Community Care Review Autumn 2018 by The Intermedia Group

Autumn 2018

Australiaâ&#x20AC;&#x2122;s magazine on home and community-based care and support

Working to lift dementia practice

Dementia Australia at the forefront of virtual reality education This issue: IN FOCUS

COMMENT

EDUCATION

INCLUSIVE AGED CARE

ASSISTIVE TECH

WELLNESS

CDC budgets Community radio pilot

Reform a year on ATSA Expo

Quality standards Reablement approach

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editor’s desk

PUBLISHED BY: The Intermedia Group Pty Ltd ABN 9400 25836 82 41 Bridge Road, Glebe NSW 2037 Australia Ph: 02 9660 2113 Fax: 02 9660 4419 www.intermedia.com.au MANAGING DIRECTOR: Simon Grover PUBLISHER: Mark Kuban AUSTRALIAN AGEING AGENDA EDITOR: Natasha Egan COMMUNITY CARE REVIEW EDITOR: Linda Belardi NATIONAL ADVERTISING MANAGERS: Mark Ryu Carolyne Gowen GRAPHIC DESIGNER: Leanne Hogbin PRODUCTION MANAGER: Jacqui Cooper HEAD OF CIRCULATIONS: Chris Blacklock cblacklock@intermedia.com.au ph 1800 651 422

Taking stock of reform agenda

rom a staggering increase in market players to increased transparency around unmet demand for home care, the Increasing Choice in Home Care reforms have ushered in significant change in the sector. Some 12 months on from the introduction of the changes, we asked providers to reflect on the initial successes and challenges. Jeremy McAuliffe from Benetas shares his provider’s perspective (see page 14) and highlights the gaps in information and navigation support that currently exist for consumers to exercise choice. Like many in the sector, he says the May budget should deliver increased investment in home care to address the scale of older people waiting for care. Tracey Silvester from Queensland provider Envigor (see page 30) says system problems with incorrect home care subsidy payments and package withdrawals have proved challenging. For the latest government data on the home care packages program, see our report on page 8. The jump in approved providers to over 800 players (up 60 per cent on mid-2016) reflects a rapid rate of growth. While consumer-directed care aims to encourage flexible and creative service provision to meet the needs of clients, consumer spending requests can push the envelope of what is allowable under the program. We investigate the issue on page 10. Elsewhere this edition, we take a look at the latest developments in the field of assistive technology in ageing and disability. As always, please get in touch with your ideas and feedback.

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Disclaimer

This publication is published by The Intermedia Group Pty Ltd (the “Publisher”). Materials in this publication have been created by a variety of different entities and, to the extent permitted by law, the Publisher accepts no liability for materials created by others. All materials should be considered protected by Australian and international intellectual property laws. Unless you are authorised by law or the copyright owner to do so, you may not copy any of the materials. The mention of a product or service, person or company in this publication does not indicate the Publisher’s endorsement. The views expressed in this publication do not necessarily represent the opinion of the Publisher, its agents, company officers or employees. Any use of the information contained in this publication is at the sole risk of the person using that information. The user should make independent enquiries as to the accuracy of the information before relying on that information. All express or implied terms, conditions, warranties, statements, assurances and representations in relation to the Publisher, its publications and its services are expressly excluded save for those conditions and warranties which must be implied under the laws of any State of Australia or the provisions of Division 2 of Part V of the Trade Practices Act 1974 and any statutory modification or re-enactment thereof. To the extent permitted by law, the Publisher will not be liable for any damages including special, exemplary, punitive or consequential damages (including but not limited to economic loss or loss of profit or revenue or loss of opportunity) or indirect loss or damage of any kind arising in contract, tort or otherwise, even if advised of the possibility of such loss of profits or damages. While we use our best endeavours to ensure accuracy of the materials we create, to the extent permitted by law, the Publisher excludes all liability for loss resulting from any inaccuracies or false or misleading statements that may appear in this publication. Copyright © 2018 - The Intermedia Group Pty Ltd.

Linda Belardi, Community Care Review Editor Tel: 02 8586 6198 Email: lbelardi@intermedia.com.au

Contributors 1. JEREMY MCAULIFFE from Victorian provider Benetas shares his perspective on the hits and misses of the recent home care reforms. 2. An increasing trend of older people and families opting to self-manage their package is coming to home care, writes ROSS MCDONALD. 3. Community care needs to push ahead

Staff

with embedding a reablement focus, writes ROXANNE GELLE. 4. LORRAINE POULOS, a trainer with extensive experience working with government and industry, provides some advice for providers on preparing for the new single quality framework.

L-R: NATASHA EGAN Editor Australian Ageing Agenda; MARK RYU National Advertising & Marketing Manager, Print and Digital; CAROLYNE GOWEN National Advertising & Marketing Manager, Print and Digital

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contents

24 3

EDITORâ&#x20AC;&#x2122;S DESK

NEWS

IN FOCUS 10 What should a package pay for? 12 Knocking down language barriers

SPECIAL COVERAGE: ATSA EXPO 23 The role of assistive technology gathers momentum 24 Building a user-led community on assistive tech 26 Resources in the works to boost take-up of smart devices

YOU AND I 31 Help for a fresh start

EDUCATION AND TRAINING 32 How to prepare for the new quality standards

RESOURCES

OPINION 14 Home care reform: hits and misses

WELLNESS

16 Taking choice and control a step further

28 Pushing ahead with reablement focus

COVER STORY

ONE ON ONE

18 Working to lift dementia practice Dementia Australia at the forefront of virtual reality education

30 Embracing local solutions

33 Resources to support inclusive aged care 34 Community action plan launched to tackle elder abuse

COMMUNITY CARE REVIEW

news New measure to boost home care take up By Linda Belardi

THE DEPARTMENT of Health is notifying older people on the home care queue three months before they are to be assigned a package to encourage them to plan for services. The measure introduced in late February aims to reduce the time taken for older people to activate their package and increase overall take up of available care, the department said. The letter to be sent to consumers will encourage older people to contact the Department of Human Services to complete an income assessment form and start comparing home care providers. The Department of Health said 54 per cent of consumers it had surveyed had not yet started researching providers 35 days after being assigned a package. The letters will also be used to encourage consumers on the queue to opt out if they are not actively seeking services. The department said its research showed 31 per cent of older people who had been

assigned a package had decided not to take it up but hadn’t yet opted out of the queue. A further 30 per cent were still deciding whether to take up a package 35 days after being assigned one. An older person can opt out if they are not ready to take up a package but still retain their place in the queue, should they choose to rejoin later. The department encouraged providers to opt a consumer out of the home care queue if their needs are being met by an interim package. This will avoid an automatic upgrade to

a higher-level package and a buildup of unspent funds, the department’s said in a webinar broadcast in February. The department said it would be focusing on ensuring the queue is made up of those with a “genuine and immediate intention” to access services. ACAT assessors also have a role to play in identifying if a client is immediately seeking services. The letters are in English and older people requiring the information in another language will be referred to the Translating and Interpreting Service (TIS).

PRIORITY LEVELS FOR HOME CARE The department said the proportion of consumers being assessed as high priority and requiring urgent care was also higher than expected and would need to be addressed. The department said it had been working with ACAT assessors to ensure that high priority approvals reflected only urgent cases and were based on a person’s current care needs. High priority approvals impact where packages are assigned nationally. n

Governments work on elder abuse plan By Darragh O’Keeffe and Linda Belardi

NEW PROTECTIONS for seniors and ensuring nationally consistent laws to respond to elder abuse are among the key goals of a new national plan being developed by federal and state governments. Attorney-General Christian Porter said the national plan would bring government, business and community stakeholders together to properly address the critical issue. The plan was a cornerstone recommendation of the major Australian Law Reform Commission report on elder abuse, handed down last June. The ALRC’s report covered a range of areas including family 6

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agreements, superannuation, banking and enduring appointments. Almost a third of its 43 recommendations involved changes to the laws governing residential and community aged care. It recommended strengthening protections for seniors in aged care including a more extensive scheme for reporting and investigating alleged incidents. It also proposed a new benchmark for adequate staffing levels in aged care, more extensive employee screening and regulation of “restrictive practices.” Speaking at the National Elder

Abuse Conference in across health, Sydney in February, Mr community services Porter said the plan had and other portfolios five key goals: to develop the plan, • promote the in consultation autonomy and with seniors, the agency of older community sector people; and the business and • address ageism and financial sectors. promote community Christian Porter Along with issues understanding of relating to the family elder abuse; law system, Mr Porter told the • achieve national consistency; Sydney audience he intended • safeguard at-risk older people to make elder abuse policy “a and improve responses; and personal and central focus for • build the evidence basis. the next 12 to 24 months.” But he said that addressing The Council of Attorneyselder abuse was not just a legal General expect to receive a draft issue and that attorneys-general of the national plan by the end would work with ministers of the year, he confirmed. n

news Call to link falls prevention with home support services By Natasha Egan

AMID ONGOING efforts to lower stubborn falls rates, new research shows fewer seniors are now being referred to prevention programs after a fall than a decade earlier. The drop in referrals is despite findings that people who are referred to a prevention program are half as likely to fall. The research is based on a 2015 survey of 1,991 Western Australian Home and Community Care clients across 10 organisations, and compares

the rate of falls between 2005 and 2015. The rate of falls had hardly moved in the decade – with 48 per cent of respondents having fallen in the previous year and 33 per cent in the previous month. The survey found only 27 per cent of those who had fallen were referred to a falls prevention program, which is significantly fewer than the 31 per cent 10 years ago, said lead author Dr Elissa Burton from

Neighbourhood networks to tackle isolation A NEIGHBOURHOOD social networking site that aims to reduce loneliness and social isolation among seniors has taken out the top prize at the inaugural Senior Living Innovation Challenge. The competition run by the Institute for Future Environments at Queensland University Technology and four industry partners encourages entrants to develop innovative products and services for older people to engage and participate in their communities. Design integration lead at Bolton Clarke and a nurse practitioner Matiu Bush was announced as the overall winner on 27 February for his pitch, One Good Street. The idea behind One Good Street is a social networking site that aims to give communities the opportunity to offer their

assistance and skills – from hot meals to respite during a heatwave – to older people and carers living in their neighbourhood. “One Good Street inspires and empowers neighbours to make a real difference in the lives of older citizens,” said Mr Bush, who picked up $20,000 for his project. “If we look at social isolation in older people through the lens of a market we can begin to design a marketplace for connection,” he said. Mr Bush has also designed a feature in One Good Street that matches isolated older residents with each other to encourage the sharing of informal supports and joint home visits from service providers. Senior Living Innovation is a collaboration between the QUT, Bolton Clarke, BallyCara, Aveo and IRT Group. n

Curtin University’s School of Physiotherapy and Exercise Science. “If people are referred for falls prevention services then they are 47 per cent less likely to fall. We need to make it easier for seniors to access these services,” Dr Burton said. “When someone falls, they are more likely to then have another fall if nothing is done to help.” Respondents who thought they would definitely fall or might fall also had a higher likelihood of falling. “Our results indicate the importance of community care organisations incorporating balance exercise programs into their services and referring their clients to a falls prevention service or program as soon as a fall has taken place or someone is considered at high risk of falling,” Dr Burton said.

Being hospitalised following a fall also increases the likelihood an older person will enter residential care. Older home care clients need assistance to prevent falls without thinking they will have to go into residential care if they tell someone they have fallen, she said. The research was published in Clinical Interventions in Aging in February.

FAST FACTS • Of those who reported falling in the previous year, 42 per cent fell once; 24 per cent fell twice; 12 per cent fell three times; and 14 respondents reported 12 falls while two people with balance problems estimated 60 falls each. • Half of respondents fell in their home while a quarter fell in their yard and 13 per cent fell in a public place. n

Matiu Bush

COMMUNITY CARE REVIEW

news Report confirms long delays for high-level home care By Linda Belardi

AROUND 3 IN 10 older people have been waiting more than 12 months for their required level of care, new government data shows. The Minister for Aged Care Ken Wyatt released the third home care data report on 2 March, which for the first time included information on the time consumers have spent waiting on the national queue. According to the report, 28,000 older people have been waitlisted for more than a year and almost all are waiting for a level 4 package. Nearly all were receiving an interim package while they waited for their assessed level of care. A further 27 per cent (28,000 older people) had been waiting between six and 12 months for their assessed package, the data showed. In September last year Minister Wyatt said almost 200 people who had been waiting more than two years

for care had been connected to services under the new prioritisation system. At 31 December, there were 104,602 people on the national queue, an increase of 3 per cent on the previous quarter. The Department of Health advised older people with a medium priority that the wait time for a high-level package was more than 12 months and six to nine months for Level 1 and 2 packages. Around 46 per cent of people on the national waitlist were assigned or receiving an interim package. The department said strong approval volumes were driving growth in the size of the queue. The report showed nationally 82,000 older people were on the queue for a highlevel package, up fromÂ 79,000 at the end of September. Over 31,000 people were approved for home care in the December quarter.

CONSUMERS IN CARE Despite the large number of packages being released into the national pool, the number of consumers in care has increased by only 2.7 per cent (1,933 consumers) since the home care reforms started on 27 February. At 30 September 2017, there were 74,205 consumers in a home care package, up from 72,272 in February 2017. Of the consumers who exited a home care package during the September quarter, the median time in care was 12 months and the maximum time in care was 21 years, the report said. Around 4 per cent of consumers in care exited each month during the quarterly reporting period.

HUGE GROWTH IN MARKET PLAYERS

expand reaching 806 approved providers at the end of December, up 61 per cent from mid-2016. In the last quarter alone, the number of new providers increased by 5 per cent. The department does not provide data on how many of these new home care providers already delivered some form of aged care.

PACKAGES RELEASED The health department assigned 50,000 home care packages to consumers over the December quarter, 17,000 more than the previous quarter. However, timely data on the take up of assigned packages is not available. Since 27 February 2017, the government has released 130,751 packages to consumers. n

The number of industry players continues to rapidly

Mental health app shows promising results for carers By Linda Belardi

NEW RESEARCH has highlighted the benefits of using a mobile phone app to manage stress and build the resilience of informal carers. The StressLess app was developed by Deakin University researchers in partnership with service provider Australian Unity. The app features a self-paced program on stress management, as well as prompts and individual feedback to help carers monitor their stress levels and mood over time. The universityâ&#x20AC;&#x2122;s School of Psychology led a five-week randomised controlled trial testing the effectiveness of the app among 110 carers aged between 26 and 64. The results showed one in four carers who used the app experienced a decline in stress symptoms, compared with 15 8

AUTUMN 2018

per cent in the control group. The app was found to be most beneficial for those experiencing high levels of stress, with almost half of this group showing an improvement in their symptoms. Average resilience scores in the face of stress also improved more significantly among the intervention group. Lead researcher Associate Professor Matthew FullerTyszkiewicz said the results demonstrated the potential for the StressLess app to deliver more accessible and costeffective stress management and coping strategies to carers. He said the free app could be seen as an additional resource among a toolkit of strategies and supports for carers. Associate Professor FullerTyszkiewicz said the app helped

carers draw on techniques such as breathing and relaxation exercises to help manage stressful situations and shorten periods of stress. It also reminded carers of the importance of prioritising their own health, which has a flow-on effect to their ability to continue in their caring roles.

Over 80 per cent of carers in the trial found the app intuitive or easy to learn to use, however a lack of time to engage with the app was identified as a barrier by some. A further study is underway to assess the impact of the app on participants over a longer follow-up period. n

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COMMUNITY CARE REVIEW

in focus

What should a package pay for?

From dog grooming to roof repairs, providers are receiving a wide range of consumer requests for home care spending, reports LINDA BELARDI.

ome care providers say they are fielding a growing number of outof-scope purchase requests under consumer-directed care, which is raising a number of dilemmas. While promoting choice and flexibility, consumer-directed care is also challenging service providers to consider and negotiate a wide range of uses for package funds. Industry peak body Leading Age Services Australia recently surveyed its home care members to identify the types of requests providers were receiving. Examples listed ranged from everyday household appliances such as TVs, fridges and dishwashers to lounge room furniture, the installation of blinds, outdoor landscaping and the purchase of Chinese medicine. LASA warned in a competitive environment, where providers were driven by the desire to retain clients, rules could be bent. “Providers have reported observing the inappropriate use of package funds by consumers and competing providers,” LASA says in its report on the February 2017

AUTUMN 2018

Increasing Choice in Home Care reforms released on the anniversary of the changes. The peak body says the issue should be closely monitored. Home care provider CEOs tell Community Care Review some consumers are threatening to switch providers if their requests are not met. While it’s only a small number of cases, it’s happening at an increasing rate, they say. A growing trend in the proportion of funds being spent on goods rather services is also bringing this issue to the forefront. Tracey Silvester, executive manager at Envigor, says the situation presents a moral dilemma for providers. “I have been seeing requests for things to be paid out of people’s home care packages that I don’t view as reasonable. “For example, we have had people ask us to fund repairs to their plumbing in their backyard, to repair an antique clock that held high sentimental value to the client and to air condition a person’s whole house. While there are valid arguments that can be made, is that what the program was intended to fund?

“Providers have reported observing the inappropriate use of package funds by consumers and competing providers.”

“The families of consumers have been incredibly forceful in asking us to fund some of those items,” she says. “It comes down to a moral judgment and that is quite difficult because you don’t want your client to go to another provider. Morally, we have said no to a few things and people have moved on as a result.” The Quality of Care principles set out what a home care package can and can’t be used for. Items identified as excluded include food, rent or mortgage payments, holidays, entertainment, gambling, home modifications or capital items not related to a person’s care needs, and care or services already subsidised by the government. While there are clear objectives that guide the program and specific items that are not allowed, there is a large grey area in the middle that providers must navigate.

KEY CONSIDERATIONS When considering consumer requests, Sabine Phillips, a partner with law firm Gadens, says providers should keep in mind the fundamental principle of home care package funding, which is to enable a person to remain in their own home. She says approved providers are ultimately accountable for how government funds are used and if expenditure is allowed on items that are out of scope, they could be in breach of their obligations under the Aged Care Act. An increase in reporting and compliance action around this issue is possible as

in focus competition for customers in the sector intensifies, she says. Discussing some of the cases she has advised on, Phillips says a provider was asked to fund expenditure on a costly and unproven elixir that claimed to treat Alzheimer’s disease. Another challenging scenario for a provider was the discovery that an iPad intended to support the social goals of a client had been gifted to a family member. In response to providers seeking advice in this area, Gadens has developed a guide to help organisations when considering consumer requests. Phillips says there are four questions a provider should ask if they are unsure about whether a consumer’s expenditure request is allowable. These are: 1. Does it support a care recipient to live at home? 2. Can it be provided within the resources available? 3. Is it consistent with the care recipient’s personal goals that are detailed in their care plan? 4. Can the service be provided in a way that ensures the provider complies with its obligations? Unless a provider can satisfy these requirements, then the answer to a request should be no, she says.

CLIENT CIRCUMSTANCES Jacki Attridge, Uniting’s head of home and community care operations, says the context of an individual’s request, such as their location, is important to consider. “For example, a lawn mower may not be

WHAT’S NEEDED?

Sabine Phillips

Sean Rooney

a reasonable request for a city dweller, or even someone living in town. “It may be appropriate for someone on a rural property for the purposes of fire protection to clear the land around the home. Uniting’s support advisors will ensure that the context of the request is clearly understood.” She says good communication with a client is important to understand the reasons behind a request and to avoid making assumptions. The organisation attempts to be as flexible as possible, balancing the needs of their clients with their responsibilities as an approved provider, says Attridge. The Department of Health says the types of care and services provided under a home care package will depend on the person’s assessed care needs. A package should help older people to stay at home, provide tailored services and cover a person’s care and safety needs. If a package is used to contribute towards the cost of items within a consumer’s home, the impact on a person’s individual budget, capacity to deliver other care and services and responsibility for any maintenance should be considered, the department says.

Silvester says government regulation is not the answer. “If you stifle creativity then it will reduce the capacity of providers to respond to the different needs of clients.” Instead, she argues for greater consumer education of the objectives of the program and excluded items. LASA chief Sean Rooney agrees clear communication between providers and consumers is essential to ensure the appropriate expenditure of home care funds and highlights the role of education. “Providers understand the importance of consumer choice in promoting independence, autonomy and quality of life at a time when support becomes more important. “However, consistent information is needed for both consumers and providers to understand the principles for how package funds can be used. “We are aware that the Australian Competition and Consumer Commission is currently developing information resources for consumers to support their engagement with home care package providers,” he says. A spokeswoman for the Department of Health says it does not routinely monitor subsidy expenditure but works with the Aged Care Complaints Commissioner to resolve issues that are reported. She confirmed no compliance action has been taken against a provider in relation to expenditure on a non-allowable item or service. “The department responds to general queries from providers about permitted uses of home care package funding and provides advice in some exceptional cases,” she tells CCR. n

Start a conversation

16 – 22 April is National Advance Care Planning Week. Join us in encouraging Australians to discuss what living well means to them. You can host an advance care planning event or even just start a conversation. Help us get more people to discuss their future health care preferences with loved ones. Find great ideas, resources and conversation starters online. Find out more:

acpweek.org.au Join the conversation:

#acpweek18

COMMUNITY CARE REVIEW

in focus

Knocking down language barriers Harnessing the potential of community radio is one initiative being piloted to educate multicultural communities about aged care, writes LINDA BELARDI.

ilingual aged care experts are working with ethnic radio stations as part of a new project to boost awareness of the aged care system among culturally and linguistically diverse seniors. Terrie Leoleos, program manager of the Speak My Language initiative, says knowledge of the service system – and in particular My Aged Care – is low in many migrant and refugee communities, with language and literacy a key barrier. “The program is about building confidence, awareness and understanding of the aged care system among communities and seniors,” she tells Community Care Review of the project, which launched in March. “It’s also a call to action. We hope the information our listeners receive hits home enough for them to seek help.” For many older people, ethnic radio is an accessible and trusted source of information and is frequently rated 12

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highly as the preferred medium for communication, Leoleos says. The pilot is targeting 25 languages, across 80 ethnic radio stations in four states and territories – NSW, Victoria, Queensland, Tasmania and the ACT. Bilingual facilitators with aged care expertise will work with radio hosts to produce a six to 14 week on-air program on aged care and healthy ageing topics.

“It’s a model that puts communities in the driver’s seat.” A key part of the bilingual facilitator’s role will be to find aged care experts, professionals and consumers who speak a second language to share their stories and have on-air conversations. “It’s a model that overcomes the barrier of language and puts communities in the

driver’s seat. They get to drive messages to their own communities and they know how best to deliver those messages,” she says.

A SHARED JOURNEY Leoleos says critical to the program will be the sharing of consumer experiences. “We hope that people sitting in their lounge room at home listening to a story will say, ‘that sounds like me.’ And where they may sit at home and feel there is no hope, they will hear somebody in their own language say, ‘I have been there and this is how I overcame these obstacles.’ It’s those stories that make change. “It normalises what seems to be a very individual situation and emphasises the message – ‘you can reach out and this is the kind of help that is available for you’”. Based on extensive consultation, a series of 14 popular aged care topics were identified for discussion on air. These include accessing the My Aged Care gateway, understanding assessment and

in focus services, planning for the future, consumer rights and responsibilities as well as topics such as dementia and elder abuse. “Given the Commonwealth’s focus on wellness, reablement and restorative approaches, we would like to demystify what that means to our clients and embed that into many of the key messages and stories that we tell,” she says. To extend the content’s reach, the recorded conversations will be available to download as a podcast from speakmylanguageradio.com. In-depth panel discussions with guest speakers will also be available to download through the speak my language virtual café series. The project is a collaboration between the Ethnic Communities Council (ECC) of NSW, ECC Victoria, ECC Queensland, the Special Broadcasting Service (SBS) and the National Ethnic and Multicultural Broadcasters’ Council. The two-year pilot received a $1 million Dementia and Aged Care Services grant from the Federal Government to develop its community education model and training resources for hosts and bilingual facilitators. Leoleos says the pilot’s evaluation will help inform the rollout of a national model. Researcher and consultant Carrie Hayter

says the Speak My Language initiative is a welcome development. Hayter has recently completed a research project on the experiences of service providers across South West Sydney on navigating the community care reforms. Educating and empowering older people and their carers, particularly from CALD backgrounds, to know how to access and engage with the aged care system was the most commonly reported issue from providers, says Hayter. She says the needs and perspectives of older people from CALD backgrounds, including older refugees demand more attention in public policy. Considering that one in three people over 65 were born in a non-English speaking country, these issues are not a minority concern for the aged care system, she says. In addition to the Translating and Interpreting Service (TIS), Hayter advocates for the My Aged Care contact centre to actively recruit bilingual staff, similar to the operation of Centrelink’s multilingual phone service.

MAJOR REPORT HANDED TO GOVERNMENT Tackling some of the systemic barriers

facing CALD seniors, a two-year long investigation undertaken by Partners in Culturally Appropriate Care (PICAC) has made six recommendations to government to improve the accessibility of the aged care system. The My Aged Care CALD Accessibility report submitted in late 2017, which the government is yet to release, recommended: • setting up information hubs in shopping centres and at community events • delivering community education programs in consultation with community leaders • making cultural competency an accountability measure for governmentfunded aged care service providers • translating information in community languages, which is also supported by access to the TIS and bilingual staff • targeting community groups using most appropriate technologies and media • establishing one comprehensive assessment process that uses welltrained and culturally-competent staff and interpreters. The Department of Health told CCR it was considering the report’s findings and acknowledged more could be done in some areas. n

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COMMUNITY CARE REVIEW

opinion

Home care reform: hits and misses Lengthy wait times and gaps in navigation support have emerged as critical issues in the ﬁrst 12 months of the government’s aged care changes, writes JEREMY MCAULIFFE.

Portability of packages has been effective, with ample anecdotal evidence of consumers electing to transfer from one provider to another. There is no data on the full extent of portability movements, but for Benetas, portability has been a relatively small proportion of overall movements. As might be expected, consumers opting to switch providers peaked in the months after the changes commenced and subsequently slowed. Importantly, it’s there and working for consumers, so a win for the program. t’s a year on since the Federal Government introduced the Of interest are the drivers of client movements. They are a Increasing Choice in Home Care (ICHC) reforms to improve the mixed bag and include dissatisfaction with existing arrangements, way home care services are delivered to older Australians. As the pursuit of a better deal (fees particularly), relocation to name suggests, the changes were designed to enhance another area, and convenience (for example, couples consumer choice through the introduction of funding consolidating care to a single provider). An interesting following the consumer, package portability, and more consequence is client transfer to newly approved timely access to care. providers that had previously been an informal partner Ultimately, the reforms sought to progress long-term (retirement living is a prime example). policy directions proposed by the Productivity Commission There is no doubt funding is following consumers. in 2011 and subsequently advanced through various Packages are now assigned to consumers who subsequently elements of the 2012 Living Longer Living Better reforms. select a provider. Another win for the ICHC reforms. It is timely now to reflect on the extent to which ICHC is Underlying this, however, are some unexpected outcomes. achieving its intended outcomes. Enhancements to the My Aged Care (MAC) service Jeremy McAuliffe

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opinion finder aimed to give older people more information, including details of fees and charges, service availability and specialisations. However, it is very evident choice remains a challenge for many consumers. A significant proportion of home care clients don’t know how to respond following assignment of a Home Care Package by MAC, and many wait until the close of the 56-day acceptance period to act. An unfortunate consequence of this has been the withdrawal of packages, and the subsequent anxiety arising for both consumers and providers, especially when wait times have been lengthy. What best guides consumer choice remains a complex matter and perhaps one of the reform’s grey areas. The Tune Review zeroed in on this and referred to the need for “a system navigator and outreach services”. The recommendation has merit and can be implemented in a number of ways, extending beyond the independent service proposed by David Tune. More consumers are contacting Benetas’ customer centre prior to engaging with the aged care system, and ahead of being assigned a package, to make enquiries and shop around. Our responses to enquiries are now more timely and purposeful, consistent with system navigation concepts and customer support principles. There is an equally strong focus on the service offer of other providers, with competitor analysis and mystery shopping initiatives being undertaken by providers. In this sense, the Productivity Commission’s want for increased competition and a more marketbased sector is beginning to play out. Reform will claim this as a win.

ENHANCING CONSUMER SUPPORT Without question, the most significant outcome of ICHC to date has been the increased visibility of the number of consumers awaiting care and the wait times for care. Contrary to favourable satisfaction levels recently reported by market research firm AMR, consumers supported by Benetas express significant concern about wait times whether this be for assessment, approval or assignment of care. The extent of unmet need is now well-documented and has attracted volumes of comment. Given the gap between supply and demand, and considering package turnover rates, without a substantial increase in the total number of packages available, wait times can only blow out. A large and growing number of waitlisted consumers are in receipt of an interim package, receiving some care but less than their assessed entitlement demands, and at the expense of consumers assessed for a lower level of care. This is a further expression of the supply and demand shortfall. The total amount of care available remains a challenge for government but there is opportunity to maximise take up of the care that is currently available. We should look to what can be done to enable the earliest commencement of care, post assignment of a package. On the surface, the allowable 56-day acceptance period (with a 28-day extension) provides time for consumers to make important decisions about providers once a package has been assigned, but it also arguably delays starting care where the full 56 or 84 days are utilised. Consumers are usually waitlisted for extended periods of time prior to package assignment, and there is opportunity to utilise wait times by introducing requirements for consumers to nominate a preferred provider ahead of being assigned a package. The introduction of a letter to provide advance notice to consumers of forthcoming package assignments is a positive move. This could go a step further asking consumers to advise MAC of their preferred provider ahead of assignment. For consumers, what needs to be worked through does not change, however their readiness to accept an assigned package quickly is accelerated

For providers, early engagement with consumers and a role in system navigation would be universally welcomed. This seems like an easy win for the ICHC changes.

UNSPENT FUNDS We shouldn’t lose sight of the need to use available funds as well as possible. The level of home care package underspend is not reported and may be unknown, but anecdotally providers speak of substantial and increasing funds held in surplus. There are many ways of assessing the cause and consequence of unspent funds, but in any sense unspent funding is a lost opportunity to meet care needs. As the ICHC measures didn’t set out to address this, it is a call to action for the Australian Government if the full intent of aged care reform is to be realised. There are a number of considerations for the Commonwealth such as whether it needs to look at a different funding model, rethink how people are assessed, what to do with surplus amounts, and address the client mentality of “saving for a rainy day”.

BUDGET MUST DELIVER The extent to which access to care has changed is a moot point. More consumers engaged with the aged care system, assessment for a specific level of care, visibility of wait times, service finder enhancements, and genuine choice of preferred provider are positive changes to the system. These achievements, however, are compromised by the growing demand for care. We look to the May Federal Budget for a response to the Tune Review, as well as a significant boost in package numbers to ease the bottleneck of more than 100,000 older Australians waiting for care at the level they need. n Jeremy McAuliffe is general manager home care at Benetas.

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opinion

Taking choice and control a step further A growing number of operators in the market are facilitating older people and their families to manage their own package, writes ROSS MCDONALD.

he choice and control now given to home care package recipients is a welcome game changer. However, the program doesn’t offer quite as much independence as the National Disability Insurance Scheme. In the NDIS model, individuals can choose to self-manage their funding, with or without administrative support. And with limited exceptions, the NDIS has no mandatory requirement for a coordinating organisation. So, what does a self-managed home care package look like? The key features exist for home care packages to be consumer-led. For example, individuals with a home care package can currently choose: • their provider and whether they wish to change providers at any stage; • how they want to spend the monies, in a manner significantly more flexible than the NDIS as the money is not allocated to specified areas; • who and when services are delivered, and • how much they pay. However, pure self-management, where the consumer manages their own care plan and budget, has not yet happened. There are a number of elements holding this development back. These include: • the custom that providers ‘package’ administration and case management services together • the legacy of many providers using their own staff for services • the legislative duty of care put on providers of home care packages and subsequent staffing and risk management overheads • limited integrated technology options, incorporating scheduling, invoice approvals and payments. Some providers are currently offering ‘bare bones’ home care management services. The assumption being that the care recipients will not be requiring frequent support and will largely manage the care 16

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delivery themselves within the agreed budgets. In return, the case management fees are significantly lower than other clients who require higher levels of care. But even the bare bones home care management services still have management fees. These include administration and case management amounts that in some cases exceed 20 per cent of the funding. However, this is still significantly below an approximate industry average of 30 per cent with some operators charging above the 50 per cent mark.

“What we will see in the future will be similar to the deregulation of the superannuation industry.” Change to pure self-management in the industry is no longer an if, rather a when. Developments in the industry are already visible with: • New entrants. These new home care providers aren’t necessarily following the industry script around administration and case management charges. Many are simply costing in one management fee and others are charging only for administration. If case management is requested, this will be added as a cost or an independent case manager will be sought. • Organisational cultures are changing. Many service providers are making their case managers more independent to that of their direct care staff, to the benefit of the care recipient. Providers are becoming more flexible with the ability to use other organisations where there are service and price benefits compared to in-house options. • Home care provider duty of care is increasingly being supported by advances in technology. Some examples include

online care worker verification services that provide reference, qualification and police checks, client wellness monitors via clockout processes, telehealth, personal alarm/trackers, home sensors, and carebots (friendly interactive robots). • Software is appearing that claims full integration of home care provider administration requirements. What we will see in the future will be similar to the deregulation of the superannuation industry. The superannuation services started providing a range of options from self-managed to more premium offerings. Changes in super were also the result of government deregulation and technology advances. It won’t be long before providers appear in the marketplace with pure selfmanagement options. They will allow care recipients and their informal carers to: • have a single low administration fee. For example, a fee of 4 per cent of the total package value is being charged by Local Guardians, related to Capital Guardians, which requires complete self-management or clients to either competently be their own case manager or bring in an external case manager • manage with or without case management services • select their own case manager, as approved by the provider, and most likely an external provider who has demonstrable strengths in care and governance • bundle up the offering with easy-to-use software and an integrated care and financial management tool • get value added freedom with debit cards, and other similar types of cash out options. The only question remaining is whether it will be months or years before these solutions are standard. n Ross McDonald is the founder of Capital Guardians, a provider of financial management services to aged care and disability operators.

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As part of the three-hour EDIE workshop participants are provided with an immersive experience that enables them to see firsthand the challenges faced by people living with dementia and their families. The EDIE app explores a moment in time as Edie, a person who is living with dementia, faces difficulties undertaking simple activities of daily life. Participants are able to develop unique insights into how to improve their

cover story

dementia practice and ultimately achieve positive outcomes for people living with dementia. There has been growing uptake and increased interest around the EDIE workshops among home care workers, Director of the Centre for Dementia Learning at Dementia Australia, Dr David Sykes says. “The importance of dementia education is increasing, given the majority of people with dementia are living at home and the scenario used in EDIE is one they are familiar with.” Dr Sykes says the benefits to the home care workforce are significant as this new education tool delivers helpful insights, for example, first and foremost what it is like for someone living with dementia at home. “From these insights participants are able to identify how they can improve their practice to better support those living with dementia. “VR is a great learning aide which enables participants to be engaged in a way which cannot be achieved through more traditional formal workshops or online learning.”

The workshop has been designed to achieve a number of outcomes, including: • a greater understanding of dementia across various stages; • a consumer perspective of dementia support; • how to identify support needs in partnership with the client and their carer; and • how to develop a dementia support plan with a focus on enabling a person to live more confidently with dementia.

DEMENTIA AUSTRALIA - THE NEW VOICE OF ALZHEIMER’S AUSTRALIA Dementia Australia (formerly known as Alzheimer’s Australia) is the peak,

“The importance of dementia education is increasing, given the majority of people with dementia are living at home.”

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cover story aimed at addressing the gaps in mainstream services. Dementia Australia is a member of Alzheimer’s Disease International, the umbrella organisation of dementia associations around the world. Commenting on the name change that took place last October, Dr Sykes says it has been well received by people living with dementia, carers, family members and healthcare professionals. “It now recognises the support we offer to people with all forms of dementia, not solely Alzheimer’s. “As a single organisation we can have a greater impact and a stronger voice as well as offering better services and greater reach to better represent the people we serve.” He says while there are still Alzheimer’s associations in the UK and US, Australia has shown international leadership in moving to change the name.

non-profit organisation for people with dementia and their families and carers. They represent the more than 425,000 Australians living with dementia and the estimated 1.2 million Australians involved in their care. Dementia Australia works with consumers, all levels of government, and other key stakeholders to ensure that people with dementia, their families and carers are appropriately supported – at work, at home (including residential aged care) or in their local community. Their close engagement with consumers means that Dementia Australia is an important advocate for those impacted by dementia. The peak organisation is also well-placed to provide input on policy matters, identify service gaps and draw on its expertise to collaborate with a wide range of stakeholders, including researchers, technology experts and providers. In addition to advocating for the needs of people living with all types of dementia, and for their families and carers, Dementia Australia provides support services, education and information

Building community awareness of dementia

One of the big issues surrounding dementia is that despite two-thirds of people acknowledging that someone close to them had a dementia diagnosis, awareness and understanding of dementia remains low. A recent survey undertaken by Dementia Australia found that while the prevalence of dementia is increasing, a majority of those surveyed did not understand the relationship between Alzheimer’s and dementia. “Dementia is the most significant chronic disease facing us, but the least recognised and understood,” Dr Sykes says. “In 2018, there are 425,000 people living with dementia and 250 diagnosed daily. Every three seconds someone in the world is diagnosed with dementia” “These surveys help us to get some clarity on community understanding around dementia and what we need to address, and more importantly what the community and government need to address. It is an important lobbying tool.”

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AUTUMN 2018

A NATIONAL APPROACH TO LEARNING As part of Dementia Australia the Centre for Dementia Learning has been

established. The centre builds on over 30 years of experience and, for the first time, provides national access to a comprehensive suite of evidence-based learning and consultancy services to help improve the quality of support and quality of life experienced by people living with dementia. A new online learning hub, www.dementia.org.au/CDL with access to a suite of online learning programs, the latest journal articles, conference presentations, podcasts and YouTube clips, enables people to stay across contemporary practice changes in dementia care and support that apply to home care, residential and acute health sectors. Dr Sykes says a major UK study on

cover story ‘A new layer of understanding’ Sara McDonald, a case manager with Sacred Heart Mission, says attending Dementia Australia’s Enabling EDIE Workshop has changed the way she approaches her work. “It really hit home for me that this is what a person is experiencing 24/7. I get to take the headset off but a person with dementia is living with potentially constant confusion of noises because of the lack of ability to filter – a ticking clock might be a pounding noise for them, a long dark shadow might be scary or look like a big gaping hole. “All these examples combined could easily make it challenging for someone to manage with what seems simple tasks to us. And if they are unable to communicate their fear or confusion that would add to the stress of any situation. “I know now that I can make a difference by influencing how the person in my care feels. “If I remain measured, calm and patient this sets the tone for the environment around us. “I’m not going to make major design changes in every home I go to, but I can step back and take stock of the lighting and other elements that might be causing confusion or creating tension.” An experienced social worker, McDonald says, “In my role with Sacred Heart Mission every day we are supporting people living with dementia in all types of settings – in their home, in cars, taxis or public transport, shopping centres, social settings and at appointments – any of these environments can be unpredictable. “By constantly assessing the settings I can best support someone by preempting what might cause some distress or confusion so I am potentially avoiding a situation that could escalate. “I didn’t know what to expect of the virtual reality training because I’d never done anything like it before. “It totally resonated. “Even though I was in a training room with other people, I felt lost and alone in this scary world … My heart was racing and afterwards I had to steady myself on the back of a chair. “To experience dementia in virtual reality gives you a new layer of understanding,” McDonald says.

“VR is a great learning aide which enables participants to be engaged in a way which cannot be achieved through more traditional formal workshops or online learning.” dementia education was recently released looking at what makes effective dementia education and found that the following were important elements: • the duration of education sessions • using face to face delivery with the opportunity for interactive activities and group discussion • delivery by experienced facilitators who are also experienced in dementia care. “This is a great affirmation for the approach taken at the Centre for Dementia Learning being the right approach for maximising the effectiveness of education,” says Dr Sykes. “It is very much a partnership approach with providers who need to be able to include opportunities to apply the learning in practice for the knowledge translation to occur.” He says mobile learning helps to overcome many of the barriers facing the home care workforce in undertaking further education, such as the dispersed nature of the workforce. “The nature of the sector means that it does not have a workplace with their workplace being someone’s home. It is also a highly casualised and part-time workforce, often with limited or poor experiences with more formal education and sometimes having English as second language.” n

Contact Dementia Australia on the National Dementia Helpline: 1800 100 500

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ATSA Expo

The role of assistive technology gathers momentum Developing new strategies to deal with a more consumer-driven world is vital, DAVID SINCLAIR tells KYMBERLY MARTIN.

emand for assistive technology is growing and being shaped by the shift to a consumer-driven market, says David Sinclair, executive officer of Assistive Technology Suppliers Australasia (ATSA). “The industry will need to develop and refine suitable strategies to manage these changing demands,” he says. Each provider of assistive technology is encouraged to educate and equip themselves with the latest information. This is not just in the disability space but the ageing sector as well, as person-centred choice and control is embedded in both systems. “Assistive technology is an integral element for enabling people to fulfil their life goals and objectives, providing opportunities for all. The National Disability Insurance Agency has also recognised this with the recent release of a market insight that demonstrates the growth and opportunities for the AT sector in the context of the NDIS,” he says. According to the NDIS market insight, over 13,000 participants received AT from 800 registered providers in the year to June 2017. The NDIS assistive technology market is forecast to reach $1 billion in 2020. In 2016-17, personal mobility equipment such as wheelchairs and walkers and care product groups accounted for over 70 per

cent of AT expenditure. is government reform of vehicle Registered providers of standards, including mobility assistive technology also grew by access vehicles. 38 per cent in the quarter to 30 In February this year, the June last year. Minister for Urban Infrastructure The ATSA Independent Living and Cities, Paul Fletcher 2018 expos have been designed introduced five bills into to support the industry in this Parliament to replace the existing Motor Vehicle Standards Act. time of change, providing quality David Sinclair, ATSA The aim is to provide increased education and highlighting executive officer consumer choice through advances in assistive devices. expanding and improving the The industry body also pathways for importing specialist and expects growing consumer interest in the enthusiast vehicles including performance, expos and has included several consumer low emissions and mobility access vehicles. education sessions at each event. This legislative package, which is According to Sinclair, two important intended to come into effect from 2019, Federal Government undertakings should is the most important set of changes to not be overlooked in early 2018. The first the Australian Government’s regulation of is the Senate inquiry into the need for motor vehicles in almost three decades. regulation of mobility scooters by the Consultation on the draft bills closed in Rural and Regional Affairs and Transport mid-February. n References Committee The ATSA Independent Living Expos “The inquiry should focus on the real 2018 will be held at the Melbourne issues – education and infrastructure and not Showgrounds on 16-17 May and the just the mobility device itself,” says Sinclair. Perth Claremont Showgrounds on “We need to consider how and why these 30-31 May. For a list of exhibitors devices are used, not simply their speed and full conference program go to and weight.” atsaindependentlivingexpo.com.au. Sinclair says he is concerned about the Community Care Review is an event potential for overregulation. media partner. The second development taking place COMMUNITY CARE REVIEW

ATSA Expo

Building a user-led community on assistive tech A new project is demonstrating the potential of peer-led information sharing around assistive technology, writes LINDA BELARDI.

he Independent Living Centre WA has launched a new initiative to change the way people with disability access advice and information on assistive technology. The project called AT Chat is building an online community where people with disability can learn and share information about assistive technology from other users. Project leader Danielle Loizou-Lake, an exercise physiologist, says the project is challenging traditional models of information sharing and advice. “The difference with this initiative is that it’s peer-to-peer information-sharing and that’s the essence of AT Chat,” she tells Community Care Review. The project is being led by a group of people with disability who are all users of assistive technology, and more than 300 West Australians with disability were

Emma McKinley, a speech pathologist with ILC WA demonstrates the latest in eye-gaze technology.

consulted as part of the project’s development. Loizou-Lake describes the project as a “landmark initiative” that is advancing peer support models to build capacity for people with disability. Participants were consulted for the project through focus groups and a survey. They reported social media, and in particular Facebook, was their preferred method for receiving and sharing information.

MULTIMEDIA CONTENT AT Chat Facebook’s page (@atchatwithus) posts weekly video content on a wide range of topics such as AT for sport and recreation, accessibility features of smart devices and

The AT Chat team (back L-R) Zel Iscel, Danielle Loizou-Lake, Neil Berrick, (front L-R) Joscelyn Franciscus and Nick Passanisi.

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innovation in eye-gaze control technology. The videos include two series: AT + me, which captures real-life stories of people with disability and how they use their assistive technology and Tech Tuesday, which features an expert discussing the functionality and uses of certain types of assistive technology. The aim of the project is to normalise the use of assistive technology and encourage others to consider its possibilities, says Loizou-Lake. “The theme of AT Chat is ‘live, play, work’, so it’s about how AT supports people to live their life, participate in sport and recreational activities and in business and employment,” she says. The project sends the important message that people with disability are capable contributors and assistive devices can play an important role in enabling people to participate in everyday life and pursue interests, she says. In recent videos, para-equestrian dressage rider Fleur Litster discusses the assistive equipment she uses to ride and compete with her horse Gus. While fellow assistive technology user Clint Morgan outlines the range of devices he uses daily to stay active, including getting out on the driving range to play golf. Some of AT Chat’s short videos have been viewed more than 8,000 times and all posts include links to the equipment and devices mentioned. “All of our content shows people living

ATSA Expo too tricky, we tag in an expert from the ILC WA to help, such as a speech pathologist or occupational therapist,” she says. AT Chat distributes an online newsletter and hosts face-to-face gatherings to continue the conversation offline. Loizou-Lake says the consultations identified access to information as the biggest barrier to utilising assistive technology. Cost and follow-up support were other obstacles named.

ANALYSING THE DATA The AT Chat team is working with the University of Western Australia to analyse and publish the data gathered during the three-month consultation. In the middle of the year an evaluation of the project will determine its impact on increasing pathways to information to help with decision-making around assistive technology. The project received funding from the Disability Services Commission in WA, which ends in June. The short videos are also accessible for people with a vision or hearing impairment. Danielle Loizou-Lake and engagement officer Joscelyn Franciscus are presenting on the initiative at the ATSA Independent Living Expo in Perth on 30 May. n

Consumer focus groups on the use of assistive technology were held across WA. Project officer Danielle Loizou-Lake is pictured with participants in Broome.

their lives,” says Loizou-Lake. “We never focus on the disability; you’ll never know what a person’s disability is unless you pick it up yourself because it’s not about the disability, it’s about the person and the interests and activities they are engaged in.” Loizou-Lake says about 70 per cent of people that engage with AT Chat have a disability, while the rest are searching for information on behalf of a friend or family

member, which highlights a role in increasing awareness of assistive technology. The videos are also being watched by a wide range of age groups, including among 45 to 65 year olds. The project, which officially launched in October, has also set up a Facebook group called Chatterbox where people with disability solve each other’s problems around assistive technology. “If the problem becomes

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ATSA Expo

Resources in the works to boost take-up of smart devices By Linda Belardi

national project is underway to improve the awareness and use of smart technologies among people living with dementia in the community. The initiative by Queensland-based social enterprise LifeTech is developing a suite of online resources for people with dementia, their carers and service providers. The project secured funding in the Federal Government’s latest Dementia and Aged Care Services funding round and will create eight self-paced online learning modules, as well as videos and fact sheets on the uses families will engage with these of smart assistive technologies. resources and that aged care Digital stories will also capture organisations will utilise them consumer and carer experiences to upskill their staff in working of using the technology, which alongside people who are can include tablet devices, home technology users.” monitoring systems and smart She says the community speakers with voice-controlled care workforce has an important personal assistants, according to role to play in supporting the Zoe du Cann, LifeTec’s learning and Zoe du Cann uptake and ongoing use of smart development coordinator. technology but staff skills and knowledge in “The resources will explore the use this area is low. and benefits of smart technologies for The free resources to be released later people living with dementia and also cover this year will be peer reviewed by people considerations on how to choose and with dementia. implement these technologies,” she tells Community Care Review. du Cann says limited awareness of the “We are hoping that consumers and smart technologies available and their

potential benefits hampered their use among people with dementia and their carers. “People need access to information about technology options, particularly considering the enormous range and often overwhelming diversity of technologies available,” she says. Among the rapidly growing market are smartphone apps, monitoring devices such as GPS watches, and in-home sensors that can detect falls and environmental hazards. The online learning modules will be broken down into shorter segments to allow people to select topics of interest, as well as engage in deeper learning. Capturing digital stories of people with dementia and their carers will provide an opportunity to better grasp their technological needs and wants, she says. “There is more work to be done in terms of understanding the priorities of people with dementia and hearing their voices.” Aside from information, other barriers to using smart technologies can include cost, ongoing support in maintaining and troubleshooting devices and reliability, she says. n Zoe du Cann is presenting on advances in smart technologies for people living with dementia at the ATSA Independent Living Expo in Melbourne on 17 May.

Harnessing the potential of virtual reality By Kymberly Martin

DISABILITY SERVICES provider the Endeavour Foundation is demonstrating the benefits of using virtual reality (VR) to develop the skills of people with disability in a kitchen environment. Using equipment from the US, and only just being released in Australia, users don a special VR headset that is connected to a laptop or desktop that immerses them into a 360-degree world to interact with virtual items. “A person with disability can move into the virtual world to simulate any number of tasks within a safe environment where we can support learning and correct any mistakes,” says the Endeavour foundation’s Stewart Koplick. “The beauty of VR is that it allows you to make these mistakes several times within a safe environment until the process is right, which you cannot do in a real kitchen without some risk,” he tells Community Care Review. He sees VR as new mode of learning that is interactive and engaging. “While you can do online and school-based teaching, VR goes beyond that because it makes learning more effective

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and uses technology which young people are interested in. It is possible to create any scenario from real life virtually. And as technology continues to evolve, it is not just about recreating a visual experience but a physiological one as well,” he says. Stewart Koplick is presenting on the opportunities of virtual learning environments and simulation at the ATSA Independent Living Expo in Melbourne on 16 May.

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wellness

Pushing ahead with reablement focus Successfully embedding a wellness approach into community aged care requires a coordinated, holistic approach, writes ROXANNE GELLE.

the aged home care sector that was completed in June 2017 by Nous Group. This review gained information on the sector’s current understanding and uptake of wellness and reablement. The Living Well at Home: CHSP Good Practice Guide, first published in 2015, also advocates for service providers to use a wellness approach, which “involves assessment, planning and delivery of supports that build on the strengths, capacity and goals of individuals, creatively addressing problems or ellness and reablement are key values of the barriers and encouraging actions that promote a level of Commonwealth’s home support and home care independence in daily living tasks, as well as reducing packages programs. As these programs continue risks to living safely at home.” to operate and we enter a new phase of developing a The guide goes on to define reablement as “timecombined service from mid-2020, more attention is being limited interventions that are targeted towards a given to how we provide services. In particular, how do we person’s specific goal or desired outcome to adapt to enable people to continue to live a good life in the place some functional loss, or regain confidence and capacity of their choice? to resume activities.” The introduction of the Regional Assessment Service Roxanne Gelle THE EVIDENCE (RAS) provided an opportunity for a specifically trained The recent legislative review of aged care reform workforce to champion the wellness approach. RAS undertaken by David Tune recommends: assessors, independent to service providers, use the National “the government and providers work to improve access to wellness Screening and Assessment Form (NSAF) to determine people’s care and reablement activities to provide greater choice and better support needs and the types of services and supports that would assist a for consumers to live independently.” (recommendation 29) person to live well in their community. A support plan is developed The concept of embedding wellness and reablement into the and used to inform referral to various service providers (this could aged care sector is viewed internationally as an important strategy be to CHSP-funded organisations or other services available in the to reduce the cost of services for consumers and, through tailored wider community). assessments, aims to enrich consumers’ choices and suggestions Providers may be funded for one service type or several. Where for more appropriate services. a consumer requires many service types, there may be a need A plethora of government reviews and reports has been for several different service providers to be involved. Although undertaken over the past 12 months, with many referring to the all providers can offer services guided by a wellness philosophy, importance of wellness philosophies in aged care services. Of note, the use of many providers can complicate and impede the is the national review of wellness and reablement approaches within implementation and oversight of a reablement-style of service.

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wellness ROLE OF ALLIED HEALTH Allied health and nursing professions are well versed in wellness, reablement and restorative care. Occupational therapists aim to positively support and enable functional independence of people with a wide variety of disabilities resulting from disease, injury and age-related changes that may impact on their ability to participate in occupations of daily living. OTs work as members of a multidisciplinary team to assist consumers to understand their strengths and abilities, as well as difficulties they may have performing various activities. The main aim of allied health is to assist people to live well and enable participation in chosen activities. With a focus on social and health issues, allied health professionals aim to assist a person to regain and/or retain their independence, adapt to changing health and ability levels and/or learn new skills. Strategies to achieve this may include review of nutrition, assessment of mobility and physical function, prescription of assistive technology, provision of exercise programs, home modifications to improve access, education and practices to learn new ways of doing activities.

WELLNESS, REABLEMENT AND RESTORATIVE CARE Clarifying the concepts of wellness and reablement and what they offer is important. The broad overarching wellness approach can be practiced by knowledgeable personnel when providing any service. Reablement support provided within the wellness approach is a strategy that requires a considered review of how a person is functioning in their community. An example of an intensive reablement service is the federallyfunded Short-Term Restorative Care program that was introduced in 2017. This offers an 8-week targeted program to improve functional independence. However, there are limited places nationally for this program. The CHSP is a less formal opportunity to offer a reablementstyle service that is short term and responsive to client needs. Providing services with reablement in mind requires knowledge and understanding of evidence-based strategies that can assist people to achieve their goals and interact more fully with their environments, principally to do the activities they want, need and like to do.

packages. The amalgamation of the RAS and Aged Care Assessment Teams would create a more streamlined assessment process for consumers and deliver better quality services for older Australians. We believe an integrated program would enhance opportunities to adopt a reablement focus in the delivery of home care.

LEARNING FROM WA Western Australiaâ&#x20AC;&#x2122;s Home and Community Care program is transitioning to the CHSP on 1 July 2018. While the current model is like the CHSP, in that the RAS provides an initial assessment, a distinct difference in WA is that where support services are required the RAS remains involved for six to eight weeks to guide and monitor the implementation of a reablement plan. Essentially, WA has aimed to provide a reablement assessment service at the point of entry to community aged care services and look at a range of evidence-based strategies to assist people to regain independence using a time-limited plan. Ongoing support is based on the outcome of this initial period of intervention. To enable people to make better choices that are tailored to their personal situations, Occupational Therapy Australia believes the inclusion of a short-term service that can provide initial expert knowledge, guidance and monitoring of support needs (such as that provided by the WA model) would be beneficial. Generally, people look to access aged care services following a significant health event in their lives that has changed their ability to complete everyday activities. This initial time-limited service could enhance the sharing of information and provide an opportunity to facilitate better outcomes for people as they navigate through aged care services in the future. n Roxanne Gelle is an Occupational Therapy Australia representative on the National Aged Care Alliance (NACA).

AN HOLISTIC APPROACH Implementing wellness and reablement support cannot be successful with isolated services. Allied health is one part of a broader team that work collectively and in collaboration with a consumer, their family or community networks and employed care workers. David Tuneâ&#x20AC;&#x2122;s review has identified several requirements that need to operate in synergy to provide wrap around services from a well-trained workforce that is responsive and supportive of changing physical, social and emotional wellbeing to enable people to continue to live independently and well in the community.

SYSTEM CONSTRAINTS While the CHSP contracts service providers to deliver specific service types funding has not been available to coordinate, liaise or oversee the outcomes of interventions provided. For example, where a referral is made to an OT for a program to assess and improve independence, outcomes of recommendations and interventions may be improved when specific consumer goals are implemented and supported by other members of the home care team. Access to care coordination and a service to oversee the changes in support needs would increase the opportunity for reablement. Occupational Therapy Australia fully supports the creation of an integrated care at home program to replace the CHSP and home care COMMUNITY CARE REVIEW

one on one Profiling people in community care

Embracing local solutions Provider executive TRACEY SILVESTER talks to LINDA BELARDI about reform, innovation and expanding choice in community care.

he transparency of the home care package waitlist is a welcome development and will be critical to future government planning, says Tracey Silvester, executive manager of Queensland provider Envigor Home Care. Reflecting on the first 12 months of the Increasing Choice in Home Care changes, which commenced in February 2017, Silvester says visibility of unmet demand for home care packages is an important step forward for the sector. However, the Federal Government must now act to address the large number of older people currently without access to any services. The return of some 13,000 unoccupied packages to the national pool from 27 February 2017 was also a positive move to better align need with demand, she says. Tracey Silvester As intended by the reforms, consumers are also starting to exercise their right to switch providers. “We have had nearly 300 people move their package across to us in the first year of the changes, so we can see that consumers are making a choice about who they want their provider to be.” However, the rollout of the changes has been hampered by administrative system issues leading to incorrect package withdrawals and the accumulation of significant unpaid subsidies. Incorrect package withdrawals have been distressing for consumers and time-consuming to have reinstated, says Silvester, who has previously held roles with Queensland Health and a number of community care providers in Queensland. In early February this year, Envigor was owed in excess of $150,000 in unpaid subsidies due to payment errors. “That has a significant impact on our cash flow.”

EXPANDING PORTABILITY INTO HOME SUPPORT Silvester says the choice and control available in the Home Care Packages Program is creating demand within the Commonwealth Home Support Program to offer similar opportunities. “There has been a lot of promotion about consumer-directed care, but it’s only for a percentage of the funding that is available in community aged care. “Consumers are expecting consumer choice, but they don’t get a true choice of provider if they are using CHSP services.” Silvester says Envigor held off on tendering for the CHSP in anticipation of the move to a single in-home care program from mid-2018, which was later delayed by the government. 30

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DISABILITY SERVICES In addition to aged care, the organisation, which was established in 2012, is also a registered provider of the National Disability Insurance Scheme, specialising in the care of older people with a disability. Silvester says clients who were eligible to transition to the NDIS wanted to stay with Envigor under the scheme, which prompted the organisation to become a registered provider. The majority of Envigor care staff work across both ageing and disability, which has the added benefit of adding variety to their jobs, she says.

A DIFFERENT BUSINESS MODEL “Our business model and our expansion strategy has been focused on creating local solutions to people’s care needs,” says Silvester. Envigor, which is the community care arm of Seasons Aged Care, operates as a network of small business units spread across the state with the autonomy to make local decisions. The business unit managers are encouraged to build strong relationships with their clients and communities to deliver responsive and individualised services, she says. As part of its local business partner model, the managers share in the profits of the business unit.

DIVERSIFYING INTO HEALTH COACHING Expanding its service offerings, Envigor recently launched a chronic disease management service for people of all age groups, which is enabled by a digital platform. “The monitoring service involves a team of registered nurses and trained workers with a background in aged care, personal training and health coaching,” says Silvester. The program aims to work with a client’s GP to improve a person’s motivation and compliance with important lifestyle and health changes via regular phone and videoconferencing support. A traffic light system notifies the team about a person’s progress and prompts a staff member to intervene if a client misses their medication or their symptoms escalate. “The clients can see what their health looks like all in one place via an app that sits on their smartphone. “Managing a chronic condition such as diabetes is hard work. We believe this is an opportunity to help people be accountable, take control of their health and improve compliance with their health regimes.” n

you & i It’s all about relationships

Help for a fresh start Case manager MARIANNE TROUPE enjoys thinking outside the box to meet the needs of home care client CHARLES WAINWRIGHT. MARIANNE’S STORY

harles started as a client with us in the beginning of last year. He had just had a second below-knee amputation and he was living in public housing and required extra support. When I first met Charles, it was about identifying what his needs were. He was in a one-bedroom unit that was not equipped for anyone with any type of disability. Charles Wainwright with Villa Maria Catholic His partner Trish, Homes case manager Marianne Troupe. who is his carer, was also commuting between her daughter’s place in Melbourne and Charles’ house because there was nowhere for her to stay. It was difficult for him, so we put in an application to the housing department for more appropriate accommodation and were sufficient, with his own independence. He told there would be a two-year wait. During does all his own shopping now, and his that time, Trish had a mini-stroke and was dishes at home. He has someone to come experiencing carer stress. I tried to move in and clean once a week, which is great. He the whole process forward and we were has a new level of autonomy and can make successful in relocating Charles to a larger his own decisions. unit in a different suburb of Ballarat, which I’ve noticed a massive difference in his was fantastic. It is a two-bedroom unit socialisation as he is able to get out of the and has full disability access. He has clear house. His partner is also able to come stay pathways to all rooms in the unit. The sink with him and is moving in full-time. We and stove are at his level and he is able to have helped Charles access a financial loan cook. The shower has also been modified to through Good Shepherd to purchase a car, meet his needs. so that when Trish comes to stay, she can Charles has always been active drive him. throughout his life, particularly walking, His new unit is also very close to a so it was important to work closely community centre, so he is now engaged with physiotherapists and occupational with computer courses and he is learning to therapists to focus on getting back his use a Breezie tablet. mobility. He was trying on the prosthesis There were two things he wanted to do but that was very difficult for him. It also in learning digital skills. The first was to takes time, so he used his funding for a connect with his daughter in Perth through motorised wheelchair. We were also able to Facebook, which he has been able to do. get him an adjustable bed, which enables He is also able to connect with friends that him to get out of his wheelchair. he hasn’t had contact with for a very long We have set Charles up to be very self-

“He has a new level of autonomy and can make his own decisions.”

time. He also wants to find his family. Charles was adopted, and his family was in Canada, so we funded an ancestry.com membership for him. We will also talk to the Canadian embassy to try to track down the information he needs so he can continue with that process. It’s been so fulfilling to help Charles get back to what is important to him and enable him to stay at home and fulfil his goals.

CHARLES’ STORY I was in hospital and the transition care program put me in touch with Marianne. The support I receive has had a really good impact on my life. I’m more independent now. I can do what I want to do. I’m not stuck at home all the time. I cook, I have my own shower, and do everything myself. I wanted to learn the computer. I’m getting there, slowly. It’s confusing sometimes, but I’m getting there. I’m going back this year to do more computer courses. I’m also going to the Men’s Shed because I like carpentry. It’s great because I can get out once a week to the Men’s Shed and that gives me a day of doing something. I’m happy that Marianne has done that for me. I’ve also started researching my ancestry. I was adopted when I was four years old. I just got the paperwork. I only have three sisters left, but I have to try to find out where they are. I’m having a bit of trouble with my father’s side of the family because I don’t have his parents’ details. I only have the year that he was born and the year that he died, so it’s making it very difficult. I have regular meetings with Marianne where I talk about what I need. I like that I can have a say and we can plan my package together. n As told to Linda Belardi COMMUNITY CARE REVIEW

education & training Resources, programs & professional development STRATEGIES FOR SUCCESS with Lorraine Poulos

How to prepare for the new quality standards M

ost of you would be aware of the new draft single set of quality standards called the Aged Care Quality Standards, which are designed to replace the four sets of standards currently covering residential care, home care, the National Aboriginal and Torres Strait Islander Flexible Aged Care program and transition care. It is anticipated the new standards will be in place from July 2018 when the 12-month transition phase begins. Providers of human services are often required to meet several sets of standards in order to receive government funding. The new standards will hopefully streamline this process in aged care. At Lorraine Poulos and Associates, we are currently developing an easy mapping document to assist providers to understand and implement the changes. I hope the following observations and suggestions assist as you prepare for the introduction of the new standards.

NEXT STEPS According to the health department, providers will be supported during the transition period and are encouraged to: • align their system, policies and practices with the new standards • support staff to understand the requirements of the new standards • support care recipients and their families, carers and representatives to understand what the changes mean for them. The Australian Aged Care Quality Agency and industry peak bodies will be supporting providers and consumers to implement and understand the new standards.

WHAT’S NEW? If we compare the Home Care Standards and the draft Aged Care Quality Standards 32

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there are many similarities and some new requirements. Firstly, the current Home Care Standards have always had a strong consumer focus with Standard 3 – ‘Service user rights and responsibilities’ being a key part of the framework. The new standards include a consumer outcome statement which is an indication of the future focus on outcomes for consumers. It is hoped this will encourage innovation and excellence in care provision. This is followed by an organisation statement outlining the overarching expectations of providers and a list of requirements organisations must demonstrate.

“Consider having a consumer advisory group to encourage a stronger consumer voice.” There are many similarities with the current standards and the draft new standards. For example, standard 8 – ‘organisational governance’ in the new framework covers areas such as risk management, clinical governance, continuous improvement, identifying and responding to abuse and neglect and ensuring clear responsibilities and accountabilities. Many of these requirements are included in the expected outcomes in the current standard 1 – ‘effective management’. What has changed is that there is more detail and a much stronger focus on protecting the consumer and their rights. Standard 2 in the current Home Care Standards – ‘appropriate access and service delivery’

Lorraine Poulos

can also be closely aligned with the new standard 2 – ‘ongoing assessment and planning with consumers’. The promotion of independence is a key component of the Home Care Standards via expected outcome 3.5 Independence. However, the new Standard 4 – ‘services and supports for daily living’ is more prescriptive and includes requirements relating to shared care. For example, the standard states that when others are involved in care there is a requirement for a more inclusive model and accompanying documentation. These examples should help you to review your current policies and practices and start to match them to the new standards.

SUGGESTIONS FOR PROVIDERS 1. Review your clinical care practices and governance framework. 2. Review your care plans when clinical care is provided and when care is shared with families and others. 3. Invest in an auditing program that aligns with the new standards. 4. Consider having a consumer advisory group to encourage a stronger consumer voice within your organisation and services. As many providers actively work towards achieving a model of care that is more centred around the needs of consumers, it is important that organisational policies match your practice. I believe the new standards will deliver better outcomes for consumers and raise the standard of care. As always, I welcome your feedback and suggestions. n Lorraine Poulos is a trainer and consultant with experience working with government and aged care providers. Contact admin@lorrainepoulos.com.au

resources Professional materials, guides, publications & other helpful tools Tips for simple assistive aids in the home THE INDEPENDENT Living Centre WA has released a consumer guide on simple assistive equipment and home modification options to support older people to remain independent at home. The Making Choices, Finding Solutions Guide provides useful tips and advice to help people to manage everyday tasks and common frustrations. The guide addresses a range of simple solutions that can be found in local stores and online to assist older people in the kitchen, bathroom, laundry and with outdoor tasks, dressing and housework. An everyday activities checklist helps users to identify their needs and common difficulties. Download the resource from ilc.com.au

New consumer guide for accessing the NDIS DEMENTIA AUSTRALIA has developed a resource to help people with younger onset dementia understand and navigate the National Disability Insurance Scheme. The toolkit guides individuals and their carers through the process of applying for the scheme and preparing a support plan. Maree McCabe, CEO of Dementia Australia, says the introduction of the NDIS offers people living with younger onset dementia options of choice and control over the services available. “However, for a person with cognitive impairment navigating this new system can be daunting and complex,” she says. “It is through consultation with our clients and the National Disability Insurance Agency that we have been able to develop this important resource to provide a pathway of support that ensures people are best equipped to maximise what is accessible through the NDIS,” Ms McCabe says. The resource, featuring case studies and a planning checklist, provides information and advice on developing goals and managing an NDIS plan. April Williams, a carer for her mother Christine, says the resource is targeted to the specific needs of people living with younger onset dementia. “Trying to understand the NDIS on top of caring for mum has been overwhelming. This toolkit offers case studies, a valuable checklist and help to understanding developing plans and goals. It will support people with younger onset dementia to get the best out of the NDIS and to live connected and fulfilling lives,” Ms Williams says. The resource for people with younger onset dementia and their carers was funded by the NSW Department of Family and Community Services. The toolkit is complemented by a short 5-minute video sharing the experiences of carers and people living with younger onset dementia. Visit dementia.org.au

Resources to support inclusive aged care SERVICE PROVIDERS with bilingual staff are being encouraged to register their service with a new online directory launched by the Centre for Cultural Diversity in Ageing. The directory aims to make it easier for consumers and carers to search for bilingual aged care staff who speak their language in their region. A second online tool, the Bilingual Agency Staff Directory, has been created to help aged care providers search for bilingual staff from other agencies to meet the language and cultural needs of their clients. Registration is free for approved aged care providers. Other resources launched by the centre include a set of standards for inclusive service delivery. The three standards provide a framework for embedding inclusive practice within aged care organisations. The Inclusive Service Standards were formally launched at the LASA Tri-State Conference in February and are available to download as an online resource. The centre’s popular Culturally Inclusive Aged Care Practice Guides have also been updated and are intended to be used by managers and staff to inform direct service provision. The practice guides set out key considerations for service providers and cover the following topics: • accessing interpreter services • communication • data and demographics • food and nutrition • leisure and lifestyle • living environment • spiritual support • working with bilingual staff. Access the series of resources from the Centre for Cultural Diversity in Ageing’s website. Visit culturaldiversity.com.au COMMUNITY CARE REVIEW

resources

Community action plan launched to tackle elder abuse THE FIRST ACTION plan developed specifically to assist the community to tackle elder abuse in Victoria was launched in February by Colleen Pearce, Public Advocate of Victoria. The plan, developed by the National Ageing Research Institute with support from Seniors Rights Victoria, the Office of Public Advocate, and community service providers, identifies gaps and sets out 10 priorities to address elder abuse. The priorities include the need to clarify the relationship between family violence and elder abuse; raise community awareness of elder abuse; increase ways to help older people disclose elder abuse without fear and provide education and training on elder abuse for all health professionals in health and aged care services. “Elder abuse is a serious problem in Victoria yet, like many issues that affect older people, it is treated as a second-class problem,” 20171102 Community Care Review NOV 123X88.pdf 1 1/02/2018 5:08:49 PM NARI director Associate Professor Briony Dow says.

“This action plan lays out simply what needs to be done to tackle the complexities of elder abuse by the community. It contains the views of older people,” she says. NARI research has shown that tackling elder abuse is difficult not least because older people do not want to talk about their experiences. “Many older people we have spoken to feel deep shame and fear further abuse,” Dr Dow says. The Elder Abuse Community Action Plan for Victoria has been funded by Gandel Philanthropy. NARI is currently undertaking work to design a new screening tool for elder abuse. Download the action plan from nari.net.au

Resources to improve delivery of palliative care TWO LOTS OF palliative care resources, including new standards, guidelines and support materials, have been released to support aged care providers. Palliative Care Australia launched the 5th edition of the National Palliative Care Standards and the Palliative Care Service Development Guidelines to help guide services, health professionals on delivering high-quality palliative care. The revised nine standards, down from 13, make it easier for health services to implement and report against the standards, PCA chief executive Liz Callaghan says. The standards stipulate the importance of access to community and inpatient-based services for aged care residents. The documents have been designed to complement work underway to update the National Palliative Care Strategy, which is due to be released later in 2018. The new standards and guidelines are available to download from palliativecare.org.au

TRAINING CARE WORKERS Elsewhere, Leading Age Services Australia (LASA) has launched Making Choices for Life, a training resource to help home care providers and staff adopt a person-centred palliative care approach. The resource includes videos and fact sheets on: • advance care directives • pain • diversity • emotional responses to death and dying and access to bereavement care and support. Download the resources from lasa.asn.au/palliativecare-resources.

CMY

SHARE THE GOODS

Do you have a resource that community care organisations and staff should know about? Send the details to editorial@communitycarereview.com.au 34

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cover story cover story

Autumn 2018

Australia’s magazine on home and community-based care and support

dementia practice and ultimately achieve positive outcomes for people living with dementia.

you & i

The workshop has been designed to achieve a number of outcomes, including:

There has been growing uptake and increased interest around the EDIE workshops among home care workers, Director of the Centre for Dementia Learning at Dementia Australia, Dr David Sykes says.

It’s all about relationships

one on one

Working to lift dementia practice

Dementia Australia at the of virtual reality educ forefront ation

Immersive virtual reality technology is changing the way home care workers understanding and approach are ing dementia care, reports Kymberly Martin. he importance of dementia

education for home care workers has received a significant boost following the introduction of the Educational Dementia Immersive Experience (EDIE) workshops by Dementia Australia. The EDIE workshops are Dementia Australia’s second innovative use of technology to promote learning experiences which touch, move and inspire participants to improve their practice. This offering builds on its multi-award winning world-first Virtual Dementia Experience launched in 2013. EDIE uses virtual reality technology to give those working with people living with dementia and their carers a greater understanding of the experience of dementia to improve the support provided.

Working to lift dementia practice

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Dementia Australia at the forefront of virtual reality education COMMENT

EDUCATION

INCLUSIVE AGED CARE

ASSISTIVE TECH

WELLNESS

CDC budgets Community radio pilot

Reform a year on ATSA Expo

nity care Profiling people in commu

Reablement approach

outside the box E TROUPE enjoys thinking GHT. Case manager MARIANN care client CHARLES WAINWRI to meet the needs of home

DEMENTIA AUSTRALIA - THE NEW VOICE OF ALZHEIMER’S AUSTRALIA

BELARDI about reform, SILVESTER talks to LINDA Provider executive TRACEY choice in community care. innovation and expanding

“The importance of dementia education home iscare he transparency of the increasing, given the majority is a welcome waitlist packageof people with and will be critical to dementia are livingdevelopment says Tracey at home.”

future government planning, of Queensland Silvester, executive manager Care. provider Envigor Home months of the Reflecting on the first 12 Care changes, Increasing Choice in Home 2017, Silvester which commenced in February demand for home says visibility of unmet step forward care packages is an important for the sector. must However, the Federal Government number of older now act to address the large access to any services. people currently without unoccupied The return of some 13,000 pool from 27 packages to the national a positive move to February 2017 was also demand, she says. Tracey Silvester better align need with consumers As intended by the reforms, to right their are also starting to exercise SPONSORED FE ATURE switch providers. across to us people move their package “We have had nearly 300 that consumers are COMMUNITY so we can see CARE REVIEW 19 in the first year of the changes, to be.” who they want their provider making a choice about the changes has been hampered However, the rollout of to incorrect package leading issues by administrative system of significant unpaid subsidies. withdrawals and the accumulation distressing for been have Incorrect package withdrawals Silvester, to have reinstated, says consumers and time-consuming Health and a roles with Queensland who has previously held care providers in Queensland. number of community of Envigor was owed in excess In early February this year, “That has a due to payment errors. $150,000 in unpaid subsidies cash flow.”

Y INTO EXPANDING PORTABILIT HOME SUPPORT in the Home Care

Quality standards

Help for a fresh start

s Embracing local solution

significant impact on our

This issue: IN FOCUS

David Sykes