cottage model, care staff took up the role of housekeeper – undertaking personal

Left to right: Anne-Marie Corboy, HESTA CEO; Mary Fromberger, Wahroonga Aged Care; Helen Williamson, Bankstown City Aged Care; Craig Mills, RSL Care; Kylie Whicher, ME Bank; and Jean Kittson, awards MC

care, support and assisting with activities. Residents were given more of a say in the way the facilities were run and where appropriate they took over aspects of the cooking and cleaning, while visiting nursing staff provided clinical expertise. The Outstanding Organisation award was presented to Queensland-based provider RSL Care. The award acknowledges a group that has made a significant contribution to aged care in Australia through development and/ or provision of high-quality care. RSL Care was recognised for its work maintaining

services in the aftermath of 2013’s devastating floods. CEO Craig Mills accepted the award on behalf of the company, and explained the impact of ex-cyclone Oswald, which affected 15 of RSL Care’s 29 retirement and residential aged-care communities. The judges praised the group’s work throughout the crisis, highlighting that most of the centres were operational again within hours or days as a result of the high level of organisational preparedness among the staff. Winners shared a $30,000 prize pool, courtesy of sponsor ME Bank. n

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news

Healthcare funding crisis looms Official warns that spending will engulf whole state budgets in two decades. By John Mitchell and Amie Larter

ational media is too consumed with refugee boats and carbon taxes – when there are bigger issues at hand. That’s the view of Community Services and Health Industry Council (CSHIC) CEO Rod Cooke, who points to predictions that within 20 years under current policy, “every state government’s entire budget would be spent on health and care”. Cooke says that means healthcare deserves greater attention. “We think it is an election issue, but the elected officials haven’t woken up to the fact,” he said. He added that both major parties were focused on issues that “aren’t as pervasive as health and care. It is a crisis that we know about now, but nobody’s doing anything”. Cooke, who occupies a position between the education and health sectors, says Australia is continually “reinforcing the current paradigm of the medical model that’s sending us broke”. In order to change, he urges a move from cure to prevention, with a better focus on wellness. “It’s about shifting to a consumer-led model of care, where consumers determine what care they get and where and how,” Cooke explained. “It’s about delivery in the home and community, which is where people want it to be done, not in really expensive hospitals with really expensive super medical specialists.” Other big-ticket items on the agenda should be the ageing population and workforce, Cooke said. The health workforce is facing what CSHIC describes as a “double whammy”. It’s part of the fastest-growing and largest part of the Australian workforce; however, there are already shortages in it and these are likely to get worse with the ageing of that workforce.

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“The industry needs 800,000 aged-care workers over the next 20 years, as well as an extra 120,000 to 125,000 disability workers over the next three to five years and I don’t know where they are coming from because our unemployment rate is so low,” he said. “Even the number of long-term unemployed isn’t enough; even if we got everyone of them a job there’s not enough to go around.” Cooke considers the shortage more of a vocational education and training issue than a matter of higher education. He questions the high levels of funding for doctors – when most of the work is done by people without degrees – and is calling for a national promotional campaign to attract more people to VET programs. n

August–September 2013 | 11

news

This is where it

hurts

Pain, experts say, is all in the brain. By Aileen Macalintal

ur brain produces the illusion that is pain. “No brain, no pain. No body part? The brain can still make the missing part hurt,” said professor Lorimer Moseley, who develops nonpharmacological treatments for those who suffer from chronic pain. Every year, chronic pain disorders cost Australia about $35 billion. Moseley, who heads the Sansom Institute for Health Research, said pain was the result of the brain’s complex evaluative process that decides when something is so dangerous that an action is required. “I think the elderly, like the non-elderly, should understand as much as they can about pain and seek out a good coach, who can help them identify all the things that make their pain worse – these are not just activities but can be behaviours, thoughts, beliefs, relationships, grief, diet and lifestyle.” This does not mean the elderly should avoid pharmacological treatments, he explained. “Some pharmacological treatments are fantastic,” he said, “However, as a rule, medications are not a long-term solution for chronic pain. The evidence clearly shows that they don’t, on the whole, work. I would also suggest that elderly should not just go for brain-targeted treatments.” Another expert in pain, Dr Tasha Stanton, discussed the topic with Moseley at the University of South Australia’s Successful Ageing Seminar. Stanton said the question of what actually happens when a person is in pain might sound like an easy one but isn’t. “We used to think that in order to feel pain, there had to be damage to the tissue,” Stanton said. “It was also thought

12 | August–September 2013

that if there was damage to the tissue, then someone must feel pain. But neither of these is true. “There are many reports of soldiers in life threatening situations, who despite having terrible tissue damage, report feeling no pain. Or sometimes, despite having no evidence of tissue damage, people do experience pain. So this is where the role of the brain comes in.” When a tissue is damaged, she said, a message is sent up the spinal cord to the brain. “However, this is not a message of ‘pain’; it is a message of ‘threat or danger’. Thus the brain has to decide, based on what it knows about the current situation, the past experiences that relate to the current situation and many other factors, whether or not that stimuli should be perceived as pain.” The brain can read the message as “this is important, get all the information you can about this” or it can inhibit the signal – “this isn’t that important, ignore”, she said. In the case of chronic pain, the signal interpretation becomes complex. Experts such as Stanton think some chronic pain may be partially due to increased sensitivity of this system. Many things can alter the level of pain that someone experiences and two of the major pain modifiers are expectation and attention. “If you expect something to be really painful, like back pain when reaching down to tie your shoe, this does tend to result in more pain,” Stanton said. “Also, if you strongly expect that something will relieve your pain, regardless of what that something is, pain is often reduced.” She clarified that this doesn’t mean expectations of relief will drive away pain

completely, but says evidence has shown that one’s natural pain relief system can reduce the level of discomfort. “Attention is a bit more tricky,” Stanton said. “Sometimes distraction can reduce pain, but sometimes attention to a painful body part can help.” At an experimental level, experts have found many ways to help reduce pain and they hope they can apply these findings in clinical settings. “For example, we know that the act of merely looking at your body part reduces pain,” Stanton explained. “However, this reduction in pain is quite small and has only been demonstrated for experimental pain. So the challenge is to transfer this to the clinical setting.” She further explained that a person’s perception of their painful body part is also important in how much pain they feel. “Some people have experienced pain relief by making the body part look smaller than it actually is – looking through backwards binoculars. The work I am doing suggests that illusions that change the size of a painful body part reduce pain.” Thus, a number of painful conditions are not necessarily reflective of the amount of tissue damage. “For example, in back pain, one might feel nervous about doing a certain activity because it hurts and thus one believes that the activity is further damaging their back,” Stanton said. “We know that our expectations, our past experiences – how scared or nervous we are and many other factors – contribute to the amount of pain we feel.” Stanton said knowing this could help someone in pain try more regular activities that they may have stopped doing. n

news

A holistic approach to dementia care education has resulted in the launch of two world-first initiatives. By Amie Larter

www.agedcareinsite.com.au

Thought leaders

acing predictions suggesting that over 1 million Australians will have dementia by 2050, the University of Tasmania has launched two world-first education initiatives – an associate degree and a massive online open course (MOOC) – both specifically dedicated to dementia care. Following the World Health Organization’s designation of dementia as the public health issue of the 21st century, UTAS conducted a national survey to ascertain knowledge of the ailment amongst care staff in facilities and the community. With results suggesting a clear knowledge deficit, researchers developed the first of the two initiatives – the associate degree in dementia care. “Understanding the trajectory and biological basis of dementia forms the basis of our programs aimed at improving the quality of care,” said the co-director of UTAS’s Wicking Dementia Centre, professor Andrew Robinson. “We recognised that there needed to be a much more comprehensive approach to developing knowledge of dementia, and that’s why the associate degree has been designed for care staff, but with family members and carers in mind as well.” The first semester of the course was launched last November. The second intake began classes in July. “We are really excited with the associate degree because for this semester, we have been able to take what is predominantly an online course and offer the foundation units as face-toface components at different locations across Australia,” course coordinator Andrea Carr said. The course is popular. UTAS has set up independent training facilities in Adelaide, Canberra and Newcastle – in addition to its Sydney and Hobart campuses. “We have had people coming from Coonabarabran to Sydney and from Kangaroo Island to Adelaide,” coordinator Carr confirmed. “The interest the course has raised and the commitment of the people in the agedcare sector is quite heartening and it’s an

exciting place to be at the moment.” Students are required to complete 16 units of study for the associate degree, which is designed to be part time to cater for those with other commitments. It covers an extensive range of topics, including normal ageing, risk factors, diseases that cause dementia, pathology, stages and progression and practical care strategies. UTAS has gained approval to extend the course for an extra year, which will give students the option to complete an extra eight subjects and graduate with a full bachelor’s degree in dementia care. To complement this offering, the university has launched its first MOOC offering, Understanding Dementia – a free 11-week course that aims to provide education to the community and the aged-care workforce. The MOOC went live in July and its first iteration boasted 6300 registrants from over 30 different countries. “For us, [to reach these figures] was quite an amazing feat,” Carr explained. “When we look at online learning, we think we will gain so much from people from different backgrounds and countries contributing to discussion around their knowledge of dementia.” Professor Denise Fassett, dean of the Faculty of Health and Science, said the online course would link cutting-edge research with teaching and learning expertise. “This MOOC is designed to appeal to a broad range of students, from healthcare professionals to residential facility support staff, from health policymakers to social scientists, as well as people in the early stages of dementia and their family and friends – plus all those with a general interest in the condition.” Robinson believes the holistic initiatives will provide further career pathways for students and add value to the aged-care workforce. “Building capability and capacity will make [aged care] a more attractive area for young people to work in because they will be able to more effectively make a difference in the care provided to people with dementia,” he said. n

August–September 2013 | 13

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Video-conferencing carts are bringing rural Queenslanders to specialists based in cities. By Amie Larter

video-conferencing pilot scheme is giving aged-care residents in rural Queensland access to specialised healthcare. Ouriptel is working closely with Queensland Health on a tele-health initiative that has Millmerran Centenary Retirement Village and Brodribb Retirement Village in Queensland using a mobile communications system to help improve access and outcomes for residents. Known as the aboutcoms cart, the device is an independently powered mobile gadget attached to a touchscreen PC that enables wide-view video and close up cameras for diagnostic purposes. The cart connects the nursing home staff and residents to nominated Queensland Health facilities, and it’s as easy as switching the device on, logging in and dialling into the facility with a click of a button. Once linked with the specialist, there is the option of recording the consultation and storing it securely on the Ouriptel system. Nursing homes also have the ability to share medical records with the specialist by screen sharing on the device. Cath Frame, clinical care manager at Millmerran facility, which is located in the Darling Downs region about 208 kilometres west of Brisbane, has been extremely impressed with results thus far. “Being in a rural area, telehealth practices have a lot of benefits for the residents, as well as the facility and the community,” Frame said. “They increase access to healthcare for residents, as there is no cost to the family or the resident. It is certainly something I want to look at implementing more permanently at the end of the pilot.” Ouriptel managing director Colin Hickey said the device was designed to fit seamlessly into disparate systems, and is the answer to the huge struggle for organisations to get doctors into facilities. “Aged-care facilities are struggling to get anyone to attend the aged people as a specialist because they really don’t have the time to travel to all these different 14 | August–September 2013

places,” he said. The carts address that problem. “They are made to be able to be wheeled right up to the bed, so the consultation can happen right then and there without the patient having to be moved or transported.” The Millmerran facility has for quite some time struggled to attract geriatric rehabilitation services (GRS) to its area. In the first of nine scheduled consultations for the pilot, a resident was linked to GRS at Toowoomba Base Hospital, about 90 kilometres away. “I was impressed with the first consult – it was thorough, very patient-focused and went for over an hour,” Frame confirmed. “The consultation focused on what the problem was with the resident, looking at what they had been experiencing, what we

had been experiencing, current treatment plans and options we could [perform] in the facility safely.” What once required taking an ambulance out of the emergency service for a day, as well as the assistance of an enrolled or registered nurse, can now be done in a room at Millmerran – or even bedside if the resident is unable to move. Hickey explained that the alternative to the conference call for that original consultation would normally have cost the government close to $4000 – this option costs a mere $38. The company, which has quite a few aged-care facilities throughout Queensland interested in its device, is in talks with government about the potential savings and hopes to expand nationally. n

calendar

2013

• World Alzheimer’s Day

• Better Practice 2013 – Perth

• Parkinson’s Awareness Week

• The National Nursing Forum

• 4th Annual Healthcare Complaints

• National Conference on Incontinence

21 September Worldwide fightdementia.org.au

SEPTEMBER

• Prostate Cancer Awareness Month 1-30 September Nationwide prostate.org.au

25-30 September Nationwide Parkinsons.org.au

• Jean Hailes Women’s Health Week 2-6 September Nationwide jeanhailes.org.au

Management Conference 26-27 September Sydney Harbour Marriott, NSW healthcareconferences.com.au

• 12th Australian Palliative Care Conference 3-6 September National Convention Centre, Canberra, ACT dcconferences.com.au

OCTOBER

• 2013 Seniors Week Tasmania 1-7 October Statewide cotatas.org.au

• National Play Up Convention 5-6 September Luna Park, Sydney NSW artshealthinstitute.org.au

• Dementia + Recreation National Conference 2013 10-11 October Melbourne totalagedservices.com.au

• National Stroke Week

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

• Rotary Health’s Hat Day 11 October Nationwide hatday.com.au

• 2nd Annual Reducing Avoidable

Pressure Injuries Conference 16-17 September Novotel Melbourne on Collins, Victoria healthcareconferences.com.au

• Dementia Awareness Week 16-22 September Nationwide fightdementia.org.au

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

• Carers Week 2013

13-19 October Nationwide carersaustralia.com.au

17-18 October Perth accreditation.org.au

20-22 October Canberra acn.edu.au/forum

23-26 October Perth continence.org.au

• Retirement Living Summit 2013 24-25 October Melbourne eiseverywhere.com

• Pink Ribbon Day 28 October Nationwide cancer.org.au

• Dementia +

Community Care Conference 2013 30-31 October Victoria totalagedservices.com.au

• Aged Care

Nurse Managers Conference 2013 30-31 October Victoria totalagedservices.com.au

Aged Care Nurse Managers Conference 2013

0915 0930

•

National Nutrition Week 13-19 October Nationwide nutritionaustralia.org

Welcome & Introduction

Managing Your Career in the Aged Care Industry

This session will provide delegates with an insight into the current and contemporary ways in which employees can manage their own personal “employment brand”, align their career goals to their current workplace, and build skills to actively manage their career progression. Recruitment and career development requires a commitment from the individual and clarity of intent. When these can be harnessed and shared, there are a number of strategies and opportunities to build career landmarks, demonstrate competence and plan for appropriate progression through the industry. Tim Biddle, Human Resources Manager, SELMAR Institute of Education; Bachelor of Social Science (Honours), Grad Dip HRM, Certificate IV in Training and Assessment

1015

“Navigating through the Apprenticeship Maze”

Apprenticeships, traineeships, funding, selection, partnering, submissions, RTOs, competency, candidates & much more … an absolute maze of issues & intricacies. This session aims to clarify the landscape & enhance your understanding & choices on offer. Renee Briggs-Gordon, Business Relationships Leader, MEGT Apprenticeships Centre

1045 1115

Morning tea, networking & trade expo Engaging families in the care of residents with dementia Residents’ family members and friends can play an important role in the dementia care team. Using family carers as a resource can improve the lifestyle and wellbeing of residents with dementia, and reduce the likelihood of behavioural issues. But family members also need support and information about dementia to help them to cope with changes in their family member. In this session you will learn how to: • Educate and support families about dementia • Enlist families as sources of information about the person in care planning • Include families in daily activities within the facility Denise Whimpey, Carer & Community Education Officer, Carers Victoria

• Veterans Health Week 14-20 October Nationwide dva.gov.au

1200

“… but I didn’t start it” - Dealing with escalating behaviours Having a toolbox of professional strategies to deal with escalating, emotive or even potentially explosive situations is vital for all managers & staff working in residential aged care. Whether in dealings with residents, families, other visitors, staff or even contractors situations can unfold where words & actions become ‘heightened’. This session will provide an overview of how to meet the challenges of these situations.

To list your event on our calendar page, please email details to amie.larter@apned.com.au or insite@apned.com.au

Linda Pye, Mental Health Nurse, RN, BA, Grad. Dip. Org. Psychology, Cert IV Training & Assessment

1245

Lunch, networking & trade expo

1345

Clinical update - ‘Funny little turn’ or epilepsy?

This session will provide an epilepsy update including an overview of the importance of Epilepsy Management Plans and professional development opportunities for workers in aged care. Alison Hitchcock, Education and Training Manager, The Epilepsy Foundation of Victoria. RN, BHSc, Critical Care Certificate and Cert IV in Workplace Training

1415

“Incident” Reports - beyond completion …

Even in the age of ipads, specialist software & continuous improvement, are we effectively & efficiently capturing & responding to incidents within our services. Are all appropriate ‘incidents’ recorded or are we just skimming the surface? Does it depend on who is working ‘on that shift’? An important update & discussion for an essential management/ clinical responsibility.

Nan Austin, National OHS Manager, Australian Red Cross Blood Service, MB(Personal Injury), MBA(Technology Management)

1500 1530

Afternoon tea, networking & trade expo Stories from the Field (1)

These unique & diverse ‘stories from the field’ are designed to engage, enlighten & motivate!

1615

Close Day One

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For more information visit www.henro-tek.com.au www.agedcareinsite.com.au

Conference Program

Day 1 Program - Wednesday October 30 2013

Distributed by Statina Heathcare International August–September 2013 | 15

policy & reform

Breaking down

perceptions

Whilst aged-care residences are often in the media spotlight for the wrong reasons, there are plenty where residents, staff and visitors enjoy a close bond. By Louis White

argaret Thompson is a ‘young’ 71-year-old. Despite recovering from knee surgery, Margaret has never felt more alive than since she moved to Bupa Bateau Bay aged care residence on the NSW Central Coast. “It is like living in a home,” she says. “It has all the facilities, the staff are friendly and there are plenty of amenities.” Having moved to Australia 20 years ago from Lancashire, England, Margaret feels right at home at Bateau Bay, where she has resided for the past two years. “There are bus excursions for those that want to get out and for those that can’t there are morning and afternoon teas as well as lovely lunches and dinners,” she says. “There are plenty of activities such as shuffleboard and bingo and I would consider a lot of the staff to be my friends, as I would a lot of the residents. “My quality of life has definitely improved since I moved here.”

16 | August–September 2013

While aged-care residences are often in the media spotlight for the wrong reasons, there are plenty of aged-care homes where residents and the staff are happy. “I have worked in the aged care industry for 19 years and previous to that I was employed in the hospital system so I had a good idea of what to expect,” Michelle Parish, general manager of Bupa Bateau Bay, says. “When I arrived here four years ago I thought it was important to get the community involved and to have a coordinated activities team and program in order to get the residents up and about. “There was only one volunteer when I arrived but now we have 18 and they are essential to help get the residents moving.” There is also the case of one special volunteer – 10-year-old Charli Blackburrow – who regularly visits on Tuesday afternoons. “They love chatting with her and talking about their lives and their families,” Parish says. Charli started visiting because she

policy & reform

had moved from Victoria and was missing her nanna. Bateau Bay has both high and low care facilities where there is physiotherapy and podiatry available. They have also taken an innovative approach to dementia care with the introduction of pet and music therapy, which is combined with a dementia support group for relatives, friends and the wider community. “It is important that the residents – no matter what their condition – feel like human beings,” Parish says. “We need to treat a person as a person. We want them to try to live as normal a life as possible. “We emphasise to staff to concentrate on the person not the illness.” Parish says that getting residents out and about, where possible, has a great effect on their mental state. “We have had residents go away for a few days holiday and they come back invigorated,” she says. “One group stayed in a cabin, which allowed them to cook their own meals and walk in the outdoors. It makes them feel alive again.” Parish’s views are backed up associate professor Evonne Miller from the Queensland University of Technology who interviewed 15 residents over a 12-month period at BallyCara, a residential aged care facility on Brisbane’s Redclife Peninsula. The aim of the research was to focus on specific characteristics such as individual (attitudinal, emotional, spiritual, social and health), structural (environmental, www.agedcareinsite.com.au

design) and cultural (management ethos, philosophy of care and caregiver attributes) that enable and support older people to be happy, actively age and have a good quality of life in residential aged care. “There is surprisingly little research on daily life in aged care,” Miller says. “We talk a lot about dementia and other illnesses, but very little about the actual experience of life in aged care. “There are a lot of negative misconceptions out there, but Australia has very strong monitoring and accreditation processes to ensure quality and compliance and the vast majority of people who work in aged care do so because they enjoy working with older people. The fact is mistreatment is very, very rare.” Miller says that her research discovered that the majority of people moved to health care after a significant decline in their health. They also lacked the energy and time associated with managing their day-to-day lives. Even basic tasks such as cooking and cleaning became difficult. Sadly, but not surprisingly, most elderly people were reluctant to move to aged care because of pre-conceived ideas about what to expect. “Two months after the move, however, 75 per cent rated themselves as enthusiastic or very enthusiastic to be living there,” Miller says. “Our initial findings show that this satisfaction with living in aged care centred on the safe and supportive environment, forming positive peer and

staff relationships, and being able to easily participate in social activities.” Miller says that being surrounded by people of similar age helps them fit in more easily and an array of people to talk to helps form friendships. BallyCara enabled residents to remain independent and free, which was very important to a majority of residents. “Overall, our research revealed that residents found life easier, they were more socially active and it provided structure around their daily lives,” Miller says. BallyCara is a residential aged care facility with 120 nursing home residents comprising 40 low-care and 60 high-care, as well as 230 independent living units. “We thought it was important to broaden the scope of BallyCara to incorporate living in the community,” says chief executive officer Marcus Riley. “We spent a lot of time acquiring knowledge into what the elderly wanted to make their lives not only more comfortable but enjoyable,” he says. “We wanted to know what they wanted to do in their everyday living.” Riley, who has been at the helm for four years, says it was important to get all staff on board to ensure that everyone was working towards the same priorities. “It is important that everyone wanted to make a better standard of living for the residents that live here,” he says. “We now have set goals and priorities for the residents, which gives them something to look forward to.” August–September 2013 | 17

policy & reform

Riley cites the case of an elderly gentlemen who had become wheelchair bound and could no longer undertake his favourite pastime of swimming. His demeanour had changed and he was, naturally, getting depressed. With the help of staff understanding his needs, they were able to arrange for him to swim regularly and now he is enjoying life again. “Everyone here at BallyCara is totally committed. I think that reflects in the fact that we have satisfied residents,” Riley says.

Carinity Aged Care Brookfield has used the power of singing to bring joy and companionship into the residency. They have formed their own choir much to the delight of those involved. “The ‘Brookfield Songsters’ started in 2010, after some residents at Carinity Aged Care Brookfield expressed an interest in singing,” says care manager Nadia Fletcher. “The centre’s chaplain, Lyndon Niemann, also thought it would prove to be a relaxing therapy – one that would

provide participants with an opportunity to socialise, keep their minds sharp, and possibly even slow memory loss. Three residents came to the first session, but numbers have grown steadily over three years to the point where there are now over 20 members. “We aim to make everyone feel like one of the family, so the ‘Brookfield Songsters’ is open to anyone who wants to participate, not just people with musical experience or excellent voices. Every resident is invited

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18 | August–September 2013

policy & reform

to participate just before the practice sessions on Tuesday afternoon. Residents from the high- and low-care areas of the aged-care centre take part, as well as the lifestyle units. “We have seen a number of positive signs since the ‘Brookfield Songsters’ began. Staff, volunteers and participants report a high degree of interaction between the choir members, both inside and outside the rehearsals, including between the more independent residents of the lifestyle

units, and those in high and low care. The choir also provides an opportunity for some of the children to work with their parents. “Participants with mild dementia are more responsive and the sessions also help to soothe some of the symptoms, like agitation and confusion.” John McDermott was chairman of Southern Cross Care for 20 years, a Catholic organisation that has member organisations in each state and territory in Australia. They provide residential care, mental health services, respite care and community services to anyone in need. McDermott says part of the problem of attracting quality staff to aged care residences is the attitude of the general population. “The general public don’t like the thought of aged care even though they are going to be old one day themselves,” McDermott says. “Australians now live 20 years longer than they did at the end of World War II. The consequences of that are many, such as people’s quality of life continues as does the expense on the government to provide pensions and health care services. “While aged care facilities have improved considerably over the past 20 years we

need aged care residents to be more authoritative and speak out for themselves. They need to be more assertive in demanding respect.” McDermott also believes it is difficult to attract doctors and nurses into aged care because of lower pay scales. “We need to address the pay differential because it is not warranted,” he says. “Those in the health services profession who are prepared to devote their time to look after the elderly should not be penalised financially for doing so.” Lindon de Griffon, operations manager at Baptcare, says that attracting the right staff is the key to ensuring happy residences. “I think the atmosphere and the care are dictated by the staff you employ,” he says. “Our recruitment strategies are essential to ensure that we attract the staff that want to be here and will make a difference to the lives of the residents.” He believes that it is important to carefully explain to new residents what to expect because many have pre-conceived ideas. “It is a matter of assessing their needs and explaining to them what goes on,” de Griffon says. “After they initially settle in, the overwhelming majority always say the same thing: ‘I should have moved in here sooner.’ ” n

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August–September 2013 | 19

policy & reform

Home

truths T

Serious allegations of ill-treatment in residential care facilities were recently made on the ABC television program Lateline, but the solution isn’t simply a matter of more funding and tighter regulation. By Michael Fine

20 | August–September 2013

he public crisis of trust that followed the report on the ABC’s Lateline about problems in residential aged care facilities on July 15 is just the most recent in a long list of such sad episodes. Lateline revealed serious allegations of poor treatment of the most vulnerable and frail residents. There were also accusations of malnutrition amongst residents, as well as examples of bullying and intimidation towards family members who sought to intervene to correct problems. Other media quickly picked up the theme. For the next few days, talkback radio, letters to the editor and other forums including Twitter were filled with more chilling stories. This all served to remind us all of the kerosene baths incidents of a decade ago, as well as similar incidents in the 1980s and 1990s. Of course most homes are not like this, but while industry leaders pointed this out they also quickly used the opportunity to request more public funding for all homes. Naturally, more funding would be nice, but somehow this solution didn’t seem to fit the problem this time. If the incidents of abuse are truly exceptional, what would be the guarantee that they would not remain exceptional? Many in the industry point with some justification to the failings of the current accreditation scheme. Accreditation of residential care is an admirable end in itself, but is strongly based on paper trails, documentation and accountability. It requires large amounts of staff time – taking senior staff away from direct engagement with residents – when this is what is most needed. All the paperwork in the world will never deal with undocumented acts of abuse, intimidation and loss of trust. Is a return to the Outcome Standards monitoring system that operated prior to 1996 worth

considering? Certainly that system has a proven track record and was successful in lifting standards across the board before it was abolished by the Howard Government. No need to abolish accreditation, but neither can it be left as the main method of quality assurance. Other questions arise. What is it that causes such problems in residential care? Despite the limits of funding, the problems don’t seem to be endemic to all aged care, as the community care system has shown. Why has there not been a single critical incident reported nationally in the media in the home and community care or packaged care system over the past 20 years? There is no loss of trust in community care services. Nor is there is a cry for government to act to guarantee standards. The positive results for community care can hardly be a result of the tight regulation of standards or the generous funding available to those who receive their care in their own home. Is it that those who need care in their home still feel responsible for their own choices? Or is it that we are willing to accept occasional evidence of neglect in people’s own home much more readily than when a person surrenders responsibility for their wellbeing to the management of a residential care facility? Are residential facilities simply more prone to problems because of their institutional character? After the bad news, perhaps the ABC’s Lateline could do something to help. They could promote trust in aged care by following up their story and drawing attention to the extensive systems of care in the home currently available. The days in which aged care was confined to residential care facilities have well and truly passed. n

Michael Fine is adjunct professor in the Department of Sociology at Macquarie University in Sydney.

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policy & reform

Pride

of place Recent legislation acknowledges the unique needs of lesbian, gay, bisexual, transgender and intersex people. By Dr Jude Comfort

t is timely to comment on the place of LGBTI (lesbian, gay, bisexual, trans/transgender, intersex) people within the aged care agenda. We have seen LGBTI elders moving from an invisible population within the aged care area to one where important recent legislative advances are starting to acknowledge the unique needs of this group. This has occurred under both the aged care reform Living Longer. Living Better agenda and also to changes relating to religious exemption under anti-discrimination legislation. Achieving LGBTI inclusive aged care will not happen overnight across the sector, but there is now a clear direction for the way forward which will benefit everybody, not just LGBTI clients.

So why does LGBTI-inclusive aged care matter?

It matters because this is best practice. It matters because for too long this marginalised group has been invisible. It matters because social change around LGBTI issues has been rapid and aged care providers need to keep up with this and changing societal values. It matters because we are talking about how people experience service delivery in older age. And it matters because many older LGBTI people anticipate aged care means losing connection to their LGBTI community and friends and a loss of being valued for who they are. It is easy in 2013 to think that we as a nation have come a long way in acceptance of sexuality and gender diversity. While there have been gains, there is still much to be done. Anecdotally, we still hear of both overt and covert homophobia in the treatment of LGBTI people. Older people who are seeking support as they age are reaching a potentially vulnerable time in their life. We know that some feel they may need to go back in the closet at this time. The experience of an LGBTI person born in the 1920s or 1930s is very different from someone born today. In short, they have had a life of discrimination where they were treated by the church as sinners, by the law as criminals and by the medical profession as having a mental illness. Aged care providers need to put into practice inclusive approaches. They need to ensure that upper management actively supports such an approach. Such approaches will benefit all – LGBTI clients, family carers and staff and the agency itself. This will hopefully see many more agencies moving to a point of celebration and the assumption that you will have LGBTI clients and staff – even if they do not openly. Many aged care providers are actively reviewing their policy and 22 | August–September 2013

practice to ensure that they are an inclusive practice. For example, the innovative and comprehensive LGBTI policy and practice changes of UnitingCare Ageing ACT/NSW was recently recognised by winning a Pride in Difference award. The outcome of such advances will be older LGBTI clients will begin to feel that they are understood and valued as part of an aging Australia and that any pretence of having to fit into a heteronormative aged care environment – usually at the expense of their own mental health – will disappear. Aged care providers by the very nature of their business are in the business of providing the very best care they can. Most aged care providers are ready for the challenge of moving into this area. n Dr Jude Comfort is the Chair of GRAI (Gay, Lesbian, Bisexual, Trans and Intersex Retirement Association Inc.). She is also a leading researcher at the School of Public Health at Curtin University in Perth with a special interest in LGBTI health issues. These views are her own and are not necessarily those of the university.

EXTRA To stay informed and be an ally there are several things aged care agencies can do: • Read the National LGBTI Aged Care Strategy www. health.gov.au/internet/main/publishing.nsf/Content/ 44E7132570CB0438CA257AD9001432CD/$File/lgbtistrategy.pdf • Influence senior management to get on board and remind them that it is not a choice but a requirement to provide LGBTI inclusive practice • Join GRAI via the website www.grai.org.au • Join the National LGBTI Health Alliance at www.lgbthealth.org.au

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construction & design

New look can help now Don’t wait for the next generation of hospitals, a few changes can make current environments better for dementia patients. By Richard Fleming

dmission to hospital can be a confusing and frightening experience for people with dementia. Their problems with memory, orientation and confusion and difficulties with communication often lead to extended stays. This is evident in the increased risk of complications and co-morbidities associated with hospitalisation for people with dementia. Recent estimates from New South Wales show that people with dementia stay in hospital almost twice as long as those without it, averaging 16.4 days of care, compared with 8.9 days for other patients. The average cost 24 | August–September 2013

of hospital care for people with dementia is also higher than for people without ($7720 per episode, compared with $5010). The fact that people with dementia are spending, on average, more than two weeks in hospital must give us pause. Whilst they may tolerate the busy, complex environment of a hospital ward without serious negative effects for a day or two, placing a confused and anxious person in such an environment for two weeks is unlikely to help them to a full recovery. Perhaps part of the problem lies in the nature of most hospitals. They are places where sickness is treated and illness is the focus of attention.

The presence of someone with an illness, such as dementia, that does not respond to treatment and that makes addressing other conditions (for example a fractured hip) difficult, must be extremely frustrating for busy nursing and medical staff. Perhaps we have to face the fact that until a cure for dementia is found – one that can be delivered via pills or injections – the design of today’s hospitals is unsuitable for people with this ailment. Perhaps we need to step back and ask: is there another way? Rather than designing hospitals to maximise the efficiency of the delivery of treatments, why not design them to reduce confusion, agitation, depression, apathy and powerlessness? Even better, rather than focusing on symptom reduction, why not focus on the promotion of health and well-being? It is well established that people heal more quickly in less clinical environments, with views, lots of natural light, plants and artworks. This focus on health and well-being rather than illness has been conceptualised as a salutogenic, as opposed to pathologic, approach. Quite specific ideas on how to build environments that promote well-being have already been well described. In fact, such facilities are already in use in other fields of medicine. For example, when you enter the new Royal Children’s Hospital in Melbourne, you are greeted by the sight of a four-storey, multi-coloured monkey. Just downstairs in the waiting area is a huge aquarium full of beautiful tropical fish and around the corner is – surprise, surprise – a meerkat enclosure. What have these things got to do with treating illnesses? Nothing at all. They are about encouraging wellness and lifting the spirits. What would be the equivalent features in a hospital catering for older people, particularly those with dementia? It may be hard to think about it now, but there will be an answer. Whilst we are working on finding the inspirational features of the next generation of hospitals, we must get on with re-designing existing hospitals so they reduce confusion, agitation, depression, apathy and powerlessness by applying the knowledge that we have gained in designing residential aged-care facilities for people with dementia. To help accomplish this, the Australian Government, through the Department of Health and Ageing, has funded the NSW/ ACT Dementia Training Study Centre to

construction & design run two-day workshops in every Australian state and territory this year on design – not just in acute care, but also in rehabilitation and multipurpose services, where people with dementia spend a much longer time. The lead designer of The Royal Children’s Hospital, Kristen Whittle, will be discussing the application of his approach to the care of people with dementia at several of these workshops. The events will be followed by consultancy services for individual wards or units within healthcare settings. This will ensure that the ideas generated in the workshops are applied to existing facilities. We cannot let the present situation continue while we wait for new hospitals to be built. There is so much that we can do now in order to improve the hospital experience for people living with dementia. n Professor Richard Fleming is a psychologist who has specialised in the development of services for people with dementia for 30 years. He is director of the NSW/ACT Dementia Training Study Centre at the University of Wollongong and a consultant on designing dementia-friendly healthcare and residential care environments. A fully referenced version of this article can be found at www.agedcareinsite.com.au

Designing for Dementia workshops The NSW/ACT Dementia Training Study Centre will run two-day workshops around Australia until the end of September on designing dementia-friendly healthcare facilities, including inpatient units. The Designing for People with Dementia workshops are funded by the Australian Government and aimed at health planners, facilities managers, clinical and allied health managers, health professionals and design consultants.

NSW/ACT Dementia Training Study Centre director professor Richard Fleming

Upcoming workshop dates: Darwin, 11-12 September; Adelaide, 16-17 September; Brisbane, 19-20 September; and Perth, 26-27 September. To register your interest in attending the workshops, or for further information about the hospital design project, email dementia@uow.edu.au

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construction & design

Worth

a visit

A tour of aged-care sites in Europe and the UK leaves local officials encouraged and enlightened. By Amie Larter

ustralia’s senior living and aged-care sectors’ skills and expertise are on par with their European contemporaries, according to results from a recent study tour. Eight leaders from industry organisations throughout New South Wales, South Australia and Queensland were selected to visit facilities throughout the UK, Germany and the Netherlands. Independent management consultancy Thinc, in conjunction with Marchese Partners, organised the tour to scope out overseas best practice and look for innovative ideas to bring back to the Australian sector. During the eight days spent on the ground, the group went through 11 facilities, speaking and touring with senior management in order to identify major learning opportunities for Australian aged-care providers. The report, European Lessons Learnt: The major opportunities for Australian aged care providers, highlights key findings from the study – as well as the main areas where Australian businesses can learn. Along with social and cultural elements, use of technology and quality of care, respondents agreed that design was at the top of the list for lessons that could be learnt from European counterparts. The use of innovative design ideas to open up facilities to local communities was one of the major learning points drawn from the site visits. In the UK, the group spent half a day touring the facilities of one operator – St Monica Trust – which had three uniquely different offerings. One of the stops on the tour was its Westbury Fields site in Bristol, where an integrated retirement village and care facility is built around an abandoned cricket oval. The organisation partnered with the local cricket association to be able to use the clubhouse weekly. This means people are coming through not just to visit elderly relatives and friends, but also to use services. National aged care lead at Thinc, Kathryn Wilson, says this was a great example of innovative design used to encourage integration with local

www.agedcareinsite.com.au

August–September 2013 | 27

construction & design Three for the road Along with innovative design ideas; tour participants identified three top tips Australian providers could learn from Europe and the UK: • Embrace technology to optimise space and improve outcomes for residents. A great example of this was the installation of sensors in rooms to monitor movement. The hope is to tailor and improve design for residents. Incorporating technology allows facilities to bring the community to residents in real time – streamlining church services, webinars, etc. • Explore partnerships with local and national sporting associations and bodies, heritage groups and education providers to create an environment that promotes greater social interaction with the community. • Exploit international best practice in design and care for dementia patients. New overseas models are unique examples of possible considerations when building anew or refurbishing an existing dementia care facility.

communities – providing opportunities for people who may not necessarily have family members in the facilities themselves. “In Australia, we have been trying to work out ways in which we can integrate with the community for the better part of four or five years – rather than making people part of a community no one wants to be involved with. “It offers a fantastic place for the local community to come to, and gives residents an opportunity to be part of the community and activities – rather than being isolated.” Matt Row, general manager New South Wales for RetireAustralia, also found the spread-out UK design, which opted for single- and double-level villa living, as opposed to European multi-level, high-density living, most relevant. Out of the three destinations, he said England was probably the most similar to his operations in Australia; therefore it was easy while there to see what could be implemented back home. He noted another of the St Monica Trust sites in Bristol, Sandford Station – an integrated retirement village and care facility built around a decommissioned railway line – as an excellent example of incorporating the needs of the elderly into independent-type communities. Adopting a house-based design, this site provides dementia patients with a high level of independence within what appears from the outside as normal housing. Internally, however, the design looks like a regular living arrangement; rooms were joined together but maintained as separate houses. Row said it was this “homely environment” that was one of the most impressive aspects of the whole trip. “Even the kitchen was designed exactly to look like someone’s home kitchen, which they had done to make people feel at home. They weren’t actually cooking all the meals in a commercial-style kitchen; they were bringing in the food and finishing off the preparation in the normal looking kitchen.” Facilities in the Netherlands were also highly praised for their “innovative use of design to promote independence amongst dementia patients”. The De Berkenstede facility in Amsterdam received special mention for its “clusters – six rooms in residential settings that have a very non-clinical appearance and feel.

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   28 | August–September 2013

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construction & design It was agreed that the general standard of design throughout the German facilities visited was high, with effective use of lighting and particular attention to buildings’ external details given special mention. The tour was deemed a success by those involved and it may be considered as a bi-annual event. “It was most pleasing to see that, although there were definite lessons to be learnt, we weren’t way behind the curb,” says Deborah Muldoon, Life Care general manager innovation and service development. “Just seeing what other ideas are out there gives us an opportunity to change what we have got at the moment.” n

Key findings • The Australian industry is on par with the European countries visited, with similar skills and expertise. • There are still significant opportunities to learn from the European facilities/systems visited. • The top three areas for Australian providers to learn: 1. The innovative use of design to encourage integration with local areas 2. Social/cultural opportunities to ensure facilities are welcoming for families and the wider public 3. New developments to improve the quality of care • European providers face similar issues to Australian aged-care organisations, particularly around funding, operating in fragile economic environments and providing effective models of care. Source: European Lessons Learnt – The major opportunities for Australian aged care providers

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www.quicksew.com.au August–September 2013 | 29

practical living

How art

can bypass

the limitations

of dementia

Moments of connection with people who have advanced dementia are possible and art can make these moments happen. By Kim Pickworth

pecial moments with loved ones who have dementia can become rare over time. The movie The Notebook highlighted the moving connection you can have through alternative ways of engaging and bringing them into the moment. Now, people are using art as a way to make fictional moments such as those portrayed in film a reality for people with dementia. Research shows that cognitive stimulation slows the inevitable mental decline in people with dementia. Increasingly, organisations with interests in dementia are looking at nonpharmacological engagement programs to help families and those living with the condition. The benefits are breakthrough moments of connection together. A recent report from the Australian Institute of Health and Welfare found the number of people living with dementia is expected to triple before 2050, reaching about 900,000. For a vast number of Australians, this means dementia is a future reality. As dementia retains its high priority

30 | August–September 2013

health status, new and innovative ways of managing the condition for those with it and their families remains a high priority. Many organisations are looking at art programs as innovative methods to engage with and elicit positive reactions from those with dementia in response to global dementia research trends showing positive results of cognitive stimulation. New York’s Museum of Modern Art (MoMA) pioneered a program in 2006 called Meet Me at MoMA to give those living with Alzheimer’s disease an expressive outlet and opportunity to engage in conversation inspired by their exhibitions and art collections. Research commissioned in 2008 by MoMA by the New York University Centre of Excellence for Brain Imaging and Dementia showed that the program had genuine benefits for its participants. The report stated that there were positive changes to mood both directly after the program and in the days following the museum visit for people with dementia and

their caregivers. Caregivers reported fewer emotional problems, and all but one person with dementia reported elevated mood. Since then, art galleries in Australia including the National Gallery of Victoria (NGV) and National Gallery of Australia (NGA) in Canberra have taken MoMA’s lead and developed arts programs and activities for people with dementia. The NGA has also established a training program for arts and health professionals which is run in city and regional galleries in NSW, Queensland and the Northern Territory. Psychologist Dr Michael Bird and a team of researchers analysed the effect of the NGA’s program, which took people with dementia on outings to discuss artworks at the gallery. The results showed that participants were engaged from the outset and remained engaged. They became animated, gained confidence and were able to discuss and interact with the artworks and the social process.

practical living Despite no evidence of long lasting effects, one carer said, ‘you do it for the moment’, lending to the title of the research paper and encapsulating a sense that the activity is worthwhile even if the benefits are only evident whilst the program is running. Art and Memory is another innovative program that was developed by the NGV. It started as a program to give people with dementia living in the community opportunities to interact with art and has now combined efforts with a pilot program

developed by Melbourne aged care provider Emmy Monash called Art Down Memory Lane. This award-winning art program is specifically designed for participants in residential care and aims to establish a lasting, residual effect on participants in a structured manner. Inspired by the approach of Boston-based organisation Artists for Alzheimer’s, the program goes beyond basic engagement to leave lasting effects on the participants through multiple facilitated workshops participants attend before going to the gallery. Heading up the Art Down Memory Lane program at Emmy Monash is Juanita Beckinschtein. “At a basic level, engagement via art is fitting for those living with dementia because it taps into their imagination,” she says. “Beyond this, the engagement triggers both intellectual and emotional stimulation and people with dementia are perfectly able to respond to both. At the gallery, the level of constructive engagement within the group can be described only as miraculous. “Art has shown to be a very powerful tool that entices participants to reflect on their lives through the paintings. People with dementia perceive artworks in a different manner to most because they are captivated by detail.” Gina Panebianco, head of education at the NGV, explains that a lot of work, time and resources that go into developing arts programs. This includes tailored and specific training which is necessary for all involved in facilitating workshops, but the outcomes are extraordinary and worth the effort. “Art programs for people with dementia promote socialisation by using works of art as resources of conversation,” he says. “The results demonstrate reduced anxiety, strengthening of the thinking process, and increasing participants’ confidence, self esteem and sense of wellbeing.” Engagement via art for people with dementia and their families has proven to be a way in which to connect and see the responsiveness in loved ones eyes, even if only for a moment. These programs are about supporting the community, being innovative and challenging the status quo. However, not everyone has access to structured art programs, or even social day trips that can provide stimulating activities. “Lobbying and planning for resources and funding to make cognitive stimulation and arts programs available for everyone living with dementia should be a priority for all those involved with dementia care,” says Dr Tanya Petrovich, manager of business development and learning and development at Alzheimer’s Australia Vic. n Kim Pickworth is senior account manager, health and ageing at Melbourne public relations agency Ellis Jones.

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August–September 2013 | 31

practical living

Alive with

Alzheimer’s

An internationally acclaimed photographic exhibition featuring people with Alzheimer’s is touring Australia. By Aileen Macalintal

PHOTOS: Cathy Greenblat

eople with dementia are commonly perceived as “empty shells” or “no longer here,” but as a globetrotting photo exhibit has been showing, life goes on after a diagnosis of dementia. The internationally acclaimed Love, Loss and Laughter collection brings together over a hundred touching photographs of elderly people who are laughing, dancing, painting, singing and playing musical instruments, among other ordinary activities that people do. The collaborative work is the brainchild of American sociologist and social photographer, Cathy Greenblat, who took the photographs in the US, Europe and Asia. In March and April, Greenblat added to this growing body of work by photographing Australians living with dementia in NSW and Victoria. The exhibit has already visited Canberra, Hobart and Melbourne, where it was received warmly.

32 | August–September 2013

Ita Buttrose, national president of Alzheimer’s Australia, launched the tour in Melbourne. “Everyone has a favourite photograph and we look forward to thousands of visitors as the exhibition moves across the country,” she said. “We have also had a very positive response to our grassroots photography exhibition, which is running alongside Cathy’s photographs. It is terrific to see the community getting involved by submitting photographs that capture the experience of living with dementia to be displayed alongside the exhibition when it visits the city nearest them,” she said. “The pictures we have received are very moving, and I wish to thank everyone who submitted photographs and encourage others to get involved.” Buttrose said the photographs show that people with dementia continue to have needs for social interaction and

practical living Ita Buttrose at the tour launch for Love, Loss and Laughter.

engagement in the same way as other members of the community. Over the past nine years, Greenblat took photographs from high-quality Alzheimer’s care in the USA, Japan, France, India, Canada, the Dominican Republic and Monaco, while putting together the exhibit and a book showing dementia differently. The exhibit has reached Glasgow, London, Madrid, Salamanca, Geneva, Washington and New York. “I was asked to come to Sydney and Melbourne to add images from Australia to the set,” said Greenblat, who is a professor emerita of sociology at Rutgers University in the US. “I did so, and there are now 22 new images enriching the story the exhibit tells that people with dementia are “still here”, able to do many things if we change the way we treat them,” she said Initially, Greenblat had reservations about taking photos of the subject but was eventually drawn to spending time with those she photographed so she could understand their character, their level of progression of dementia, and get the photographs that most accurately portray these aspects. “When I recuperated from a 1998 breast cancer, I decided I wanted to do more photographic work,” she said. “I requested an early retirement and planned to undertake a project but I didn’t know what the topic would be. I first photographed during a master class with Mary Ellen Mark at an old age home in Oaxaca, Mexico.” She then found another place to photograph elderly people, at the Silverado Senior Living’s residential facility in

Escondido, California for 90 people with Alzheimer’s disease and related disorders. “I had not wanted to photograph Alzheimer’s,” she said, “as I was afraid of it, but this place showed me it was possible for people to have many moments of pleasure and even joy despite mid to late stage Alzheimer’s. “I photographed for seven weeks there, and in 2004, I published the book Alive With Alzheimer’s.” What prompted her to do the tour was a realisation that visual images could be powerful teaching tools. “Until 2001, I did some small-scale photography myself, but mostly looked at other people’s photographs, particularly those that dealt with social issues, and most particularly, with health and health care.” She hopes the exhibit can help illustrate and provide a higher quality of life for people with dementia in spite of the absence of cure or prevention to the disease. She expects people who viewed the exhibit to have a different way of seeing dementia for she believes people who have it are not empty shells as their laughter can enrich everyone’s spirit and love can flow among them. Alzheimer’s Australia’s Buttrose said everyone has “much to learn from Cathy’s photographs”. “The theme of this exhibition is the promotion of social engagement for both the person with dementia and their family carers and the reinforcement of one of the key priorities – to ensure that people with dementia have equal access to the services we all enjoy in the community,” Buttrose said. She said nobody should live in shame for being diagnosed with dementia. In fact, they should continue to be treated as valuable members of the community. n

Locations and dates See Love, Loss and Laughter at the following venues: Adelaide, 5-19 September, Burnside City Council Atrium Brisbane, 1-11 October, Judith Wright Centre for Contemporary Arts Sydney, 7-27 November, Parliament House

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August–September 2013 | 33

practical living

Say Yes

to Yoga

Research confirms that yoga improves balance and mobility, and can also reduce the risk of falls. By Amie Larter

very year, a third of all Australians over 65 experiences a fall – reducing quality of life, independence and sometimes resulting in serious injury or disability. The strong link between exercise and reduced falls in older people is well recognised, with popular balancepromoting activities including tai chi and home-based Otago exercise programs proving effective. However the challenge still remains; getting the elderly involved – and maintaining their interest. Results released last year from an Australian study examining older people’s participation in fall prevention exercise or physical activity revealed that participation is low. Only one in eight participated in strength training, while only one in six participated in balance training. Low participation rates and lack of elderly-attractive exercise options prompted researchers from The George Institute for Global Health in Sydney to investigate yoga as a potential physical activity option for older adults.

34 | August–September 2013

In spite of increased global participation in yoga from people of all ages – little research has been done on its effect on balance and mobility and reducing the risk of falls. Researchers conducted a 12-week program of Iyengar yoga, a branch of the popular Hatha yoga which focuses on balance, precision and alignment. It was part of the lead up in their long-term quest to answer the question: Does yoga prevent falls? The project involved 54 people aged between 59 and 87 and was based in the Yoga to Go studio in the Sydney suburb of Petersham. People were divided into two groups; one participated twice a week in the yoga program while the other was given an educational book only. Of interest was whether older people would cope with a yoga program that was quite challenging to their balance, and also whether or not they would keep coming back. Dr Anne Tiedemann from The George Institute and the University of Sydney said that the study unearthed encouraging

practical living results and reconfirmed that yoga isn’t just for the young. She said the trial demonstrated the balance and mobility-related benefits and feasibility of Iyengar yoga for older people, and the need for further investigation into yoga for preventing falls. “After 12 weeks there was significant improvements in balance and mobility in the people that did the yoga program,” she said. “It was safe for them to do, and they really enjoyed it.” Participants who completed the yoga course showed significant improvements in balance and mobility – measured through validated measures used in falls prevention research. Previous studies have revealed that if you perform well on the balance and mobility tests, you are less likely to have a fall than the people who didn’t perform well. Sixty-nine year old Kaija Muntz and her 82-year-old husband Donny both attend a one hour Iyengar yoga course every Thursday morning. They started the practice through the 12-week study. Kaija, who likes to walk her dog daily, has arthritis, asthma and problem knees. She said the classes have minimised falls and increased flexibility around her arms, chest and legs. “Some of the poses are quite challenging – however I am quite alright with [completing the class]. It is really well designed.” Kaija said this is an appealing exercise option for the elderly because it’s not only good for you, but it’s also fun. “We get together and have a little bit of a laugh at each other and ourselves,” she said. Tiedemann is hoping to further the research in a larger 500-person oneyear study that will measure participants’ falls on a monthly basis in order to gain evidence based results on whether or not yoga can prevent falls. n

Kaija Muntz, left, and husband Donny with Yoga to Go director Romina Sesto

What is Iyengar yoga? Iyengar yoga is based on the teachings of Yogacharya BKS Iyengar. Aged 94 and still practicing yoga daily, his premise is: “Yoga is for everyone. You do not need to be an expert or at the peak of physical fitness to practice yoga”. With a strong focus on postural alignment and precision, Iyengar has made yoga available to all with the use of props such as bolsters, straps, blocks and chairs to facilitate better alignment and support in the postures. The Iyengar style of yoga began its fame in the west in the 1950s and Iyengar’s book, Light on Yoga is regarded as the definitive guide to its philosophy and practice. The foreword was written by Yehudi Menuhin, one of the world’s most famous violinists and conductors and one of Iyengar’s first students from the west. There are almost 300 registered Iyengar yoga teachers in Australia and over 70 Iyengar yoga schools covering each capital city, including over 30 in and around the Sydney region. Iyengar yoga schools can be found by region at www.iyengaryoga.asn.au. Kirsten Shteinman is an Iyengar Yoga teacher at the Iyengar Yoga Institute of Bondi Junction. She conducts classes for seniors; the next term begins in September. Call 0420 456 550 for more details

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August–September 2013 | 35

practical living

How to make texture-modified meals pass the taste test Say goodbye to texture-modified food that is boring, repetitive and tasteless. Dietitian Samantha Murray discusses common problems residents have with the meals and provides some helpful tips on how to make them tasty and nutritious.

exture modification is aimed at making chewing and swallowing easier and safer for individuals diagnosed with dysphagia. Dysphagia (difficulty with swallowing) may be a result of a stroke, head or neck injury, neurological disease, cancer, cerebral palsy, difficulty chewing, dementia, or simply as a result of aging. Reduced oral intake, malnutrition and aspiration are all possible outcomes of dysphagia. Texture-modified diets are described according to the level of processing the food has undergone to achieve the desired texture. Fluids are described according to the thickness required. In 2007, texture-modified diet terminology was standardised throughout Australia in consultation with speech pathologists and dietitians. Modified meals include texture A or ‘soft’ meals, Texture B ‘minced and moist’ and Texture C ‘smooth pureed’ meals. The goal of texture- modified diets should be to allow residents to consume adequate food whilst maintaining normal nutritional status and reducing the risk of choking and aspiration. Assessment of a resident’s chewing and swallowing ability should ensure safety whilst providing the least restrictive diet modification.

Common problems with texturemodified meals within Residential Aged Care Facilities (RACFs)

Research has shown that residents with dysphagia are often at greater risk of malnutrition. So we need to ask ourselves: ‘Are we doing enough to make these 36 | August–September 2013

meals tasty and nutritious to ensure every mouthful counts?’ Here are some common scenarios that can prevent residents from getting optimal nutrition within RACFs: • Meals have been watered down to create the right consistency but this reduces the overall nutritional value of the meal • Meals look bland and unappealing to the residents, meaning less food is eaten • Meals have been blended together at the dining table into one bowl. This is unappealing and makes it very difficult for the resident to determine what they are actually eating • There may be limited variety in texture modified menus • Meals such as lunch and dinner may be the same dish, which contributes to monotony • Minimal choices available for morning and afternoon tea or nothing is available because staff are unsure what to serve • Smooth puree meals are served to those only requiring minced and moist. This may occur if it is seen as easier to puree everyone’s meal, or facilities have incorrect equipment to mince correctly • Texture needs are not reviewed to check that the resident still needs the existing modification • Ill-fitting or painful dentures or poor dentition. A dental review may remove the need for texture modification The good news is texture-modified diets

can be made nutritious and delicious by having some simple steps in place within each aged care facility. Here are some tips and tricks to improve the appeal and nutrition of texture modified meals within your facility: • Plan your menu so that most, if not all, menu choices are able to be produced into all three textures: soft, minced and moist, and smooth puree • Ensure food service and carers are educated regularly about texture modified meals; why they are required and the importance of getting it right • Ensure a variety of foods are offered and ensure adequate flavour to increase the appeal • Conduct regular audits to ensure meal particle size meets the texture standards. Regularly weighing meals will also confirm if the portion size is suitable • Standardise recipes to ensure consistency in meal delivery Some further strategies at meal times to boost the nutritional value of meals include; • Use fortified milk (milk enriched with milk powder) as a drink and on cereal • Ensure porridge is made on milk and try adding cream for additional kilojoules • Sugar or honey can also be added to cereal or porridge • Make scrambled eggs with fortified milk or cream • Add skim milk powder, cream, sour cream, eggs or grated cheese to soups, vegetables, main meals and sauces

practical living • Add extra milk powder, eggs and sugar to desserts • Always serve desserts with added cream, ice-cream, custard or yoghurt.

Going the extra mile

In addition to this, food service staff should look at innovative ways to go the extra mile to make these meals appealing. Some tips include: • Preparing gelled products (may not be suitable for those on thickened fluids) • Using food moulds to recreate the look of the meal rather than serving all the components with a spoon or ice cream scoop • Using piping methods • Soaking breads, cakes and even sandwiches (with puree fillings). Texture-modified meals don’t need to be bland and boring. They do require some careful planning. Liaise with your consultant dietitian and speech pathologist about how you can meet the requirements of your facility. n Samantha Murray is an accredited practising dietitian and accredited nutritionist. Her article is written on behalf of the Dietitians Association of Australia Rehabilitation and Aged Care Interest Group.

SERVE SIZES A standard serve of vegetables* is about 75g (100-350kJ) or:

medium

cup

5½

Women

1 medium

cup

19–50 51–70 70+ years years years Men

Women

½ cup cooked

cup

Grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties

80g

Men

4½

Women

apple, banana, orange or pear apricots, kiwi fruits or plums diced or canned fruit (with no added sugar) (½ cup) fruit juice (with no added sugar) dried fruit (for example, 4 dried apricot halves, 1½ tablespoons of sultanas)

65g

cup

large

Serves per day 19–50 51–70 70+ years years years

Lean meat and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans

½ cup (120g) ²/³ cup (30g) ¼ cup (30g) 3 (35g) 1 (60g) 1 small (35g)

bread roll or flat bread cooked rice, pasta, noodles, barley, buckwheat, semolina, polenta, bulgur or quinoa cooked porridge wheat cereal flakes muesli crispbreads crumpet English muffin or scone

A standard serve (500-600kJ) is:

100g

125ml 30g

1 slice (40g) ½ medium (40g) ½ cup (75–120g)

Serves per day 19–50 51–70 70+ years years years

65g

1 medium 2 small 1 cup

Or only occasionally:

A standard serve (500kJ) is:

²³

½ cup cooked

cooked green or orange vegetables (for example, broccoli, spinach, carrots or pumpkin) cooked dried or canned beans, peas or lentils green leafy or raw salad vegetables sweet corn potato or other starchy vegetables (sweet potato, taro or cassava) tomato *with canned varieties, choose those with no added salt

A standard serve of fruit is about 150g (350kJ) or:

Serves per day

small

Fruit

slice

Men

½ cup 1 cup ½ cup ½ medium

19–50 51–70 70+ years years years

Vegetables and legumes/beans

medium

½ cup

Serves per day

cup

Men

2½

Women

2½

80g 100g 2 large (120g) 1 cup (150g) 170g 30g

cooked lean meats such as beef, lamb, veal, pork, goat or kangaroo (about 90–100g raw)* cooked lean poultry such as chicken or turkey (100g raw) cooked fish fillet (about 115g raw weight) or one small can of fish eggs cooked or canned legumes/beans such as lentils, chick peas or split peas (no added salt) tofu nuts, seeds, peanut or almond butter or tahini or other nut or seed paste *weekly limit of 455g

A standard serve (500-600kJ) is:

cup

slices

¾p

cup

Serves per day 19–50 51–70 70+ years years years

Milk, yoghurt, cheese and/or alternatives, mostly reduced fat To meet additional energy needs, extra serves from the Five Food Groups or unsaturated spreads and oils, or discretionary choices may be needed only by those adults who are taller or more active, but not overweight.

Men

2½

3½

Women

2½

An allowance for unsaturated spreads and oils for cooking, or nuts and seeds can be included in the following quantities: 28-40g per day for men less than 70 years of age, and 14-20g per day for women and older men.

1 cup (250ml) ½ cup (120ml) 2 slices (40g) ½ cup (120g) ¾ cup (200g) 1 cup (250ml)

fresh, UHT long life, reconstituted powdered milk or buttermilk evaporated milk or 4 x 3 x 2cm cube (40g) of hard cheese, such as cheddar ricotta cheese yoghurt soy, rice or other cereal drink with at least 100mg of added calcium per 100ml

For meal ideas and advice on how to apply the serve sizes go to:

www.eatforhealth.gov.au

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clinical focus

A new look at old wounds Experts say limiting bandage options and providing special skin care can improve healing for aged patients. By Louis White

ound care management is a delicate matter. Ensuring that a wound doesn’t become infected is crucial. Amongst the elderly, whose recovery from illness and injury will take longer, managing wounds is especially important. Current research reveals that more than 25 per cent of residents in agedcare facilities have a wound. Wound care accounts for more than 50 per cent of community nursing and it’s a daily requirement for nurses to care for people with wounds in clinical practice. Australia is one of many countries investigating best practice for wound care management and has some leading experts on the matter. In the area of venous leg ulcers research and practice, Dr Carolina Weller, senior research fellow, health service management research unit department of

38 | August–September 2013

Epidemiology & Preventive Medicine, Alfred Hospital, is an expert. “Compression is used to treat venous leg ulcers that are secondary to venous insufficiency; it assists by reducing venous hypertension, enhancing venous return and reducing peripheral oedema,” Weller says. “Healing potential is decreased if compression is not applied. “A study published in the Australian Family Physician in May 2012 showed that nurse knowledge of venous leg ulcer management is suboptimal and that current practice does not comply with evidence-based management guidelines. “Evidence-based practice integrates the best available research evidence with information about patient preferences, clinician skills and available resources to make decisions about patient care. Barriers to the use of research-based evidence can occur when time, access to the literature,

search skills, critical appraisal skills and implementation skills are lacking.” Weller states that many different clinical trials have reported the large number of bandage options complicates the different compression systems, as different bandages need different application techniques. “Up until recently, there was no simple way to apply an economic alternative for health professionals,” Weller says. “A clinical trial published in Wound Repair and Regeneration in November 2012 reported that the three-layer, tubular-form bandage could heal people with venous leg ulcers. This system has now been translated into practice and used in primary health care and hospital settings with good results.” Weller also states that it is important for nurses and medical staff to be up to date on the latest research and practice concerning wound care management. “Clinical guidelines appear to be one of the most effective methods of applying evidence to improve quality of care but little is known about the best way to implement them into everyday practice,” Weller says. “The Australian Wound Management

clinical focus

Association has developed clinical practice guidelines for prevention and management of venous leg ulcers in collaboration with the” New Zealand Wound Care Society. Associate professor Geoff Sussman has been involved in wound management for over 30 years, in clinical research, clinical practice and teaching, and has over 100

www.agedcareinsite.com.au

publications. He says understanding the cause of wounds is critical to research. “Much of the latest research centres on our understanding of the mechanisms of wound repair and what has gone wrong with a non-healing wound,” says Sussman, director wound research, Wound Foundation of Australia, Monash University.

“This will lead to the development of new products that will correct the imbalance in the wound. The important issue in treatment is to fully identify the cause of the wound and then consider what properties the product to be applied requires.” Sussman also explained some particular issues related to wounds in elderly patients. “Ageing has a significant impact on the body’s ability to regenerate tissue and heal after injury,” Sussman says. “Some of the effects ageing has on tissue are reduced dermal thickness, weakened dermal-epidermal junction, reduced Vitamin D, collagen and moisture, reduced migration of capillary epithelial cells, epidermal turnover, increased fragility of capillaries and compromised inflammatory response. “Skin integrity reduces with age, dermal thickness is reduced, and there is a weakened dermal-epidermal junction. Acute and chronic wounds are common in older people in particular. Skin tears are very common. If treated correctly they will heal quickly; if treated incorrectly they will take a long time to heal. “It is essential to ensure as the skin ages that appropriate measures are taken, such as not using soap or other alkaline pH products that will increase the drying and therefore cracking of the skin.” Repeated washings with soap may reduce the normal skin flora, leading to an increased colonisation of the organ with coagulase-negative staphylococci; this effect has been linked to the shift in skin pH caused by soaps. n

August–September 2013 | 39

clinical focus

Under

old protocol

More elderly patients are presenting in emergency departments, presenting new challenges for staff. By Amie Larter

mergency departments throughout the world are experiencing increased presentations of elderly patients, sparking concerns that procedures, along with physical design, may need to be rethought. In response to the changing demands of the ageing population, a team of international researchers has conducted a survey that explored the characteristics and outcomes of 2282 patients are aged 75 and over at EDs. In total, 13 EDs were involved in the study, from

seven countries: Australia, Belgium, Canada, Germany, Iceland, India and Sweden. Patients were initially assessed on cognition and physical function, mood, comprehension, falls history, nutritional status and presence of pain or dyspnea. Researchers then tracked the progress of patients by interviewing them, examining medical records and speaking with hospital staff. “Older patients have complex problems before they arrive at EDs and even more complicated

Your Patients Can Benefit From Rational Medication Use

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clinical focus

needs when they get there,” lead researcher professor Len Gray, of the University of Queensland, said. “[They] require specialised care to avoid missed diagnoses, to prevent complications associated with frailty, and to ensure best care and appropriate discharge planning. “Our study highlights to all those who haven’t taken an interest in this that there is a substantial issue that needs some sort of thought.” TA R G E T I N G

Y O U R

Elderly patients were found to have some common complaints; a significant number had geriatric illnesses – including cognitive impairment and mobility problems – and most were largely dependent on others. Overall, 48 per cent already had geriatric syndromes before becoming unwell, a figure that increased to 78 per cent in the ED. Gray said there was growing concern that elderly patients presenting to the ED were “not really getting the customised care they probably deserve”. Liz Cloughessy, executive director at the Australian College of Emergency Nursing, said the ED was probably “not the most appropriate place for the elderly patients, especially high-risk delirium and falls patients”. “It is difficult to create an appropriate environment in the ED where these patients can be observed,” she said, explaining that it’s preferable for them to have less stimuli

M A N A G E M E N T

N E E D S

but that’s difficult to arrange within an ED and this often makes their confusion worse. Gray said quite a number of hospitals around the world were combating this by incorporating sections in the ED to cater specifically for older people. “In larger departments, there is an argument for segregating patients to some extent, so people with like problems can have the staff assess and treat them,” Gray explained. “You can’t put all people in one general ward and expect to get the best outcome, so certainly bigger departments could look at streaming frail older people into a section where the staff are familiar.” Smaller hospitals with limited resources were encouraged to further educate generalist staff so they could handle multiple kinds of problems. Researchers hoped that results from the study could provide a “thorough understanding of the clinical and psychological needs of older patients in the ED”, in order to redevelop protocols and services. Concerns were also raised over ED staff perceptions that their role was to assess and manage severe illness and injuries and that geriatric care was inappropriate. The report stated, “If this view is maintained, the case for introducing specialist teams and even specialised environments becomes more justified, so that such high-risk patients can benefit from comprehensive geriatric care.” In Australia, a growing number of hospitals are already developing specialist aged-care teams to work within the ED, identifying and treating older people. Aged-care nurses, who specialise in delirium, challenging behaviours, dementia and other issues, can also act as a valuable recourse to all ED staff, Cloughessy said. n

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August–September 2013 | 41 18/02/13 8:25 AM

clinical focus

Mind the mind drugs MJA report suggests steps for risk-management that can rein in the use of psychotropics. By Amie Larter

lderly residents of Australian nursing homes are being prescribed psychotropic medications in excess, in dangerous combinations and for too long, a Medical Journal of Australia report states. A series of editorials published in MJA have revealed concerning figures, calling for reductions in usage, as well as the development of alternate strategies to “prevent inappropriate use”. Geriatrician and clinical pharmacologist Sarah Hilmer from Royal North Shore Hospital and University of Sydney, is joint author of Rethinking Psychotropics in Nursing Homes. She says she has witnessed some of the cumulative detrimental effects the medications have on older people. “As a clinical geriatrician, I see a lot of adverse effects from the use of anti-psychotics, and I also see a lot of patients with behavioural problems from dementia who don’t really have the resources to manage optimally,” she said. MJA invited Hilmer to write a perspective on the issue collating thoughts on the reasons for such high usage rates, and approaches that could cause reductions and avoid inappropriate use. Hilmer and co-author Danijela Gnjidic, early career fellow at NHRMC, highlighted the risks associated with psychotropics in residential aged-care facilities, including increased possibility of falls, pneumonia, hospitalisation and death. The report outlined the efficacy of non-pharmacological management options, which often result in similar outcomes to pharmacological options. However, as noted, such methods are reliant on skilled nursing and allied health staff – a problem considering the already limited resources within aged care. Hilmer and Gnjidic went on to assert the ethical importance of a shift towards non-pharmacological care, which could potentially lead to similar outcomes with “less maleficence”. MJA received a letter in response to the perspective from research fellow Juanita Westbury and professor Gregory M Peterson, both from the University of Tasmania’s School of Pharmacy. They suggested that “awareness raising and education of health practitioners and residents’ relatives” was key to reducing this alarming problem. They moved past analysing patterns of usage, instead calling for the evaluation of solutions for broad-scale implementation. Westbury and Peterson are working with researchers on a new program, RedUSe, for nursing homes across Australia. It aims to empower aged-care staff, pharmacists and general practitioners through education and awareness of the quality use of sedative medication. “We believe [this] will improve the provision of care to residents, resulting in an enhanced quality of life,” Westbury said.

42 | August–September 2013

clinical focus

Hilmer and Gnjidic acknowledged this response, quick to reiterate the importance of education and training; however, they added that in isolation this would not be enough to address the issues aged-care facilities face with psychotropics. Australian Work Health and Safety Regulations state that risks must be managed through a hierarchy of controls, they explained. And use of psychotropics should be considered in the same way you think about any other hazard. “We applied a basic risk-management framework to it, commonly used by Safe Work Australia, which displays a hierarchy of risk control where number 1 is the most effective and number 6 is the least effective,” Hilmer said.

Six-point risk control

The first step in that six-point framework is to get rid of the hazard altogether, but in this case that’s not an option. “You can’t do this with psychotropics because they do have therapeutic roles for some nursing home residents for short periods of time at a low dose,” Hilmer said. Step two – substituting the hazard with a safer alternative – has been effective against

behavioural and psychological symptoms of dementia. This would involve obtaining and training more skilled staff to deliver nonpharmacological therapies, minimising the need for psychotropics. Hilmer describes step 3, as “isolating the hazard from anyone who could be harmed”. She suggests this could be done through policy changes limiting the prescribing of psychotropics – by indication, dose, duration and “rules that promote withdrawal after six to eight weeks”. The fourth step involves reducing the risk through engineering controls, for example using electronic prescribing to reduce inappropriate use. This is followed by administrative controls – educating and training existing staff. “Education of existing staff, step 5, is a relatively weak control,” Hilmer explained. “It’s better than nothing but it’s not a terribly effective way to reduce risk and doesn’t usually have lasting effects beyond the people you have educated.” The weakest possible control in this framework is step 6 – the use of personal protective equipment. This is where you accept the hazard is there and do what you can to prevent getting injured by it. n

CHANGES TO ACFI FUNDING FLAG A NEED FOR TRAINING UPDATE Since changes to the ACFI were introduced in February it has become clear to Lyn Turner, Director, National Care Solutions that not all facilities were well prepared for these changes and may be at risk of not capturing the funding they are entitled to through submission of their ACFI appraisals. Lyn has been working in the aged and community care sector for over 12 years and has been with National Care Solutions, a specialist aged care consultancy provider, for the past 6 years. Prior to this Lyn was Education and Training manager with ACQ (now LASA) for 7 years. Lyn was a national trainer in the rollout of the ACFI in 2007 and 2008 and has continued to work with nursing homes to ensure they are fully aware, through her training, of the “world of ACFI.” Lyn has worked with many homes where over a period of maybe 12 months they have seen their ACFI daily average claim rate climb from around the $100/day per resident to over $140.00/day per resident. For an 80 bed facility this can mean an increase of $3,200 per day or $1,168,000 per annum. Lyn says the improvements are simply recognition of the assessed care needs of the residents being accurately recorded in all clinical documentation by well trained staff who recognise what documentation is required to make a claim. The congruence of the progress notes, assessments and care plans is essential to this success. www.agedcareinsite.com.au

Lyn is also an external assessor with the Aged Care Standards and Accreditation Agency so is mindful of accreditation requirements as well when training/consulting. Lyn works with your staff in an action learning environment to ensure all stakeholders are working towards the same goal of recognising the assessed needs of their residents and documenting appropriately to ensure ethical claims that are upheld at validation. With the changes to ACFI in February there is a need for further education for most ACFI Appraisers to ensure they have the correct documentation as required at validation. Lyn is happy to come to your site to work with your staff to ensure you are claiming for any funding you are entitled to in relation to the ACFI.

National Care Solutions provides high quality aged care training and consultancy in the following areas ✓ ACFI Training, Preparation & Review. ✓ Preparation and submission of tenders/ ACAR/general applications ✓ Training & Development Services ✓ General Management Consultancy Services (including management mentoring) ✓ Human Resource Assistance ✓ Internal auditing, Preaccreditation gap analysis audits ✓ Preparation and submission of accreditation applications To have us come on site and work with you to help you reach your goals please contact: Lyn Turner 0418733786 lyn@nationalcaresolutions.com.au

www.nationalcaresolutions.com.au

Don’t Agonise

Organise

August–September 2013 | 43

clinical focus

Breathe

easier

Curtin researchers’ simulations help make lung treatments more efficient. By Aileen Macalintal

urtin University researchers say they are revolutionising drug delivery for people with asthma and other lung diseases. Associate professor Ben Mullins, lead researcher from the School of Public Health, said the work would result in “improved quality of life through more effective and less obtrusive delivery mechanisms for required medications”. Researchers said respiratory illnesses were the most common causes of death in people over 65 years old. Among the top

44 | August–September 2013

five killers of the elderly are pneumonia and chronic obstructive pulmonary disease, which claims one patient every 10 seconds. “Diseases such as COPD, asbestosis, silicosis, mesothelioma, and other lung cancers primarily affect the elderly, for a variety of reasons, including long latency periods,” Mullins said. He said asthma affected about 15 per cent of the Australian population and that $358 million was spent on medication for it alone each year – but more than 95 per cent of that amount is wasted because of inefficient drug delivery. “[The drug] is not delivered to the appropriate target area of the airway and the main reason for this is that models that accurately predict the capture of

clinical focus particles on moving surfaces in unsteady flow, such as in human airways, do not exist yet,” he said. From the researchers’ perspective, no works have accurately resolved airflow inside the lungs when the organs are expanding and contracting. This has inhibited the optimal delivery of aerosol medications to the affected regions of the lungs. “Since most – let’s say 95 per cent – of existing aerosol-delivered medication does not reach the target region, we think we can improve significantly on that using our models,” Mullins said. Asked what is revolutionary about the research, Mullins said, “We are, at present, the only group in the world that can do physiologically realistic simulations. That is, we can make the ‘chest’ expand and contract to create the airflow and ‘inhale’ [aerosol] particles – as happens in a real human or animal.” Mullins added that his research group is also the only one that has simulated particles as liquids in relevant models, and this is important because many medications are delivered as liquid droplets and other simulations treat them as solid particles.

“We [also] realised that no other researchers … had simulated full, realistic lung expansion and contraction as a means of driving the flow, as occurs in reality,” he said. “Therefore, we started adapting our existing models to respiratory research, with the help of very high-resolution CT scans of live animals and humans provided by our collaborators.” Aside from improving drug delivery, the research also aims to help develop tools to give doctors better information prior to surgery. “Current lung function testing cannot always predict the outcomes or efficacy of lung surgery,” Mullins said. Most members of the research team have a strong background in aerosol science and technology and have already developed models for other engineering applications. “All [members of] the research team have a keen interest in respiratory medicine and respiratory research, and we always planned to expand our aerosol research into this area,” Mullins explained. “However, the starting point for our models was for the collection of liquid aerosols in filters.”

The models do have their limits, however. They are useful in studying patterns of flow and deposition in the organ but “the results obtained may not be directly applicable to real lungs”, Mullins’ team stated in its paper, The Influence of Moving Walls on Respiratory Aerosol Deposition Modelling. “The works using CT-based lung geometries are perhaps better in this regard,” the report stated. Team members are looking forward to saving millions of dollars in wasted drugs with a wide range of engineered particle collection technologies and aerosol drug delivery devices. Their report has been published in the Journal of Aerosol Science. In their proposal, researchers stated, “This project will also provide top-quality research/ training opportunities for post-doctoral research, PhD and undergraduate honours degree students, through its combination of experimental design, numerical modelling and analysis of results”. The research is in collaboration with the Telethon Institute for Child Health Research and funded by the Asthma Foundation WA. Researchers said their success would “advance existing fluid dynamics and particle technology expertise in Australia.” n

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August–September 2013 | 45

workforce

Top role call The results of ACI’s Top 5 Inspirational Aged-care Professionals poll for 2013 are in, and these are the uplifting leaders who got your vote. By Amie Larter

Scaling the summit

A fast-tracked career led to Cynthia Payne stepping into the CEO’s role at SummitCare when she was only 33

Graduating as a nurse in 1992, Cynthia Payne knew aged care was what she wanted to pursue from her very first exposure to the sector. “It was just so apparent that the industry was ripe for change and that, as a nurse, there was going to be an ability to have quite an impact,” Cynthia says. This enthusiasm and her own potential to influence change didn’t go unnoticed. She found she had a strong network around her supporting her career progression from a young age. When she stepped into a role at the Australian Nursing Homes and Extended Care Association (now known as Leading Age Services Australia), she worked alongside Sue Macri – a person she has considered a mentor for many years and today a friend. “When I worked with Sue, it was during my late 20s, and it was a really formative part of my career,” Cynthia says. “She really helped me understand the bigger picture of aged care.” Working for the aged care peak body during what was a time of fundamental reform for the sector, Cynthia gained experience in advocacy and policy on both state and national levels. Now 44, she has been with 46 |August–September 2013

SummitCare for 11 years and has seen the company develop into the award-winning business it is today. In 2012, it was the only aged-care organisation to win gold at the Australian Business Excellence Awards – an improvement on the silver award from the previous year. Inspired and motivated to ensure that potential leaders have the same opportunities that allowed her career to develop, Cynthia ensures that talented young workers are on mentor agreements and are connected with senior executives within the organisation. “As leaders ourselves,” she confirmed, “we need to support the education of those individuals.” For the last seven years, she has also spent about 40-50 hours annually supporting young women, as part of the Lucy Mentoring Program provided through the University of Sydney and the University of Western Sydney. Her work also extends beyond the organisation with her involvement as a representative on a range of committees and boards, including director and treasurer of Leading Age Services Australia NSW and ACT, as well as director and inaugural chair of the board for the Arts Health Institute. As much as she is focused on capacity building for SummitCare, she is committed

Position: CEO Works at: SummitCare Career: 22 years

to getting providers, stakeholders and government officials talking about how the industry can be advanced. “As a facilitator and a leader you have to be listening and you have to be connecting with the people you work with,” she says. “It’s not just the people within the organisation, however; it is the people that you interact with more broadly – that can [include] stakeholders and government. “Being a good networker and a good leader means getting to know the people in your networks, helping them to really achieve and connecting the richness of the change that can happen – you can’t just do it on your own.” More than ever, she wants to bring about what she has labelled “disruptive change” – opening up the eyes of people to see different viewpoints. “As a market, we generally would be classified as quite immature,” she says. “Heavy regulation has stifled innovation in its broader sense for staff and providers. We need research-based practice to inform future models of care.” She uses the example of the Play Up and Sing Out Loud programs run by Arts Health Institute to illustrate that “bringing creativity to care is a fundamental shift around how people view the interaction and what that therapeutic base actually is”.

workforce High-tech heroine

Helping older people and aged-care organisations embrace new technology has become Desleigh de Jonge’s passion

It was the ageing population and a background in the disability sector that sparked Desleigh de Jonge’s interest in the aged-care sector. Desleigh is now dedicating her time to helping older Australians age in place and has built a reputation for consumer-orientated analysis of assistive technologies. This she accomplishes through her role as digital transition strategy development officer at Lifetec, an organisation providing free impartial information from health professionals to help maximise independence and safety. “What we want to do is ensure that older people know what kinds of assistive technologies, design and modifications can be utilised to enable them to remain independent, engaged and participating in their communities,” she says. As a woman in her 50s, Desleigh says she is even more committed to keeping aged-care organisations and the community up to date on the different

technologies available to remain independent and living in the community. Desleigh works along with the elderly, aged-care providers and other service providers to educate people on the effects of ageing and the kinds of considerations that are necessary in terms of older people’s homes and maintaining usability. “It’s not just about our information being available, it’s about where it’s available and how those decisions can be facilitated,” she says. “For instance, many of our clients have heard of an iPad but most don’t own or know how to use one. So we ran an information session on how an iPad or other tablet can help you to remain engaged in the community. A surprising number had been given one but were not using it.” Desleigh also works with organisations to help them identify where people may benefit from assistive technologies most. She runs regular workshops for aged-care providers to provide the latest information to a group that she says traditionally hasn’t used technology extensively. “We are currently working with an organisation that is putting technologies

Power of warmth and positivity

A nurse for nearly 50 years, Beryl Osman has been caring for people nearly her entire life

It’s certainly no surprise that a woman who believes a simple smile can do wonders is loved by all she deals with. Beryl Osman spends three days a week with the elderly folk at Dougherty Apartments in the Sydney suburb of Chatswood – and “loves the place”. Her caring nature is recognised by colleagues and residents alike. She is described as a “truly giving woman who always has time for anyone”. Day to day in her clinical role, Beryl assesses sick residents, looking after wound management, dressings and infection control. She gained most of her experience in the hospital system, originally training as a registered nurse and midwife, before completing specialist courses including intensive care and cardiac nursing. When university training came in, she also did her master’s degree as a mature-aged student, which she describes as a great experience, as it kept her up to date with students and young nurses coming through the system. www.agedcareinsite.com.au

It wasn’t until six years ago that Beryl had the urge to work in the aged-care sector. “I think when you are younger you have other ideas and opportunities, and then suddenly it just felt like the right time for aged care – not because I’m getting older, I think it was just the right time for me.” Care seems to be second nature for this humble woman, and extends well beyond the clinical realm. She always has time for one-on-one chats with any resident, trying in any way possible to make every day a joy. Once a month, residents attend Beryl’s Banter, an informal time where she is not acting as an RN, rather having fun and talking to the group during their happy hour. “If you have a smile on your face and a bit of positivity with them, it changes their outlook completely,” she says. “Ageing happens to everybody and it shouldn’t be the end of life because you are getting older – it should be a new beginning where you experience different things.” Her care and heart seem to show no end, as she regularly spends her annual leave in Nepal, where she has assisted in setting up the Kushudebu Public Health Mission and Sanjiwani Public Health Mission.

Position: Digital transition strategy development officer Works at: Lifetec Career: 30 years through there respite cottages, and then helping the people evaluate the effectiveness of that technology in their circumstances,” she says. Desleigh hopes to investigate a more integrated service delivery model, in the hope of further improving access to technology – both for those who have the extra funds to afford it and for those on pensions or in less fortunate positions. “So when a nurse goes out and discovers a client with a particular need, rather than having to go and source information, they just get out an iPad and give us a call on the spot,” she says. In addition to her endless passion for providing strategic advice and clinical services that positively affect older people and people with disabilities, Desleigh also spent 12 years teaching students at the University of Queensland, as well as writing reports and finishing books. Her written work focuses on the point where people decide they are no longer functioning well in the environment they’re in and decide to find out about doing things differently.

Position: Clinical care coordinator Works at: Dougherty Apartments Career: 46 years These clinics are central points for disadvantaged and remote villages, and Beryl has played a role not only in fundraising but also in building. She finds her volunteer work to be the perfect opportunity to engage residents in life outside the home. “A lot of our residents don’t have families,” she says. “They haven’t got the ability to go out as much and socialise, so they need to know what’s going on in the outside world. “I have involved the residents in fundraising for Nepal. They have raised money to help build the clinic, supply medical supplies, pay the doctor and things like that.” This gives residents something to look forward to. They become more animated and the trip turns into a topic of conversation long before she leaves. “Really, they forget about their illness, they forget about their aches and pains. This dedication to the lives of the elderly has made her first runner-up for the Nurse of the Year Award. “2013 has been an outstanding year for me,” she says, “and it’s not over yet!” August–September 2013 | 47

workforce Practice makes perfect

The role of nurse practitioner is gaining better recognition, thanks to Sharyn Speakman

About six years ago, Sharyn Speakman decided she wanted to contribute more to the aged-care industry, so she embarked on the lengthy process of becoming a nurse practitioner. Today, she is working across three facilities on the mid north coast of NSW – and loving every minute it. “I wish there were more hours in the day but it’s very satisfying because of the difference I can make every day to people who appreciate it – it’s very rewarding.” The nurse practitioner role within aged care is gaining more recognition. The position was first listed on the most recent aged-care workforce report, which showed an estimated 294 aged-care NPs in Australia. The position emerges at a time when government incentives are now keeping older people at home longer. “Entry to a residential facility occurs when people are much older, their chronic diseases are more advanced and they are frailer,” Sharyn says. This shift raises questions about the

best ways to recognise and respond to patients’ deteriorating health to achieve the best possible outcomes, and Sharyn strongly believes the nurse practitioner role addresses this issue effectively. Authorised to assess, investigate and treat a variety of illnesses autonomously and in collaboration with GPs, Sharyn’s scope of practice includes most of the illnesses that a GP would generally deal with. She is able to write referrals to specialists, discuss and document advance care plans, deal with complex wound management, review and instigate falls prevention strategies and also deal with infections, pain, palliation, mood and behavioural problems of dementia. “It means after I see people it can be up to five minutes before a treatment is organised because I am able to write scripts or medication orders,” she says. “I usually ring the GP if it is something serious – because it’s a collaborative role.” Largely as a result of her efforts, falls at the Karingal Gardens high-care facility in Taree have dropped significantly, and unnecessary hospitalisations at the site have decreased by 89 per cent.

Flying high

Joy flights are just one of Sam Lufa’s ideas to keep the minds and bodies of residents active

Always looking for ways to improve the lives of elderly residents, Sam Lufa is the enthusiastic and thoughtful lifestyle coordinator at TLC Aged Care’s Noble Manor facility in Melbourne. Tasked with the responsibility of ensuring all residents are involved in meaningful activities on a daily basis, Sam takes pride in knowing that every day he is helping make the lives of residents more enjoyable. He works with a team of 10 lifestyle assistants and physio-aids, along with volunteers who help run the activities program every day, giving residents a choice of about 28 activities a week. Under Sam’s guidance, the team has implemented a range of innovative programs, including art exhibitions, Ventura bus tours, picnics to Emerald Lake, as well as scenic tours. The group was recently nominated for 48 |August–September 2013

a Best Practice award for the innovative flight program, in which residents take to Tooradin airport for a half-hour joy flight to Phillip Island and French Island. “The flight is for people with all different levels of care needs,” Sam says. “A lot of aged care places would simply say it’s too much to go through taking the residents and having them in the plane, as a lot of our residents are high care – but we get doctors approval, do the risk assessment and find out if it’s going to be something new we can try. “I believe if we don’t take risks, we are not going to find out what’s out there for them.” All residents at the facility have a lifestyle profile completed to ascertain their interests. Sam has also initiated meetings with family members to get their feedback and input on programs. “Family members and next of kin know more about the resident and may be able to tell us something that we may be able to include in an upcoming program to further meet the needs of the resident,” he says.

Position: Nurse practitioner Works at: Bushland Health Group Career: 22 years Colleagues are impressed with the outcome and there has been significant staff feedback reflecting strong support for Sharyn’s work and how it has made a difference to other nurse work at the facilities. Sharyn’s own job satisfaction, as well as that of residents and their relatives, is also evidence of the effectiveness of the role. In a bid to showcase the NP model of care being used at facilities where she works and the positive effects it can have in delivering rapid care to residents, Sharyn is speaking at healthcare conferences and is involved in national projects to increase awareness. She hopes this will lead to recommendations to the government to increase the funding support for NPs in aged-care facilities, as well as to the Medicare rebate NPs are able to charge when bulk billing patients. “I think nurses need to hear more about the role, I really want to encourage whoever is interested,” she says. “The wider community also needs to hear about the role and value of an aged care NP.”

Position: Lifestyle coordinator Works at: TLC Noble Manor Aged Care Career: Five years Sam has also modified the programs for those living with dementia, which has led to the dementia unit being described as a “very peaceful environment”. He has trialled sensory movies using a projector onto the big screen, making it easier for residents to see. “Because there is no storyline, it is easy for them to follow what’s going on, so it cuts down behaviours in the dementia unit,” he says. Sam stumbled into the industry during a student placement for his diploma of welfare course. He admits he had a preconceived notion of what the industry would be like – but found it the opposite. “I used to change jobs every six months because I used to get bored with what I do and this is the job I have stayed in for such a long time now,” he says. He is thrilled with his chosen career path, and goes home happy at the end of the day knowing that he has put a smile on the face of residents.

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workforce

In short supply

Rural and regional aged-care providers face many challenges in recruiting and retaining staff. A mix of remedies may be the answer. By Tracey Mesken Published last February by the Department of Health and Ageing, The Aged Care Workforce, 2012 Final Report stated that three-quarters of residential aged-care facilities identified shortages of staff in multiple occupations; 63 per cent reported shortages of registered nurses, 49 per cent were short personal care assistants (PCAs), and 33 per cent needed more enrolled nurses (ENs). During the survey period, employers reported high staff vacancy rates, as a third of facilities had vacancies for RNs and PCAs. The study reported that RNs were the most difficult group to recruit, showing an average of seven weeks to fill vacancies. As a result, many RNs are working longer hours than they prefer. The report states that 29 per cent of RNs in residential aged care are working more than 40 hours a 50 |August–September 2013

week whilst only 6 per cent want to be working these extended hours. And RNs in the industry report high work-life interference, the highest among the aged-care work force groups and higher than the Australian workforce average. The report concludes that there is substantial pressure on employers to both retain RNs and continually recruit them from universities and the broader social assistance sector.

The cost of staff turnover

Studies examining the cost associated with employee churn show a mix of direct and indirect costs, including: Direct costs • Advertising the vacancy • Fees paid to recruitment agencies • Fees paid to consultancies for

conducting interviews, tests, medical exams and reference checking • Termination payouts, including long service leave and payments in lieu of notice • Cost of hiring short-term replacement staff such as agency workers • Overtime paid to employees filling in for the vacant position • In-house costs associated with recruitment, appointment, induction and acclimatisation to a new workplace with its unique processes and culture. Indirect costs • Loss of productivity during the final stages of employment (for the departing employee) • Loss of productivity (and damage to morale) from employees filling in for the vacant position • Risk to patient care when carer teams are short staffed • Damage to reputation if quality of care is adversely affected, even for a short period

workforce Top reasons RNs nominated for leaving their last aged-care job Most

important reason

• Moved house/location

17.5

• To find more challenging work

10.5

• To get desired work hours

9.9

• To avoid managers that I did not get along with

9.9

• To achieve higher pay

9.6

• To be closer to home

7.9

• To reduce stress

8.0

• Family care responsibilities

3.3

• Made redundant

2.8

Source: The Aged Care Workforce: Final Report 2012 (percentages do not total 100, as only top 9 responses are shown).

• There has been a longstanding differential in award rates between aged care and acute care sectors • Aged care is seen by many nurses as less challenging than acute care The 2012 report notes that problems with short staffing include: • Insufficient numbers of RNs with specialist aged-care knowledge • Slow recruitment leading to staffing and rostering challenges during the waiting period • Challenges with successful rural and regional relocation. The recruitment burden may be reduced by maximising retention of existing staff. What then are the reasons RNs leave employment? The report found the reasons nurses leave employment include personal factors relating to their life stage, further education needs and family demands and factors relating to the workplace.

• Risk to compliance with regulations governing minimum standards of care and • Reduced productivity during the early stages of employment (for the new employee). Accurately determining the cost of staff turnover is difficult. Whilst the cost of recruitment can be easily assessed, it is harder to put dollar values on lost productivity, reduced morale, lowered retention rates as a result of overwork and the cost to a facility’s reputation through under-servicing patients. The estimated costs of staff turnover vary from as low as 15 per cent of annual salary payments (Access Economics, July 2010) to 33 per cent (US Department of Labor) to 90 per cent to 200 per cent for senior roles (University of Melbourne 1998). For a more detailed exploration of how the costs of staff turnover were determined, review the calculator at WorkPlace Info, workplaceinfo.com.au/human-resources-management/hr-strategy/ costs-of-employee-turnover.

Summarising the research

The Aged Care Workforce Report indicates that the major recruitment challenge is for nurses, particularly RNs, and this is exacerbated in rural and regional locations. Earlier reports suggested that residential aged-care RNs are in short supply because: • Most training organisations focus on training graduates for acute care (aged care is offered as an elective) www.agedcareinsite.com.au

Personal factors include • Relocation due to family members, including spouse work needs • Prioritising household responsibilities, including family care demands • Others reasons, including to undertake further study or to retire Retirement of ageing workers is looming. The Aged Care Workforce Report states that a total of 26.6 per cent of direct care residential aged care workers were either nurse practitioners (0.2 per cent), RNs (14.9 per cent) or ENs (11.5 per cent). Of these, 27 per cent are 55 or older, whilst only 19 per cent are 34 or younger. The median age of RNs is 51 and that of ENs is 49. Workplace factors include • To find more challenging work • To get the working hours they want. To use RNs as an example, the report shows that 33 per cent work 16-35 hours a week, 34 per cent work 35-40 hours a week and 28 per cent work more than 40 hours. This is compared with what nurses want: almost 40 per cent say they want 16-35 hours, 50 per cent want 35-40 hours and only 6 per cent say they want more than 40 hours • Dissatisfaction with management practices/culture • To achieve higher pay rates In a report published in 2002, Recruitment and Retention of Nurses in Residential Aged Care, the Australian Centre for Evidence Based Aged Care and Commonwealth Department of Health and Ageing identified the key workplace factors leading to attrition as: • Lack of physical and emotional respect from other healthcare professionals and lack of inclusion in treatment decision-making (recognition) • Opportunities for education and career advancement (recognition) August–September 2013 | 51

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workforce • Opportunities to develop leadership capability and influence operational management (culture) • Staffing shortages and resulting overwork and guilt and anxiety associated with inability to provide quality resident care (appropriate staffing). In summary, staff reasons for leaving employment are both personal (intrinsic) and professional (extrinsic workplace factors). The workplace factors leading to reduced staff retention include: the desire to find more challenging work; working more hours than desired, which is associated with short staffing; dissatisfaction with management practices and culture; a desire for more recognition and a desire for higher pay. Recruitment problems include insufficient numbers of skilled RNs, perceptions that aged-care nursing is less challenging, award rates for aged-care RNs and problems in relocating to rural and regional locations. Strategies to improve recruitment and retention In the first of their report from their “Building the Lucky Country” series, Where is Your Next Worker? Deloitte suggest that skills shortages are a major risk for Australian businesses. The key recommendations include investment in: • graduate recruitment programs • skilled immigrants • web-based skills (telehealth) • retention of older workers • mobilising and relocating workers • reinventing workflows to improve productivity • up-skilling and succession planning • engaging and motivating employees. Residential aged care providers rely on a range of strategies to resolve staff and skills shortages, including many of those outlined

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in the Deloitte report: • asking workers to work longer hours • up-skilling the existing workforce • paying above-award rates through EBAs • running graduate nurse recruitment programs as well as nursing re-entry programs • hiring nurses from overseas on 457 (skilled immigration) or 417 visas (working holiday) • use of non-PAYG workers, mainly agency nursing staff (the Aged Care Workforce Report indicates that 92 per cent of external staff used in residential aged care are agency staff). Asking RNs to work longer hours may be self-defeating in the longer term, leading to overworked RNs with job dissatisfaction and burnout, leading to increased attrition and an increased recruitment task. Up-skilling of the existing workforce and succession planning takes time but can make a significant contribution. For example, SummitCare attributes low staff turnover to succession planning and training. “Our staff turnover is 11 per cent, lower than the national average [23 per cent],” SummitCare general manager operations, Judith Leacock, says. “We believe that our succession planning initiative and an exceptional career development program have contributed to this.” Running graduate recruitment programs also takes time, but these programs are an important component of the strategic mix. Whilst many aged-care providers have experimented with international recruitment, few have been satisfied with the results. The providers need to engage immigration consultants and support with accreditation, then find recruits struggle to relocate and settle in rural and regional locations. The use of agency personnel is expensive and a short-term fix only.

workforce Emerging models

A new recruitment plan is emerging to deal with the challenges of skilled immigration. Recruitment companies are searching and sponsoring internationally, assisting with accreditation and immigration, relocating and seconding RNs to providers of aged care. As these companies build scale to a staff of 100 or more, they can invest in the expertise and time to support relocation of skilled staff, helping them and their families find accommodation, schools and jobs for partners. They are also providing support through the settling in period and a link to the home culture via social groups and social networking. The companies second their staff to the aged-care provider for two years or more, ensuring successful settlement and establishment into the new community before moving the RN into the aged-care provider workforce. But operators in the sector have not always had positive experiences with recruiting skilled immigrants. “There is no question that foreign workers need to be part of Australia’s large aged-care workforce,” says Gerard Mansour, former CEO of Leading Age Services Australia. “Programs that recruit workers from overseas need increased government scrutiny, and to integrate development programs, language programs, housing and lifestyle support, in order to drive up retention rates. We need good social support networks”. Telehealth is another initiative, which may reduce pressure on recruitment and retention by improving productivity of existing staff. Whilst ultimately this may have greater impact for ageing-inplace carers, there is strong interest in its potential for residential aged care. The Macedon Ranges and North West Melbourne Medicare Local is trialling links between over 40 residential aged-care facilities, 130 GPs and a small number of specialists. Inner East

Melbourne Medicare Local, Perth North Metro Medicare Local, The Rural Doctors Workforce Agency (South Australia) and Western NSW Medicare Local have all announced telehealth trials. In October 2012, the University of Queensland Centre for Online Health won a $972,000 grant to implement a trial of telehealth in residential aged care facilities. The Department of Health and Ageing is also offering financial incentives for early adoption of telehealth. It is clear that there is continuing pressure to recruit and retain RNs in the sector. The cost of staff turnover is high. As shown, short staffing and overwork are among the reasons RNs give for leaving a workplace, so reducing recruitment lag time reduces the risk of attrition. And effective retention strategies will lower the burden on recruitment. Improving productivity also reduces the pressure on skilled staff. The Deloitte report indicates that operators of aged-care operations are not alone in facing challenges from skills shortages. The best answer appears to be the development of a portfolio of strategies, including graduate recruitment programs, skilled immigration and use of web-based consulting to improve productivity, retention of older workers, relocation support programs, training and development programs and engaging and motivating employees. n Tracey Mesken works at HealthX, an Australian company that sponsors international registered nurses under the 457 visa program. For a fully referenced version of this story, visit agedcareinsite.com.au

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August–September 2013 | 53

workforce

All systems

are go Reforms have brought demands for improvement. The winners will be providers that attract quality care workers and measure performance effectively. By Barry Williams

ow do you increase efficiencies and maintain competitiveness in an industry already burdened with escalating compliance requirements and financial constraints? The answer lies in technology. With the right IT solution you can enhance employee productivity, improve customer service provision and reduce your administration costs. Every service manager can identify with the demands of delivering planned care on time and on budget. Using technology to make the most efficient use of your workforce adds leverage to both time and money. The latest generation of rostering systems automates the planning process, minimises travel between customers, and takes care of many of the costly and HR intensive tasks. Knowing that services have been delivered isn’t just important to any funder, it’s vital to your customer. Fortunately, technology provides an answer by verifying electronically that the customer visit occurred and for how long. Real time data enables alerts to be activated in the event that a visit is late or didn’t occur so that alternative arrangements can be made. Additionally, electronic data provides for end-to-end automation of payroll and invoicing, significantly reducing the expense and inaccuracy of a manual practice. There is much to consider before embarking on a full system overhaul. With the expansion of web and cloud-based services, software as a service (aka on-demand software) delivers management applications to your web browser, thus avoiding the cost, maintenance and technical infrastructure of managing your own internal system. Before addressing the issue of budget, consider your longterm goals. Your wish list is likely to include enhancing client service delivery, improving staff communications, automating payroll and customer/funder reporting requirements. It is more than reasonable to expect to achieve all these goals, and many more besides. Having made the decision to adopt change, consider what type of solution is most appropriate for your organisation. Scrutinise the key service components of customer, staff and existing systems. What importance do you place on the immediacy of information?

54 |August–September 2013

What types of technology will suit best – desktops, laptops, tablets, mobiles, or a combination? Is your existing system helping or hindering you to achieve your goals? And finally, consider flexibility. Will all of your customers fit the same solution? Will all of your staff? Once you have evaluated these objectives, you are ready to investigate potential IT or mobile solutions. Make sure to ask about set-up costs, ongoing expenses and after sales service, and assess the credibility of the supplier. Ask for testimonials. An amalgamation of systems may be necessary to fulfil your needs. This is not unusual and is often a simple matter of developing an interface for ease of operation. It is important to acknowledge that your existing system was probably not designed to accommodate monitoring data or mobile technology, so you must remember to keep your organisation’s long-term goals in mind. Implementing the right IT solution for your business will help streamline your rostering and payroll processes, allowing you to reallocate administration time and costs elsewhere. Furthermore, consistent high performing staff can be identified and rewarded, enabling you to recruit and retain quality care workers who value their position in your organisation. n Barry Williams is the general manager of eziTracker Australia. For more information, visit ezitrackerhm.com

workforce

Are you looking after

your (financial) health?

taff in the health sector spend most of their days looking after the needs of others. Here are some tips to make sure that you are looking after yourself financially.

1. Save for a rainy day

By Peter Kempster

If your child needs braces, or your car or washing machine breaks down, how well do you cope? Meeting unexpected challenges can be difficult for all of us. Ensure you don’t suffer financial stress as well by having some savings put aside. One way to do this is to open a high-interest savings account separate from your transaction account and then set up a regular transfer every payday. Even just a small amount may help you accumulate a savings nest egg sooner.

2. Stop paying fees

Do you pay bank fees, perhaps even on accounts you no longer need? Do you use ATMs at which you pay operator charges? Does your credit card have a monthly or annual fee? Most fees are avoidable. This might involve consolidating your bank accounts, or slightly altering your behaviour (for example to get cash out with EFTPOS). Dodge unnecessary fees so you save or spend more on the things that you want.

3. Balance your budget

We know that the word “budget” can be scary for many people working in the health sector but from a personal perspective it can have great benefits. Knowing and planning your income and spending can help you save up funds so that you can purchase the things you want sooner. Use a simple budgeting tool like the one on the BankVic website (bankvic.com.au) to help you understand your financial position.

4. Save heaps on your home loan

When was the last time you checked your home loan interest rate? How much could you save if you took up some of the attractive offers available today? Refinancing your home loan may allow you to pay it off sooner, or provide for school fees, a new car or a much-needed holiday. Your bank should be able to provide you with assistance regarding these and other ideas for improving your financial health. n Peter Kempster is CEO of BankVic. Disclaimer: Any advice is general advice only. Before you make any decision to acquire any of our products you should obtain and consider the relevant Product Disclosure Statement, terms and conditions, interest rates and fees and charges available from our website, any branch of BankVic, or by calling 13 63 73.

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August–September 2013 | 55

community

Set to go Lifelong tennis ace Margaret Fisher looks to make history at world championships in Austria. By Aileen Macalintal

ustralian singles champion Margaret Fisher is going to Austria for the over-80 Super-Seniors World Championships in September, with $8550 in support from crowd funding. Fisher, 83, used crowd funding to help cover her airfares and accommodation. The campaign, which closed on August 25, easily exceeded its target of $6000. “It certainly has been successful,” the Byron Bay tennis ace says. “It’s an incredible privilege to be sponsored for doing something I love.” Fisher will attempt to become Australia’s first over-80 world tennis champion but it won’t be the first time she’s travelled overseas to play. In 1953, she sailed alone to England, with three years’ worth of her own savings. She played in the British Open, Dutch Open and Queen’s Club tournaments at the time of Elizabeth II’s coronation. On top of those events, she also represented Australia in Wimbledon. “Playing at Wimbledon was absolutely exciting,” she says, remarking that she honestly can’t remember hitting a ball but that it was a wonderful experience. The huge crowd, free lunches and famous tennis players overwhelmed her back then. “I mean, I came from the country and I just could not believe that this excitement existed.” She says a series of country tournaments and inter-town competitions served as her preparation for the big matches at the time. Recently, after many years away, she’s been back in the game. In 2010, her brother inspired her to team up for the Australian Super-Seniors Championships on the Gold Coast – her first competitive matches in about 60 years. She landed a runner-up place in the singles and began training for the world championships in Turkey that same year; there she won the bronze medal in the over-80s women’s singles and silver in the women’s doubles. After winning the Australian seniors tennis championship in Perth in January 2012, she flew to Croatia, where she became the world mixed-doubles silver medallist. In that tournament, she played up to three matches a day over two weeks, in both the team and individual events. “Last year, I went to Croatia and met

56 | August–September 2013

32 women in the over 80s singles,” Fisher says. She hopes to find the 32 women again this year at the world championships. Reminiscing about her early tennis career, she says the earliest she can remember playing is in a town in the south of NSW. “From there I continued and I started teaching just after the war in ’49 and started saving and saving with encouragement from my family and saved enough money to go overseas,” Fisher says. When not playing, she taught infants and primary and secondary schools, as well as pioneering maths and reading centres in Canberra and Darwin. She also piloted courses in English as a second language in Canberra schools. Fisher plays at the Byron tennis courts with coaches and local women. “I used to play about a quarter of the year until about the 1980s. I gave it up for about 20 years, then got back into it again about

four or five years ago,” she says. “Every morning I get up, I take my dog and go to the beach. I have a couple of workouts five mornings a week.” In terms of diet, she says she always has fruits, a salad, three meals a day, no meat and a cup of coffee. “I’ve always been a milk drinker,” she adds. Her advice to those dreaming big in the tennis world: “I guess you’ve got to enjoy what you’re doing. Do your best at all times. Enjoy, practise, join competitions. Make sure that you always commit to doing your best.” One of Fisher’s sponsors is aged-care organisation Feros Care. Its CEO, Jennene Buckley, says the group had been looking for an inspired senior to showcase new ways of approaching ageing. “Margaret is everything we know older people can be,” Buckley says, “inspired, enthusiastic, fit and willing to take risks to achieve her potential.” n

community

Much to hope for from the flowers

ensory gardens are known to improve people’s emotional and physical well-being, particularly in those with dementia, who may experience anxiety and stress. In Lysterfield, Victoria, a garden that is dementia-specific and stimulates the senses has been opened by Villa Maria, a not-for-profit aged and disability services provider. The $80,000 landscaped site includes walkways, raised garden beds, a rotunda, pond, water feature and mini windmill, all designed to cater for the needs of people living with dementia. Carinya Respite Service, Villa Maria’s recreational and overnight plan, offers people with dementia in the region a chance to maintain their independence and quality of life. Research shows that physical as well as visual access to nature reduces stress, regulates blood pressure levels, helps maintain comfortable sleeping patterns and aids in the absorption of vitamin D. Carinya team leader Melanie Allsop said staff and clients were excited about

the completion of the sensory garden. “It’s aesthetically pleasing from inside the building and provides staff with a whole new space to enhance the well-being of clients,” Allsop said. She said the gardens would encourage more people to spend time outdoors and give clients the opportunity to take part in gardening, which would reward them with a sense of ownership and teamwork. “We look forward to when the plants are all in bloom and we see the full effect of the garden – we cannot wait for spring!” she said.

She said the space is also important for carers, who can gain needed respite. Allsop said the service had recently expanded its focus to become a “one-stop shop” for carers in the region, offering respite during the day or overnight at Carinya, and within their own homes. “We have also extended our Out and About program to include activities for both people living with dementia and their carers,” she said. “A recent visit to the zoo, for example, gave couples the opportunity to socialise with people in similar situations in a fun and relaxing environment.” n

Mercy Ships CEO retires Ragazzoli was head of charity that sailed hospital vessels.

ercy Ships Australia CEO Gary Ragazzoli has retired after serving for seven and a half years in one of 16 support offices around the world devoted to global charity. Mercy Ships uses hospital vessels to provide much-needed medical and community development services to people in some of the world’s poorest nations. During his tenure, Ragazzoli was responsible for raising financial support to enable the organisation to provide all of its services free of charge. He also assisted in the recruitment of volunteers who serve at their own expense for periods extending from a few weeks to long term. In recent years, the number of such volunteers has risen to nearly 60 Australians annually. The Caloundra, Queensland, headquarters of Mercy Ships, in Bulcock

www.agedcareinsite.com.au

Mercy Ships Australia - Susan and Gary Regazzoli onboard the Africa Mercy in Liberia

Street, opened 10 years ago and continues its vital work with a small staff and support from volunteers. “It has been very satisfying to see Australian support for the work being done by Mercy Ships continue to grow,” Ragazzoli said. “That has been particularly pleasing from a financial point of view during the recent difficult economic times. “Our supporters have seen the valuable work being done to help bring healing

through the skills of surgeons and medical teams to so many thousands of Africans who have none of the health services available that we in Australia simply take for granted.” He also commended the volunteers’ work in programs including community health, dentistry, agriculture and education, and their ability to bring “new levels of hope to many who struggle to live below the poverty line”. Mercy Ships, founded in 1978, has worked in more than 70 countries, providing services valued at more than $1 billion, with more than 2.35 million direct beneficiaries. Each year, more than 1200 volunteers from over 40 nations serve with Mercy Ships. Professionals including surgeons, dentists, nurses, healthcare trainers, teachers, cooks, seamen, engineers and agriculturalists are a part of it. Alan Burrell will take over from Ragazzoli in the new position of managing director. n August–September 2013 | 57

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technology

Nice view through the cloud Emerging technologies such as cloud computing and smart homes will help older Australians remain independent and maintain their quality of life. By Jeffrey Soar

regret I have about ageing is that I won’t see the exciting innovations in technology that I know will be there for the generations that come after me. I can’t, however, be too dissatisfied, since my baby boomer generation enjoyed a breathtaking pace of technological and social change that helped make our lives privileged in comparison with the hardship and deprivation of the war generation. I remember as a child seeing my grandmother sail from Princes Pier in Melbourne for her once-in-a-lifetime trip back to the UK. Our first telephone was a huge wooden box with a turn-handle (dials came later) and was installed in the hallway of my family home just at the right level for me to regularly knock my head against it (which probably explains a few things now). On the day of Princess Margaret’s wedding in 1960, my father put rows of packing crates across the lounge room to accommodate the whole village, as ours was the only home with a television, albeit black-and-white and very grainy. Baby boomers are enthusiastic users of technology and we can expect exciting changes ahead as we move into old age. We will probably make different choices about where we live, how we spend our time, and the products and services we will be open to purchasing.

www.agedcareinsite.com.au

To date, the adoption of technology for ageing and aged care has been somewhat disappointing, particularly in tele-care and tele-health; however, there is an increasing use of information systems in applications for the elderly. There are several technology suppliers with a sustainable base of clients that continually enrich the functionality of their systems. Even so, technologies such as tele-health to our homes are yet to take off, despite promising pilot projects and the availability of government funding and infrastructure. There is an old saying that the future is already here, just poorly distributed. That is evident now. Some aspects of the quiet revolution in technology include smart homes, robots, intelligent agents, stem cell therapies, new materials and driverless vehicles. Universal design promises a world that is more inclusive for people with temporary or permanent frailty or disability. There is also the boom in medical tourism, which is now a major industry for some countries. Recently, I was contacted by colleagues in China interested in pursuing a new initiative in stem cell-based technologies as part of a medical tourism proposal. Stem cells have attracted great interest and investment around the world. These renewable cells have the potential to

regenerate almost anything from skin to vital organs. Expectations are that this will lead to cures for conditions ranging from paralysis to blindness, as well as the degenerative conditions associated with ageing. It is hardly a surprise that the cosmetics industry has already embraced this technology and stem-cell based treatments derived from animal or human tissues are available. That brings me back to the so-called medical tourism market. Transport and telecommunications technology have enabled globalisation, outsourcing and off-shoring. We have witnessed how manufacturing has moved to China, software development and call centres to India, car manufacture to Japan, and many other examples. It is reasonable to expect that healthcare would also take advantage of technology for off-shoring, and that is happening in the form of medical tourism and remote reporting on diagnostic services. There is increasing off-shore use of a widening range of health and medical services, particularly those that are more expensive locally, such as cosmetic surgery and dentistry. We already have the systems in place in Australia, where almost all pathology, radiology and other diagnostic images and results are transmitted electronically. It makes little difference August–September 2013 | 59

technology to the technology if the transactions are around the corner or between countries and there is huge potential cost savings. A significant proportion of diagnostics in the US are now reported on in India. In the future, we can expect to travel overseas for a widening range of services and when we need care it may well be delivered from afar through the internet. Another innovation likely to be a game changer is cloud computing, through which access to systems and storage of data can be anywhere on the internet. Just as you now plug in home appliances at a power point with little thought as to where the power you are using was generated, in this model you will similarly use processing power, computer applications and data storage online, from anywhere in the world. This is not without risk, but it is already in widespread and growing use. It means technology applications and support will be more readily available at lower cost to individuals and organisations. You won’t need to rely on local technology experts and all you will need is a PC and access to the internet. We have had prototype smart homes with us for more than a decade and some of the individual technologies for much longer. The most pervasive device is the personal alarm, which is provided

in Australia by operators such as Tunstall Healthcare. Beyond that, there is an endless range of technologies to make homes safer, provide alerts, allow access to care services remotely, provide tracking for people at risk of wandering, and help consumers and families stay socially connected, informed and stimulated. There are also geo-location applications, which the iPhone already offers – very useful for me in knowing where my daughter is. Analysts worldwide are yet to agree on a standard design for a smart home and prototypes can be found in many countries. In Australia, the most sophisticated example is at LifeTec in Brisbane. My all-time favourite movie is I, Robot. I like the concept of the android (Sonny in the movie) as the end-user device under the control of the faceless software robot VIKI. That, in a much more benign form, is the concept being pursued by researchers including my own expert colleagues professor Hua Wang and associate professor Wei Xiang at the University of Southern Queensland, along with many others around the world. In this model, we will have the services of a software case manager who will know our care needs, provide reminders and operate through other devices. We are not far away from the environment of the Internet of

Things (IoT) where almost every electrical device can have an IP internet address. You could phone your refrigerator to check on what’s available for dinner. The fridge could tell you what you need to pick up on the way home to make your favourite dish. You could also check to see if grandma has been using her appliances, which might tell you something about how she is feeling. There is a need to maintain currency with the pace of technology; as older people, we need to push ourselves as individuals as well as take advantage of support that is available. In all state capitals and larger regional cities there are Independent Living Centres (www.ilcaustralia.org.au). These provide information and support about products and services to help people remain independent and improve their quality of life. If you live in the Brisbane region, you can take advantage of Brisbane Seniors Online (www.bsol.asn.au), which organises volunteers like me to visit seniors in their homes to assist with the basics of computers and the internet. It also offers a training program. n Jeffrey Soar is professor and personal chair in human-centred technology in the School of Management and Enterprise at the University of Southern Queensland.

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60 | August–September 2013

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technology

Helping seniors smarten up

There’s a new program in Victoria that has kids teaching seniors how to use recent technical innovations, such as smartphones and iPads. Founder Merv Stewart talks to Aileen Macalintal

martphones and iPads don’t always fit comfortably in the hands of grandpa, who often won’t touch the gadgets unless someone is patient enough to walk him through the world of apps. Senior Techies, a not-for-profit organisation founded earlier this year, runs technology training events for Victorians aged over 55. Initially, what the Senior Techies program sought to address was “digital inclusion” or access to new technologies regardless of age, income, ability or disadvantage. “Unfortunately for Australian seniors, we are about two years behind both the UK

www.agedcareinsite.com.au

and America in terms of addressing digital exclusion in our society,” Senior Techies founder Merv Stewart says. “Every time we conduct a training session in a community, we see enormous benefits first-hand, ranging from smiles, cheeky laughs and astonishment at what’s possible with new technology, to social inclusion, which can positively [affect] the loneliness and mental health of our attendees,” he says. The hands-on events provide the equipment, information and help seniors need to start using the latest technology. Each two-hour session starts with the lead trainer explaining and demonstrating five or six new skills to a group of 20 to

30 seniors. These skills range from the basic use of an iPad to engaging with social networking apps and games. One app often demonstrated is “4 Pics 1 Word”, which is popular with both seniors and young people. A young trainer then spends about 15 minutes helping the participants practise the new skill. The training can be customised for particular group needs.

Regret becomes inspiration

One thing that motivated Stewart to start this program was regret from not being able to record the story of his grandma’s generation. While growing up in Ireland, his August–September 2013 | 61

technology

family would speak often at their annual Christmas dinners. Stewart’s grandma would ask him to use the camcorder to record the story of their fourth-generation dairy farm established in the 17th century in County Derry. But the story remained unrecorded and his grandma passed on. These days, one can digitally store such stories and easily share them with family and friends. So when Stewart found a video of a senior’s technology training program in the US called Senior TechRally, he saw an opportunity to let more stories similar to his grandma’s live longer, through various technologies. Before this discovery, he had been looking for an opportunity to give back more than 15 years of IT project manager knowledge and experience to the community, particularly to those often excluded by technological changes – seniors and disadvantaged youth. The Senior TechRally videos inspired him to fulfil this goal by being a part of something similar in Australia – training seniors with the help of young people. By creating a group of seniors who understand just how easy it now is to share their stories, you make sure these tales can live on for years to come and can be passed on with the simple click of a share button on YouTube, Stewart says. “So I started to look for a training program [similar to Senior TechRally] in Victoria that I could become part of but there” wasn’t one. “The main telecommunications companies and hardware providers seemed only to pay lip service to [addressing] the technology needs of Australia’s seniors, so I was determined to change this situation.”

Youth is a great teacher

Young people aged 10 to 18, plus Stewart’s kids – aged 5 and 8 – took part in Senior Techies. Stewart says the young ones did not need to be trained on the iPads, as it all comes completely naturally to them. 62 | August–September 2013

“I observed awkward 12- or 13-year-olds walk into our session and come out after delivering two hours of one-on-one training to a senior, standing tall and asking when the next event was so that they could be part of it,” he says. The seniors, who come from a wide cross-section of the local Camberwell community, evaluate the sessions positively, emphasising how the inclusion of the young people had a powerful impact on them. The reaction to the event went beyond the organisers’ expectations. “I had never used an iPad,” says one participant, 76. “I now want to buy one.” Another asked when the next event would be, hoping to get more advanced information.

What’s next

Stewart says he is amazed at how quickly the seniors get the technology. “Most of our attendees have never touched [the gadgets] before our events and by the end they are often browsing happily away in the app store, sending emails and pictures and reading articles online,” he says. There are times when challenges such as fear of breaking the gadgets or fear of computers come in the way of learning, but the trainers make sure the users overcome these obstacles straight away. “One of the very first things we show the senior is the home button,” Stewart says. “If you ever find yourself in an unfamiliar page or app on an iPad, just press the home button at the bottom of the device. “We also show them covers to protect the iPads, but give them confidence that they are pretty difficult to break.” Stewart says he intends to roll out a national Senior Techies event after refining the program in Victoria during the next six months. The organisation will be running at least eight events in the coming months, from Camperdown to Wonthaggi, and in Melbourne.

Beginner iPad training lessons • What is an iPad? • How to take pictures with an iPad and share them by email and messages • How to take videos with an iPad and share them with email and YouTube • How to make video calls using FaceTime and Skype • How to use the App store and download apps • How to stay safe online • How to make your iPad easier to use

Melbourne schools were showing interest in hosting the events as the program aligns with their community outreach work. Senior Techies will continue to focus on working with the youth to show older people how the latest gadgets can help connect them in new ways to the community and their families, and reduce their fear of technology. n

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