Australian Ageing Agenda September-October 2024 by The Intermedia Group

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Driving quality care

TOP ON everyone’s agenda recently has been the proposed legislation for a new Aged Care Act.

Introduced into Parliament in September after a tense few weeks where many feared bipartisan agreement unlikely (page 8), it has spent the following weeks under the scrutiny of stakeholders and the Senate (page 12).

Like you, we eagerly await the Senate’s final report – due 31 October – and the government’s response to it.

The goal of the legislation –aligned with royal commission recommendations – is to drive quality care.

This is the same goal as a recently funded collaboration project led by the Registry of Senior Australians investigating how the workforce impacts care quality.

ROSA has teamed up with StewartBrown, two aged care providers and four other partners including this publication for the five-year project.

It includes linking to StewartBrown’s quarterly aged care performance survey data for residential and home care providers.

“We know that workforce affects quality but an in-depth, population level investigation in an Australian setting hasn’t been done. This will give us enormous capability to do that now. So it’s very exciting,” says ROSA director Professor Maria Inacio.

I am also excited about our role in the project, which includes keeping the sector informed about its progress.

You can read about the project on page 10 and expect to see more when and as information becomes available.

In the meantime, I hope you enjoy these and the many more stories inside.

And as always, I encourage you to connect with us and your fellow readers if you have a story to share or comment to make.

Until next time,

Natasha Egan

Australian Ageing Agenda Editor

Tel: 02 8586 6132

Email: negan@intermedia.com.au

Brief

Bill must pass before Christmas

Providers focused on improving the

20 The Aged Care Act – does it go far enough?

Research, policy and practice must be aligned

One on one with Kate Thwaites: Champion of the (older) people Perspective with Elly Murphy: Rehab reaps rewards

30 Leadership talk with Peter Williams: Relentless pressure of

32 ‘Yes means yes’ Operations

34 Procurement insights with Darren Whalen: Fostering a culture of continuous improvement

36 Future of home care

38 Lessons from implementing enhanced sensory care

40 A bundle of support

42 Restoring function

44 Dementia: Forming friendly first responses

45 Dementia: Improving palliative paramedicine

46 Ask the expert with Dr Tesfahun Eshetie: Prescribing cascades in long-term care

47 Research news: What is successful ageing?

Ideas & inspiration

48 AAG: Celebrating 60 years

50 Products

Our team

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1 Leadership and career expert Dr Edwin Trevor-Roberts discusses the qualities of great leaders (page 28).

2 Academic Dr Sara Karacsony shares learnings from an aged care project found to improve quality of life for residents with dementia at end of life (page 38).

3 Researcher Dr Joan Ostaszkiewicz outlines a project underway to strengthen the capacity of the aged care workforce to identify, prevent and manage indwelling urinary catheter issues (page 40).

4 Drug safety expert Dr Tesfahun Eshetie talks about prescribing cascades and their impacts on older people (page 46).

Jodie

Talkback

“There isn’t any monitoring by the government as to whether providers provide services or not. When the funds go into your account at the end of each month, the first amount that is taken out is service provider fees. So it doesn’t matter if no services have been provided, the providers always get their fees. This enables providers to not give the service they should.”

Robin Rodgers responds on AAA online on a new report that finds consumer dissatisfaction with home care providers

“The evidence from the USA is that self-reported staffing data is inaccurate and misleading. No doubt it is the same in Australia. The five star USA system is based on payroll data. It is a mandatory reporting system which is actually accurate and useful, a stark contrast to the Australian 5 star system”

Kathy Eagar reacts on LinkedIn to the latest care minutes data

“Great to see support for respite services following a dementia diagnosis. Unfortunately, due to the grants being exclusively for approved providers of aged care, there is no support for people living with younger onset dementia and childhood dementia who are not eligible to access aged care services. Dementia is not an old person’s illness and our national dementia strategies need to reflect this.”

Dr Rodney Jilek comments on LinkedIn on government grants awarded to providers to improve respite care for people with dementia living at home

“I am not surprised by this article. We have been pushing to have a simple streamlined immigration process to allow us to bring in qualified care workers – both nurses and PCAs – for over two years. All this government does is put yet more roadblocks that if they were not there would solve the issues.”

Robert James Farrow comments on AAA online on the sector-wide shortage of allied health workers

1Superwithdrawals threaten retirement security

COTA Australia warns that many Australians are withdrawing from their superannuation for essential healthcare, threatening their retirement security.

“Very timely indeed. The horrific nature of Australia’s proposed new aged care system makes it imperative we move in a new, more caring direction. The proposed system appears to be driven by the commercial interests of corporate providers, rather than consultation with older people. Let’s hope WHO throws a spotlight on this looming dystopia.”

Peter reacts on AAA online on the World Health Organisation’s call for global aged care reform

“I love this. It should be an initiative in every aged care home nationally. It would heavily reduce the number of aged care residents experiencing falls and spending time in hospital. Watch the ramping and overcrowding reduced in our public hospitals if this were the case.”

Lyn Whitely posts praise on LinkedIn for gyms installed in aged care homes

“The ageing population needs a skilled workforce who receive acknowledgement and remuneration that is competitive and appropriate for the skills needed to multitask, support a vulnerable population, have incredible assessment, prioritisation, emotional intelligence and leadership skills with a understanding of the increasing compliance of the aged care sector.”

Meaghan P comments on LinkedIn on the staggered rollout of pay increases

They it said

“We’ve established a solid team at ARIIA, and now others are in a position to take that on and carry it forward.”

Former ARIIA research director Professor Sue Gordon

“The fact that too many older people are still not getting the mandated minutes of care is a real concern.”

COTA Australia CEO Patricia Sparrow

“Today, we announce a needs-based arrangement that makes financial sense, a system that helps more homes have more services for older Australians.”

Minister for Aged Care Anika Wells

“We need to build the home as the centre for where people can live with dementia, age well, age in place, and ultimately have end of life.”

HammondCare CEO Andrew Thorburn

Call for submissions

The next issue of Australian Ageing Agenda (November-December 2024) is reporting on the following and we welcome reader input.

EXECUTIVE: Facilities of the future

We’re looking at the must-have features and the latest design trends in residential aged care settings. From furnishings and fittings to gardens and exercise equipment, we’re keen to show you how the future looks inside and out.

OPERATIONS: Hygiene & cleaning

Did you know that carpets can act as air filters? From air quality to floor coverings we’re investigating the current issues, thinking and strategies for cleaning teams to consider for the aged care places they are responsible for.

FRONTLINE: Clinical software

We’re going to delve into new and innovative clinical software helping aged care managers, nurses and care workers provide best-practice person-centred care, compliance, documentation and reporting.

Get in touch if you have something to share: editorial@australianageingagenda.com.au; or promote: mryu@intermedia.com.au

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The Brief

Reform

progresses

Bill aims to boost provider viability, system sustainability

By Natasha Egan

AFTER MONTHS OF uncertainty

the government introduced Aged Care Bill 2024 into Parliament on 12 September after reaching agreement with the Opposition.

Central to the $5.6 billion package and the new Aged Care Act are higher fees to support provider viability and system sustainability.

Minister for Aged Care Anika Wells called it “a need-based arrangement that makes financial sense, a system that helps more homes have more services for older Australians. Our reforms will create better and safer care,” she said.

The legislation aims to improve the quality of aged care, and protect the rights of older Australians such as through a statement of rights, and new duties and penalties to hold aged care providers and leaders accountable, and empower them including via supported decision-making.

Across residential and home care, the government will pay 100 per cent of clinical care costs – as recommended in the Aged Care Taskforce report.

Individuals will pay more according to their means towards everyday living and independence support in home care – which includes meals, showering and gardening – and non-clinical care and accommodation in residential aged care.

The breakdown includes government paying $3.30 for every $1 paid by aged care residents and $7.80 for every $1 paid by home care recipients.

The family home will continue to be treated as it is under the new system.

A lifetime contribution cap of $130,000 across home and residential care applies to an individual’s nonclinical care costs regardless of their means or duration of care. Every Support at Home contribution counts towards the cap.

Existing aged care recipients will not pay more than they are under a noworse-off measure.

Despite the bipartisan support, Shadow Minister for Aged Care Anne Ruston said she wanted to make it clear this was Labor’s package of reforms and not a co-designed process.

However, she said the Coalition worked to ensure the reforms did not unreasonably disadvantage Australians who have saved for their retirement.

“That is why we pushed the government to include grandfathering

arrangements, lifetime caps, and a lower taper rate… We have fought for additional funding for aged care providers in the bush,” Ms Ruston said.

In residential aged care, accommodation reform and resident contributions will ensure the growth and viability of the sector, the government said.

Changes include replacing the means-tested care fee with a nonclinical care contribution indexed twice a year in line with inflation, increasing the maximum room price by $200,000 to $750,000 and allowing providers to retain 2 per cent of each new residential accommodation deposit – RAD – each year for up to five years.

“The government will review the accommodation supplement settings over the next two years and consider phasing out RADS from 2035 subject to an independent review,” Ms Wells said.

Support at Home

The package includes $4.3 billion for the new Support at Home program.

Coming into effect on 1 July 2025, the program features eight funding levels and aims to reduce wait times to three months from assessment by July 2027.

The package includes:

• support for 300,000 more participants in the next 10 years

• shorter average wait times from assessment to receive support

• more tailored support with eight ongoing classifications up to almost $78,000 a year

• three categories of support – clinical care, independence and everyday living

• support for home modifications with up to $15,000 to make a home safer

• faster access to assistive technology like walkers or wheelchairs

• means-tested fees with self-funded retirees paying 80 per cent of everyday living costs and 50 per cent of independence costs.

On 1 July 2025 people with a home care package or on the national priority system will move to the new home program and maintain their level of funding and any unspent funds.

A Senate Community Affairs Legislation Committee is reviewing the legislation through public consultation with a final report due 31 October. n

Causes of death Data shows dementia close second

By Christopher Kelly

HEART DISEASE IS the leading cause of death among Australians, according to the Australian Bureau of Statistics.

However, the nation’s mortality numbers for 2023 show that dementia is a close second with less than 250 deaths separating the two.

As the stats show, heart disease was the cause of 9.2 per cent of deaths, while dementia accounted for 9.1 per cent of deaths during the period.

“We’ve seen a drop in heart disease mortality and a rise in dementia deaths over time associated with both improvements in medical treatment and healthcare, and an ageing population,” the bureau’s Lauren Moran said.

“This is changing our leading causes of death.”

Indeed, dementia is shown to be the leading cause of death in South Australia, the Australian Capital Territory and, for the first time, New South Wales.

Dementia has been the leading cause of death among Australian women since 2016.

In 2023, dementia accounted for 12.2 per cent of female deaths compared to 6.4 per cent of male deaths.

In response to the ABS data, Dementia Support Australia head of professional services Marie Alford told Australian Ageing Agenda the increasing number of people with the disease is having an impact on carers, families, the health system and residential aged care.

“While there has been some progress with treatments, the reality is there is no cure.”

There are around 421,000 Australians living with dementia. Without a significant intervention, this number is expected to increase to more than 812,500 by 2054.

“With over 400,000 people already living with dementia, let’s ensure there is ongoing funding available to provide the best support we can to improve quality of life for those living with dementia, including ensuring help is available to assist the person to live in their own home as long as possible,” Ms Alford said. n

ROSA adds workforce data

A funding grant supports a five-year collaboration with seven project partners to investigate how the workforce impacts care quality.

The Registry of Senior Australians has teamed up with StewartBrown, two aged care providers and four other partners for a five-year commonwealth funded project examining the impact of workforce on older people’s care quality and health outcomes.

The ROSA research centre –which is based at the South Australian Health and Medical Research Institute – integrates data from the aged care, health care and social welfare sectors to provide an full picture of ageing-related outcomes.

It has secured a $3 million Medical Research Future Fund National Critical Research Infrastructure grant – announced in September – to update and expand its platform to include StewartBrown’s workforce data plus quality indicator, funding and star ratings data.

The grant allows ROSA to expand Australia’s first multisectoral data research infrastructure and undertake this groundbreaking study, says ROSA director Professor Maria Inacio.

The project’s overarching goal is to drive quality across residential and home care. Within that the project has three main aims.

Firstly, to identify the optimal aged care workforce components, such as care minutes, skill mix and models of care, and levels required to improve quality and safety of care. This includes to minimise undesirable outcomes and improve health and social outcomes in residential aged care facilities and home care settings.

Secondly, to identify national unwarranted variation in quality of care and workforce related best practices by providers for people accessing aged care and subgroups with established health disparities, such as dementia, Aboriginal and Torres Strait Islander and culturally and linguistically diverse.

Thirdly, to examine the real-time impact of workforce related aged care reforms on care quality in residential aged care and home care.

In addition to StewartBrown, project partners

“We know that workforce affects quality.”

include South Australian aged care providers ECH and ACH Group, SA Health’s Office for Ageing Well, peak bodies Council on the Ageing South Australia and Aged and Community Care Providers Association, and this publication.

Dataset updates and boost

On the backend, the funding supports ROSA updating its existing datasets for another five years plus adding new data related to recent reforms – including Star Ratings, the National Aged Care Mandatory Quality Indicator Program and Australian National Aged Care Classification for the residential aged care sector.

It also includes linking to StewartBrown’s quarterly aged care performance survey data for residential and home care providers back to 2010.

Inacio welcomes the opportunity to partner with aged care sector benchmarking and accountancy firm StewartBrown to undertake this work.

“They’ve been incredibly supportive of this idea of us overlaying the information they’ve collected over many years from providers to look at opportunities to improve quality of care and the pressure points in relationship to workforce and quality,” Inacio tells AAA

“We’re focusing on looking at the number of hours that have been dedicated to residents at different facilities, and also in home care packages.”

The ROSA team will then overlay that data with its own data on the relationships between investment and workforce at different types of services and its outcome monitoring system.

Inacio has also welcomes Australian Ageing Agenda’s involvement in the project. AAA’s role involves updating the sector’s stakeholders on the project through its print and online channels.

Professor Maria Inacio

ROSA’s project aims to identify optimal aged care workforce components, such as care minutes and models of care, to improve quality

“It might take quite a bit more cost investment to get the outcomes that we need.”

“Our partnership with AAA is unique and exciting. AAA will play a key role in sharing the findings of this work to the sector and ensure that our findings can quickly find their way into the hands of those who are actively involved in caring for older Australians and are ultimately affected by the elements we are studying.”

Australian Ageing Agenda is also excited and proud to partner on this groundbreaking project.

“We regularly hear from our readers and contacts about pressures related to workforce and the actual and potential impacts this is having on organisations and individuals,” says AAA editor Natasha Egan.

“We’re looking forward to engaging with the sector about this project and keeping stakeholders informed about its progress and findings over the next five years.”

Project partners

• StewartBrown

• ECH

• ACH Group

As one of the key communication partners, AAA will also advise on the development and implementation of the dissemination plan.

Project timeline

The first year of the project involves setting up, getting modifications in place and starting to work on the linkage.

• SA Health’s Office for Ageing Well

• Council on the Ageing South Australia

• Aged and Community Care Providers Association

• Australian Ageing Agenda.

Preliminary work is already underway to initiate the linkage, and Inacio expects some of it will be operational by early 2025.

After that the team will focus its analysis on key areas of reform including care minute targets.

“We’ll start by looking at the associations of workforce with quality with the intent of making recommendations about adequate and optimal care minutes,” she says.

“What can we learn from what happened in the last 12 years to inform the recommendations?”

The current minutes were recommended based on international literature and not necessarily the situation in Australia, she says. “We’re hoping this is going to overcome that limitation.”

The analysis will also look at other relationships with quality like cost. “Sometimes it might take quite a bit more cost investment to get the outcomes that we need, so it’s understanding those relationships,” Inacio says.

After identifying best workforce elements, the second research component will look into workforce composition, education, and other markers related to quality outcomes.

“We’ll be able to look at national variation in that regard and potentially identify areas that have large disparities,” says Inacio. “And then the third area is about monitoring the impact of the aged care reforms and care quality.”

That will focus on the workforce implemented reforms including the mandatory care minutes and how that affects quality of care at a population level nationally.

“That will be interesting because working under the assumption that these things are true – game-changers for quality – we should see quite substantial changes. Or do we not see changes? Or is something else required to change the dial on quality?”

In addition to this project, the new updated contemporary datasets available for another five years will support existing and new work, says Inacio.

“Having these resources updated and with new elements added means that a lot of other research can be done.” n

Project aims

 identify optimal workforce components such as care minutes, skill mix and models of care and the levels required to improve quality and safety in residential and home care settings

 identify national unwarranted variation in aged care quality and workforce best practices

 examine the real-time impact of workforce related reforms on aged care quality.

The Registry of Senior Australians team

68,109

Australians approved for a Home Care Package but waiting to access it – May 2024

36,524

People waiting for a level three package

9 to 12 months

National average wait time for level three package, as of July 2024

14,497

People on an interim HCP, as 31 March 2024

44,107

People not offered interim HCP but have Commonwealth Home Support Program approval

Average amount of days it takes a person classified as low priority to receive an aged care assessment

80-89

Typical age of people receiving home care

65%

Women account for around two in every three people using home care

40%

Percentage of older Australians living independently who need assistance with at least one activity each day

Source: Life on the wait list –Anglicare Australia

Finalising the Act

A Senate inquiry has heard views on the proposed new legislation. NATASHA EGAN reports.

By 18 October the Senate committee tasked with reviewing Aged Care Bill 2024 had published 70 submissions and was three-quarters of the way through a national tour of public hearings.

While everyone seems to welcome the legislation in general, they don’t always want the same thing when it gets down to the detail.

Aged & Community Care Providers Association chief executive officer Tom Symondson told the Melbourne hearing that ACCPA “unequivocally supports” the bill and is “very excited” about the landmark reforms it provides.

But he added concerns over the time, challenge and cost of transitioning to the new system and called for a staged approach to implementation.

“If we’re going to achieve the changes the bill seeks to deliver on, we need the time to do it properly so that the reform does not just fail,” Mr Symondson told the inquiry. “That requires 6-12 months from when we have all the information; that means all of the rules.”

Appearing at the same hearing was national aged care provider Bolton Clarke.

Speaking with Australian Ageing Agenda prior, CEO Stephen Muggleton said he was “looking forward” to the passage of the new Act and welcomed “provisions that will support greater funding certainty and sustainability” for residential care.

However, he too expressed reservations.

“From the home care perspective, we are recommending elements of the proposed reforms be deferred pending further review to minimise the risk of major service disruptions and reduced services for those who most need them.”

He’s not the only one.

The week earlier, Catholic Health Australia fronted the inquiry and called for the Support at Home to kick off from July 2026, a year later than slated, to ensure an effective implementation.

“We’re calling for a modest delay or a shadow pricing approach to make sure the reforms can be implemented smoothly with no unintended consequences,” CHA’s director of public health and in-home support policy Alex Lynch told AAA

“Providers also need time to implement the changes, including updating IT systems, training staff and informing clients.”

Lorraine Poulos, managing director of aged care training and consultancy organisation LPA, said pushing back the start date would be delaying the inevitable.

However, she agreed there were significant financial, ICT and workforce ramifications for providers.

“All the elements of the reform changes announced are what we’ve been anticipating and expecting. But we don’t think home care providers have enough information to make sound decisions until we have the pricing information from the Independent Hospital and Aged Care Pricing Authority,” Ms Poulos told AAA. LPA would support a 12-month preparation window from the date that the Aged Care Act receives royal ascent, she said.

COTA Australia chief executive Patricia Sparrow is not keen on more delays to the in-home program.

“COTA Australia wouldn’t support a blanket 12-month delay but would consider supporting tailored timelines for specific, complex elements of implementing the program,” she told AAA ahead of her appearance at the inquiry.

Turn to page 20 to hear more from Ms Sparrow on COTA’s views.

Likewise Acting Inspector-General of Aged Care shares his views this edition (page 18) and warns the Bill must pass before Christmas break and be implemented on 1 July 2025.

“If it’s not, then reform will unravel, and it will take years to get it back on track.”

The Senate committee’s final report is due by 31 October. n

CMO announces retirement

Noticeboard

Australia’s chief medical officer

Professor Paul Kelly has retired from the Department of Health and Aged Care. Serving as the head of the interim Australian Centre for Disease Control since 1 January 2024, Professor Kelly joined the department as chief medical advisor in 2019 and has held the position of CMO since 2020. Professor Kelly brought his technical knowledge and communication skills to provide reassurance to the public during the Covid-19 pandemic, as well as offer critical advice to governments. Professor Kelly’s last day in the department was 21 October 2024.

New CEO at COTA Vic

LPA appoints Galiazzo GM

Experienced aged care executive Marisa Galiazzo has been appointed general manager of Lorraine Poulos and Associates to assist with the growth of the Sydney-based consultancy and training organisation as well as the evolving sector. Ms Galiazzo – who joined LPA Consulting as a senior consultant in June 2023 – has over 25 years of leadership experience in government and the not-for-profit roles. She spent over 10 years at home care provider Care Connect, where her roles included general manager of aged care and national manager for the out-of-hospital care program. Ms Galiazzo also worked at the Department of Health and Aged Care for over five years.

International advocate and policy specialist Ben Rogers has been appointed chief executive officer of Council on the Ageing Victoria and Seniors Rights . Mr Rogers began his career in the health and wellbeing sector in the United Kingdom and Victoria and started as policy and advocacy manager at COTA Victoria and SRV in 2022. He has been acting in the role since with and alreasy accomplished the rollout of the peak’s new individual membership framework, launch of an elder abuse campaign.He began as permanent CEO on 9 September.

Sue Gordon leaves ARIIA

Aged Care Research and Industry

Innovation Australia research director

Professor Sue Gordon has left the organisation after helping set up and establish it. Professor Gordon was central to the successful tenders that developed the model for ARIIA and oversaw its establishment at Flinders University and continuing expansion under a $34-million government grant. This has included building a team of over 30 specialists dedicated to advancing evidencebased practices in aged care and the creation of the ARIIA grants program. Professor Gordon has also had a long career in academia. Her research has covered healthy ageing, prefrailty, functional decline, and the development of the aged care workforce.

ADHA

appoints chief clinical nursing advisor

The Australian Digital Health Agency has appointed Karen Booth as its inaugural chief clinical advisor for nursing. An experienced nurse, Ms Booth joins the government body with a background in primary care, preventative care, clinical governance and leadership. Ms Booth is an influential leader who has been advocating for the role of nurses in digital health for many years. She has been a key contributor to the advancement of digital health in the nursing profession and played a pivotal role in the future of the Australian healthcare system as a member of the Strengthening Medicare Taskforce.

Experienced pharmacist joins PainChek

Digital pain assessment vendor PainChek has appointed registered pharmacist Christelle Ucinek to grow awareness and adoption of its technology as part of expansion plans across the aged care, hospital, disability, palliative and home care sectors in Australia and New Zealand. Ms Ucinek, a specialist across aged care and disability, joins PainChek as senior commercial manager with over 13 years of experience in the healthcare sector. She was most recently general manager of electronic medication manager Medi-Map, where she worked for over six years.

Altura gains new general manager of learning

Altura Learning has announced Dr Roshmeen Azam as its new general manager of learning. As Altura Learning begins to expand, Dr Azam will guide the company in offering clinical leadership for both national and international distributed learning resources and play an essential part in driving the company’s evolution. Maintenance of clinical standards in residential care and home care courses will be one of Dr Azam’s main priorities in her new role, plus presenting leading practice content, and the advancement of new non-accredited learning

Expert joins Anglicare’s dementia program

Dementia care professional Victoria has been appointed as the clinical Anglicare’s Specialist Dementia Care Program units. Responsible for the growth of both new and current programs, Ms Cain will offer clinical oversight to guarantee best-practice dementia care principles and the highest quality of care is given to all residents.

With previous job roles such as dementia consultant, residence manager, national consumer dignity and risk advocate and registered nurse behind her, Ms Cain takes on the role with a wealth of aged care experience, a Bachelor of Nursing and a postgraduate degree in gerontology from Griffith University. n

Marisa Galiazzo

Karen Booth

Professor Sue Gordon

Ben Rogers

Professor Paul Kelly

Dr Roshmeen Azam

Victoria Cain

Christelle Ucinek

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Bill must pass before Christmas

THE INTRODUCTION

of Aged Care Bill 2024 to parliament is an historic step forward in the aged care reform process. The Bill will directly implement 58 recommendations of the royal commission as well as consolidate the many others that have already been enacted by previous reform legislation.

It maintains the vitally important momentum for change.

When the new Aged Care Act becomes operational next July, it will over time inexorably change aged care for the better.

Many more people will get higher levels of support and care at home. There will be greater investment in the sector. We will have tougher standards and stronger regulatory action against poor providers. Standards of governance will rise. And most importantly, people

needing and receiving care will have comprehensive rights that providers will be required to respect.

That said, the Bill is not perfect.

I and my office have repeatedly highlighted two fundamental royal commission recommendations not adopted by government.

These are the creation of a single, seamless, comprehensive program that removes the silo walls between residential, home care and home support, and a universal right to care when need is assessed, so that care is provided on demand.

These were highlighted in our 2024 royal commission progress report, and our submission to and appearance before the Senate committee tasking with reviewing the proposed legislation.

This Bill does neither. Government is not ready to

“If not, then reform will unravel.”

go there, regrettably. There are other concerns as well, not least lack of a plan for the Commonwealth Home Support Program.

Other stakeholders have other issues – some want more, others less, while some want stronger, others weaker. The concerns are somewhat predictable. Some of the proposed changes have merit.

However, as they are pursued before the committee, the Senate itself, and the media, stakeholders should pay heed to the lessons of the Living Longer Living Better Reform of 2013, which nearly did not pass as the sector bickered before the Senate committee.

COTA Australia won that battle, getting key players to publicly back the Bill. But it was a close call.

This Bill needs to pass whether or not government agrees to any improvements, and pass before the Christmas break, and be implemented on 1 July 2025.

If it’s not, then reform will unravel, and it will take years to get it back on track. n

Providers focused on improving the lives of seniors

IN OTOBER WE released our inaugural State of the Sector Report, highlighting the opportunities and challenges facing the aged care sector in Australia, including funding, workforce, reform and the priorities for a better future.

The report is significant because it reflects the views of providers, those with boots on the ground caring for our loved one’s day in, day out.

The number one priority for providers is improving the lives of older Australians and they are achieving strong results, even with the challenges they face.

The demand for aged care is growing, highlighting the urgent need to create a system that delivers high quality care now and into the future, however the report found seven out of 10 providers were concerned about Australia’s readiness to support an ageing population.

continue to lose money and the margins of home care providers are crashing.

When asked about challenges facing the aged

care sector, 92 per cent of providers nominated government funding (under current policy settings before implementation of Aged Care Bill 2024 currently before the parliament) as a concern.

The problems are worse in regional and rural areas or thin markets. Worryingly, 20 per cent of smaller providers were not confident in their ability to provide aged care services in the next 12 months.

This shows just how vital the Australian Government’s response to the Aged Care Taskforce as part of the new aged care bill is, when it comes to making the aged care sector more sustainable

Half of providers (51 per cent) believed aged care reforms were pointing the sector in the right direction. However, the pace of change is worrying providers, with 64 per cent saying transition timeframes were too fast, and 84 per cent believing

new requirements will put a greater strain on the sector.

Providers are also feeling the brunt of worker shortages, with just 36 per cent confident they would be able to recruit enough staff to meet their increased care minutes. Current migration settings aren’t the answer, with 64 per cent unable to access the workers required under current arrangements.

Even under such challenging circumstances, providers are doing a great job to serve their communities.

In a recently released government report on resident experience, 85 per cent of the surveyed residents said they were likely to recommend their aged care home to someone, showing a high level of satisfaction.

That’s the number one priority for providers –improving the lives of older Australians. n

Tom Symondson, chief executive officer of Aged & Community Care Providers Association

Ian Yates, Acting Inspector-General of Aged Care

REQUEST FOR PROPOSAL

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The Aged Care Act – does it go far enough?

BY THE TIME you read this we may have a new Aged Care Act. However, as I write this, we are still at the stage of scrutinising the 550-plus pages of legislation as no doubt, many of you are. We are also preparing to appear before the Senate Inquiry.

The Act responds to the number 1 recommendation from the Royal Commission into Aged Care Quality and Safety.

Having rights is incredibly important to the older people we represent and they want them now. There are concerns regarding whether they will be real and enforceable or just words on a page.

COTA Australia is advocating that all government officials in aged care must comply with the Statements of Rights – not just providers, but also the commission and system governor (Department of Health and Aged Care), assessment services and My Aged Care.

The other areas that older people have focused on include the need for greater clarity and information

(some of which we know will come in the rules), service accessibility, workforce shortages and whether the quality of care will improve as a result.

A particular focus on Support at Home highlights that there is general support for the 8 levels, access to two additional amounts for restorative care and end-oflife (last 13 weeks).

There are concerns that self-management is missing in action. The new pooled 10 per cent care management approach could actively work against this and reduce an individual’s ability to meet their needs.

COTA Australia undertook a small survey, following a joint webinar on the Act with our OPAN colleagues.

We found the majority of those who responded were still supportive of those who could afford to paying more for their care, however, an even higher number were concerned about whether they would still be able to afford the services.

This is in large part due

to the paucity of concrete information available for an individual to be able to work out what they would have to pay. We are all awaiting that information to enable analysis and commentary on the fairness and equity of the new regime.

We have made a range of recommendations to strengthen the regulatory regime, particularly given the removal of criminal penalties as part of the deal between the government and opposition, to ensure there

are deterrents in the system so older people are not at risk of ongoing neglect.

Concerns remain on the accountability and transparency of aged care system governance, services and regulators.

The recently released care minutes data underscore why older people, the community and COTA Australia remain concerned on this front.

After a year with significantly increased funding six out or 10 providers still do not meet the requirements. And not in the areas where you would expect workforce issues to really bite.

We do understand there are issues in some areas and that the model doesn’t work well for some specialised providers, for example, those supporting homeless residents. Care minutes must be met, and action needs to be taken to ensure compliance.

I hope as you prepare for implementing the new Aged Care Act from 1 July 2025 you keep the older person and their rights at the centre of everything you do. n

Research, policy and practice must be aligned

RECENTLY WE marked the 34th United Nations International Day of Older Persons – also known as UNIDOP.

Designated by the United Nations General Assembly in 1990 and observed on 1 October every year, this UNIDOP serves to acknowledge the contributions of older adults across the globe, address the issues affecting the experience of ageing, and highlight the distinct hurdles they encounter.

This year, UNIDOP focused on three clear objectives.

First, to elevate global awareness and comprehension of the Universal Declaration of Human Rights. By strengthening human rights protection and mobilising stakeholders to enhance

protections for older adults across the globe, we may safeguard the rights of current and future generations of older adults.

Second, to promote intergenerational models that enable the exchange of knowledge and experiences among different age groups.

In 2023, AAG’s national conference featured a workshop on intergenerational practice highlighting the many benefits, including breaking down ageism and fostering a sense of solidarity between generations.

Finally, the third objective of this year’s UNIDOP focused on a life course approach to ageing that supports individual and community wellbeing at all ages.

As a social gerontologist, I’m particularly interested in the life course perspective as a framework for understanding life-span development, human agency, historical time and place, timing and linked lives.

Put another way – and paraphrasing from a 2012 paper by Jon Hendricks –to make sense of any given period of a person’s life, we must consider the cumulative

and continuous experiences and contexts in which that life is being lived.

As we’d expect, the objectives of the 2024 UNIDOP align with the four main actions areas of the UN Decade of Healthy Ageing 2021-2030:

• combatting ageism

• age-friendly environments

• integrated care

• and long-term care.

These all require a solid evidence base to inform the implementation of improvements from theory into practice.

Only when research, policy and practice are aligned can we hope to achieve a vision of a world where every person is valued, heard, seen and respected as we age. n

Dr Claudia Meyer, president of the AAG

Patricia Sparrow, chief executive of COTA Australia

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Champion of the (older) people

KATE THWAITES, who in August was the inaugurally appointed Assistant Minister for Ageing, takes her new role very seriously indeed. She speaks with CHRISTOPHER KELLY.

The day before spoke with new Assistant Minister for Ageing Kate Thwaites – the longawaited new Aged Care Act had landed at parliament’s door.

“It’s significant legislation and it will mean that older people can enter aged care feeling secure that the system is sustainable,” Thwaites says.

Under the Act – one of the most meaningful sector reforms in decades and a key recommendation of the Aged Care Taskforce – individuals with means will be required to contribute more to non-care costs, such as everyday living and independent supports in home care and accommodation and hospitality services in residential care.

As well as introducing a new user-pay model to raise additional funding, the Act is very much focused on protecting the human rights of the older person.

“We know from the work that the government has done with the Aged Care Taskforce that older people want to make sure that, when it is time for them to enter aged care, their rights are respected,” says Thwaites – the Labor federal member for the Melbourne electorate of Jagajaga, a seat she has held since 2019.

The Act will also better support older Australians to age at home, a common desire among many of Thwaites’ constituents. “I know from talking to many older Australians that they see aged care as something they hope not to access,” she says. “They would like as much as possible to age in their home – so that’s also part of these reforms.”

Before entering politics, Thwaites was a journo who for six years worked for the national broadcaster ABC. “When I started as a journalist I got to do fantastic work talking about the work governments were doing and holding governments to account.”

But, as Thwaites tells AAA, “I got to the point where I was thinking, ‘What would it be like if I was one of the people who was trying to create the change and move our country forward and make sure that it is a place where everyone is valued and leads the life they want to lead.’”

make sure we are helping older Australians.”

was like ‘Well, these are all things that I think are important, I should get in there and have a go.’”

The newly created role of Assistant Minister for Ageing – Thwaites’ first ministerial appointment – is an opportunity to do just that.

“It’s very exciting,” Thwaites says. “It’s a new role for government that’s recognising the value that older Australians bring to our country.”

You only have to hear Thwaites talk to realise she is taking her new responsibilities seriously.

“I want to make sure that we are helping older Australians … that they feel like they are able to age securely in the way that they want to, so I’m pleased to have this role.”

While Thwaites is aware “how important it is for older Australians that aged care works for them” – she tells AAA that ageing is about much more than that.

Older Australians also want to feel financially secure. “The number one issue that people are facing is cost of living and certainly that is something that I’m very aware of and the government is very aware of,” she says.

“Older Australians have worked hard all their lives, they deserve to know that as they approach the end of their life they are going to be secure and have a good retirement.”

Thwaites adds: “I’m particularly aware that for people on a fixed income – such as the pension or other income support payments – that every dollar counts. We will continue to put a focus on cost-of-living relief and also making sure that older Australians do feel heard within government and within our community more broadly and do feel like they have a champion in me for their concerns.”

During the first few months in her new role Thwaites has been busy meeting with various advocacy organisations such as National Seniors, COTA Australia and the Older Person’s Advocacy Network – “all groups that do wonderful work supporting older Australians”.

Among the topics discussed: ensuring older people are digitally connected to the outside world.

“One of the things that can feel most challenging for them is the fact that so much of life is now lived online. If you haven’t done that for most of your life, there are barriers there,” Thwaites says.

Another topic of conversation: strategies to help older Australian remain in the workplace.

“Maybe doing a bit of work here and there – not just for the economic benefits of it – but also for the connections it gives you. There is a benefit to us all as a community when older people are still working.”

It’s also about enabling older Australians to continue to feel valued and appreciated, Thwaites says. “They still want to be involved, they want to be able to lead independent lives.”

However, all-too-often ageism stands in the way. Thwaites –a working parent with two young children – tells AAA that, as a community, we probably don’t value older people as much as we should.

“We have to get a lot better at recognising that older people have done a really good job at running their own lives, that they do have agency and capability. I see part of this role as me being that champion for older people to make sure that they are getting the prominence and the recognition that they should have.”

There’s that descriptor again: “champion”. Rather than a cheesy aside, you get a real sense that Thwaites means what she says – and means business. “So much as possible I will be supporting older Australians to live the lives they want to lead.” n

Fact file: Kate Thwaites is

n also Assistant Minister for Women and Assistant Minister for Social Security

n a former media adviser for Oxfam Australia

n a former public servant

n a graduate of RMIT University where she gained a degree in journalism

Kate Thwaites chats with constituents

Rehab reaps rewards

The goal is to ensure independence is achieved long-term so older people can remain living at home, occupational therapist ELLY MURPHY tells JODIE WOLF.

Every career comes with its share of challenges, and for occupational therapist Ellie Murphy, one concern is the issue of staffing shortfalls when people leave the public sector in favour of private work.

Murphy works for Victorian public service Monash Health in the homebased rehabilitation team as well as runs her own business, servicing people privately through Home Care Packages and the National Disability Insurance Scheme.

Having worked as a health professional for over a decade she can understand why the public sector workforce is often lean.

“We have an under experienced workforce because once they get to a point where they know enough, they’ll earn more money in private,” Murphy tells Australian Ageing Agenda

“The way of the future is to encourage people to do both. You’ll keep people in roles to be educators for younger staff, but they’ll also have a little taste of private work. There needs to be something in place that aims to retain people who are more experienced.”

Murphy has been with Monash Health for four years in a role she considers vital role for people over 65 who have experienced strokes.

Rehabilitation is her goal, ensuring independence is achieved long-term for her patients.

“It’s about assisting them to remain living at home. Looking at things like modifications to the home equipment, supporting confidence and relearning things, such as how to get in and out of a car or a bed,” says Murphy.

different services” are being provided to 64-year-olds and 66-year-olds.

“It’s okay for those that get on the NDIS before they turn 65 because they can carry that over. But if they become disabled after 65 on the aged care system, then that’s significantly lower than what you get on the NDIS. In contrast, you look at our 65-year-olds nowadays and they’re not even retired,” Murphy says.

“You have to understand many different areas of funding because it depends on what [an individual] client’s needs are and what funding they have, to know what you’re navigating to get that for them.”

Murphy’s journey in health and aged care began at 18 as a personal care attendant while studying nursing. She then transitioned into occupational therapy.

“A lot of them are very determined to be independent so it gives you motivation to help them maintain their lifestyles.”

The complexity of the clients she treats can prove challenging on a daily basis.

Not surprisingly, funding is often a consideration for Murphy and her clients, especially as not all of them are eligible for the NDIS, with little financial help for those who may become disabled after they turn 65.

“A lot of our clients are from very low socioeconomic backgrounds. You have a lot of funding constraints in public hospitals. There’s only so much you can provide as a therapist, so when they come from these backgrounds, that’s where it gets quite hard.”

Murphy hopes to see change arrive in the future, especially when two “completely

“You have to understand many different areas of funding.”

“I’ve been in the health area for 13 years and having fallen into it from a very young age, it’s what I know,” explains Murphy. “I feel a lot of empathy for the elderly and gain a lot from them too in their wisdom they have to share.”

Based out of the Kingston Hospital in Cheltenham, south-east of Melbourne’s central business district, Murphy travels 30 minutes north to work from her home in Frankston.

Each day is varied, says Murphy, who explains that being in a multi-disciplinary team, they have every base covered when it comes to providing care.

“We spend 30 to 40 per cent of our day with a client,” she says. “And 60 per cent of the day dealing with paperwork, red tape, funding applications, allocating and prioritising our waitlist and liaising with other staff members.”

Murphy says she can see longevity in her current career now she is balancing her own business and maintaining the stability that comes with being employed by the hospital.

“Having flexibility of both keeps things interesting and different,” she says.

Despite her career being highly “taxing” and at times “distressing” Elly tells AAA “the good days” keep her going.

“Appreciation from your clients and seeing how the results have impacted their lives are the days I work for,” says Murphy.

“Especially those who may have had big strokes and one of their goals might have been to pick their grandchild up and they end up being able to. Seeing people gain their independence back is highly rewarding.” n

Elly Murphy

Elly Murphy with a client in the community

ADigitally transformed

After two years of using Humanetix ACE Platform, Kurrajong Nursing Home can’t imagine continuing without it.

s the care needs of residents increase and the demands for quality, personalised care and regulatory requirements change and grow, outdated and paperbased care management systems are no longer adequate.

In today’s residential aged care – as recommended by the royal commission – providers need technology and data-driven solutions that help to continuously improve care quality, empower staff, and foster innovation.

For many aged care homes around the country, achieving this revolution in aged care delivery and outcomes will require a digital and cultural transformation.

This was the situation facing Terese Gatt, Director of Nursing at Kurrajong Nursing Home – a standalone residential care facility 75 kilometres north-west of Sydney on the lower slopes of the Blue Mountains.

After working for several organisations and trialling various products, Gatt says she’d never found a system that was “exactly right” to achieve the transformation in care delivery, planning and reporting required. That was until she discovered the Humanetix ACE Platform.

Just over two years ago, Kurrajong Nursing Home moved from a paper-based clinical management system to ACE, resulting in improved outcomes for residents and compliance, says Gatt.

“We implemented ACE in 2022 and then we had an audit shortly after, and we passed all standards. ACE definitely helped us with becoming compliant with the commission 100 per cent,” Gatt tells Australian Ageing Agenda

Kurrajong Nursing Home has been using the ACE pointof-care platform throughout the organisation and has seen many benefits including streamlined workflows and reporting, resulting in increased efficiencies and improved documentation.

“Before using ACE, our staff would provide all of the care that they needed to do for their shift, and then sit down and write their notes. With ACE, they can pop it on their iPad and put it on the trolley that they wheel around so they’re able to write their notes contemporaneously, so their record keeping is more accurate now too.”

has been extracting data to write performance improvement plans.”

According to Gatt, the aged care home couldn’t be without the platform now, as it has reduced many burdens including cutting time spent on paperwork from two weeks to just 20 minutes.

Among the benefits for staff, says Gatt, is they can update care plans and assessments in one place and no longer have to use multiple systems.

“It just makes life easier, and you can spend more time on the floor caring for residents than you do sitting in the office doing your paperwork,” she says.

These time-saving benefits are among the trends seen by Sofia Zainal, Head of Product at Humanetix.

“Looking into our records, we’ve started seeing staff spending more time with the residents, as opposed to doing business on computers,” says Zainal – who along with

With ACE, Kurrajong Nursing Home staff can view and update care plans and assessments wherever they are

Director of Nursing Terese Gatt says ACE has helped transform care delivery, planning and reporting

Gatt was instrumental in leading the digital transformation at Kurrajong Nursing Home.

With increasing care needs from residents who are coming into residential aged care later, it offers a much-welcomed benefit, says Zainal. She envisages all aged care homes implementing technology such as ACE due to the impressive benefits it can offer the workforce.

And despite some workers initially feeling hesitant to leave paper processes behind, Zainal says advanced technology will be the only way to keep up with the increase in demands when it comes to clinical care and the systems needed to manage it.

“One of the exciting things for us is that the system can be integrated with other systems out there,” Zainal tells AAA.

“As an example, Kurrajong Nursing Home is using a medication system that’s already integrated with the ACE Platform. That means the data collection and looking at the reports of what has been conducted for an individual at a care and medication level is a lot easier.”

technology is “a change-maker” for the aged care sector.

“We want to try and empower people to deliver better care for residents,” Shih tells AAA

From Gatt’s perspective, the data insights available via ACE have been central to benefits from the implementation at Kurrajong Nursing Home including with resident outcomes.

“The most significant improvement for myself as director of nursing is being able to extract data from ACE to write performance improvement plans and see how the home tracking on quality indicators, for example,” she says.

“I’m so passionate about this system because it is just so good. I have been in the position where it is so hard to get the data you need and for the director of nursing and care managers like me, this system is going to save time. You can then spend your time more wisely doing things that are going to improve your residents’ lives.”

Gatt has also found that since implementing ACE, the home has been able to use the real-time data it gathers to identify issues and respond accordingly. Of note, the home reduced the number of falls among residents through simple roster adjustments.

“We focused on falls and then we were able to see from that data that we had a large number of falls of a morning around 6.30. In response we moved our handover time so there would be more staff on the floor,” Gatt tells AAA

“We implemented more staff starting a little bit earlier when these residents seem to be getting up and moving around and our falls dropped significantly. It’s greatly improved our care for our residents because we can see from the data what they need.”

“You can spend more time on the floor caring for residents.”

“The reason I’m at Humanetix is because my grandfather had a terrible experience in aged care and was treated as a bunch of tasks and things to be done, as opposed to being seen as a human,” says Shih.

“The trick for us is doing it in a way that gets nurses, clinicians and care workers excited to use the system. We have a hypothesis that rather than not liking to use technology, staff don’t like using medical management systems that aren’t user friendly. Our gamification element to the software is about getting people excited about giving them an incentive to use the system.”

Shih is referring to a new gamification feature being developed for ACE that rewards staff for using the system. It involves assigning points to activities in staff members’ workloads that are considered important. The points are added up at the at the end of the year and turned into prizes.

Gatt – whose team has been involved in the design and development of rewards – says nurses and care staff on the floor are seldom rewarded for doing a good job.

“You get in trouble if you don’t do it right but there’s nothing to say ‘thank you’ for getting your records in on time and completing your care schedule. By adding gamification – which will lead to a reward – is exciting and empowering for staff to think about and gives them an incentive to get their work finished.”

There is still more to come from the Humanetix ACE Platform, says Zainal – who expects the system’s capabilities and features will continue to grow and evolve in line with the sector’s needs. On the current agenda is the integration of sensors.

“We’re looking into how we can pull the data from the fall sensor directly, and then we’ll know the exact date and time of a fall, for example, because it comes from the sensor itself,” says Zainal.

“It then becomes more about how we make sure that when there is an incident, it can be reported accurately, more efficiently, and ultimately help the team deliver better care. It’s all very, very exciting.” n

Shedding superherothe perception Executive

Behind the mask, great leaders are only human, writes DR EDWIN TREVOR-ROBERTS

Iremember how proud Henrietta was of a present that one of her staff gave her.

Henrietta was a facility manager in a mediumsized aged care company and one of her team had given her a very large white mug that had two words written on it in bold red capital letters: BOSS LADY.

She was chuffed by this present and it sat pride in place on her desk so that when you walked into her office it was the first thing that you saw. Henrietta was completely unaware of the impact the words BOSS LADY had on those who came into her office.

More critically, Henrietta was unaware of how those two little words changed how she perceived herself as a leader, and how it affected her behaviours.

Henrietta is not an isolated case. The vast majority of leaders are unaware of the unconscious schemas that guide their attitude towards leadership and their subsequent actions. This is a major issue because – when we aren’t aware of the basis from which we operate – then we tend to react to things and not display our best leadership behaviours.

And in today’s world, people expect so much from their leaders – they expect their leaders to be superheroes. Yet the reality is leaders are simply human beings having a leadership experience.

Which begs the question: how do people experience you as a leader?

Dr

We experience leadership like we experience all things in life: a deeply embodied one. We take in information through our five senses – primarily sight and hearing. This information then immediately generates an emotional response.

Take, for example, the clinical manager who jumps from solving one crisis to the next – always busy, always running. When asked why they don’t focus on the strategic priorities that would minimise the crises, their response is that they simply don’t have the time.

Leaders who operate from this space – what I call the embodied world – are reactive and, while they certainly get problems solved, people experience them as distant, stressed and lacking empathy.

An additional problem is that brain science tells us that when we regularly react from a place of crisis our behaviours become habits. After the last few years, we have become really, really good at responding to crises.

A key leadership capacity, then, is to retain a state of equanimity by managing one’s own emotions. As a leader, every interaction with another person is an alchemic moment, because how you respond will either damage the relationship or strengthen it.

We need to continuously manage our emotions in every single interaction throughout the day so that we can respond positively every time. When we do, we create a psychologically safe workplace.

Edwin Trevor-Roberts

Yet how difficult is this in reality?

Emotions are like beach balls. If you try and hold a beach ball underwater, as soon as you let go it explodes upwards out of the water. Same as our emotions. Investing time to learn techniques to process our emotions is invaluable.

Leaders who are able to consciously manage their emotional responses to events operate from the interpreted world which is where we utilise our pre-frontal cortex to think through what is happening and respond in a considered manner.

Using discernment to think through a response is what separates humans from other species. Once we think clearly, then we tap into our full capacity of curiosity, strategic thinking and innovation.

The 9th century Indian Prince Monk Shantideva says: “If, with mindfulness’ rope, the elephant of mind is tethered all around, our fears will come to nothing, every virtue drops into our hands”.

It is possible to think clearly at all times, but our mind requires training to remain aware of what is happening at this very moment. So much of our time is lost ruminating on the past or solving future problems that don’t exist yet.

When we are fully present in the moment, people experience empathy and validation. In this space, our true humanity arises and we operate from our inner world of beliefs, convictions, values and identity.

Great leaders know what they stand for and what is important, and this drives their thoughts and behaviours. When we regularly reflect on what it is to be a leader then we are able to have the greatest impact on others. Yet we spend so little time reflecting upon how we want to show

“As a leader, every interaction with another person is an alchemic moment.”

up as a leader or how our experiences are shaping how we think about ourselves as a leader.

I recall a regional manager we worked with who used to be a director of nursing and an expert in dementia. People would come to her all the time to seek her advice. So when she was promoted to regional manager, she continued to think that leadership was having all the answers and sharing her knowledge. People experienced her as always talking, always having an opinion, and not listening.

It was only when she reframed what it was to be a leader that things changed. We helped her to reevaluate her perspective on knowledge: that leaders are catalysts for others to discover the knowledge themselves rather than her original belief that she had to be the font of all knowledge.

Perhaps we can also learn from Pythagoras who suggested that we reflect on these three questions at the end of each day: What have I failed? What have I accomplished? And what have I neglected?

Great leaders spend time investing in their inner capacity so that their thoughts, behaviours and reactions to the inevitable challenges of life are aligned to their self-belief in what it is to be a great leader.

Leadership matters. While people may think they want a superhero as a leader, what they truly want is to work with a good human being. n Dr Edwin Trevor-Roberts is a leadership and career expert and chief executive officer of Trevor-Roberts, a national business specialising in leadership development career transition

Relentless pressure of change

Ongoing reform also brings opportunities, says OneCare chief executive officer PETER WILLIAMS.

Can you tell us about your professional background? I began my healthcare journey as a registered nurse, qualifying with a degree in health science in 1993. While completing my degree, I worked in aged care, which shaped my passion for the sector. Over the years, I’ve also worked across the acute and community, enhancing my expertise and leadership skills. My continuous desire to learn led me to pursue several postgraduate qualifications, including a Master of Business and a Master of Education. In 2022, I was awarded the Meg Gilmartin Churchill Fellowship, which enabled me to conduct international research on global aged care models and their transferability to the Tasmanian aged care sector.

As CEO, what would you most like to achieve in the year ahead?

Drawing from my Churchill Fellowship research, my key goal is to make functional reablement a core service in aged care. More aged care providers are beginning to prioritise innovation in improving consumer function, particularly strength and balance, enabling older adults to live more independently. At OneCare, we’ve already seen consumers greatly enhance their independence through allied health services like physiotherapy, exercise and better nutrition. I aim to expand these innovations, ensuring functional reablement becomes a standard of care across the sector.

Which reforms do you consider the most important?

The Aged Care Taskforce recommendations are critical to the sector’s future. It is evident we need comprehensive reform to ensure older Australians receive quality care. I believe that political leaders from all sides must commit to the full implementation of these recommendations as part of the new Aged Care Act. Additionally, increased funding is vital for the sustainability of residential, home and community care services, and for the sector’s ability to freely innovate to be future ready. While consumer co-contributions can be a fair solution for those who can afford it, a strong safety net must be maintained for those who cannot.

How are you dealing with the pace of the reforms?

The rapid pace of reform within the aged care industry is unprecedented. As a leader, I often feel the relentless pressure of change, but I also recognise the opportunities that come with it. It’s essential to stay grounded in how we respond to these changes. At OneCare, we emphasise the importance of self-care and mental health for staff. It is important to take care of ourselves so we can continue to care for others and to purposefully make time to reflect and think.

What’s needed to improve the rollout and success of the reforms?

To ensure the success of aged care reforms, it is essential they are person-centred, sustainable and balanced. First, we must prioritise empowering older Australians, giving them greater choice and control over their care, with a focus on enabling them to live

safely at home for as long as they desire. Secondly, the system must be sustainable, with stable, innovative providers who can meet future demands. Thirdly, the cost structure of aged care must be more transparent and equitable, allowing consumers to clearly understand their financial responsibilities. Lastly, the recruitment and retention of qualified staff, especially in regional areas, remains a significant challenge. Without addressing workforce shortages, the success of these reforms will be difficult to achieve.

What strategies are you using to enhance the skills of your workforce?

At OneCare, we recognise the value of our diverse workforce and actively seek to empower our staff to lead confidently. We offer scholarship funding for continued education. Additionally, we invest in ongoing staff training and leadership development. By enhancing skills and providing more frontline roles, we are ensuring that our team remains equipped to meet the needs of our current and future consumers.

What do you do to ensure the wellbeing of yourself and leadership team?

The wellbeing of myself and our leadership team is a priority at OneCare. We invest in an annual leadership retreat, where we take time to reconnect with the company’s vision and priorities. I strongly encourage leaders to disconnect from the constant demands of the workplace. Spending quality time with family, engaging in social events, and being part of our community are all essential for maintaining balance. Our organisation continues to invest in initiatives that support wellbeing such as our wellbeing magazine, employee appreciation days and community engagement and support programs.

What advice do you have for new and emerging leaders?

Authenticity and humanity should be at the core of leadership. Despite the challenges and busy-ness of our sector, it is essential to always find time to truly engage with staff and consumers. Be present onsite whenever possible. Honest, face-to-face conversations about challenges help build trust, and empowering others to succeed is key to effective leadership. New leaders should celebrate their team’s achievements, lean into the expertise around them, and showcase the talent they have. Use your position of influence for good, and always be grateful for it. Remember to be the leader you needed when you were younger – someone authentic, not perfect, but always real. n

Peter Williams

Contact: www.throne.com.au or 02 6280 6851

3-in-1 Rail

Splayed

Fold-Down

The functions of the ‘Standard’, ‘Splayed’ and ‘Fold Down’ rails have been incorporated into the ‘3-in-1’, making it the most convenient toilet support system on the market.

The benefits of the Throne Accessories ‘3-in-1’ Rail System include:

This rail replaces the previous three models

Simplified ordering... etc

The new Throne Accessories ‘3-in-1’ Rail System will be of great advantage for:

Equipment loan departments in hospitals, schools, respite care and hospice facilities

Nursing homes and retirement villages

Hotels, motels, hostels, residential and other accommodation outlets

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THRONE SPACER

THE ULTIMATE AND MOST VERSATILE TOILET SEAT RAISER

The Throne Spacer has been developed to add height without changing the appearance of a standard toilet and toilet seat, and offers comfort and safety.

Two sizes! 50mm & 80mm heights

The best option OT’s could hope for!

Use with or without Throne Rails

The Throne Spacer fits under the toilet seat

Unobtrusively integrates with the bathroom decor

Raises the height of toilet seats and electronic bidets Easily installed and conveniently transportable

Spacers and rails are available from reputable healthcare suppliers

BARIATRIC TOILET SUPPORT RAIL

This particular Bariatric Rail model meets the needs of the larger built person. The handgrips are supported by adjustable legs that are firmly positioned to the side of the toilet by rubber-capped feet to prevent tripping. The Bariatric model comes in polished stainless steel.

‘Yes means yes’

As delegates

at the

International Dementia Conference heard, the diagnosis of a cognitive impairment does not mean someone lacks capacity to consent to sex. CHRISTOPHER KELLY reports.

“We all do it. Why does it suddenly stop when we end up in residential care?” The “it” is sex; the speaker Gwenda Darling. “Just because I have a dementia diagnosis doesn’t mean that I’m not a sexual being,” she tells delegates attending the International Dementia Conference in Sydney in September.

Darling – a long-time advocate for people living with dementia – was one of four participants in a panel discussion about sex, consent, and cognitive impairment.

When it comes to consent – living with dementia or not – “No means no, but yes means yes,” says Darling.

Darling tells delegates that, since her diagnosis in 2012, her sex drive has fluctuated. “When I was first diagnosed in the early days I became hypersexual, then I became pansexual – I would have slept with anything. Now I’ve become asexual.”

Whatever her sexual appetite, Darling says: “It’s not up to aged care workers to decide who I sleep with and when I sleep with them.”

It’s a thorny issue.

“I do understand the struggle aged care providers have,” says Ashley Roberts – a consultant at The Dementia Centre. “They are trying to protect the resident from harm, I get the idea of erring on the side of caution.”

“To deprive someone of their decisionmaking capacity is a really significant outcome.”

Ashley Roberts

Dr Nathalie Huitema

That said, Roberts tells delegates when aged care residents show one another affection people often rush to the wrong conclusion.

“We jump straight to intercourse when we’re talking about sexuality,” he says. “It’s important to know what we are looking at – what is the interaction, what is actually going on? We need to get a lot better at describing what we are seeing. We need context and we need to know intent.”

Dr Nathalie Huitema – a sexologist and psychologist who specialises in aged care – says providers should offer workforce training.

“Training and increased knowledge has a positive effect on the attitudes that people have towards sexuality. It’s very important to normalise sex.”

Providers need to support staff with clear guidelines, adds Huitema. “It’s important for care facilities to be proactive rather than reactive; I don’t think that is supportive of staff or supportive of residents.”

Steering back to consent, Olga Pandos – a lecturer in law at the University of Adelaide – tells delegates every individual is presumed to have full decision-making capacity.

“The diagnosis of a cognitive impairment does not mean that someone lacks capacity,” she says.

“And where there are incidences where we might question whether or not that person has impaired decision-making capacity, that does not mean they lack capacity to make any decision. It is decision specific. They might be able to make decisions about certain topics but perhaps not others.”

Darling agrees. “People living with dementia often say ‘yes’ or ‘no’ – but just because that’s what they say this hour, doesn’t mean it’s going to be the same in the next hour. If I give consent now it doesn’t mean in an hour’s time or two hours’ time I consent.”

it should be undertaken by someone who has the expertise to do so, says Pandos. “To deprive someone of their decisionmaking capacity is a really significant outcome.”

right to make decisions that people do not necessarily agree with,” she says.

People can act on impulse and act in the moment, adds Huitema. “I think we hold older adults to a higher standard than we do ourselves.”

Discussing the Serious Incident Reporting Scheme – which was established in 2021 to, in part, reduce sexual assaults in residential care – Pandos questions whose interests SIRS is trying to protect.

“Is it the resident, the worker, [or] the reputation of the aged care facility?”

There is, says Pandos, an inclination by providers to over-report. “Are we talking of mere acts of intimacy? Sexual act does not mean sexual intercourse. We are seeing a lot of defensive practice in our current scheme.”

Defensive practices that can infringe upon a resident’s human rights, she says, “basic sexual rights that ought to be protected and upheld”.

And talked about openly, says Huitema. She asks delegates to work with older adults on an individual level. “It’s important to view things from a resident’s viewpoint.” Understanding their sexual desires “and how we can support them in their wants and needs”.

When it’s suggested that people of a certain generation could be uncomfortable talking about sex, Huitema dismisses the notion.

“My experience is that older adults speak about it very freely. They tell me things that I think are too much information – I don’t need to know every detail.”

She adds: “They are very comfortable talking about it because nobody ever asks them about it.”

Roberts says providers need to prepare for the baby boomers who grew up in the era of free love.

“They’re going to be placing the expression of sexuality a little

Olga Pandos (left) and Gwenda Darling

Sex on the brain: Journalist Leigh Sales (left) led a spirited discussion with the expert panel on sex, consent and cognitive impairment

Fostering a culture of continuous improvement

It is essential to maintain open communication with all stakeholders, says DARREN WHALEN – head of procurement at Calvary Health Care.

How many facilities, services, residents, clients, and staff are within your procurement remit?

My procurement remit includes Calvary’s facilities across multiple states and territories. These include:

• 60 residential aged care homes accommodating more than 4,800 residents

• 514 units across 17 retirement villages, accommodating almost 500 residents

• 13 hospitals, three public and 10 private

• more than 100 types of home care services to 18,500 clients

• about 18,000 employees, plus volunteers.

What are the main goods and services you procure?

Our procurement needs vary across our facilities due to the diversified services we offer and the care we provide to residents, clients and patients depending on their individual needs.

Darren Whalen

“We are always looking at ways to be more efficient with our procurement technology.”

We procure a wide range of goods and services including surgical and medical supplies, pharmaceuticals, food and catering services, IT equipment and software and telecommunications. We also procure linen and laundry services, uniforms, records management, travel, waste management, agency staff, talent recruitment, learning and development, fleet management, facility management services, cleaning services, stationary and print items and utilities.

What procurement channels and management technology do you use?

We use a blend of centralised and decentralised procurement channels, supported by procurement management technology.

Our technology stack includes procure-to-pay platforms and contract management systems. We are currently implementing an enterprise resource planning business management software and other sourcing modules.

We are always looking at ways to be more efficient with our procurement technology, and ultimately we want systems that provide the business transparency and compliance across our procurement processes.

What roles do environmental, social, and corporate governance (ESG) and care recipients play in your organisation’s procurement process?

Calvary is committed to working with suppliers that align with our ESG values. This includes suppliers that can display examples of sustainable sourcing, ethical labour practices, and community engagement.

We acknowledge the potential impact our activities have on the environment and are committed to ensuring the continual improvement of environmental management as an integral

component in the delivery of our health, aged and community services.

Through the implementation and localisation of our Reconciliation Action Plan, we are developing procurement policies that support the participation of First Nations people in the Calvary workforce and support improving economic outcomes for First Nations suppliers.

Calvary is also committed to upholding human rights, not only with respect to its own employees but also for workers in its supply chain.

Where and how do you achieve cost and other efficiencies?

We have developed strategic sourcing approaches and leverage long-term supplier relationships. We also focus on process efficiencies by continuously improving our procurement workflows, adopting automation, and ensuring value for money.

Where are your supply chain bottlenecks and how do you navigate them?

Global shipping delays, regulatory compliance, and supplier capacity constraints are where we identify most supply chain bottlenecks. It is crucial that we maintain our diverse supplier base, build strong relationships with key suppliers, and implement contingency plans when required – such as alternative sourcing strategies and inventory buffers.

What other procurement challenges is your organisation facing and how are you addressing them?

As a healthcare provider, Calvary’s challenges are not unique. Everyone across the health and ageing sector is having to respond to the impacts of inflation, navigating complex regulatory environments, and ensuring supply chain resilience. Our procurement team, and other partners across our business, closely monitor market trends, engage in proactive contract negotiations, and invest in supplier development programs to continually build a more robust and responsive supply chain to suit our needs.

What advice do you have for your counterparts?

We all need to embrace digital transformation in procurement, prioritise ESG considerations when selecting a supplier, build resilient supply chains through diversification and above all, maintain open communication with all stakeholders. Through these efforts procurement teams can foster a culture of continuous improvement that benefits the organisation, and ultimately the residents, clients and patients we serve. n

Future of home care

Sensor technology will assist older people to age in place, reports CHRISTOPHER KELLY.

With most older Australians preferring to stay at home rather than enter a residential aged care facility, medical technology is increasingly being developed to enable people to age in place.

Established in 2016 with funding from the New South Wales Government, the NSW Smart Sensing Network is a not-for-profit innovation network that brings together universities, industry and government to gather and translate worldclass research into smart-sensing solutions.

In that regard, the NSSN developed the Healthy at Home initiative to investigate how sensor technology can support people to stay at home for as long as possible.

The idea behind the project is to create a techdriven model of care – a model that is significantly less expensive than aged care or hospital care.

Catherine Oates Smith

“People want to stay in their homes.”

“The aged care royal commission found that people want to stay in their homes, they don’t want to go to an aged care facility,” NSSN MedTech theme leader Catherine Oates Smith tells Ageing Agenda. “So the purpose of the Healthy at Home initiative is to help people stay healthy at home and out of hospitals and out of nursing homes.”

Joining the NSSN in October 2022, Oates Smith is responsible for engagement with university, government and industry stakeholders in medical technology.

As she explains to AAA, the sensor technology is being used to collect data. “And that data is communicated either to the person themselves, their carer, a GP or a telehealth service. The idea is that people are able to get the care that they need at home – both from a preventative and from an emergency perspective.”

The sensors – either embedded in wearables or situated around the home – record all manner of information.

“Some of the data is biometric information – about heart rate and breathing and other things that help tell a doctor

or a nurse how that person is travelling,” Oates Smith says.

The information received can even anticipate an unexpected event. “For example, there are sensors that can predict if someone will soon have a fall. This information can trigger urgent, preventative alerts.”

Diving deeper into the tech’s capabilities, Oates Smith tells AAA that in hospitals there’s a measurement called “between the flags”.

“It’s a set of parameters that tells the nursing and the medical staff that we are safe in a certain biometric parameter,” she says. “If we fall outside of the flags, then we are in the danger zone and an alert goes off and someone in the hospital attends to our needs.”

However, as yet, no such biometric measures exist for care in the home. With the help of sensor technology, Oates Smith and the team are working to remedy that.

The benefits for older people are clear, she says. “It will give them better agency over their own health. It means that they can stay more in control of where they live and how they communicate with carers.”

Oates Smith tells AAA the Healthy at Home consortium is also working alongside three local health districts “because we recognise that the need for care at home arises when people go to hospital and realise that when they come home they need some help.”

The idea, says Oates Smith, is to make sure that the transition between hospital and home “is a smooth one”.

Aged care providers are also involved in the Healthy at Home program – “we are in regular communication,” says Oates Smith – and are showing a keen interest in sensor technology.

As well as partnering with providers and LHDs, the Healthy at Home group is collaborating with older people themselves.

Oates Smith tells AAA the consortium is committed to older

people participating in the development of the Healthy at Home program.

With that aim in mind, NSSN conducted a 1,000-person survey to gauge the acceptability of sensor technology in the home – the results of which will be announced at an event at Parliament House in Canberra in November.

Consisting of one-on-one interviews, the initial findings of the survey were very positive, Oates Smith says. “Once people understand that the technology can help them stay at home longer, can help them communicate with their carers, can help them avoid going to hospital, can help them avoid going to a nursing home, then they’re very happy with it – but they need to understand it. And part of this exercise is helping them to understand that technology is there to help them achieve their aims and their goals.”

The Healthy at Home program is, says Oates Smith, a process of human-centred co-design. “It’s about making sure that we don’t do anything that imposes technology or does anything ageing citizens feel unhappy about. We’re very focused on making sure that the people who are going to be using the technology are happy with the technology.”

As the Australian Government’s reforms of the home care sector indicate, the intention is to enable older people to age in place and have autonomy over their own health.

To accommodate this shift, Oates Smith tells AAA the government needs to support homebased care solutions, such as sensor technology.

After all, she says, “it’s the future of home care, people having increased agency over the choices about where they want to live and achieving their aim – which is to stay at home.” n

The apps driving tech-driven care Among the industry partners collaborating with NSSN and the Healthy at Home project are the developers of My Medic Watch. Funded by the NSW Government, My Medic Watch is a series of smart detection apps that – though a smart watch device – can monitor people with chronic illnesses or seniors who experience falls or seizures.

“If a person experiences a fall it sends an alert to their nominated caregiver and all of their events are recorded into a portal,” explains My Medic Watch cofounder and advisor Helene Blanchard.

“With the Healthy at Home project, we are trying to propose a model of care. Our contribution in that model of care is constant monitoring inside the house or an aged care facility.”

The apps – which have been clinically validated – record an individual’s movements. “If we notice a change in the activity in the individual maybe they need to address that,” Blanchard tells AAA.

For example, the data may indicate that the individual needs an appointment with a physiotherapist. “The sensors and the technology help people to stay healthy as long as possible,” says Blanchard.

An Australian company, My Medic Watch is “slowly being adopted in different countries”, says Blanchard.

She tells AAA the aim is “to have an amalgamation of different sensors and technology that could help keep people remain healthier for longer”.

As Blanchard acknowledges, Australia’s population is ageing and there is not enough aged care infrastructure to accommodate everybody. “So this is a good way to help people stay at home.”

Helene Blanchard

Lessons from implementing enhanced sensory care

DR SARA KARACSONY

shares learnings from an aged care project found to improve quality of life for residents with dementia at end of life.

Residents living with advanced dementia have unmet needs related to quality of life and palliative care. A collaboration between the University of Tasmania and aged care provider Southern Cross Care Tasmania sought to address this issue and transform care for this group of residents.

We did this through implementing the Namaste Care program with the support of a translational research grant from Aged Care Research Industry Innovation Australia focused on enhancing quality of life for residents.

What is Namaste Care?

Namaste Care – to honour the spirit within – is a structured, person-centred program that promotes comfort and pleasure through multisensory activities, such as gentle massage. It includes staff, volunteers and family carers.

The group program takes place in an environment as free from distractions as possible. It offers activities of daily living using a slow, unhurried loving touch approach.

Namaste carers prepare the room in advance with attention paid to creating a calm, relaxing and welcoming environment. Gentle, relaxing sounds or music create an atmosphere rather than provide entertainment. Natural aromas or aromatherapy diffusers create pleasing smells while visual images including photos or pictures are used for reminiscence.

Kitchen staff prepare nutritious tasty snacks and beverages for residents to help stimulate appetite and increase food intake and hydration.

The program includes important palliative care elements, such as assessment of pain and promotion of comfort that address quality of life until the end of life.

International studies show the effectiveness of this low-cost and easily set up program.

Outcomes for residents include improved verbal and non-verbal interactions, appetite and weight gain and improved pain assessment and management with a reduction in agitated behaviours and antipsychotic medication use.

The increased interpersonal human contact improves interactions with staff and makes visits with family and care partners more rewarding.

Our four-stage project introduced Namaste

“Gentle, relaxing sounds or music create an atmosphere rather than provide entertainment.”

Care into the daily workflow of two SCCTas facilities. We provided education and training to staff, family and volunteers. We also planned the daily rollout of the program with staff at the services involved, collected various data and evaluated the program over six months.

Our evaluation found similar benefits to quality of life for residents and staff, consistent with previous research. We are preparing these findings for peer-reviewed publication.

Along with the positive impacts of the program, we identified challenges that other organisations wanting to implement this program should consider.

Project learnings for wider industry rollout Leadership for a supportive and collaborative team environment

There was an unexpected change in the leadership team of the aged care organisation during the project. This resulted in a transition to a new interim executive team.

Understandably, these changes led to shifting in priorities for the organisation. However, the facility managers played a central role in supporting the project assisted by leisure and lifestyle, pastoral care and other care team members.

Dr Sara Karacsony

Namaste Care at Fairway Rise, Tasmania

We found that while middle level managers are busy with ensuring quality and safety on the frontline and attending to core business, they needed to delegate key staff to coordinate, communicate, timetable and roster the program to ensure it ran smoothly.

A whole-of-team approach is required to promote program sustainability so that it becomes part of usual care and can withstand the known operational pressures of staffing, outbreaks of Covid-19 and RSV, and regulatory visits.

At one of the services, the team included clinical and care staff, pastoral care, and leisure and lifestyle staff. As the project progressed, other staff members also supported the program as demonstrated in this comment from a participant:

“Funnily enough, even the maintenance man was involved in how we were doing things … he knew it’s because the staff don’t have the time to come and clear the room and bring the residents and reset it up. And the last person who said to me today, “Can I join the meeting?” is the rostering gentleman.”

Preparedness for change and innovation

There was a strong incentive to remodel to a more holistic palliative care approach and staff were keen to engage with the challenges of change and re-organising daily routines.

Initial readiness for implementation was based on a range of enablers, including perception of adequate resourcing, access to knowledge and information and planning.

After preliminary work to ensure executive and management support, the establishment of a group of champions who believed the program was worth running was vital to its rollout. One of those champions said afterwards:

“We get so excited by the positive reactions that we experience and we often talk about it between us ... there’s a lot of celebration to be had for Namaste, the program itself and I think it’s a new culture ... it’s something that needs to be launched and on a wider scale. Once it is, it will definitely be very much celebrated in the broader community.”

A facility manager commented:

“We knew there was going to be a need for it; a program of this nature... For those residents with physical capacity, great, and for those that don’t, then this is the alternative for them. And, this program, the Namaste Care program, is actually where I see a lot of residents fit in.”

Ongoing commitment and flexibility with education and training

There is insufficient education and training on unmet needs of people with dementia within existing mandatory training. We found that after having engaged with the Namaste Care program, staff members had greater understanding and empathy towards residents, and recognised the opportunities for improvement. One participant said:

“Sometimes what they need more than anything is that comfort and care. I feel that the Namaste program has helped me to really learn more about dementia just by observation and the reactions to different things has helped me to look closer at the disease itself and how debilitating it is.”

Ongoing and flexible training is needed for new staff at all levels to help embed this quality care program as a model of care that provides

a more holistic palliative care approach within aged care homes.

We also found a lack of confidence among staff to talk about end-of-life care. In particular, staff found it difficult to articulate the program to family members as benefitting residents approaching end of life. One worker said:

“I’ve stayed away from end-of-life care. I’ve just said that it’s a program where we can give more one-on-one care to your loved one … I’ve never mentioned to them that it’s end of life”.

Ensuring quality of life for all residents as well as care of people approaching end of life is a high priority for aged care homes and Namaste Care is a way to enhance care with a palliative approach for those who need it. This requires suitably qualified, competent and well-motivated staff who have benefitted from education to provide this.

Working with volunteers and family carers as a community of care

“Staff were keen to engage with the challenges of change and reorganising daily routines.”

Volunteers are valuable social supports who contribute to residents’ improved quality of life. Initially, the project was designed to include volunteers and family carers within a community of care approach but the facilities struggled with volunteer support.

For example, one of the services had no volunteers to call upon for their 100-plus residents.

Securing volunteers in this sector has always been a challenge even before many left during Covid-19. Addressing this gap in volunteers would help support the daily running of the program.

As well, family carers can easily participate and learn ways to engage their family member in mutually enjoyable activities.

While there is growing evidence supporting Namaste Care as a low-cost, easy-to-teach and rewarding program for all concerned, overcoming organisational challenges requires skills in change management and program implementation.

As a quality improvement program without the additional hurdles that a research project needs to navigate, there are clear benefits for residents, staff and community that add value to fundamental care. n

Dr Sara Karacsony is a senior lecturer and graduate research and adjunct coordinator at the University of Tasmania

Other UTAS researchers involved in the ARIIAfunded project include Associate Professor Sharon Andrews, Dr Melissa Abela and Dr Maryam Rouhi If you are interested in implementing Namaste Care at your organisation, email sara.karacsony@utas.edu.au or view the Namaste Care International network at namastecareinternational.co.uk

A bundle of support

A project underway aims to strengthen the capacity of the aged care workforce to identify, prevent and manage indwelling urinary catheter issues, writes DR JOAN OSTASZKIEWICZ.

Government statistics show that in 2022-23, a little over 20,000 aged care residents (8 per cent) needed support for a catheter of some type – most likely a long-term indwelling urinary catheter, or IDC.

Although IDCs are potentially beneficial, many people experience complications such as infection, particularly if the IDC is used long-term.

A recent survey of aged care homes conducted by the National Ageing Research Institute for the Victorian Department of Health found the frequency of IDC-related complications in aged care homes was high.

The 28 managers reported residents with an IDC experienced the following problems on average once or twice a month:

• catheter leakage (39 per cent)

• catheter-related infection (29 per cent)

• catheter blockage (21 per cent)

• haematuria (18 per cent)

• admission to an emergency department for an IDC-related complication (7 per cent)

• unplanned/traumatic catheter removal (4 per cent)

• IDC-associated pain (4 per cent).

Delays in responding to these complications, particularly infection and blockage can have devastating effects on a person, increasing their risk of bacteraemia, sepsis, damage to the upper urinary tract and premature death. Because of these risks, guidelines recommend removing IDCs as soon as possible after insertion or managing long-term neurologic bladder dysfunction with intermittent catheterisation.

However, these options are not always appropriate or feasible. Indeed, for some people, having an IDC is the only way to manage their bladder condition.

Research conducted by NARI found almost all guidelines about IDCs fall short of providing support. This is because they focus on shortterm management and hence, offer inadequate guidance about the prevention and management of complications associated with long-term IDCs.

Moreover, the consultation NARI conducted with managers, aged care employees and residential-in-reach clinical staff points to a need to better support Australia’s aged care workforce to deliver evidence-based person-centred care for residents with IDCs.

If we were able to better support the aged

“Almost all guidelines about IDCs fall short of providing support.”

Dr

centred resources about the emotional and clinical aspects of IDCs, we may be able to improve the identification and management of IDC-related problems. This could in turn reduce avoidable transfers to hospitals and emergency departments, which would be a win-win for both providers and

The IDC-IMPROVE Project, led by NARI, is a nurse-led interdisciplinary research collaboration funded by the Medical Research Future Fund under the 2022 Clinician Researchers Initiative. It represents a partnership between NARI, the Continence Foundation of Australia, the University of Melbourne, the University of South Australia, Central Queensland University, Flinders University, the University of Alberta, Darling Downs Hospital and Health Service,

Joan Ostaszkiewicz

the Australian Prostate Centre, Austin Health, Regis Aged Care, the Australian Nursing and Midwifery Federation, the Continence Nurses Society Australia and the Australian and New Zealand Urological Nurses Society.

It is guided by a project advisory group of key stakeholders including aged care residents with IDCs, family carers of residents with IDCs, and aged care employees.

The aim of the project is to strengthen the capacity of the aged care workforce to identify, prevent and manage IDCrelated problems. For nurses, this includes how to perform an uncomplicated routine catheter change onsite.

The project has two stages. Stage one involved the development and validation of an evidence-based intervention titled the IDC-IMPROVE Catheter Care Bundle. The bundle consists of:

• principles for person-centred catheter care

• a catheter care toolkit for managers/senior leaders

• a catheter care audit tool

trial. Half the homes will receive all components of the bundle and half will act as controls and receive some elements at the end. The project has four objectives:

 to determine the acceptability of the IDC-IMPROVE Catheter Care Bundle to key stakeholders in aged care homes

 to explore the fidelity of the implementation of the bundle

 to investigate the compatibility of the bundle with current aged care home catheter care practices, procedures and policies.

 to explore the effects of the bundle on rates of IDC-related complications and on staff knowledge and confidence to provide person-centred IDC care

Establishing the feasibility is important, particularly given the challenges providers are currently navigating. The bundle has to be acceptable, implementable, cost effective, scalable, and transferable a cross contexts.

“The bundle has to be acceptable, implementable, cost effective, scalable, and transferable across contexts.”

• catheter care capabilities for nurses and personal care workers

• an evidence-to-practice support model

• an online course for registered and enrolled nurses about person-centred IDC care

• an online course for personal care workers about personcentred IDC care.

NARI has also partnered with the Continence Foundation of Australia to deliver site-based catheterisation skills workshops for nurses to develop and practice catheterisation skills in a safe environment.

Stage two of the project involves establishing the feasibility of implementing the IDC-IMPROVE Catheter Care Bundle in aged care homes in Australia though a multi-centre, facilitylevel cluster randomised controlled feasibility trial.

NARI is currently recruiting 24 aged care homes across Victoria, South Australia and Queensland to participate in the

It is designed to support providers to meet their responsibilities under the Aged Care Act when it comes to the emotional and clinical care of a person with an IDC: not only their responsibility to minimise and manage the physical risks of catheter-associated urinary tract infection and blockage, but also to uphold and protect the person’s emotional wellbeing, independence, dignity and quality of life.

If you or your provider wish to participate in the trial or would like to know more about the IDC-IMPROVE Project, please email j.ostaszkiewicz@nari.edu.au or idcimprove@nari. edu.au or call 03 9969 6500. n

Dr Joan Ostaszkiewicz is program director at National Ageing Research Institute

Also contributing to this article: Professor Briony Dow, Associate Professor Frances Batchelor, Wendy Taylor, Elizabeth Watt, Dr Andrew Gilbert, Dr Jessica Cecil, Marie Vaughan, Caitlin Tay, Isabella Hall

and services

www.expo.atsa.org.au

Restoring function

Enabling rehabilitation and reablement in aged care requires a mutual understanding of expectations plus a transdisciplinary approach to self-directed and empowering client-centred services, write DR CLAIRE GOUGH and JUDITH LEESON.

Dr Claire Gough

Claire’s perspective

As the need for aged care services increase, policies and government recommendations look to embed rehabilitation and reablement into aged care. We know that these approaches can restore and improve function for older people to enable participation in activities that are enjoyable and provide a sense of purpose. However, in terms of practical care delivery, there are many barriers that prevent these approaches being used.

In late 2023, Aged Care Research & Industry Innovation Australia brought aged care service providers together at national roundtables to discuss the complexities of integrating rehabilitation and reablement into aged care delivery.

We met with a range of allied health professionals including physiotherapists, occupational therapists, managers, academics

and a psychologist who shared their experiences, concerns, and ideas of how to improve future services. The group widely agreed that rehabilitation and reablement should be part of daily life for those receiving aged care.

However, our published white paper details the challenges of variable terminology, funding systems, inequalities, ageism, and the expectations of older people, their advocates, and the aged care workforce to the implementation of these changes.

Ironically, one of the difficulties for organisations when attempting to provide rehabilitation and reablement in aged care is that these approaches “get people better”. They improve function, allowing people to be more independent with selfcare, attend to their gardens and live happily at home.

You are probably thinking, “well isn’t that a good thing?” Yes, it is certainly what I would want for myself and my relatives. But this means that individuals become less dependent and require fewer services.

Aged care providers receive more funding to deliver care to older people who are less able and more dependent. Indeed,

funding is approved based on the deficits that a person has at a point in time not on what might be achieved through interventions based on evidenced solutions and strategies.

Here lies the conflict between funding models, business sustainability and best care outcomes for older people and is part of the reason why terminology is important to allied health professionals as it is directly linked to funding.

As a physiotherapist, with a passion for rehabilitation, I have found great joy in teaching people to walk again following a stroke, throwing out their walking sticks and getting back to living their lives.

This is one of the big perks of the job. By successfully restoring someone to their previous function, there is ultimately a point where they no longer need physiotherapy. If I do my job well, I am no longer needed; they have the motivation and ability to head out and live.

This is a different concept and purpose to those systems and businesses where dependency and continued repeat business is valued over positive outcomes for care recipients.

Allied health professionals are essential in aged care, bringing the expertise to motivate individuals and help them to achieve meaningful and personalised goals. Delivering personcentred care that focuses on these goals and takes the time to understand a person’s past interests, current abilities and future aspirations are invaluable.

While service providers participating in the roundtables recognised allied health interventions as a crucial aspect of care, they also acknowledged the challenges. For physiotherapists, accomplishing this in a 30-minute session is demanding. It may be even more challenging for care workers who must learn and implement new skills as part of an integrated program while prioritising their essential daily tasks.

Our roundtable discussions were extremely valuable. However, these conversations lacked the voice of older people receiving care. Continuing these reflections from different perspectives, gives us the opportunity to address key points and discuss what we think the future looks like.

Understanding the expectations of those delivering and receiving care is important to allow us to focus on the key issues, and the reason Judith Leeson and I came together as an aged care consumer and physiotherapist, to explore the role of allied health in restoring function for older people receiving aged care. Dr Claire Gough is a research fellow at Aged Care Research & Industry Innovation Australia

Judith’s perspective I love a good white paper, especially one that looks at improving the lives of older people receiving support and care in their own home or in residential accommodation.

The outdated medical model of care has certainly reached its use-by date, and a more holistic model will demand a transdisciplinary approach to the provision of self-directed, client-centred services that motivate and empower.

Allied health professionals will become an essential part of the team where knowledge and skills are shared, and care workers become integral to the process of reducing dependence. Clients will be supported to articulate their goals through a facilitated process dependent on understanding the individual’s experiences, values, skills and interests to underpin the development of services which encourage agency and are meaningful.

This is not a dream, but a gradually emerging reality, supported by a passionate learning community that is developing in the aged care sector, driven by rigorous academic and industry research and experience, rich consumer input, and supported by translational research organisations like ARIIA.

A debate on terminology – rehabilitation, reablement and

restorative care – may be valuable to professionals, and essential for bureaucrats, but as an older person receiving support and care at home, I am not interested in what the service is called. I just want to know how you can help me.

And therein lies the conundrum for the client of improving function and decreasing dependence with a consequential reduction in services and interaction with people with whom you have formed a relationship.

What is worse you may have been told, as I was, that my aged care services would train me to do housework. After 70 years of balancing domestic duties, family, work, leisure and other responsibilities the suggestion was a distinct disincentive to participation.

Although I do not enjoy housework, a little gentle questioning would have revealed that I absolutely love gardening, and surely many of the interventions planned to teach me long forgotten skills of sweeping and vacuuming would be like those needed for gardening.

What is more important, I would be motivated by the hope that I could once again engage in horticultural activities. I may even be tempted to do some sweeping.

The essence of the newly drafted Aged Care Act is that services will be client-centred, with the ability to have a selfdetermined future, and that the client’s story will be the starting point for innovative and creative thinking on how to provide services that give hope, motivate action and strengthen agency in and for whatever stage the client is at in their ageing process.

While the current funding model for residential support and care reinforces dependence and rewards providers for higher, not lower, levels of dependency, the proposed model will encourage independence by acknowledging the client as the expert in their life and that hope is the essential driver of motivation to live a life of purpose and meaning.

The client centred-model of care will change the face of services for some, but utilising allied health professionals as allies will make a considerable difference over time, as aged care workers will become involved in the process of shaping client capacity and gradually relieve them of some of the more repetitive and onerous daily tasks.

This sharing of implementation, and deeper understanding of the power of reablement to restore or improve capacity, and to transform practical interventions, will transform the careers of care workers, provide satisfying learning pathways, and improve both retention and attractiveness of an aged care career option for the next cohort of helpers.

The new Aged Care Act and strengthened quality standards set the stage for a collaborative engagement among service providers, allied health professionals and consumers.

Future aged care services must emphasise meaningful physical and social activities, recognising their value for older people. This presents ARIIA and the broader allied health community to move beyond outdated medical models and champion an approach that supports the best in aged care delivery. n Judith Leeson – who was appointed as a Member of the Order of Australia for services to the community in 2005 – is an aged care consumer, founding director of Vector Consultants and a member of ARIIA’s independent board of directors

Judith Leeson

Forming friendly first responses

Improving life for people with dementia doesn’t just take a village – it takes a whole country, writes

MARIE ALFORD.

Lindsay Bent has been an intensive care paramedic for 34 years.

He led the introduction of motorcycle paramedics in Victoria and was the operational lead for the development of Australia’s first mobile stroke ambulance. He’s now the clinical lead for Ambulance Victoria’s Communications Centres, developing a model for remote clinical support for paramedics and other health services.

In 2022, he completed a Churchill Fellowship to review work by the United Kingdom’s National Health Service on dementia-friendly healthcare, particularly with regard to ambulances.

So, when he puts his finger on the one thing that would really change the game for people living with dementia, Lindsay speaks as someone who identifies problems and finds solutions.

And while dementia-friendly ambulances and emergency departments have their place, he has his sights set much higher than that.

“I would really love to see direct leadership from the federal level downwards to the states, making dementia a priority not just within health but across the community,” says Bent.

The Australian Government is currently formulating a National Dementia Action Plan, aiming to improve and integrate “policies, services and systems for people living with dementia, their families and carers”, but Bent hopes it goes further.

“The challenge is that we all must become dementia-friendly,” he says, pointing to the UK’s 2009 National Dementia Strategy as a model that led to change in many elements of society, not just healthcare.

“If we have a look at the UK experience, when they elected to become dementia-friendly on the back of the Prime Minister’s commitment to dementia, it was not just the health system that responded.

“It was also a lot of public bodies – libraries, for example, that created

“The challenge is that we all must become dementiafriendly.”

dementia action plans.

“And these organisations modified their own environments to be dementia-friendly, and educated their staff, so that when people who live with dementia come into, say, a museum, they can look after them a little bit better and give them an experience that is more meaningful to them.

“So, it’s actually broader than just healthcare – it’s across the community.”

In September, Bent was a guest on our First Responders panel at the International Dementia Conference, joining a dynamic line-up that included Assistant Commissioner of South Australian Police, Scott Duvall, Sydney Adventist Hospital director of emergency Dr Guruprasad Nagaraj and dementia and mental health law advocate Julane Bowen – whose husband lives with frontotemporal dementia.

They discussed the difficult and timely question of how emergency and health services can work together to improve outcomes for people living with dementia and avoid some of the tragic scenarios that have eventuated in the past.

As the facilitator, I had a powerful opportunity to draw ideas and insights from those in a position to know what’s needed, and I hope to share more of them with you in the coming months.

While we can’t guarantee a federal response like the one Lindsay hopes for, we can push for change in the organisations we’re a part of.

The Dementia Centre and Dementia Support Australia are equipped and eager to help in any way possible, whether through training, consultancy or ongoing partnerships, like the phone-a-friend system recently set up with SA Police to support officers during incidents involving someone living with dementia.

Speaking after the panel, Bent says he hopes that such partnerships – between the healthcare sector and first responders, and across the categories of emergency services – will become the new normal.

“We’ve shown throughout time that relationships are critical to the provision of healthcare,” he says.

“So, the various bodies within the broader health system need to regularly come together, engage with each other, understand each other’s challenges, understand the broader challenge that’s at hand, and work together to address the issues, both at the local level and then also at a systemic level.

“If we can embed some proper and meaningful working relationships that are continuous, then we’re going to move a lot further down the track to providing the targeted, best care for people living with dementia.”

He also urges all emergency services to work together to make a difference.

“I’d really like to see the three emergency services make a collaborative commitment to become dementiafriendly, and to have their staff all go through specific dementia-awareness training to give them the knowledge and the skills and the understanding of what they see day to day,” he says.

“It’s really critical that emergency services are given the ability to recognise what’s going on, and the skills to manage accordingly.”

I couldn’t agree more. Let’s all work together to see it happen. n

Marie Alford is head of professional services at Dementia Support Australia

Australian Ageing Agenda’s regular dementia section is guest edited by The Dementia Centre, HammondCare. For further information contact hello@dementiacentre.com

Marie Alford

Intensive care paramedic Lindsay Bent

Dr Madeleine Jurhman

Improving palliative paramedicine

For people who wish to die at home, including people with dementia, palliative paramedicine can play an important role, writes DR MADELEINE JUHRMANN.

In Australia, like many countries, there is an increasing desire for people to die at home, surrounded by comfort and familiarity. Yet, despite palliative care being acknowledged as part of paramedicine, few jurisdictions have specific guidelines for paramedics to deliver this care effectively.

Furthermore, paramedics are often overstretched and underresourced, making it difficult to meet the specific needs of those at the end of life.

As part of my PhD research, I focused on how we can improve this situation.

While my studies do not directly address people living with dementia who wish to die at home, it does consider how paramedicine can better support those who prefer to remain in their homes rather than be transferred to acute care settings.

This is particularly important for people with dementia, who often find the hospital environment disorienting and distressing.

My recent study, Health professionals’ and caregivers’ perspectives on improving paramedics’ provision of palliative care in Australian communities: a qualitative study, sought to understand the views of health professionals working in palliative paramedicine, as well as general healthcare professionals and family carers on how to better support people living in the community who want to die at home.

Health professionals, bereaved family members, and carers were invited to participate if they were over 18 years of age and had been involved in the care of someone requiring palliative care who encountered paramedics at the end of life in a community setting.

We explored the growing potential for paramedics to play a more prominent role in delivering palliative and end-of-life care, especially during out-of-hours emergencies.

Every participant – whether a healthcare professional or family carer – agreed that paramedics could significantly enhance care for patients, families and healthcare teams.

And they also agreed that improving palliative paramedicine requires a multifaceted approach, focusing on systems, services, communities, and individuals to close current gaps in care and ensure better access to paramedics trained in palliative care.

Education and integration in existing health networks

One of the challenges we face is integrating palliative care into the core responsibilities of paramedics. Balancing their traditional emergency response duties with a more patientcentred palliative care role will require a significant shift.

To support this integration, we recommend embedding palliative and end-of-life care education into both undergraduate and postgraduate paramedicine programs. Additionally, paramedics’ skills must be better recognised within existing interdisciplinary palliative care networks.

Drawing inspiration from international models such as Canada’s Paramedics Providing Palliative Care at Home program, we’ve seen how successfully palliative care can be integrated into paramedic practice.

Collaboration between paramedics and specialist palliative care teams is essential, as perspectives on paramedics’ roles often differ between these groups.

Supporting the broader community

The study also highlights the importance of piloting palliative paramedicine programs in regional and remote areas.

These areas often face additional challenges in providing end-of-life care, and paramedics can play a critical role in supporting healthcare teams, reducing hospitalisations, and strengthening relationships across sectors.

By building these connections, we can improve continuity of care for patients nearing the end of life.

Ultimately, paramedics are uniquely positioned to identify and support patients in need of palliative care within the community. While not every paramedic will specialise in this area, all paramedics should be equipped with generalist palliative care skills.

Expanding the scope of paramedic practice and fostering collaboration with palliative care teams will ensure paramedics are better prepared to provide compassionate, high-quality care to patients and families.

This research forms part of a larger study that offers a framework for future policies and practices in Australia and beyond, with the potential to standardise best practices and shape a more integrated approach to palliative paramedicine.

When adequately trained and supported, paramedics can enhance person-centred care, reduce avoidable hospitalisations, and help people fulfill their wish to die at home.

However, embedding palliative and end-of-life care into paramedics’ core responsibilities will require interventions at the structural, healthcare service, and individual clinician levels.

Key recommendations from our study include giving paramedics access to electronic medical records, maintaining paramedic-specific guidelines for end-of-life care, and ensuring they are connected to local palliative care pathways.

By doing so, we can empower paramedics to provide the compassionate care that so many patients and families need at the end of life, allowing more people to spend their final days where they feel most at peace – at home. n

Dr Madeleine Juhrmann is a trained paramedic and a research fellow at Flinders University Research Centre for Palliative Care, Death and Dying

Dr Juhrmann’s research was supported by HammondCare Foundation and supervised by Professor Josephine Clayton, director of research and learning at the Palliative Centre at HammondCare

Prescribing cascades in long-term care

DR TESFAHUN

ESHETIE – a research fellow with the Registry of Senior Australians at the South Australian Health and Medical Research Institute and expert in drug safety in the elderly – answers our questions about prescribing cascades.

What is a prescribing cascade?

A prescribing cascade begins when a medicine causes an adverse drug reaction that is mistaken for a new medical condition, leading to the prescription of another, often unnecessary, medicine. Sounds simple, but particularly in older adults, this can snowball quickly, leading to more medicines being given to treat a cascade of events from a previously prescribed medicine.

Older adults accessing long-term care either at home with home care packages or at residential aged care facilities, especially those with multiple chronic conditions and complex care needs, are particularly vulnerable to this cycle. The impact of prescribing cascades on medication-related quality of care is significant, as unnecessary medicines can lead to adverse outcomes and added costs.

One well-known example involves the use of calcium channel blockers like amlodipine for hypertension, which can cause lower extremity swelling (ankle oedema). If this swelling is misinterpreted as a new condition, a diuretic like furosemide might be added unnecessarily, worsening the patient’s condition without addressing the real cause.

Another example from the literature, published in the journal Geriatrics & Gerontology International, highlights a series of prescribing cascades following the initiation of an angiotensin converting enzyme – ACE – inhibitor. An older adult who started an ACE inhibitor, enalapril, to manage their hypertension developed a non-productive cough, an adverse drug event well-documented with ACE inhibitors. However, instead of recognising the cough as a side effect of the enalapril, a cough suppressant syrup containing guaifenesin and codeine was prescribed to treat the cough. The codeine caused lethargy and the cough persisted, which was then mistaken for the early stages of pneumonia. As a result, an antibiotic levofloxacin was prescribed to treat the presumed pneumonia, which then led to an antibiotic-induced diarrhoea. Diarrhoea and dehydration triggered delirium, finally led the patient to be hospitalised.

Prescribing cascades are not limited to prescription medicines. They can involve over-the-counter medicines or supplements, medical devices or procedures, for example pacemaker device insertion following medication-induced bradycardia, which could have been avoided by reducing dose or substituting with a safer alternative (doi.org/10.1016/ S0140-6736(17)31188-1).

How common are they among aged care residents?

Prescribing cascades have been recognised for nearly 30 years, yet they remain common in long-term care, contributing to polypharmacy, inappropriate prescribing and medicationrelated harm. They can be a marker of poor medication-related quality of care. Older adults receiving long-term care often are on multiple medicines – 10 on average – have complex medicine regimens, and as they transition between care settings including hospital, rehabilitation, home care and residential

aged care facilities, adverse drug reactions could be misinterpreted for new conditions. Evidence shows that over 95 per cent of aged care residents have at least one medication-related problem, and one in six of these are linked to adverse drug reactions, which often trigger prescribing cascades (psa.org.au/advocacy/working-for-our-profession/ medicine-safety/aged-care).

What can happen as a result?

The consequences of a prescribing cascade can be significant, from mild side effects to severe medication-related harms like falls and major injury, delirium or hospital admissions. These not only affect the individual’s quality of life but also place added strain on health and aged care providers and increase costs due to hospitalisations and ongoing management of medication-induced conditions.

How can you detect a prescribing cascade?

Identifying prescribing cascades is key to improving medication safety in long-term care. When new symptoms arise, it is important to ask: “Could this be an adverse drug reaction of a current medicine?” Maintaining a high index of suspicion for new sign or symptoms is critical to identify and interrupt prescribing cascades. Tools like Canada’s “ThinkCascades” list of common cascades can help clinicians identify potential cascades by systematically looking at common medicines and their associated side effects (doi.org/10.1007/s40266-02200964-9). Comprehensive medication management review, especially after transitions of care or when new symptoms arise, ensure that providers are not missing opportunities to catch adverse drug reaction early, before a prescribing cascade starts.

How can you prevent prescribing cascades?

Preventing prescribing cascades improves care quality and also supports the 10th National Health Priority Area: Quality Use of Medicines and Medicines Safety. Australia’s Choosing Wisely initiative advises prescribers to recognise and stop prescribing cascades. Prevention begins with judicious prescribing and regular reviews of a resident’s medicines to ensure no unnecessary medicines are added – in particular avoiding high-risk medicines for older adults. Clinical practice guidelines and tools, such as the American Geriatrics Society Beers Criteria, Screening Tool of Older Persons’ Prescriptions – known as STOPP – and other explicit criteria to identify potentially inappropriate prescribing, help clinicians make safer choices for older adults.

If a prescribing cascade has already started, deprescribing – systematically reducing dose or stopping medicines – can improve care quality and reduce harm. Technology, such as clinical decision support tools, can also alert clinicians to the occurrence of a prescribing cascade during prescribing decisions. Recognising and stopping prescribing cascades are essential yet often overlooked steps for optimising prescribing practices and improving medication-related quality of care in long-term care settings. n

Dr Tesfahun Eshetie

The secret to ageing successfully lies in remaining active, independent and engaged, according to research from Curtin University.

The paper, published in the journal Gerontologist in October, examined perceptions of successful ageing through a survey of almost 2,000 participants aged 65 and over in Australia, New Zealand, the United Kingdom, Ireland, Canada, and the United States, between September 2021 and April 2022. More than a quarter of the respondents currently live in Australia (544).

Researchers got to hear firsthand what older people think on the topic, says lead author Elissa Burton – an associate professor at Curtin University’s School of Allied Health and co-lead of the dementia and ageing team domain at Curtin enAble Institute.

Dr Elissa Burton

What is successful ageing?

Older Australians value independence, resilience and social-emotional connections, DR ELISSA BURTON tells JODIE WOLF.

“Recent research about successful ageing is now starting to engage older people, rather than looking at large health datasets for the answers,” Burton tells Australian Ageing Agenda

“I find working directly with older people very inspiring because they are so honest, have been through numerous experiences and have wisdom we should tap into more.”

The study discovered older people consider many aspects of their life when it comes to ageing successfully and not just their health, says Burton.

“Our research found the most important aspect of successful ageing was being actively engaged and independent. Physical activity and wellbeing, being resilient and accepting some things in life were also important. As were social-emotional connections and support, health promotion and being mentally healthy and maintaining cognition.”

Burton says her team was “very happy” with the results, most notably because they had “strong representation” from people living in regional areas and remote areas including small towns and farming communities.

“One aspect that did surprise me a little was how important outlook on life was, in particular having a positive outlook on life. For example, one participant reported it was important to them to take a lively interest in the world around us,” she says.

The online survey was distributed to seniors predominantly via Facebook advertisements in each of the target countries but also to participants on a research database, a link on the Council on the Ageing Western Australia newsletter, the Strength for Life newsletter, and the Injury Matters e-newsletter.

Respondents had a mean age of 73 and about three-quarters of participants were female. The survey also asked about where the older people lived and who with, education level, employment status, children, medications, and activities of daily living.

They were also tasked with answering the following questions:

• Please describe what ‘successful ageing’ means to you?

• Do you feel like you are successfully ageing?

Themes and subthemes of successful ageing

The research identified six key themes:

• actively engaged and independent

• physical activity and wellbeing

• resilience and acceptance

• social-emotional connection and support

• health promotion and maintenance

• mentally healthy and cognitively sound.

“These themes illustrate the multidimensional aspect of successful ageing among the participants, which was found both within participants’ single response to the question as well as the combination of responses among participants,” the researchers say in the paper.

Descriptions of successful ageing were predominately linked to areas where someone is actively engaged in life and maintaining independence. Within this area, the research identified nine subthemes:

• enjoyment

• capable and independent

• hobbies

• knowledgeable, mentally stimulated, and continuing to learn

• approach to life

• future planning

• financial security

• employment and retirement

• volunteering.

Burton tells AAA that until now no one has explored successful ageing across different countries and continents.

“Social media now makes it possible to connect with older people around the world and although the analysis took considerable time it was definitely worth it in the end,” she says.

“The results show us how diverse people continue to be as they age and that we need to continue to consider this when providing services to assist them to successfully age.”

Burton had a National Health and Medical Research Council Investigator grant to complete the work involved in this paper. Since then, she has received a Healthway Exploratory Grant from the WA state government, which she and her colleagues will use to create a Successful Ageing Massive Open Online Course.

The MOOC will help older people and other adults shift towards successful ageing and will offer allied health students a better understanding of what older people want to age successfully. Access the paper – WhatDoesItMeantoSuccessfully Age?:MultinationalStudyofOlderAdults’Perceptions – at doi.org/10.1093/geront/gnae102 n

Ideas & inspiration

Celebrating 60 years

From humble beginnings, the Australian Association of Gerontology has achieved much over the last six decades, writes CHRISTINA MICALLEF.

The Australian Association of Gerontology has officially achieved senior status with 2024 marking the 60th anniversary of the professional association that brings together researchers, practitioners and policy makers across the diverse field of ageing.

Over the decades we’ve grown and adapted through changes in structure and leadership from a small group of specialist medical professionals to today’s nation-wide multidisciplinary community of like-minded researchers, students and professionals committed to a shared goal of improving the health, wellbeing and lives of every person as we age.

AAG began, as many organisations do, with a small group of committed and enthusiastic individuals. Gerontology and geriatrics were still emerging areas of specialised healthcare in Europe and the United States in the 1950s and early Australian geriatricians were beginning to recognise the need for an organisation to specifically focus on medical care for older people.

Dr David Wallace, a physician from Goulburn in New South Wales, attended the 4th International Congress of Gerontology in Italy in 1957, and returned to Australia determined to establish an Australian Society of Gerontology.

The society was eventually formed in 1964 as an informal gerontological group, largely active in NSW. Sixty years on, the AAG has over 1,300 members nationally. These physicians, nurses, researchers, health practitioners, psychologists, social workers, palliative care and pastoral councillors, students, direct care providers and others support one another, share insights and discoveries, develop partnerships, and learn together within the ever-growing field of ageing-focused research, policy and practice.

60 years of accomplishments

As we celebrate this important diamond anniversary, we look back in appreciation at all who have come before us in shaping what AAG is today.

The inaugural national conference of the AAG was held at the Australian National University in Canberra in June 1964 with special guest Sir John Eccles, a Nobel Prize winner, providing the opening address on the physiology of ageing.

This first conference demonstrated what would become an enduring reputation for the organisation as Australia’s genuine thought leaders on ageing. Organisers invited research and input from all professions focusing on innovation in aged care. The conference presentations were documented and shared widely, leading to an annual publication of conference proceedings, research and insights.

With the introduction of the AAG International Fellow – now known as the Gary Andrews International Fellow in honour of the former president – AAG began to attract

leading voices from across the globe to attend the annual conference, promoting the sharing of experience, knowledge and innovation across borders.

In the late 1970s, AAG adopted the banksia as its logo, symbolising the four life stages on a single plant: infancy, youth, the middle years and older age. The multitude of flowers on each spike reflect a philosophy of multidisciplinary collaboration and a holistic understanding of ageing.

The current design, launched in 2013 to reflect a more contemporary organisation with a refreshed, more modern and stylised look, portrays our commitment to collaboration, diversity and reach.

Among many milestones, we acknowledge AAG’s first female board president Glenda Powell (December 1980 –October 1985) followed by the first non-physician president Bess McRae – a nurse from Victoria (October 1985 –September 1988).

These appointments were at a time of marked professional gender imbalance, and we applaud these landmark progressive decisions. Most notably in the past decade, but not limited to, AAG has:

• evolved from an executive council to a national AAG board of directors

• introduced a chief executive officer

• been recognised for its expertise and the capability of members to assist the National Health and Medical Research Council in shaping the national agenda for ageing research while making significant contributions to ageing and aged care policy development

• formed the AAG Research Trust

• brought its flagship event, the AAG Conference, in-house and cemented its brand as a unique, top-tier event for researchers, educators, policymakers, health professionals, service providers, and advocates dedicated to improving the lives of ageing individuals

• partnered with the Australian Ageing Agenda to bring members more news and information about what is happening in the ageing and aged care sector.

A history of collaboration

AAG recognised very early on that it takes a village of different thought and expertise to make an impact, and this philosophy saw the organisation’s membership expand to individuals that

1. Old AAG logo

2. Current AAG logo

3. Dr David Wallace

4. The AAG conference dancefloor is always a hit – AAG Conference, Adelaide, 2022

5. RN Big Ideas live broadcast at the AAG Conference with Robert Tickner, Sir Prof essor Michael Marmot, Sally Goldner and Professor Julie Byles

6. The first AAG conference – Canberra 7 May 1965 (from left) Dr Ungar, Dr Sidney Sax, Dr David Wallace, Dr Arthur Everitt

7. Mark Butler, the late Baroness Sally Greengross and Ashton Applewhite – AAG Conference, Sydney, 2019

8. AAG members Katie Moss (right) and Kathleen Lawson – longtime friends celebrating their first AAG conference together, 2023

brought a range of different lenses – sociological, psychological, direct care and more – enabling an extensive breadth of knowledge to impact the whole person, in all their diversity and differing life experiences, as they age.

By the 1990s, AAG was growing its presence throughout Australia. In April 1991, the AAG was proud to expand its reach into the Northern Territory with the introduction of the NT State Division. This important step supported the introduction of the Aboriginal and Torres Strait Islander Ageing Committee in 2004 and later, the Aboriginal and Torres Strait Islander Ageing Advisory Group – ATSIAAG – in 2006.

The original Aboriginal and Torres Strait Islander Ageing Committee was an initiative of past AAG President Professor Tony Broe (2003-2006), whose long-standing involvement in the provision of health services to Aboriginal communities helped create opportunities for collaboration with Aboriginal and Torres Strait Islander peoples to inform and shape AAG policy and practice.

In 2018, the establishment of the Friends of ATSIAAG opened the door to interested non-Indigenous AAG members to participate and support the work of ATSIAAG. Now a key focus for AAG, we are pleased to support new, trusted collaborations in the NT, such as through the delivery of a first-of-its kind forum, the 2023 ‘Ageing at the Centre. Putting Elders and older people at the heart of our work’, in partnership with ATSIAGG, Friends of ATSIAGG and local service providers and partner organisations in Mparntwe Alice Springs.

Celebrating our diamond anniversary

Fast forward to 2024, AAG members prepare to come together once again from across the country and the world. In our 60th year, we will travel to Hobart in November, embracing the theme of Fresh Air – Fresh Thinking – a salute to the open minds and fresh, collaborative thinking that first brought AAG members together six decades ago.

Of course, the milestone of 60 years offers some fabulous themes and opportunities for celebration that will culminate in our special conference event. Meanwhile, we look forward to social media activities that share our proudest moments and best experiences over the years in that trademark spirit of warmth, friendship and collaboration that makes us who we are. n

Christina Micallef is AAG’s policy, research and communications officer

1. Freestanding touchscreen tablet

Designed in collaboration with industry experts, Lumin’s OneTouch freestanding touchscreen tablet is for people living with dementia and their carers. The many services, including calls, messages, photos, medication reminders and favourite radio stations, aim to help users stay connected and independent for longer. In cases of emergency, users can press a button and families are notified. The purpose-built hardware is always on and remotely monitored with no need for passwords or Wi-Fi. Users are also protected from unwanted callers and scams. Go to mylumin.org/onetouch/, call 1300 336 038 or email hello@mylumin.org

2. BESTMED moves into home care

BESTMED for Home Care is connected, easy-to-use medication software that aims to boost adherence, streamline escalations and manage deliveries. The software connects home care providers to care workers and pharmacies to maximise participant medication safety. All users on the BESTMED network can benefit from intelligent automated workflows that improve efficiency, quality and accuracy to help providers reduce clinical risk, improve transparency and ensure clients receive better care. Email sales@bestmed.com.au or visit bestmed.au/home-care

3. Brita launches water dispenser range

Water filtration expert BRITA has launched a new range of commercial grade water dispensers to Australia. The high-capacity range delivers safe, sustainable and efficient hydration solutions plus prioritises hygiene, making it suitable for environments where clean water is critical, such as aged care settings. The BRITA Top Pro water station features HygienePlus technology to protect from contamination and germs while the BRITA Extra-C Tap (pictured) features ThermalGate technologies, which automatically and regularly heat to disinfect the dispenser and protect against bacteria and viruses. Visit brita.com.au