Community Care Review Winter 2018 by The Intermedia Group

Winter 2018

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

Embracing change Catholic Healthcare’s vision for integrated aged care This issue: IN FOCUS

MANAGEMENT

MENTAL HEALTH

WORKFORCE

DEMENTIA

CLINICAL REPORT

Budget 2018

Nurturing talent

Global CEO survey

Home support training

Calling out ageism

Advance care planning

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

Getting the workforce right

n this edition, we explore some of the initiatives community care providers are implementing to tackle the significant workforce challenges facing the sector. From recruiting and retaining quality staff to responding to ongoing learning and development needs, workforce issues are top of mind for providers. On page 12, Mercy Health and Calvary Community Care share their experiences of developing a capability framework to equip their workforces with the skills and attributes needed now and into the future. Empowering care workers to make decisions to respond to clients’ changing needs is an emerging focus for providers. The value customers place on service reliability and staff consistency is also changing how providers organise their workforces in a consumer-directed world. We document the broad trend away from casual contracts in favour of permanency to support meeting client expectations in community aged care. In the intense competition for quality staff, Anglicare At Home’s general manager Marcela Carrasco says organisations need to focus on their “employee value proposition” as much as their point of difference for clients (see page 31) Completing these organisational initiatives is the national work being done by the Aged Care Workforce Strategy Taskforce led by Professor John Pollaers. The strategy, which is due to be handed to government on 30 June, is advocating for developments such as an industry-led voluntary code of conduct and a remote accord to engage on remote and very remote workforce issues. As always, please get in touch with your ideas and feedback.

All material in this publication is copyright to the publisher and/or its contributors. No material may be reproduced without the express permission of the publishers.

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. DR FRANCES BATCHELOR outlines some tips for managers on implementing advance care planning in their organisations. 2. To thrive community care organisations must develop a stronger client-centric focus and foster innovation, writes management consultant NICKI DOYLE. 3. Clinicians need to stay alert to the impact of ageist attitudes on their clients, writes

Staff

mental health social worker FELICITY CHAPMAN. 4. LORRAINE POULOS, a trainer with extensive experience working with government and industry, provides some advice for providers on embedding wellness in service provision.

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

www.australianageingagenda.com.au/subscribe-to-ccr COMMUNITY CARE REVIEW

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FO R

cover story Winter 2018

cover story

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

cover story

EMBRACING CHANGE Catholic Healthcare’s vision for integrated aged care

Catholic Healthcare has been a leading contributo r to the aged care sector more than two decades. for But over the last few years, the organisation has had to refine its strategy to meet the changing demands of the aged care industry. Since the major reforms to the home care sector in February 2017, the not-forprofit organisation has set itself on the path of innovativ as a strong, integrated ely reinforcing itself specialist aged care services provider inspired by its mission to ‘promote life in all its fullness’.

llan ‘Curly’ Andrews was a lively, robust man living in the Western suburbs of Sydney. He was happily spending his days working hard on his motorhome in anticipation of an Australia-wide before he suffered a shock trip – fall in mid-2017, rendering him bed-bound. “All my life I’d worked hard,” says Curly, in reflection. “Until [the fall] a few months ago – and that was the end of me.” As a fiercely independent person Curly was not inclined to move into residential aged care, nor seek out the support of a full-time carer. Instead, he was empowered by the home care reforms, which opened him up to a new realm of choice in selecting a provider to help him maintain the life he’d always loved, at home.

Embracing change

WINTER 2018

SPONSORED FE ATURE

“If I didn’t have Catholic Healthcare, I’d still be lying in bed today,” says Curly. Curly’s story is just one of many powerful testimonies to Catholic Healthcare’s increased focus on holistic health. Since February 2017, Catholic Healthcare increased its health and wellness offering three-fold, redeveloped its recruitment strategy and developed a state-of-the-art computer tablet that tailors content to each individual client. Catholic Healthcare’s General Manager

cover story

The McQuoin Park of Home & Community Services Therese Adami Retirement Living explains how the changes were necessary Development, due to given the overhaul to the The MyCH tablet (pronounced market. commence development “The Increasing Choice ‘Mitch’) in Home Care reforms were later this year. is a tailored service brought actually very positive for us,” she says. to Home Care “We had to take a good Package clients through hard look at our the partnership of brand and assess how we were appearing to people Catholic Healthcare and in the market.” Breezie technology. Following the changes, the Catholic Healthcare The tablet tailors its content team set upon a new strategy that directly to meet the worked to empower their clients’ needs and likes, clients. such as easy-to“Our service delivery needed to undergo change to ensure access Skype calls and pre-installed video we were meeting the needs of our customers,” says content personalised to Adami. “The them. Catholic Healthcare Mission is all about ‘promoting “The tablet uses a software life to the full’, so our changes were essentially that is increasing our focus on appropriate for the aged this for community to use,” those who use our services. These changes have allowed says Adami. “We identified us to offer more to the people we the main issues care for.” older people had with generic technology, The program Curly engaged in was just one of these and with Breezie created new alternatives changes. The Catholic Healthcare Walking with suitable for our clients.” Confidence program, developed by the organisation’s health and wellness team The MyCH tablet has had David Maher has now helped hundreds of an astounding people to improve their impact on clients, Adami stride, and is says. continuing its positive impact in group settings “Following the pilot rollout Left: Catholic Healthcare across New South Wales and south-eastern of the tablet, was named a 2016 Queensland. MyCH is now a standard offering brought finalist at the Australian The team has furthered havefor Home growth its focus on the health market services Care Package HR awards for best clients. It’s empowered and wellbeing of reforms of 2017 and ongoing its clients by developing strength of leadership development additional programs such to the market where the as the Neck and schedule heightened competitionthem to control their Back Health program and a big program. with is now their Nutrition for Seniors, both and employment offering of which had their a provider’s reputation care workers, change people. daily popular uptake in the past quality timetable great retain and Right: New partnership year. to attract should they wish, and most powerfully, influencer on their ability “We considered our customer, struck. Catholic the organisation has embraced. their behaviour and what Healthcare managing familyHiggins This is a challenge thatvisually-connect withSimon sort of explains challenges they faced, members living particularly those with Resources director David Maher different cities or even lower mobility still General Manager ofinHuman overseas. living at home,” says Adami. and compelling with Tony Randello, culture “Our organisation’s tradition, “We’revalues-based so proud we have beenstrategy and Managing Director of the organisation’s strong how Higgins mission and values have always Simon people able their for been about enriching the Retirement at Lendlease. foundation the lives of our vision for the future isto enrich our clients’ lives with these as an customers and the reforms a reputation in the industry allowed us to amplify this developsays offerings,” Adami. “This is just the for our clients. has helped the provider “We really embrace the choice they have now – and we know they employer of choice. beginning of our innovative choose us for the quality changes. and with care we offer.” undergoing rapid growth, We that have so is much more to offer and “We’re in an industry right people to In 2017, Catholic Healthcare finding thewe’re of challenges released its MyCH tablet excited (short for My that growth comes increasingfor the future.” culture, which certainly Catholic Healthcare) in a pilot trial to selected Home “We have a powerful Care Package clients. support it,” says Higgins. “We undertook significant research to assess our A STRONG FOCUS clients’ needs and wants,” says Adami. “What we recognise from ON PEOPLE that research is that as many people age, they can become quite Catholic Healthcare’s response socially isolated. That fact led us to create to a medium that would help change hasn’t only come address that.” in the form of Therese Adami new offerings to clients. The aged care SPONSORED FE ATURE

COMMUNITY CARE REVIEW

Catholic Healthcare’s vision for integrated aged care This issue: IN FOCUS

MANAGEMENT

MENTAL HEALTH

WORKFORCE

DEMENTIA

CLINICAL REPORT

Budget 2018

Nurturing talent

Global CEO survey

Home support training

Calling out ageism

Advance care planning

people, however, aids us in retaining our talent in the as competition for people having to apply more market increases, we’re the great people we innovative ways to attract of our customers.” require to meet the needs But in an increasingly competitive services consumer-directed community people talent is only market, sourcing great one part of the challenge. strategy is firmly “That’s why our people meaningful focused on implementing leaders and ways to support our frontline core purpose of their teams in our shared Higgins. delivering great care,” says people areas By investing more in key , safety such as learning, communication Higgins and recognition and reward, is to “build the most explains that their aim engaged workforce capable, confident and our people every that we can and to give stay with us.” reason to join and then to this as its Catholic Healthcare refers and the ‘Great Place to Work’ program, in learning was organisation’s investment named a finalist recognised when it was Human Resources in the 2016 Australian Leadership Institute Awards for Best Development Program. ambition to Coupled with this, is the innovation promote a culture of service supported where new ideas are encouraged, explains that “if we and embraced. Higgins culture are to build a truly client-centred our people and service offering, then to helpfully need to feel comfortable to make things, do challenge the way we and recommendations for improvement clients’ our put always deliver services that needs front and centre.” philosophy our day, the “At the end of we are a people is quite simple really – our people are business and therefore do. It is only by at the heart of what we to continue will we that them investing in be successful,” he says.

FORWARD-THINKING

Catholic Healthcare’s services are keeping Allan ‘Curly’ Andrews independent at home.

past two years, insights throughout the Enlightened from their next steps in well primed to take the Catholic Healthcare is clients and staff members. continuing its focus on future its strategic vision for the The organisation has released outlines its plans to 2020, a document that entitled, Bright Futures ageing Australia. meet the demands of an promise to client our around “The 2020 Vision is centered David Maher. explains Managing Director enrich our clients’ lives,” focus not only on the next two years is a “What you can expect over ageing in our a home for those who are about ensuring we can provide passionate is that workforce a society, but also on developing our care.” caring for those living in customers will the aged care of tomorrow, Maher explains that in a seamless that allow them to make be seeking care opportunities and then living through to moderate transition from independent environment. the residential aged care higher levels of care in plans to organisation the how details The strategic plan for 2020 This element leader in integrated care. continue being an industry recent the back of Catholic Healthcare’s of the strategy comes on which enables living provider, Lendlease, alliance with retirement where residents can seamlessly an integrated campus approach their care needs. transition according to Retirement, alliance with Lendlease “Last year we formed an our objective of strategic step for us towards which was a significant offering,” says Maher. “The care aged integrated strengthening our residential the opportunity to develop alliance provides us with a co-location existing Lendlease villages, care homes adjacent to for individuals is an attractive proposition arrangement that we know This alliance has their aged care options. and couples considering services to for us to deliver home care also opened the opportunity in New South Wales.” Lendlease Retirement residents in their homes that people want to stay “Research is telling us Maher. to supporting that,” says committed we’re and longer,

“This alliance has opened the opportunity for us to deliver home care services to Lendlease Retirement residents in New South Wales.”

are showing that “The population trends live in their own home many people continue to continue,” he says. for longer, and this will only more about “We are committed to learning and growing our what our consumers need, meet and exceed that.” services in home care to of the evolution and growth The care isn’t the only organisation’s model of provider. Catholic the for ambition exciting to establishing Healthcare is committed

more than 1,000 new accommodation 2020, in addition to places for the elderly by renewing existing refurbishing, building and

the organisation. aged care homes across because they are “Our people work with us care or supporting passionate about providing of industry that those that do. It’s the kind bed in the morning,” makes people get out of mission, our values, Maher says. “But it’s our delivering excellent a shared commitment to Catholic care, and our focus on making to work that help set Healthcare a great place n us apart and make us unique.”

ATURE SPONSORED FE

a not-for-profit Catholic Healthcare is by the aged care provider inspired you wish Catholic tradition. Should provider, to get in touch with the or visit catholichealthcare.com.au call 1800 225 474.

REVIEW COMMUNITY CARE

ATURE SPONSORED FE

WINTER 2018

Community Care Review is Australia’s magazine covering home and community-based care and support. Brought to you by the team behind Australian Ageing Agenda, the quarterly magazine Community Care Review reports on the policy, the programs and people that make up community care in Australia. All community care providers and their staff are encouraged to sign up for their complimentary subscription to ensure they don’t miss an issue.

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EDITORIAL SUBMISSIONS: Linda Belardi, lbelardi@intermedia.com.au, (02) 8586 6198 ADVERTISING ENQUIRIES: Mark Ryu, mryu@intermedia.com.au, (02) 8586 6118 Carolyne Gowen, cgowen@intermedia.com.au, (02) 8586 6200

contents

32 3 EDITOR’S DESK 6 NEWS

IN FOCUS

COVER STORY

EDUCATION AND TRAINING

18 Embracing change Catholic Healthcare’s vision for integrated aged care

30 Embedding wellness in community care

10 Budget redirects residential underspend to more packages

DEMENTIA CARE

WORKFORCE

23 Rethinking centre-based care 24 Sustaining change

12 Nurturing staff potential 14 Providers turn away from casual contracts 15 Innovative strategies tackle worker stress

MANAGEMENT

CLINICAL REPORT 26 Steps to embed advance care planning

MENTAL HEALTH

ONE ON ONE 31 Simplifying aged care

YOU AND I 32 Embracing a new-found freedom

RESOURCES 33 Starting a discussion on older people and family violence 34 Boosting knowledge of diabetes

28 Being on guard to ageism

16 Data, innovation top strategic priorities

COMMUNITY CARE REVIEW

news Quality Agency expands consumer feedback surveys By Linda Belardi

THE AUSTRALIAN Aged Care Quality Agency will publish consumer experience reports as part of its reviews of home and community-based services from later this year. The agency said it will start piloting the new consumer feedback measure by 1 July, with a full introduction of the reports later in 2018. Consumer experience reports commenced in residential aged care in July 2017. “The pilot will involve working with a number of providers in testing a broad set of interview questions,” a spokesperson told Community Care Review. To develop a set of questions relevant to the community aged care context, the agency commissioned La Trobe University to review current evidence on what drives consumer choice in community

care and how consumers assess a quality service. Eight quality domains were identified in the review by the Australian Institute for Primary Care and Ageing: • consumer control and active participation in care decision-making • continuity and rapport with support workers • flexibility and choice in service delivery, including choice of preferred service provider, daily activities and support workers • the ability to receive services at home and in their community, which was especially important to remote and indigenous consumers • services that are affordable • information and support to help understand care entitlements and manage services • feeling safe at home

— Tender Loving Cuisine — an approved meal supplier for CDC and NDIS Packages

For over 20 years, Tender Loving Cuisine has been servicing the community with award winning, home delivered meals. • 75 nutritionally balanced meal choices, many of which are Heart Friendly, Diabetes Friendly and Gluten Free • Available to clients at any level of a Home Care Package who meet the eligibility criteria for assistance with nutrition. Split payments as per the government guidelines are available. • Guidance to maximize NDIS client plans • Delivery to over 3,200 suburbs in NSW, ACT, VIC and QLD

Tasmanian Salmon with Florentine Sauce

For further details please contact our Health Services Manager – Maureen Lumello on 1800 801 200 or professionalsupport@tlc.org.au

WINTER 2018

including access to emergency assistance • timely access to information and services. The agency said it will pilot options for gathering consumer feedback including online surveys and interviews conducted in person and over the phone. The consumer questions will also cover the aged care standards. In residential aged care, the consumer experience reports capture interview data from a randomly selected sample of residents via 10 questions. Areas covered include whether consumers feel safe, their healthcare needs are met, they are treated with respect and listened to, and whether they think staff are competent. The minimum number of interviews to be undertaken for the consumer reports in home and community-based care is still being determined and will be informed by the pilot results and

consultation, the agency said. The agency has evaluated the introduction of the consumer feedback reports in residential care and said the findings are being used to inform its auditing priorities. “We have understood how the interviews can be used to more effectively identify risks and focus on areas that might require attention in our audits,” the spokesperson said. The presentation of the data will be similar to the residential care reports to ensure consistency, the agency confirmed. Home care and Commonwealth Home Support Program services are required to undergo a quality review at least once every three years. The agency undertakes a quality review of each National Aboriginal and Torres Strait Islander flexible aged care service at least once every two years. n Download the literature review from www.aacqa.gov.au

Committee set up to drive reform in aged care training A NEW AGED care-specific body is being established to tackle longstanding vocational training issues in the sector. The Australian Industry Skills Committee is creating an Aged Care Industry Reference Committee to review and drive changes to aged care training standards and outcomes. The Aged Care IRC will be responsible for updating qualifications and identifying changing skill needs. The quality and job-readiness of aged care graduates through the VET system has been a longstanding sector concern. John Pollaers, who is chair of the AISC and the Aged Care Workforce Strategy Taskforce, said the taskforce was told

there was “a clear case for change” in aged care training. “We need to examine entry-level qualifications and career pathways, along with recognition of the full range of competencies required as we move toward living well models of care and recognise the benefits of integrated care,” Professor Pollaers said. The AISC has consulted on the proposed membership and structure of the committee and is expected to announce the final make up later this year. The AISC was established by the COAG Industry and Skills Council in 2015 to expand the role of industry in the development of vocational education and training. n

news Home care queue puts unspent subsidies in the spotlight By Linda Belardi

INDUSTRY PEAK bodies and service providers are calling for a government review of unspent funds in home care as new data shows surpluses continue to climb. Aged and Community Services Australia and five not-for-profit provider groups are the latest to call for action on the issue among a series of recommendations to boost access to home care. ACSA, Anglicare Australia, National Presbyterian Aged Care Network, Baptist Care Australia, UnitingCare Australia and Lutheran Aged Care Albury jointly recommended steps be taken to maximise the use of available subsidies. Benchmarking data from accounting firm StewartBrown published in Apri showed average unspent funds per client increased by 27 per cent to $5,400 in the six months to December. A consumer attitude of saving for a ‘rainy day’, incorrect or outdated assessments and an increase in automatic upgrades from My Aged Care have all

ONLINE POLL RESULTS THE READERS of Community Care Review had their say in our recent web poll. Do you support the proposal to claw back large amounts of unspent home care package funds and redirect the subsidies to provide additional packages? YES (89%, 66 Votes) NO (11%, 8 Votes) Total Voters: 74

been cited as potential reasons for an accumulation of funds. Based on a survey last year of 34 home care providers, industry peak body Leading Age Services Australia estimated unspent funds could be in excess of $200 million. LASA’s analysis found 16 per cent of packages with unspent funds had leftover subsidies in excess of $10,000 and some providers reported consumers with surpluses over $20,000. The national peak body has called for large amounts of unspent funds to be clawed back and redirected into the system.

In a recent paper addressing this issue, LASA said automatic upgrades via My Aged Care have contributed to an increase in unused funding since the introduction of the Increasing Choice in Home Care changes last year. “It is suspected that many consumer upgrades are poorly matched to a consumer’s current care needs,” the report said. Consumers may also be unready or reluctant to accept additional services, it said. ACSA has argued that clients with large amounts of unspent funds that are not being saved for an agreed purpose should

not be automatically upgraded to a higher-level package. The extent of unused subsidises in the system has come into sharp focus considering the size of the home care queue and the urgent need for extra packages. Government data shows nearly 105,000 people are waiting to receive a home care package at their assessed level of need. The system also currently does not facilitate the downgrading of a client to a lower-level package, especially in the context of an reablement approach to care. n

New wellness reporting for home support COMMONWEALTH Home Support Program providers will be required to submit an annual wellness report under new funding conditions announced by the Department of Health. As flagged in the 2017 budget, the new CHSP funding conditions to embed a wellness approach will be implemented from 1 July. The government will use the reports to track the progress of the sector in embedding wellness into their services, with the first report due by 31 October. Services will be required

to outline their organisation’s implementation of a wellness approach. The department said the reports will also be used to identify gaps and the need for industry support. A reporting template is currently being developed and will be available to providers by the end of August. The funding conditions included in the two-year agreements to existing services were developed in consultation with the CHSP National Aged Care Alliance working group, a departmental spokesperson told Community Care Review.

According to the department’s updated CHSP manual, services will be required to offer choice to clients, accept referrals to deliver short-term as well as ongoing services, and review all clients’ services at least every year. From 1 July, the department will also introduce a new data audit of up to 10 per cent of CHSP providers each year. The audit will include a review of My Aged Care service information, client support plans and service provider data in the DSS Data Exchange.

“Depending on outcomes of the internal audit, the department may contact individual service providers to discuss their service delivery patterns,” the updated CHSP manual said. A new funding condition attached to the contracts also requires organisations to provide data to the department on all existing CHSP clients who are not currently registered with My Aged Care. The department confirmed to CCR it has no plans for a growth funding round for the CHSP. n COMMUNITY CARE REVIEW

news Research exposes toll of unpaid travel and overtime By Linda Belardi

LOW-PAID DISABILITY support workers are spending large amounts of their working day in activities that are unpaid, a new study has found. The RMIT University study analysed the work patterns and pay of 10 employees delivering support under the National Disability Insurance Scheme over three consecutive work days. The research investigated two main types of unpaid work – travel between clients and overtime spent on administration and providing extra support to clients. Of the 10 workers in this study, half recorded 12 per cent or more of their work time as unpaid, including one worker who spent 21 per cent of their time consumed in unpaid work. The financial cost to the already low-paid support workers was significant, ranging from $8.84 to $180

over the three days studied. If all travel between clients and overtime had been paid, the workers would have received between 2 and 27 per cent more pay, according to the study published in the Economic and Labour Relations Review. The frontline workers raised unpaid travel time as a particularly negative aspect of their jobs, especially when client visits were short. As an example, one support worker in the study spent an hour and a half travelling directly between clients in a day. The mainly part-time workers cited fear of jeopardising further work opportunities as a key reason for not turning down shifts that involved a lot of travel, as well as a sense of responsibility to their clients or managers. A provision for paid travel time is not included in the

industrial award for the sector, and only one employer in this research paid for travel between clients as part of an enterprise agreement. However, seven of the disability support workers received a per-kilometre reimbursement for using their own cars when travelling between clients. “Employers appear to have actively exploited the lack of clear minimum standards: paying vehicle allowances for travel between assignments suggests acceptance of this activity as work – while not paying wages for this time,” the authors wrote in the study’s published findings.

UNPAID OVERTIME Half of the workers in the study accrued 50 minutes or more over the three days in unpaid work completing administration such as writing up client notes or providing extra support to clients. The authors described this form of unpaid work as “endemic” and invisible to employers as the additional work was often absorbed into the

unpaid time between their shifts. Unexpected events such as client illness, family carers returning home late or a mismatch between client needs and funded supports were cited as some of the reasons for providing unpaid support to clients. The staff reported it was often difficult or impractical to claim the regular overtime. “Inferior benefits and conditions for social care workers were established in Australian employment regulation long before the introduction of the NDIS. However, our findings support the view that the NDIS is further institutionalising employment practices that produce wages underpayment,” the authors say. The research was conducted by RMIT researchers Fiona MacDonald, Eleanor Bentham and Jenny Malone. Legal cases have been brought in New Zealand and England to challenge the practice of unpaid travel time between client visits resulting in recognition of travel time as paid work time.n

Building a virtual carer network A NEW RESEARCH project is investigating the potential of video conferencing as a tool to combat isolation among carers of people with dementia. The study by Central Queensland University will see small groups of primary carers take part in weekly video chat groups to facilitate social support and share information. The project builds on previous research that demonstrated the effectiveness of video-based peer support groups for people with chronic conditions. “The program is about connecting isolated carers to each other to positively influence 8

WINTER 2018

their caring experience,” project manager Atosha Clancy said. Rather than having a clinical or therapeutic focus, the groups are designed to build social networks and are run by experienced facilitators over a six-week program. The research project will evaluate the impact of the video-based chat groups on the resilience, quality of life and mental health of rural, regional and remote carers. The social support groups, which include up to eight participants in each session, commenced in May and run until June next year.n

healthcare

VIVIR SERVICE LOCATIONS

Vivir Community Care Vivir’s aim is to ‘make lives better’ for elderly Australians. Part of this is enabling people to live a good life in the place of their choice. A growing number of older Australians wish to live well in their own home. Productivity Commission surveyed older Australians, and reported in 2015, that over 60% of older Australians wish to age in place.

Far North

Northern Fitzroy

This is due to three possible reasons:

Central West

• Those who wanted to stay in their home as long as possible • Those who had an emotional attachment to the property • Those who liked or were familiar with their property’s location Whatever the reason, older Australians seek flexible and tailored services to continue to live well in their own home. The government has responded to this by increasing funding to the home care sector and introducing home care packages that are delivered on a consumer directed basis where assessed care needs are centered around the person. High quality, person-centred care has been embedded in the practice of Vivir’s allied health professionals for almost 20 years. To respond to the demand for our services in the community, Vivir have partnered with home care package providers to ensure older Australians receive personcentred and flexible care in their homes. All services are delivered by our dedicated team of professionally trained Allied Health professionals. Our quality service provides the individual with supported independence in their own home. Their personal preference listened to, understood and met. We deliver Individual treatment programs tailored specifically to help clients achieve their goals!

Wide Bay-Burnett Brisbane North Coast Central Tablelands Murray

Newcastle & Hunter Central Coast Sydney South Coast

Adelaide

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West Ballarat Bendigo South West

Canberra North East South Gippsland

Geelong

Tasmania

SUCCESS STORY:

WE FOCUS ON: • Person centred care • Flexible individual choices • Age well and wellness philosophy WHY VIVIR: • Geographic spread: Our extensive network services Australia’s eastern seaboard • Centralised coordination of services to respond promptly to client needs • Dedicated scheduling team • Single point of contact for case manager • Large professional workforce able to cover a huge geographical area including remote locations • Workforce with diverse cultures and multilingual skills • Proactive and collaborative communication • High quality systems that provide transparent service reporting • Comprehensive reporting

vivir.com.au

Meet Barbara, one of our community clients that we are currently providing physio services for. Barbara has lived in her home that her husband build for over 50 years and her biggest wish is to remain here for the rest of her life. Her pride and joy is her backyard where she has a beautiful fernery with an abundance of plants that she has been tending to for many years. She needs a bit of help these days with some tasks but is determined continue looking after her garden as much as she can as she feel it’s a great way to keep her active and motivated. Through physiotherapy we have been able to help Barbara improve her fitness and balance, enabling her to continue doing the things she loves.

1300 184 847

in focus

Budget redirects residential underspend to more packages Extra high-level home care packages and greater flexibility in aged care funding headlined the announcements in the May Budget. LINDA BELARDI reports.

ost of the Federal Government’s 14,000 extra high care packages announced in the May Budget will be released into the system over the next two years, the Department of Health has confirmed. The department told Community Care Review around an additional 8,700 level 3 and 4 packages would flow into the national pool in the 2018-2019 financial year. “The release strategy will support the market to respond to demand and grow sustainably,” a spokesperson said The Turnbull Government allocated $1.6 billion over four years to the budget measure, which is being funded by reallocating unused residential care funding to home care. In the budget, the government announced it would combine the residential and home care programs from 1 July this year to allow for greater flexibility in the allocation of aged care funding. Previously, unused residential care funding was returned to consolidated revenue. Officials told a Senate Estimates hearing on 30 May that demand for residential care was lower than expected and the underutilised funds had been redirected to home care places under the flexible approach. According to the budget papers, the government has set a target of reaching 151,500 home care places by 2021-22, which exceeds the 10

WINTER 2018

growth target of 140,000 packages originally set under Labor’s Living Longer, Living Better reforms. There are currently around 88,000 packages in circulation. More than 74,000 high-level home care packages will be available by 2021-22, the department said. The government is aiming to make 232,300 residential places available by 2020-21, which is a reduction of 7,300 places on last year’s budget estimates. The extra high-level packages in the budget follow the government’s budget neutral decision in September last year to convert 17,825 level 1 and 2 packages into 6,000 high care packages. These packages have been released into the national pool. Although welcomed by industry, the additional packages in the budget fall short of providing immediate relief to the 82,000 older people waiting on the national queue for a level 3 or 4 package at 31 December. Despite the hype in the lead up to 8 May, this year’s budget did not see a major injection of funding into aged care above already budgeted expenditure growth (see table).

SYSTEM NAVIGATOR PILOT Elsewhere in the budget, the government has responded to a key recommendation of the Tune Review to help older people struggling

in focus to navigate the system by piloting a navigator and outreach service. As part of the $7.4 million budget measure, the government will trial four programs including 30 aged care information hubs, 20 community hubs, six specialists offering one-on-one support to vulnerable people and six financial information support officers in the Department of Human Services. The federal health department told Senate estimates it had begun consulting with the sector to inform the design of the pilot. It said different approaches could be trialled to determine the most appropriate model, and an integrated approach to the four services would be necessary. It said some programs may be opened up to a competitive tender process as part of service delivery.

ASSESSMENT, NEW REGULATOR While not committing to an integrated community aged care program, the government announced its intention to move to a single assessment workforce from 2020. The sector has been calling for the government to combine the Regional Assessment Services and state-run Aged Care Assessment Teams into a single workforce. A new streamlined assessment framework will be designed with the aim of improving the timeliness and efficiency of aged care assessments, the government said. The $14.8 million framework will be developed by groups across the aged care sector, including aged care service providers, consumers and existing assessment workforce organisations. The budget confirmed the government’s adoption of a new independent aged care regulator, the Aged Care Quality and Safety Commission, which will bring together the functions of Australian Aged Care Quality Agency, Aged Care Complaints Commissioner and aged care regulatory functions of the Department of Health. The new body is set commence from 1 January next year and is budget neutral.

The health department said dementia-focused care technology was a relatively new market with “untapped potential” to help people with dementia to live at home for longer.

WHAT’S MISSING FROM THE TUNE REVIEW? While the budget took steps to address many of the 38 recommendations made by David Tune in his review of the Living Longer, Living Better reforms, the Senate estimates hearing was told the government would be formally responding to the remaining proposals. In home care, this includes replying to the recommendation to introduce a Level 5 package to increase the options for older people with high-care needs to be cared for at home. Introducing mandatory consumer fees in the Commonwealth Home Support Program and removing the discretion of providers to waive client contributions in home care packages were also recommendations made by David Tune. The review also proposed making the basic care fee proportionate to the value of the package subsidy. For those seeking short-term single services such as meals or community transport, the Tune Review recommended trialling a simplified My Aged Care assessment process. n

AGED CARE BUDGETED EXPENDITURE

2017-2018 Budget paper forecasts

20172018

20182019

20192020

20202021

$17.1b

$18.6b

$20.0b

$21.2b

2018-2019 Budget 20180502 Community Care Review MAY 123X88.pdf 1 2/05/2018 paper forecasts $17.2b $18.7b $20.1b

12:08:44 PM

$21.2b

REABLEMENT TRIAL The Turnbull Government is also pushing ahead with the implementation of a wellness approach in the Commonwealth Home Support Program by trialling an assessment model that focuses on reablement. The new model will be trialled with up to four Regional Assessment Services and an estimated 100,000 CHSP clients with the aim of building client capacity and reducing the need for ongoing services. A short-term reablement phase before referral for ongoing services is a feature of aged care systems internationally. Training programs, resources and practical supports will also C be introduced to support the wider adoption of wellness and M reablement approaches in the sector, the government said. Y The two-year reablement trial will receive $29 million in CM government funding. MY

NEW MENTAL HEALTH, EXERCISE PROGRAMS CY

A mental health service to tackle social isolation and grants to CMY boost participation in sport are among other measures announced K in the budget to support older Australians in the community. The Australian College of Mental Health Nurses will receive $20 million to pilot a nurse-led mental health service to help tackle the health effects of loneliness among people over 75 living in their own homes. The pilot commencing in January 2019 will run in three regions across Australia. The Federal Government said it would also fund a $23 million grants program to increase community sport and exercise programs targeting people over 65. Elsewhere, the government announced a $5 million program to trial new technologies in dementia care. COMMUNITY CARE REVIEW

workforce

Nurturing staff potential Two aged care providers share their experiences of implementing initiatives to define and develop staff capabilities, LINDA BELARDI reports.

organisation’s business – health services, residential aged care and home and community care – was also established to provide feedback on the framework’s development ahead of its rollout. “The framework outlines behaviours that our current and emerging leaders should aspire to model at each stage of their career journey,” says Thomas. The capability framework identifies six leadership levels – selfn an effort to build leadership capability across its organisation, leader, team or project leader, service leader, operational leader, large not-for-profit provider Mercy Health introduced a leadership strategic leader and organisational leader. Each position at Mercy capability framework in 2016. Health has been matched to one of the six leader levels. Organisational development and diversity manager Alicia Thomas says the framework creates transparency around Thomas says the framework considers its entire 9,000-strong expected behaviours. national workforce as potential leaders. “Staff can explore what sort of behaviours are expected of them “The framework articulates what we expect of our leaders at all at their leadership level and at the next leader level, so they can levels, and the central premise of the framework is that all Mercy start exhibiting those behaviours if they have aspirations to be Health people can be leaders regardless of their position title. promoted or move into a different position,” she says. “They don’t need to have executive manager, team leader or The framework also sets out the professional development supervisor in their title – all people at Mercy Health can be a leader opportunities that are available to staff at different career stages in their respective roles,” she says. from within Mercy Health as well To design the framework, as externally. Mercy Health’s HR team led by its The capability framework is organisational development manager underpinned by six core leadership undertook a literature review, capability clusters, which have been analysed the results of its employee drawn from Mercy Health’s strategic surveys and reviews and conducted plan and organisational values. internal focus groups with staff. These are performance, growth and A learning steering committee sustainability, self-development, with representation from across the advocacy, innovation and collaboration. Alicia Thomas Amanda Loh Rashmi Somu

WINTER 2018

workforce Thomas says the framework has many applications, including informing workforce planning, recruitment and selection of staff, professional development plans, and career and succession planning. To raise awareness of the framework and its uses, education sessions have been held with staff across the organisation with the goal of embedding the framework into everyday organisational processes. Since introducing the leadership capability framework, Thomas says Mercy Health has experienced a fall in staff turnover and improved workforce engagement as measured by staff surveys. “Our hiring managers are selecting candidates that are better aligned to our desired leadership capability level and our mission,” she says. By discussing the framework at the interview stage, clear expectations about a candidate’s role and career progression are communicated from the outset, which also positively impacts retention. Thomas says a key challenge in implementing the framework has been ensuring it is applicable to diverse roles across four different business units. Mercy Health is continuing to evaluate and promote take up of the framework to build a culture of continuous learning and selfdevelopment, she says. The organisation’s leadership capability framework was recognised as a finalist in the Australian HR Institute (AHRI) awards last year.

TARGETED APPROACH TO LEARNING The capability framework is now driving Calvary Community Care’s learning and development budget to bridge the gap in workforce capability. “Instead of a white wash approach to learning and development it’s given us very targeted areas of focus, so it’s cost efficient,” says Loh. Capability gaps can also be embedded across all learning programs, she says. “The framework gives people a vision. Part of the drive for this is to offer a career framework to people as well,” she says. Loh and Somu say the biggest challenge has been getting buy-in from staff, which was helped through the project’s collaborative design. They say bringing staff along on the journey and clearly communicating the goals and benefits of the project has been critical to its success. “This project is about enhancing what staff are already doing. It comes from a positive space,” says Loh. “Through these learning opportunities, our staff feel more valued and are clearer about what achievements and what they need to work towards,” she says. As part of the organisation’s new learning and development programs, Loh is using coaching sessions and strategies that promote self-responsibility to encourage sustainable behaviour change. In early June Loh shared the organisation’s experience of developing its “internal learning transfer team” at the Australian Institute of Training and Development conference. n

“The framework identifies the personal attributes that staff should hold such as resilience, compassion and positivity.”

CLOSING THE GAP Like Mercy Health, Calvary Community Care has recently embarked on a project to future-proof its organisation by identifying and addressing gaps in staff capabilities. In 2017, with help from consultancy firm MacArthur Capital, Calvary Community Care set about developing a capability framework for its 2,000 employees. The organisation ran consultation workshops with staff across the country and reviewed capability frameworks in place internationally within and outside the industry. Learning and development manager Amanda Loh says the framework was developed from the ground up with significant input from all levels of staff. “It would have been easier for us to say, ‘these are the capabilities we think we need’, but I don’t think we would have achieved the results we are now getting,” she says. The framework identifies the personal attributes that staff should hold such as resilience, compassion and positivity. Interpersonal, problem-solving and technology skills also feature prominently, says Loh. In line with organisational strategies the framework emphasises the importance of customer service and relationship building, adds Calvary Community Care’s director of human resources, Rashmi Somu. Being client-focused also means empowering its support workforce to observe and identify a customer’s changing needs. “The role of the support worker is no longer just about keeping to a care plan or task list. They are best placed to identify other customer needs to truly assist the enablement process of living independently at home,” says Somu. The framework complements other organisational initiatives aimed at building the self-awareness, confidence and conflict resolution skills of support workers, he says. For organisational leaders, the framework emphasises the importance of managing change, strategic thinking and inspiring direction.

COMMUNITY CARE REVIEW

workforce

Providers turn away from casual contracts In the face of increasing competition, integratedliving has made significant workforce changes, the organisation tells LINDA BELARDI.

arge not-for-profit community care provider integratedliving has moved away from a primarily casual workforce in a bid to deliver greater continuity to clients and boost staff retention. Permanent staff now make up over 80 per cent of its workforce, up from 40 per cent prior to the recent home care changes. The organisation, which operates in NSW, Victoria and Tasmania, has also lifted the minimum number of contracted hours for part-time support workers from an average of five to 20 hours per week. Georgina Chalker, the organisation’s chief people and customer engagement officer, says an analysis of its workforce in late 2016 highlighted the challenges the provider faced in delivering continuity and consistency to clients with a casual workforce model. Among its large casual workforce, it was common for staff to hold multiple jobs with different employers, which contributed to fluctuating staff availability. “Our market research identified what was most important to our customers, and that was service quality, reliability and continuity,” says Chalker. Casual labour is now used predominantly to cover short notice or unplanned gaps in the rostering of its large permanent part-time workforce, she says. integratedliving is an example of a broader industry trend away from casual employment contracts in home care. According to the latest aged care census released last year, casual staff fell from 14

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27 per cent of the community aged care workforce in 2012 to 14 per cent in 2016. Over this time, permanent part-time employment jumped 13 per cent, to make up 75 per cent of the workforce. Community care workers experienced the strongest growth in permanent parttime employment when compared with nurses and allied health staff working in home care and support. Chalker says moving to a core permanent workforce is helping the organisation offer continuity to customers and deliver job security and certainty to staff, with flow-on effects to higher employee satisfaction. “With a permanent team there are advantages when it comes to the retention of staff. We have also increased our training and development considerably because we know we will enjoy the benefit of what we invest in our people,” says Chalker who joined aged care from the mining and manufacturing industry. Shifting away from a large staff pool working a small number of hours has also created efficiencies in the administrative and head office support required.

VALUING SUPPORT WORKERS integratedliving is also investing in improved career progression pathways to further recognise and develop its care workforce, says Chalker. A new role has been created called a customer support advisor, which can only be filled via internal promotion from its support workforce.

“Once we had this core permanent team, we started to create reward, recognition and retention strategies that have allowed the value of the support worker role to shine in our organisation,” she says. Chalker says getting the workforce right has set the organisation up to succeed in a competitive home care environment. “Our home care packages are thriving and that’s a testament to the quality and the reliability of what we are delivering via our support workers to our customers.”

RETHINKING RECRUITMENT Other major HR changes at the organisation have included implementing more timely recruitment processes to fill staff vacancies, which is complemented by detailed workforce planning. This has had the effect of reducing delays in the commencement of services and use of brokerage arrangements, she says. The organisation’s resource and service plan is now better able to predict workforce needs before gaps emerge, she says. In preparation for the industry reforms, the provider has changed its recruitment criteria to emphasise customer-service focused qualities and commenced psychological profiling of all candidates. “We think more about the characteristics of the person – are they flexible, adaptable and customer-service focused? “We now focus on the talent of the individual rather than tenure or experience in a certain role or the industry itself.” n

workforce

Innovative strategies tackle worker stress New research investigates the main sources of job stress for home care workers and ways to minimise it, LINDA BELARDI reports.

rom buddy programs to increasing staff autonomy, a new guide has captured best-practice strategies to reduce home care worker stress. The industry guide developed by researchers Dr Sarah Oxenbridge and Justine Evesson draws on the findings of new research, which included interviews with 49 home care workers and 22 leading-practice employers in the aged and disability sector. The resource outlines a range of initiatives from low-cost strategies to improve staff recognition and communication to new ideas about organising care workers into selfmanaging teams. Oxenbridge says home care workers are often reluctant to report job stress, which means supervisors need to be trained to spot the signs of stress and intervene early. “The practice guide gives home care workers and employers some ideas for what works best to prevent or reduce stress and how organisations can improve what they are doing now,” she tells Community Care Review. Common sources of home care worker stress identified in the study relate to the intensity and insecurity of the work, poor relationships with supervisors, a lack of respect and recognition for their work, and high standards of care not being delivered. Oxenbridge says access to supportive managers and peers is critical to reducing and managing stress. The guide highlights the value of mentoring and peer support initiatives to

reduce the isolation of staff and to create opportunities for home care workers to share knowledge and debrief with colleagues. For example, leading-practice employers in the study ran paid team meetings and held drop-in sessions at local cafes to bring home care workers together. Care worker-only group sessions also provided opportunities for home care workers to support each other and raise issues, the study found. To prevent burnout, some organisations offered staff a mix of shifts across home care, residential care and respite and varied their roles to include both domestic assistance and complex care. Oxenbridge says work rosters are a significant source of stress for home care workers and a primary way for employers to improve the quality of care jobs. Providing sufficient hours, limiting travel time by matching care workers to clients in local areas and reducing broken shifts are key strategies of best-practice employers in the research. Some workplaces are also trialling the use of home care worker self-rostering where teams set the roster together, allocate new clients and swap shifts between staff. Technology is also allowing workers to display and update their work availability in real time and for employers to more effectively advertise shift vacancies, she says.

SELF-ORGANISING TEAMS A promising innovation to reduce worker stress identified in the research is the development of self-managed or autonomous teams, such as the Dutch Buurtzorg model.

In these flatter organisational structures, teams of care workers can work together to make decisions about the recruitment and development of staff and how care is delivered. They can also support each other by sharing ideas, expertise and offering support. However, Oxenbridge says team members require training on how to work effectively as a team for the model to be successful. Models of self-directed teams are currently being piloted within disability services in Victoria.

POLICY RESPONSES In addition to provider-led initiatives, the researchers say industry quality standards and funding conditions could place a greater emphasis on employee wellbeing and reducing care worker stress. Government grants could also be made available to home care providers to expand the trialling of self-managing teams in Australia. The researchers also recommended further investigation into how job stress is experienced by home care workers in rural and remote areas, by those employed by brokerage agencies and using online platforms. The research project was funded by the NSW Government’s Better Regulation Division Applied Research Program and involved industry partners United Voice and the Attendant Care Industry Association. n Download the research report and practice guide from the Centre for Applied Disability Research at www.cadr.org.au. COMMUNITY CARE REVIEW

management

Data,

innovation top strategic priorities Community care providers must develop a stronger client-centric focus and foster creative thinking to thrive, writes NICKI DOYLE.

o meet the needs of their customers leading Australian human and social services, including aged care providers are adapting and transforming. They know that doing nothing is not an option. Change that’s the watchword for human services around the world. What’s the driving force? Increasing customer demand, notably in aged care and other segments. At the same time, as needs rise, funding ebbs, which creates additional pressure. Many organisations are struggling and at the point of crisis. For this reason, KPMG spearheaded a global study to highlight the challenges, priorities and, above all, the opportunities in this broad space. We uncovered rich information in our survey and interviews with more than 100 human and social services CEOs and senior executives from Australia, Canada, India, Germany, UK and the US. When we analysed the findings, common concerns and insights emerged on how to tackle issues. We titled our report Listen,Learn,Lead to underscore the importance of listening to customers and learning from them in order to lead the change. The main message takes the form of a two-pronged strategy – develop a stronger client-centric focus and a broad innovative initiative to support it. These actions are interlocking and must occur in tandem. 16

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And the critical timeframe for this transformation to take root is over the next three years.

right staff and supporting them with HR processes. Customer affinity is a simple concept. However, achieving CUSTOMER AFFINITY it is not. It is a complex and There is a huge opportunity to multifaceted process which entails better meet customer needs collecting and analysing data. throughout the aged care That requires connected, agile sector. The starting point: renew technology that ultimately leads to Nicki Doyle service delivery built around the enhancing customer interactions. customer. As such, the study And that, in turn, leads to a makes the case for “customer affinity.” discussion of the role of strategic innovation. Customer affinity means developing STRATEGIC INNOVATION and demonstrating a strong understanding TO UNLEASH POTENTIAL of the customer. It includes knowing what customers need now, and in the future, and Most human and social services leaders how services can meet and exceed their report they are not keeping pace with expectations and preferences. Creating the global economy in innovation. They affinity requires capturing, recognising and also indicate they are not using data and acting upon a wide range of information. analytics to guide their approach. They This vantage point requires new ways of understand the need for innovation and thinking and working and even fundamental rated it their second highest priority. To or structural change. them, it represents the means to address This term encompasses understanding issues by improving how services and the a customer’s informal network, such as system work. friends, community groups, family and That said, innovation requires both informal care or support. It includes staff purpose and discipline – as a formal who serve customers, who are on the process within an organisation. In this way, frontline and thus in the best position to it is supported by objectives, resources and create and display customer affinity. For this leadership and optimised by internal and to occur, staff must have the time to listen external feedback. Embedding innovation and respond to the customer. That requires in strategy fosters a culture in which attracting, retaining and motivating the new ideas are welcomed, explored and

management developed. This encourages more creative thinking and empowers staff to effect change in the organisation. How can aged care organisations engender high-level innovation? • Build it into strategic objectives: set targets and goals to make innovation part of daily jobs and operations. • Define the approach: create a pathway with milestones and checks to ensure ideas receive constructive review and for the initiative to maintain progress. • Resource the idea: dedicate time to develop and challenge ideas. • Rally around it: set the tone top-down for innovation to drive its success. • Listen: test ideas by evaluating feedback and then, as needed, refine, improve, scrap ideas and benefit from lessons learned.

PRIORITIES FOR CHANGE Our report highlighted the following top priorities of CEOs in the sector to help transform their organisations over the next three years: • Build a stronger customer focus to better meet needs Developing customer affinity is the number one priority of 44 per cent

of CEOs surveyed. By enhancing it, organisations can improve the design and delivery of services. •F oster innovation The human and social services sector lags behind the global economy in the effectiveness of innovation processes. Only 13 per cent of CEOs indicate they are effective innovators as they lack a strategic approach that ensures ideas are appropriately reviewed, tested and deployed.

“Embedding innovation in strategy fosters a culture in which new ideas are welcomed, explored and developed.” •D evelop and manage talent Staff often are caught between tighter budgets and increased demand. The constant need to do more with less can result in stress, lack of motivation and ultimately the loss of key human

resources. This situation weakens service quality and places a premium on supporting employees. •B ecome more data-driven Data is key to developing customer affinity, but 50 per cent of CEOs are not using data effectively. Their organisations, however, have unparalleled access to a vast amount of information about those they serve. In a world that is data-driven, there is significant untapped potential. • Digitise the business for technology transformation Many governments are undertaking largescale digital transformation projects. This is a response to many processes in the sector being unwieldy, disconnected and paper-based, which weakens the quality of information organisations gather. Around 24 per cent of leaders rated digitisation as a high priority as old processes limit agility and flexibility. To track developments and pinpoint new issues, the survey will be conducted again in 2019. n Nicki Doyle is a partner at KPMG Australia in the health, ageing and human services sector. Download the inaugural 2018 Human and Social Services Outlook Survey from kpmg.com

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cover story

EMBRACING CHANGE Catholic Healthcare’s vision for integrated aged care

Catholic Healthcare has been a leading contributor to the aged care sector for more than two decades. But over the last few years, the organisation has had to refine its strategy to meet the changing demands of the aged care industry. Since the major reforms to the home care sector in February 2017, the not-forprofit organisation has set itself on the path of innovatively reinforcing itself as a strong, integrated specialist aged care services provider inspired by its mission to ‘promote life in all its fullness’.

llan ‘Curly’ Andrews was a lively, robust man living in the Western suburbs of Sydney. He was happily spending his days working hard on his motorhome in anticipation of an Australia-wide trip – before he suffered a shock fall in mid-2017, rendering him bed-bound. “All my life I’d worked hard,” says Curly, in reflection. “Until [the fall] a few months ago – and that was the end of me.” As a fiercely independent person Curly was not inclined to move into residential aged care, nor seek out the support of a full-time carer. Instead, he was empowered by the home care reforms, which opened him up to a new realm of choice in selecting a provider to help him maintain the life he’d always loved, at home. SPONSORED FEATURE

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cover story

of Home & Community Services Therese Adami explains how the changes were necessary given the overhaul to the market. “The Increasing Choice in Home Care reforms were actually very positive for us,” she says. “We had to take a good hard look at our brand and assess how we were appearing to people in the market.” Following the changes, the Catholic Healthcare team set upon a new strategy that directly worked to empower their clients. “Our service delivery needed to undergo change to ensure we were meeting the needs of our customers,” says Adami. “The Catholic Healthcare Mission is all about ‘promoting life to the full’, so our changes were essentially increasing our focus on this for those who use our services. These changes have allowed us to offer more to the people we care for.” The program Curly engaged in was just one of these new changes. The Catholic Healthcare Walking with Confidence program, developed by the organisation’s health and wellness team has now helped hundreds of people to improve their stride, and is continuing its positive impact in group settings across New South Wales and south-eastern Queensland. The team has furthered its focus on the health and wellbeing of its clients by developing additional programs such as the Neck and Back Health program and Nutrition for Seniors, both of which had popular uptake in the past year. “We considered our customer, their behaviour and what sort of challenges they faced, particularly those with lower mobility still living at home,” says Adami. “Our organisation’s tradition, mission and values have always been about enriching the lives of our customers and the reforms allowed us to amplify this for our clients. “We really embrace the choice they have now – and we know they choose us for the quality care we offer.” In 2017, Catholic Healthcare released its MyCH tablet (short for My Catholic Healthcare) in a pilot trial to selected Home Care Package clients. “We undertook significant research to assess our clients’ needs and wants,” says Adami. “What we recognise from that research is that as many people age, they can become quite socially isolated. That fact led us to create a medium that would help address that.”

The McQuoin Park Retirement Living Development, due to commence development later this year.

David Maher

Simon Higgins

The MyCH tablet (pronounced ‘Mitch’) is a tailored service brought to Home Care Package clients through the partnership of Catholic Healthcare and Breezie technology. The tablet tailors its content to meet the clients’ needs and likes, such as easy-toaccess Skype calls and pre-installed video content personalised to them. “The tablet uses a software that is appropriate for the aged community to use,” says Adami. “We identified the main issues older people had with generic technology, and with Breezie created alternatives suitable for our clients.” The MyCH tablet has had an astounding impact on clients, Adami says. “Following the pilot rollout of the tablet, MyCH is now a standard offering for Home Care Package clients. It’s empowered them to control their schedule with their care workers, change their daily timetable should they wish, and most powerfully, visually-connect with family members living in different cities or even overseas. “We’re so proud we have been able to enrich our clients’ lives with these offerings,” says Adami. “This is just the beginning of our innovative changes. We have so much more to offer and we’re excited for the future.”

A STRONG FOCUS ON PEOPLE Therese Adami

Catholic Healthcare’s response to change hasn’t only come in the form of new offerings to clients. The aged care

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dementia care

Rethinking centre-based care Australia is the latest country to trial a promising Dutch model of community-based dementia support, reports LINDA BELARDI. 3Bridge’s meeting centre support program

n an Australian-first trial, NSW community service provider 3Bridges is piloting an integrated model of dementia support pioneered in the Netherlands. The Meeting Centres Support Programme founded by Professor Rose-Marie Dröes from VU University Medical Center in Amsterdam provides person-centred support to people with mild to moderate dementia and their carers in the community. The model provides an alternative to traditional day centres and has grown from two meeting centres in 1993 to over 144 Dutch centres today. A European trial of the meeting centres in the UK, Italy and Poland was also completed last year with positive results. The key aspect of the Amsterdam model is the recognition that to support a person living with early-stage dementia also requires providing guidance and support to a person’s carers to help them cope with and adjust to changes. As a result, the meeting centre provides a combined program of support to both the person with dementia and their carer at the same time and in a single setting. The integrated supports include recreational, social and creative activities for the person with dementia, and advice, information and emotional support for informal carers. Weekly counselling sessions and regular day trips are also available to both. As part of the Australian pilot, 3Bridges has set up a meeting centre at Carss Park in South-East Sydney, which is open to people with dementia of all ages and their carers three days a week, says Amal Madani, the organisation’s director of reframing ageing. Staff at the centre include a team leader experienced in dementia education and counselling, a social worker, diversional therapist and exercise physiologist. The meeting centre aims to provide strategies to help people manage the practical, emotional and social adjustments that take place following a diagnosis of dementia, says Madani, who has received training from the model’s founder in the Netherlands. Support plans are reviewed monthly with the person with dementia and their family carer to ensure supports are responsive and individually tailored to their needs, she says.

3Bridges is partnering with the University of Sydney to evaluate the implementation of the Dutch model in the Australian context, including its cost effectiveness compared to traditional day centres. International studies of the model have shown family carers felt more competent to provide care and experienced less burden and isolation, while the person with dementia became more active and socially engaged. Admission to residential care was also delayed for those attending the meeting centre. Madani says important opportunities to model supportive behaviours and person-centred approaches are provided to family carers. “The carer can observe how our team members engage with the person with dementia and can take what they learn out of that observation and modelling and apply it at home,” she tells Community Care Review. The community support program creates an inclusive and social environment for people with dementia and their carers, she says. “Visitors to the centre don’t necessarily know who the person with dementia, the carer or the staff member is. Club members and centre staff prepare and cook lunch together, sit and eat together and go for walks as a group. “The program also works to destigmatise dementia, which is important,” she says. As part of the model, 3Bridges runs regular free public education sessions on dementia for the local community and service providers. While club member feedback has been positive, recruiting people with mild to moderate dementia to participate in the trial before their symptoms progress has proven to be the project’s biggest challenge, Madani says. To learn from the experiences of other countries, Madani is attending an international conference in Amsterdam in early June where she will also visit meeting centres in operation in the Netherlands. Madani will also present on the initial stages of the Australian pilot at the congress. The two-year trial received funding from the Australian Government’s Dementia and Aged Care Services fund. n COMMUNITY CARE REVIEW

dementia care

Sustaining

change

Now in its fifth year, an initiative led by Alzheimer’s WA is changing how home support providers deliver services to people living with dementia. LINDA BELARDI reports.

he City of Swan Community Care Services in Perth is one of more than 50 organisations to take part in a largescale project to drive improved outcomes in dementia care in the community. The WA Home and Community Care program provider says it has made significant changes to its service culture and philosophy since becoming involved in the Dementia Partnership Project in 2015. Focusing on a person-centred approach has seen its day centres shift to a homelike environment, the council’s CEO Mike Foley says. “We have a domestic kitchen, open access to tea and coffee making, lots of flowers and this year, a pet budgie and Rainbow Lorikeet. We also have a communal worm farm that plays a role in the upkeep of the roses and the growing of vegetables in the garden,” Foley says of its new dementia-specific facility in Beechboro. “We have received great feedback from those who come into our Dementia Partnership Project environment and notice the difference with our services,” he says. The initiative funded by the Department of Health in Western Australia and run 24

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“The Dementia Champions Program has trained over 120 champions from 50 community care providers to be ‘agents of change’ within their organisations.” by Alzheimer’s WA aims to equip HACC providers with the tools to better support clients living with dementia. Project lead Caroline Horlock from Alzheimer’s WA says the initiative was born out of a need to create sustainable change in dementia care practice. While staff training and education is important, it is just one element of creating culture change or a sustainable paradigm shift around supporting people with dementia in the community, she says. The project builds the capacity of home support providers through strategies such as coaching, mentoring and change management support.

Horlock says the goal is to replace taskfocused practices with a person-centred approach. “We use a capacity building and change management model to enable service providers to move from a fairly traditional way of supporting people living with dementia in the community to one that is much more enabling, and focused on independence and wellbeing,” she tells Community Care Review. “We are trying to break down the ‘them and us.’ People with dementia are not different to us. They have the same feelings, needs and responses, so we are working to shift people’s perceptions of people living with dementia as more than just a list of symptoms and behaviours.” Since the project commenced five years ago, 19 providers including the City of Swan have undergone an intensive oneon-one partnership with Alzheimer’s WA to encourage whole-of-organisational change. Undertaken over a period of 18 months to two years, the partnership examines the service provider’s processes, operations and culture to encourage sustainable change.

dementia care ENABLING ENVIRONMENTS A key focus in respite and day centres is helping providers to create enabling environments for people with dementia to promote participation and independence, says Horlock. “It’s about breaking down routine and structures that are common in day clubs and having much more spontaneity and variety,” she says. “We strive to create environments that support individuals to experience things for themselves. For example, a watering can that is already filled up with water might be a cue for someone to go and water a plant rather than having planned garden activities. A kitchen can also be opened up to enable club members to make themselves a cup of tea. “People are often doing these things themselves at home, but when they come into a service they can be disempowered and disabled by the fact that people do things for them.” Staff and volunteers are encouraged to include people with dementia in the centre’s daily activities such as preparing lunch and setting the table, which helps to build self-esteem and relationships with others, she says.

DRIVING LOCAL CHANGE Another key initiative of the project has been the creation of the Dementia Champions Program, which has trained over 120 champions from 50 community care providers to be ‘agents of change’ within their organisations. The champions receive a scholarship

to undertake a Certificate IV in Dementia Practice, ongoing mentoring and workplace visits from program coordinators, as well as networking opportunities. Horlock says a community of practice has developed amongst the trained champions who share their experiences and learnings with each other of working to drive change in their organisations. To promote ongoing improvement, Alzheimer’s WA has introduced a yearly registration process for the dementia champions to demonstrate their continuous learning and capacity building activities. To be a registered champion, the staff member must accrue a minimum of 100 professional development points each year through activities such as attendance at workshops, conferences, network meetings and by implementing and sharing workplace improvements. Horlock says 38 dementia champions received registration last financial year. The City of Swan Community Care Services has two dementia champions and another staff member is currently undertaking a Certificate IV in Dementia (CALD) Studies, Foley says. The project has encouraged those with an interest in dementia care to further develop their skills and knowledge, he says. “A number of staff recently enrolled in the Eden Alternative philosophy model of support. The leadership team in our dementia care services area are now fully trained in this philosophy and are recognised as Eden Associates. The city is currently developing a framework for transitioning to this model of support.”

Complementing the champions program, the project has also hosted a symposium for service providers since 2014 to help guide and encourage changes in practice. Videos of the sessions are posted on the Dementia Partnership Project’s website (dementiapartnership.com.au) and Alzheimer’s WA’s YouTube channel as resources for providers.

EVALUATION To measure the impact of the project, Griffith University’s Professor Wendy Moyle has led an evaluation of the model gathering feedback from organisations, staff and clients. The evaluation reviewed all aspects of the project – the one-on-one service partnerships, dementia champions program, annual symposiums and website resources. Horlock says the findings are positive and show the impact of the project on changing the culture and practice of providers. The report has been submitted to WA Health but has not yet been published. At the time of writing, the future of the project under the Commonwealth Home Support Program was under negotiation. It also remains to be seen if WA HACC’s entry into the CHSP from 1 July this year will create an opportunity for the model to be brought to other states. n Since speaking with Caroline Horlock for this article, Ms Horlock has left her position with Alzheimer’s WA. Jason Burton, head of dementia practice and innovation at Alzheimer’s WA, presented on the Dementia Partnership Project and its outcomes at the International Dementia Conference in Sydney on 7 June.

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clinical report Where research meets practice

Steps to embed advance care planning Community care workers have an important role to play in helping older people plan ahead for their future care, writes DR FRANCES BATCHELOR.

documenting an advance care plan and work alongside the general practitioner in doing so. It is also an ideal time to initiate ACP conversations with community aged care clients as they are less likely to have cognitive impairment which may preclude them from appointing a substitute decision-maker and making a formal advance care plan.

dvance care planning is a process where people can plan for their future health care and personal needs. It BARRIERS TO ACP allows people the opportunity to make their values and preferences Some of the reported barriers to known to family, friends and having ACP conversations with healthcare staff. community aged care clients Evidence shows that ACP include: Frances Batchelor benefits the person, their • a lack of knowledge or clear family and other people who understanding about ACP care for them. These benefits include • aged care workers having the improved care and increased adherence perception that it’s not their role to to a person’s preferences by healthcare have conversations with clients about staff and family members, higher staff ACP, which can be exacerbated by not satisfaction, reductions in unwanted having clarification about roles and hospitalisations and medical treatments, responsibilities of all staff in this area reduced stress and anxiety for family, and • difficulty engaging with an older person improved psychological outcomes for because of factors such as the topic of surviving relatives. death and anything related to it can be To assist with the development of a new considered taboo, or that clients do not national resource for aged care providers consider themselves as being old and we explored how ACP is implemented in therefore do not want to talk about it the community care setting and the role • clients having cognitive impairment community care providers play in this. before being able to express and Community aged care workers are in an document their preferences ideal position to support clients in having • limited education about ACP ACP conversations. All community aged •u ncertainty amongst staff about the care staff can play a role in ACP. A home legislative requirements for ACP or the care worker may be in a position to have a legal validity of the ACP documentation conversation with their client about future used, particularly as there are preferences, whereas a case manager differences in legislation between the or care coordinator may be able to states and territories. explain the steps involved in making and • lack of consistency in relation to storing 26

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an advance care plan leading to difficulty in accessing the ACP in emergency situations.

OVERCOMING CHALLENGES Factors that are seen to facilitate timely and effective ACP include: • having ACP conversations early before a person has cognitive impairment that impairs their decision-making • a good relationship or rapport between the aged care worker and the client This will assist the aged care worker in determining the right time to have ACP discussions, and also assist the client in feeling comfortable to have these conversations, which can be sensitive. • having knowledge about ACP and the relevant state-based legislation. Access to regular training and education around ACP and opportunities to develop communication skills in this area can assist staff. • understanding and being aware that clients can be diverse in many ways, including culture, life experience, sexual preferences, and health. This diversity can impact on a person’s preparedness to have an ACP conversation.

MAKING ACP ROUTINE With the increased number of people wanting to remain living in their own homes and the prevalence of cognitive impairment increasing, the number of people receiving community care who also have cognitive impairment is likely to increase. Therefore, it is important to integrate the early implementation of ACP into regular practice in community aged care. Ensuring there are clear policies

clinical report Where research meets practice and procedures in place explaining the implementation of ACP, that are known and communicated to all staff is vital. There is a need to increase the level of public awareness of ACP and the importance of having an advance care plan. The wider community needs to be educated and informed about what ACP is, the benefits of ACP for themselves and their family and how they can develop an advance care plan. Regular education and training for all aged care workers will help to raise their awareness of ACP, the benefits and how it can be implemented. Aged care workers need to be encouraged to discuss ACP with their clients early and regularly. Having integrated systems across health and aged care organisations will improve the continuity and sharing of information, for example e-health records that include an individual’s advance care plan can be easily shared between providers.

ADVICE FOR MANAGERS It is important that the implementation of ACP is supported by all levels of staff and embedded into the organisation’s everyday practice. To ensure this happens managers can do the following: • Ensure there is an organisation-wide, evidence-based ACP policy that is known to all staff, reviewed regularly and endorsed and communicated

by managers. The policy should include information about having the initial conversation, recording and documenting, storing, retrieving and activating an advance care plan. • Appoint clinical leaders or champions in ACP within each team to support the implementation of the process. • Clearly outline the role of each team member in ACP. • Ensure there are systems in place to enable ACP conversations to be embedded within existing processes such as admission and assessment processes, for example, include a prompt for staff to ask clients whether they have an advance care plan at intake. • Provide education for staff about ACP and also effective communication to assist with having an ACP conversation. • Recognise that both the aged care workforce and aged care clients are diverse and may have different attitudes to death and dying. Ensure that education is provided to staff and clients about ACP and that the initial conversation is held in a personcentred manner. A national resource has been developed by the National Ageing Research Institute and Advance Care Planning Australia for use in aged care. Download Advance care planning in aged care: A guide to support implementation in community and residential settings from the Advance

ADVANCE CARE PLANNING: STEP BY STEP 1. I nitiate and have a conversation with an older person, listen to them talk about their values, beliefs, goals and preferences for care. 2. Know and record who the substitute decision-maker is. An older person may need to be prompted to select, prepare and appoint their substitute decision-maker. 3. Document a person’s preferences. This can be done on an advance care directive or advance care plan. 4. E ncourage an older person to discuss and share their advance care directive or advance care plan with the relevant people. This may include family, other aged care workers or health care professionals. 5. Regularly review, and if necessary, update the advance care directive or advance care plan.

Care Planning Australia resource hub: www. advancecareplanning.org.au/resources. n Dr Frances Batchelor is director of clinical gerontology at the National Ageing Research Institute.

COMMUNITY CARE REVIEW

mental health

Being on guard to ageism Clinicians need to stay alert to the impact of ageist and disempowering attitudes on their clients, writes FELICITY CHAPMAN.

he way our Western society The following are five forms of views ageing can be less than ageism or attitudes that I suspect complimentary. exist in our Western society: If we, as a society, do not • Ageist attitude #1: Urgh! warmly embrace the concept of • Ageist attitude #2: ageing or decline then it is not “O” is for obsolete. too much of a jump between this •A geist attitude #3: and having unhelpful (explicit or It’s not worth it. implicit) attitudes toward those •A geist attitude #4: Felicity Chapman who are ageing and declining. What do you expect? We might, justifiably, pride •A geist attitude #5: ourselves on our ability to have a nonWhere’s the progression? judgemental approach to humans of all AGEIST ATTITUDE #1: URGH! shapes and sizes, of all ages. But even the most saintly among us lives in a broader I loved opening up the Weekend Australian context and, in counselling, this translates magazine one lazy Saturday morning to find to an awareness of the multitude of ways local Byron Bay identity “Feather” staring that ageist attitudes can be affecting your back at me in a skimpy bikini proudly client – and even the counselling process displaying nearly every bit of her weatheritself or how you view your work. and life-worn 78-year-old body. She was Staying interested and satisfied in photographed by Natalie Grono for the 2015 work related to older adults is also about National Photographic Portrait Prize and understanding the cultural milieu that made her way as a finalist. Feather (and surrounds you. What messages about older Natalie) did not end up winning the Portrait adults infiltrate the media, policies and Prize but she won my heart. general discussion? What social attitudes or I am sure I was not alone in my beliefs might sap desire instead of fuel it? appreciation of the way Feather stared Being forewarned is to be forearmed. self-assuredly down the camera lens but my When we are able to see clearly through the family brought me back to the real world. mist of ageism we can be more alert to stories “Urgh!” my 14-year-old son exclaimed as of prejudice or disempowerment and help he spied the picture, “That’s ugly!” and he our clients find a way to position themselves pleaded for me to spare him the image that against such dominant discourses. was spoiling his breakfast. 28

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Had Feather been a 20-something Ferrari model I am sure his response would have been somewhat different. So, what teenage boy would want to see an old lady in a bikini, I hear you say. True. But is his reaction representative of a general distaste for “old”? In Buddhism an old person is believed to be a heavenly messenger. Why? Because, as the teaching goes, one is reminded of how unhelpful it can be to feel shocked, humiliated or disgusted at such a sight for this will one day be their destiny. To deny the inevitability of age is to stay locked in a state of suffering; trying to hold onto a Peter Pan life of “forever young” when reality speaks of something else. Perhaps the “Urgh!” is less about the older person per se that we see and more what they represent, the confronting truth of our own destiny? Feelings of repulsion may also fuel negative stereotypes about seniors. What might start as a reaction to something “old” becomes a blinkered appraisal for all in that category. Advanced seniors can be lumped into one large melting pot of “Urgh!” without an interest to offset negative attitudes with positive ones. One study that examined the judgements people make about older adults discovered that negative stereotypes were more commonly

mental health “You can be on the lookout for how your clients might become entrapped with disempowering attitudes about their age and stage in life.”

Feather and the Goddess Pool. Photo by Natalie Grono.

associated with those over 80 than for those in the younger senior age group. Attempts to offset unhelpful stereotyping can be seen in the creation of new frameworks for working with seniors. These models aim to view adult development in more positive terms than the more traditional loss-deficit model of ageing. It encourages a closer look, an appreciation of many nuances, that can make up the experience of an older adult. And the tenets of positive psychology further fuel an interest in turning around feelings of despair or disgust so that panoramas of hope and appeal come into view. The process of ageing can then be seen

as fruitful: of gaining wisdom, of being clear about one’s identity, of thriving despite physical decline, of making the most out of any situation, of taking life firmly by both hands and never letting go until your time is up. Counselling can also be an avenue to turn the “Urgh!” inclination around. First, you can be on guard against any attitudes that may undermine what you do and actively appreciate the significance of working with a senior cohort. Second, you can be on the lookout for how your clients might become entrapped with disempowering attitudes about their age and stage in life. Could it be that

societal judgements are enlarging feelings of despair or self-disgust when this need not be so? Third, you can actively challenge any internal recoil at the idea of exploring the intimate – the sexual. True, members of “the lucky generation” may not be leaping into a conversation of this type but how much space are we creating for this in our transactions? Perhaps an initial “Urgh!” can become a more neutral and curious “Oh?” And finally, you can pay extra attention to seeing your clients as individuals instead of succumbing to polarisations of “dotty and difficult” or “sweet and lovely”. These groupings can blinker workers to important nuances of positivity or discourage clients to step outside of limiting identities. What is important is to be cognisant of how society’s values can affect our own, and can come unbidden into our therapeutic encounters or be present in how our clients view themselves. n Felicity Chapman is a mental health social worker who specialises in working with older people in both community and residential aged care. This is an edited extract from her book Counselling and Psychotherapy with Older People in Care: A Support Guide, published by Jessica Kingsley Publishers.

2018 BETTER PRACTICE FOR THE FUTURE NATIONAL CONFERENCE

Living the life I choose 22-24 August 2018 Sydney Safety, health & wellbeing aacqa.gov.au/events

22-24 August 2018

Sofitel Sydney Wentworth

Our 2018 conference is designed to explore the quality journey and how aged care services have partnered with consumers. The program is also aligned with the new Aged Care Quality Standards and regulatory framework. To register, visit: www.aacqa.gov.au/events

A gathering | A showcase | A conversation | A celebration

COMMUNITY CARE REVIEW

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

Embedding wellness in community care F rom July, there will be specific requirements for Commonwealth Home Support Program providers under the conditions of their grant agreement relating to how wellness, reablement and restorative care approaches are embedded in service delivery. The updated CHSP program manual published in April states that: “CHSP services delivered to a client are expected to be, in total, lower than the Government subsidised cost for services provided under a Level 1 home care package (less than $8,000 per annum). For example, the significant majority of CHSP clients should only require small amounts of one or two support services. What are the general accepted meanings of wellness, reablement and restorative care? Wellness: A philosophy or model of care that can be applied across all service outcomes with the aim of promoting greater independence and autonomy (see CHSP Program Manual 2018, page 20). It is about building capacity and recognising that all people have abilities that they wish to regain, retain or minimise the loss of, regardless of their level of frailty. Reablement and restorative care: Reablement approaches tend to engage clients in a process of identifying strengths and capabilities in the context of setting their own functional goals or targets. It is short term and time limited. Restorative care must involve evidencebased interventions and have clinical input to assist consumers to achieve an agreed outcome, for example to walk a certain distance or improve strength. These programs include measuring a client’s progress after a set time. What are the benefits of embedding wellness, reablement and enablement approaches in service provision? • The waitlist for home care packages 30

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may reduce if CHSP providers adopt a philosophy and model of care where there is an expectation that people referred to the CHSP have some capacity to improve or can be taught to self-manage their health. This is a departure from the mindset that the service is a ‘service for life’ or an ongoing entitlement. For example, domestic assistance is often viewed by family and consumers as a ‘cleaning’ service. • Consumers will be encouraged to be active participants in their support and care plan. • There will be increased job satisfaction as staff provide a more holistic, outcomesbased care model. • It will open up meaningful career pathways such as allied health assistant roles and nursing services.

What are some of the challenges for providers? The main challenges include: • increased turnover of consumers resulting in greater workload for providers with admission, assessments and scheduling • expectations of some consumers with the attitude of ‘doing for’ resulting in complaints • additional time and resources required to implement these models with no increase in funding for training • a culture of staff not wanting to change to a more active model • volunteers wanting to stay with the ‘helping’ model • CHSP consumers requiring higher levels of care and not being able to move to a home care package due to a shortage of places or an unwillingness to take up a package due to fee inconsistencies between the programs • consumers refusing to pay the proposed service fees and providers unable to refuse a service based on inability to pay • case management/coordination costs not being costed into the subsidy in

Lorraine Poulos

recognition of the additional time and monitoring required with reablement and restorative care. Much work is being done by My Aged Care, Regional Assessment Services, Aged Care Assessment Teams and CHSP sector support organisations to embrace these approaches from the first contact with consumers. Hopefully if all providers are working in this way it will ensure services are delivered in line with a client’s agreed support plan to meet their needs as identified by the RAS in CHSP services. In home care packages some providers are dealing with large amounts of unspent funds with consumers. If they were to embrace a reablement or restorative model this situation may be reversed. I have worked with providers recently to assist them to be innovative with their service model by embracing these philosophies. I encourage providers to think creatively about what consumers may value in their package beyond some of the standard service offerings of domestic assistance, personal care and transport. It is also important to note that these philosophies are not new in community care. The Active Service Model in Victoria, the Western Australian Wellness Approach and the Better Practice Project in NSW are all examples of the hard work providers have already undertaken. What is good about this push by government for more evidence of compliance is that it may result in a more consistent approach to assessment, care planning and service delivery with the desired outcome of improved services for the community. n Lorraine Poulos is a trainer and consultant with experience working with government and aged care providers. Contact admin@lorrainepoulos.com.au

one on one Profiling people in community care

Simplifying aged care LINDA BELARDI talks to MARCELA CARRASCO about pursuing innovation in home care and why client experience is king.

elivering a positive customer experience is the new battleground in home care, says Marcela Carrasco, Anglicare At Home’s general manager. Reflecting on the key differentiators of service in the deregulated market, Carrasco says providers that can deliver a seamless approach to care will thrive. “Aside from meeting their needs, people want to have a good journey of entering into the system and a good journey of care once they are in it,” she tells Community Care Review. Getting the customer experience right is a key area of focus at Anglicare, she says. The shift to a competitive marketplace has brought change but also opportunity, says Carrasco. “As providers we had been accustomed to certainty around funding and the expectations of occupancy. “In a deregulated environment, the challenge is working within that uncertainty, but the benefit is it has given providers an opportunity to innovate and do home care a little bit differently to how we have done it in the past. “In essence, it means delivering a better service to clients.” Along with the government’s home care reforms, the merger of Anglicare Sydney with Anglican Retirement Villages in mid-2016 was a driver for the organisation to rethink its operations. Empowering its care workers in their daily work and simplifying client communication through technology are new areas of innovation, she says. “We have developed an app for clients to access schedules and communicate with the organisation. We are also looking at using robotics to create efficiencies to allow us to have more time for the people side of our work.” Carrasco says an important change taking place in the sector as a result of consumer directed care is the focus on wellbeing, not just care. “Addressing the experience of isolation through a home care package is where I have seen the greatest benefits. “For example, a care worker taking a client golfing who hasn’t been in a really long time is what we want to see more of, given the wellbeing benefits for the client. “A package is about creating opportunities for people to remain connected to the community and to what’s meaningful and important to them.” The Sydney-based organisation is currently adapting its awardwinning rhythm of life philosophy of care, which is embedded in its residential care facilities, to its home care services, she says. “The model is about understanding the person, their story and putting building blocks in place that will enable the person’s wellbeing to be at the centre of their care.”

“Addressing the experience of isolation through a home care package is where I have seen the greatest benefits.”

Marcela Carrasco

While assessment tools and support plans are essential, the care delivered day to day should be responsive to a person’s changing needs, she says. Carrasco welcomes the proposed integration of the government’s national home support and packages program from 2020 to improve the consistency and continuity of services for older Australians. The new wellness reporting requirements in the Commonwealth Home Support Program will also help to establish a philosophy of enablement as foundational to the aged care system.

WORKFORCE CHALLENGES In the current environment, providers are not only competing for packages, but a quality workforce, she says. This means focusing on an organisation’s “employee value proposition” as much as its point of difference for clients. Carrasco says permanency is one way Anglicare is demonstrating its commitment to staff. Around 95 per cent of its 650-plus care workforce is permanent part-time. “We need people who are aligned with our values and philosophies, and to do that staff need to feel part of the organisation. “We are of the understanding that if we look after our people, they will look after our clients. That is what we want to reflect in our recruitment practices and support to staff.” n COMMUNITY CARE REVIEW

you & i It’s all about relationships

Embracing a new-found freedom After having a pacemaker installed and being told he could no longer drive his car, Ray found his independence again with the help of occupational therapist Anna.

Ray Whiting with Mercy Home and Community Care occupational therapist Anna Lyons.

RAY’S STORY AS TOLD BY HIS DAUGHTER MARGARET

ad has a great sense of humour and enjoys people’s company. At 94 he still lives independently in a large house with a garden. He wishes to continue living this way. I am interstate, so my sister Anne used to check in with Dad regularly, as well as drive him to appointments or outings beyond a one-kilometre radius from his home. When Anne died suddenly I organised a My Aged Care assessment for Dad. The assessor suggested Dad needed some help with his transport and an occupational therapy assessment to check on the safety of his home and garden. The night of the assessment Dad collapsed at home and had to be taken to hospital to have a pacemaker installed. During his admission Dad’s cardiologist told him that it was no longer safe for him to drive even though he had only been driving locally. Dad was really shocked and devastated. Shortly after Dad was discharged home from rehab he had his first assessment with Anna from Mercy Health Home & Community Care. From the beginning Anna treated Dad with respect and Dad trusted that she would do her best for him. Anna suggested handrails and ramps in addition to the ones that had been installed when he was in hospital. Anna also ensured Dad had the right mobility scooter and oversaw the financial aspect to ensure the correct price was paid. I was delighted to hear from Anna that Dad was following all of her recommendations with the scooter, including how to increase his speed or slow down, remembering to take water, wear a hat 32

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and how to problem solve. Dad is delighted with his new found freedom and is able to get to church, the supermarket, pharmacy, post office, his GP and other places in the community which keep him socially engaged. I was so grateful Anna supported and mentored Dad to maintain his independence and she gave me a report after each visit so I could update the rest of the family. Dad is now back cooking his own meals when he’s not out with family and friends, watering his plants, doing his own washing and ironing and managing his finances. Life’s back to normal for him and that’s just amazing.

ANNA’S STORY As an occupational therapist it was extremely rewarding to witness improvements to Ray’s health, general wellbeing and willingness to get on with his day. I first met Ray during a home and scooter assessment, where I looked at his environment to see what I could do to increase his independence. The outcome of this was to install additional grab rails, ramps and home management skills, such as timetabling and visual cues. I did a comprehensive scooter assessment due to Ray losing his driver’s licence. This involved going over the road rules, spatial awareness and cognitive

behaviour testing. Ray trialled a scooter but it wasn’t appropriate, so I organised for him to test a different scooter that suited his needs better. I graded Ray’s performance on the scooter to make sure he was safe and then reassessed this a short time later, which resulted in the removal of the restrictions I had initially put in place. Ray is a very wise man. He is a person who listens to your advice and understands why you put precautions in place. Every time I visited Ray for an assessment I made sure I called his daughter Margaret afterwards because I knew she was concerned about him being isolated from the community. I wanted to make sure his family knew that he was safe and making progress towards his goals. Ray was a lot happier when he was able to get back out in the community on his scooter. Everyone was smiling at him and saying how good it was to see him – people really missed him. It was really important for him to be able to organise his day and not miss out on what’s important to him such as going to church, the doctor or visiting the supermarket independently. Ray is very mindful and has a lot of insights into what he can and can’t do. What he thought he couldn’t do, he can now do, which is rewarding to know as an occupational therapist. n

resources Professional materials, guides, publications & other helpful tools Starting a discussion on older people and family violence SENIORS RIGHTS Victoria has launched a series of discussion papers to help advance a conversation on elder abuse as a form of family violence. The Victorian Royal Commission into Family Violence, which concluded in 2016, included a chapter on violence against seniors and several recommendations to help identify and respond to elder abuse within the family. Seniors Rights says a key goal of the resources is to build understanding between the two sectors and identify best practice approaches to integrating older people into family violence responses. Three discussion papers were launched at an event on 3 May. The event was attended by representatives from the domestic violence and aged services sectors, and the head of the family violence command at Victoria Police. The paper, Elder Abuse as Family Violence, explores how elder abuse is similar and different to other forms of family violence. It reports on the some of the causes, effects and risk factors for elder abuse. Elder Abuse, Gender and Sexuality examines how gender and sexuality identity can affect a person’s experience of elder abuse

Supporting younger people with dementia NEW ONLINE training is available for health professionals and care workers to improve their understanding of younger onset dementia. The free course delivered by Dementia Australia aims to boost awareness of the specific needs of this cohort, the impact on their lives and supports available to individuals and their carers. The training module for health staff and support workers has been funded by NSW Family and Community Services. Complementing the training course is a guide to referral and service options for people with younger onset dementia across areas such as health, social, community, legal services and resources. “The new resources are designed to assist professionals and family members by providing an improved understanding of the options available for people with younger onset dementia,” acting general manager services Dementia Australia Barbra Williams said. “Where families and carers have a better understanding of younger onset dementia, the quality of life for them and the person with the diagnosis can be improved.” Access the online training module, Understanding Younger Onset Dementia, from the Centre for Dementia Learning. See dementialearning.org.au Download Support Pathways for people with younger onset dementia: Referral and Service Options from dementia.org.au/resources

and raises awareness of the under-recognised and underreported crime of sexual assault against older women. The paper argues for further research into the ways that the gender of both the victim and the perpetrator can affect situations of elder abuse. Preventing Elder Abuse examines how elder abuse prevention requires a wide spectrum of activities from empowering individuals to tackling entrenched ageism in society. Download the Ageing Without Fear – Elder Abuse as Family Violence discussion papers from Seniors Rights Victoria’s website: seniorsrights.org.au/resources

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COMMUNITY CARE REVIEW

resources Professional materials, guides, publications & other helpful tools Cookbook celebrates joy of eating at all stages of life Boosting knowledge of diabetes A SERIES OF education modules has been developed to better equip the aged care workforce to care for a growing number of older people living with diabetes. The three learning modules launched by the Australian Diabetes Educators Association target diabetes educators, aged care nurses and care workers. The self-directed learning tools aim to improve the delivery of evidence-based diabetes care and have been designed for staff working in residential and community aged care. The online training includes three modules: • A Diabetes Educators Module has been designed for diabetes educators who provide self-management education to older people with diabetes as well as support to health and aged care teams. • The Nurses Module has been developed for enrolled and registered nurses working in aged care and covers topics such as preventing diabetes-related complications, medication management and health literacy. • The Aged Care Workers Module aims to improve the knowledge of personal care workers on topics such as blood glucose monitoring, nutrition and oral health and physical activity. The development of the aged care online modules was funded through the Australian Government’s National Diabetes Services Scheme. The modules include quizzes, activities and case studies to support learning and participants can receive a certificate of completion. Download the resources at: adea.com.au under the resources tab.

HAMMONDCARE’S executive chef Peter Morgan-Jones has collaborated with palliative medicine and allied health experts to produce a new cookbook for people at the end of life. Lobster for Josino: Fabulous food for our final days includes practical tips and more than 100 recipes that promote the pleasure and comfort of food and personal choice for people with a life-limiting illness. The cookbook has been authored by Mr Morgan-Jones with palliative care specialist Professor Rod MacLeod, senior speech pathologist with HammondCare Prudence Ellis and dietitian Jessica Lynch. Lobster for Josino was inspired by a chef’s dying request for lobster as his last meal which was refused by hospital staff. Mr Morgan-Jones worked with Josino at the Sydney Opera House and was unable to fulfil Josino’s desire to eat lobster one final time. In the book the authors explore topics such as taking a personalised approach to food, understanding sensory changes resulting from medications, and options to improve the dining experience in palliative care. The cookbook was launched in Sydney on 23 May by the CEO of Palliative Care Australia, Liz Callaghan, as part of Palliative Care Week. Visit: www.hammond.com.au/shop/food-culture

App promotes health effects of social connection A NEW MOBILE phone app is available to encourage people to prioritise their social relationships as a powerful way to improve their overall health. National suicide prevention charity R U OK? created the app in response to the findings of a national survey it conducted that found 50 per cent of Australians spend two hours or less of their weekly downtime connecting with the people who matter to them. R U OK? said the finding was concerning considering evidence shows investing in relationships is important for people’s health and wellbeing. R U OK? campaign director Katherine Newton said the app called Konnect

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aimed to encourage users to invest more time in their relationships and learn R U OK?’s four conversation steps: ask R U OK?, listen, encourage action and check in. “Konnect can help people proactively reach out to the people in their world and maintain stronger relationships. “When our relationships are strong we’re more likely to see the signs someone is struggling with life, and have the trust and confidence to start a conversation with that person,” she said. The Konnect app was funded by Virgin Mobile Australia. Download the app from ruok.org.au/konnect

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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