INDUSTRY UPDATE – FEBRUARY

Of course, February was expected to be a huge month for the industry with the first of the Royal Commission witness hearings. The hearings also called upon peak bodies and consumer advocates, and the media has been abuzz with Royal Commission related news. Many conversations have been sparked as a result; from chemical restraints, to mandatory repositioning, to formal dementia training. In addition to the Royal Commission, a new funding boost to the industry was big news, bringing with it new places for Home Care and the National Aboriginal and Torres Strait Islander Flexible Aged Care (NATSIFAC) program and an additional $320M for Residential Aged Care. Some exciting new studies are set for dementia research and falls prevention, and some great steps are planned for the Aged Care Diversity framework Action Plan. Let’s dive into the news for February!

ROYAL COMMISSION

February saw the first hearings of the Royal Commission take place in Adelaide over two weeks. The first person to take the witness stand was Barb Spriggs, the wife of Bob Spriggs, who was one of the Residents at Oakden – one of the horrific stories that sparked the Royal Commission announcement.

Evidence given by families, Aged Care Peak Bodies, medical experts and unions was received and the first fortnight concluded with a broad range of subjects brought to discussion. Such topics included: funding sustainability, staffing, training, wait times (particularly for Home Care), workloads on staff, financial issues for Providers and physical and chemical restraints.

The Royal Commission has also head out on the road; with community forums held in Sydney and Bendigo in March, and future Commission Hearings expected to be conducted in a number of regional locations as well as capital cities. Tasmania expects to have a hearing in the latter half of 2019.

The first background report for the Royal Commission has been released, titled Navigating the maze: an overview of Australia’s current aged care system. The paper summarises the Aged Care systems and services, and areas believed to be requiring ‘substantial’ reform. You can read the report here.

With a great deal of media reports surrounding the Royal Commission, the Aged Care Guide, Australian Ageing Agenda and The Weekly Source are excellent sources of information. You can also access live and past hearings via the Royal Commission webcast channel here.

With the hearings having restarted for March, there is still much to come in Royal Commission news.

RURAL NEWS

There are concerns that older people receiving emergency care in remote areas of Australia could have been prevented, had they had access to more consistent primary care. A study undertaken by the Royal Flying Doctor Service (RFDS) has shown that the reasons for transfers could link back to the absence of specialists like physiotherapists and occupational therapists to help with injury rehabilitation; absence of Aged Care services; and a lack of ‘reasonable access to oncology, haematology and palliative care’.

The study looked at 23,377 older people living in remote areas of Australia, and their reasons for RFDS air transfers between July 1, 2014 and 30 June, 2017. It also reports that Australians living in remote areas have an increased rate of dementia and Alzheimer’s, as well as cancers and heart conditions that are preventable, when compared to urban areas.

The CEO of the RFDS, Martin Laverty, has highlighted the need for ‘greater investment in primary care services’ in rural and remote communities, noting that the Royal Commission will need to address this situation.

You can read the RFDS study report here.

ADDITIONAL PLACES FOR ABORIGINAL & TORRES STRAIT ISLANDERS

From February 1, applications opened for the second round of expansion funding for the National Aboriginal and Torres Strait Islander Flexible Aged Care (NATSIFAC) program. Part of a $60 million funding expansion set to roll out over 4 years, the funding intends to increase the number of Residential Aged Care places and improve access to culturally safe services in remote, and very remote Australia. More than 900 additional indigenous Australians will have access to Residential and Home Care services in these locations that are closer to family, home or country.

AGED CARE DIVERSITY

In diversity news, the Government has introduced Action Plans to ensure that all older Australians have access to quality and culturally appropriate Aged Care. As a part of the Aged Care Diversity Framework and following on from the funding to assist Aboriginal & Torres Strait Islanders, the Government is also committed to ensuring all Aged Care services are inclusive and safe for Lesbian, Gay, Bisexual, Trans and Gender Diverse and Intersex (LGBTI) people and people with culturally and linguistically diverse backgrounds. The action plans include resources to assist Providers, Peak Bodies and Governments to reach this outcome.

You can read further on the Government’s Action Plan here.

A series of short films also launched in February, funded by the Government and intended to improve understanding of dementia and access to care for those from Culturally and Linguistically Diverse (CALD) backgrounds. The series of 15 films is titled Moving Pictures, and is based on real-life stories on how carers looking after someone with dementia have experienced navigating the Aged Care system.

MULTICULTURAL CARE

Following on from Aged Care diversity news, a Noble Park, Victoria Aged Care Facility has been given the go ahead to be Australia’s first specific Indian Aged Care Facility. Provider MiCare has revealed their intention to build a $35M, 108 bed Aged Care Facility that will be sensitive to Indian Culture. Incorporating four prayer rooms and a vegetarian kitchen, the new Facility is expected to be completed in 18 months.

CHEMICAL RESTRAINTS

The Royal Commission has sparked a great deal of interest in physical and chemical restraints since January, and the hearings in February were no different in continuing the conversation. In the January Industry Update, we reported an amendment to the new Aged Care Standards, set to begin on July 1 2019, that refers to physical and chemical restraints.

The use of chemical restraints refers to psychotropic medications such as antidepressants, antipsychotics, anti-epileptics and benzodiazepines, which are tranquilisers.

The Royal Commission hearings however, prompted more media interest in the topic. The Commission heard in February that sometimes up to 80% of Residents living with dementia were medicated with at least one form pf psychotropic drug. But the effectiveness of prescribing sedatives was considered to be low – with a difference in only 10% of Residents – and side effects from the medication prompting even more medication, the Commission heard from Geriatrician Professor Edward Strivens.

The Commission continued to hear from Professor Strivens that working with psychotropic drugs needed to start with using the smallest amounts, for the least amount of time, to ensure it functions as it is supposed to. This was also highlighted as a more time-consuming and labour intensive approach.

In May 2018, The Medical Journal of Australia published a research article that intended to assess the use of the prescribing of psychotropic drugs in Residential Aged Care Facilities, and potentially reduce prescription. You can read the article here.

MORE FUNDING

Ahead of the start of the Royal Commission hearing in February, the Government announced a $662M funding boost. This includes an additional 10,000 Home Care packages (equating to $282.4M of the boost); $320M for Residential Care, intended to assist and support the delivery of quality services (equating to approximately $1,800 per permanent Resident) and a $4.6M trial of the new Residential Funding tool that intends to replace the Aged Care Funding Instrument (ACFI) as some of areas of funding allocation. Short-term restorative care was also allocated 775 additional places. You can read further on the breakdown of funding in the Aged Care Guide’s wrap up here.

Peak bodies and advocacy groups Leading Aged Services Australia (LASA), Aged & Community Services Australia (ACSA) & COTA Australia have all weighed in on the funding boost, welcoming it as ‘much needed support’. However, there is still concern that no funding has been tied to increasing workforce numbers or supporting training and development.

The funding boost means that two new temporary subsidies have been released: An Additional Daily ACFI subsidy rate – the Temporary Subsidy Increase that will be in effect from 20 March 2019 to 30 June 2019; and a temporary general subsidy boost paid as an additional daily RCS subsidy amount for the period 1 April 2019 to 30 June 2019. You can see our updated ACFI rates tables here.

AGED CARE FACILITY DEVELOPMENTS

Aged Care Facilities are continuing to grow, with large new developments on the horizon. Arcare Springwood, a luxury, 5-star Facility, opened in February in Queensland. The $47M Facility includes a number of features, such as a movie theatre, hairdressing salon, and a boardwalk that cost $750,000.

In Sydney, Anglicare have proposed an $158M development that will include a 100 bed Residential Aged Care facility with an additional 32 attached villas. Set an hour south-west from Sydney, construction is set to begin in 2020.

Across in Tasmania, a proposed $13M Aged Care Facility has not been welcomed by the local residents, who plan to campaign against the development when the consultation opens. There are concerns that the Facility, which intends to support older Tasmanians on low incomes, does not reflect the heritage of the site, or consider the environment and local community values.

In other building news, Residential Aged Care facilities and Retirement Living Providers located in Queensland are required to complete a three-step process to ensure their buildings are not covered in a combustible cladding. As a part of the Building and Other Legislation (Cladding) Amendment Regulation 2018 (QLD), the first step is required to be completed by the end of March 2019, and is required to ensure a safe environment for both Residents and team members.

NAVIGATING A NEW ERA IN AGED CARE

The new Aged Care System Navigator trials began in February as part of an initiative to make entering the Aged Care system clearer and easier for older people to traverse. The initiative was announced in the 2018-19 federal budget as a response to one of the key recommendations by the Tune Review. The national trial includes a number of Aged Care navigator centres, specialist advisors and information hubs, intending to offer face-to-face assistance, as well as phone and online support for older people and their families attempting to navigate the system.

The $7.4M trial is in partnership with consumer peak body COTA Australia, as well as 30 other organisations and you can find out more about the trials on COTA’s website here.

MANDATORY REPOSITIONING STUDY

A new study, conducted by the University of NSW, has presented its findings that suggest that mandatory repositioning is not recommended. With the intention of preventing bedsores, mandatory repositioning is a commonly accepted practice in Aged Care. The study concludes that although the practice is supposed to be a preventative safety measure, it can in fact interfere with sleeping patterns and as a result, lead to behavioural problems. The conclusion of the study comes at an interesting time, with the Royal Commission investigating the safety and quality of care of Aged Care Residents.

You can view the full study here.

NEW RESOURCES FOR MANAGING PAIN

The Australian Pain Society has released a book that provides resources and information for those caring for older Australians living with pain to help improve relief and care. The book, Pain in Residential Aged Care Facilities: Management Strategies, is a 2nd publication which has been revised and expanded. The Department of Health is assisting with the promotion of the publication, and the Aged Care Quality and Safety Commission has utilised the book to develop guidance for the new Aged Care Quality Standards.

You can find more information on the publication here.

In further news on managing pain, a new app has been developed that utilises Artificial Intelligence and smartphone technology to enable people to express when they are in pain when they are unable to verbalise it. PainChek is an assessment tool aimed at assisting the elderly and people living with dementia, who may be suffering from pain but unable to self-report it. The app has been developed with the aim of improving pain management and works with facial micro-expressions and pain related behaviours to record and score pain levels, as well as an individual’s response to pain.

PainChek is currently being used across Australia but nationally by Dementia Support Australia, as well as more than 50 Aged Care Facilities across Australia and New Zealand. You can read further on the app here.

SPECIALIST DEMENTIA CARE UNITS UPDATE

Australia’s first Specialist Dementia Care Units (SDCU) are progressing quickly, with Residents expected to be received this year. The first 35 new SDCUs have been designed to care for those who display ‘severe behaviours’ and therefore may not be adequately cared for in mainstream care.

In February, a series of forums across the nation began, with the intention of informing the decision making tool and clinical pathway for residents, to ensure it is fair for both entry and exit from the program. $70M will be invested by the Government annually to support the program.

The SDCU prototype is being developed by the Brightwater Care Group in Perth and will be operational by July 2019.

DEMENTIA RESEARCH

New grants, funded by Dementia Australia’s Research Foundation, have been announced in February, totalling $1M towards new dementia research projects. The grants will be covering 17 new studies into dementia, covering such research as the development of a cognitive-mobility stress test; estimating the value of informal care given to people living with dementia; and the use of brain organoids and artificial intelligence for understanding dementia. You can view the full list of research projects receiving a grant here.

Another recent study has come to light that suggests that the more we move – at no matter what stage of life – the less the risk of dementia becomes. Although previous research has shown similar results of the relationship between keeping active and lowering the risk, it appears that even those who already have brain lesions of biomarkers of dementia could see benefits and allay the effects. You can read more on the study results here.

The Royal Commission has also put a spotlight on dementia, with the Commission hearing that those working in Residential Aged Care as Carers do not require formal dementia training. Dementia Australia CEO, Maree McCabe, attended the Royal Commission in February as a witness, and you can hear her discuss the impact of not having mandatory dementia training on ABC’s Breakfast Radio program here. National Seniors Australia Chief Executive, John McCallum, also echoed his concern that dementia training was not mandatory and believes that a lack of training could lead to care that was not intended to be ‘bad’, but situations could be handled ‘inexpertly’.

AGED CARE WORKFORCE NEWS

Australia’s very first Aged Care workforce industry council was established this year, to implement the Aged Care Workforce strategy, ensuring that the sector continues to attract and retain a passionate and skilled workforce. The Royal Commission has heard that the number of Registered Nurses who are working in Aged Care is decreasing; with concerns that Carers who are not as qualified, filling in on certain roles, with witnesses from the Australian College of Nursing and Australian Nursing and Midwifery Federation sharing similar concerns. ACSA CEO Pat Sparrow has shared with the Commission that the workforce will need to be tripled by 2050, and now is the time to work on attracting millennials. As a start to this, ACSA is trialling a program in Tasmania that exposes high school students – many of whom had not considered Aged Care as a post-schooling option – to the benefits of a career in the Aged Care industry.

IN-HOUSE PHARMACISTS

In our December Industry Update, we shared the news that ACT-based Provider, Goodwin Aged Care, had run a successful pilot of a first in Australian Aged Care – having an on-site pharmacist. Now, the peak body that represents Pharmacists has called for funding to continue testing the model to improve medication safety in Aged Care. Embedding Pharmacists on-site is proposed to reduce any harm caused by medication overuse and the Pharmaceutical Society of Australia (PSA) has added education and training, supporting the facility to reach accreditation standards in regards to medication management and lead ‘clinical governance and resident-level activities around appropriate use of medicines’ would be a part of this.

PSA has requested $17M in funding to test the model.

FALLS PREVENTION

In January’s Industry Update, we shared the exciting news of a development for Parkinson’s research, with a grant being provided to UNSW and Neuroscience Research Australia (NeuRA) to test ‘SmartSocks’ – designed to help stop falls in people with Parkinson’s. Even more good news this month, with a reactive balance training program also run by NeuRA, assisting those with Parkinson’s to retrain the brain to help the brain stay more agile, respond faster, and correct balance to prevent falls. The program is based on a pathway with ‘traps’ that could cause a trip or a slip – and participants, who are supported by a safety harness, walk the path, training their brains and body to respond quickly. Read more about the study from NeuRA here.

TECHNOLOGY

To technology news for February; a push for an uptake in technology in the Aged Care space was the focus of a recent Aged Care Industry Information Technology Council (ACIITC) forum. 35 attendees representing a broad range of the industry discussed their perspectives surrounding issues of technology in the sector and improving understanding. The forum also aimed to help inform their submission to the Royal Commission, as well as drawing on the Technology Roadmap.

Moving to app development, and another new smartphone app is being trialled, with the aim of bridging the gap between families, Carers, Providers and a loved one. CareApp means that Carers can (with permission of course), photograph a Resident as they go about their days, update information and record changes such as mood changes, physical changes and medication schedules. You can view more information on the CareApp here.

And in final tech news, and an exciting note to finish on. In February, two young Tasmanians have won a national science award for an invention that aims to keep older people safe. Motivated by a personal connection – wanting to keep a great-grandmother safe – two cousins have developed a device that can identify when a person has fallen and triggers an alarm. A smartwatch style device, the ‘aWear’ links to a database and can advise nursing teams on the wearer’s location in real time, and sets off an alert if it registers what it believes is a fall – even if the wearer has not pressed the alert button.

The duo had been concerned about response time if an 89 year old great-grandmother (one of their own), who lives in an independent apartment in Hobart, fell over and had no way of notifying anyone.

The tech will now head to a science and engineering fair in Arizona.

EMPATHY SUITS

A new trial is allowing people to be able to simulate what life feels like to be a Resident in a facility. ‘Empathy Suits’ are a new aspect of innovation in staff training, allowing team members to feel and understanding the various issues that a Resident may face. Officially called PAUL suits (Premature Ageing Unisex Leisure) suits, not-for-profit group ACH Group are the first Aged Care Provider in Australia to trial the suits as a part of their training. The suits are designed to emulate health conditions such as restricted movement, fatigue and eye conditions. These are simulated by the use of straps, weights and even eye goggles. The pilot program is to be rolled out in conjunction with the University of Sydney.

PALLIATIVE CARE ROADMAP

Two big pieces of news for Palliative Care Australia in February. A new CEO, Rohan Greenland, has been welcomed, replacing Liz Callaghan who was in the role for the past four years. Mr Greenland has come from the National heart Foundation, where he has been for more than 10 years.

Palliative Care Australia has also launched a new roadmap, a proposal that aims to show what the community and Government needs to do to ensure palliative care needs are met by 2030. The roadmap, titled Palliative Care 2030: Working Towards the Future of Quality Palliative Care for All, focuses on collaboration, and innovation and a commitment to ensuring that needs are met for those living in palliative care.

NEW FRAMEWORK ADVOCATING FOR AGED CARE RECIPIENTS

A new framework released nationally is setting out to ensure that people living in Aged Care receive the best assistance possible from Government funded advocates. The new National Aged Care Advocacy Framework outlines objectives, guiding principles and target groups for The National Aged Care Advocacy Program (NACAP). The NACAP guides Aged Care recipients to ensure that they are able to exercise choice, raise concerns and have an advocate throughout this process. There is a special focus on those people living with dementia, disability, cognitive decline and special needs.

FOOD IN AGED CARE

Interesting news for food in Aged Care, with an exciting new approach being rolled out across Victorian Provider Villa Maria Catholic Homes. Utilising a ‘self-directed’ approach, which follows the Montessori model, food is being presented in a non-traditional buffet-style, encouraging Residents to choose the amounts and types of foods they wish for. You can read further about the new approach to food here.

In other food news for Aged Care, the Maggie Beer Foundation, which has worked with improving food in Aged Care, has been provided with a $500,000 grant by Minister Ken Wyatt. The grant will help fund a new program that will educate and train kitchen workers in the Aged Care industry, looking at nutritional content, taste, and working with multiple diets at once for people over the age of 70. The program will be available online and be presented across 11 modules. You can learn more about the course here.

PET THERAPY ON THE LARGER SIDE

Pet Therapy has been around in many Aged Care facilities for some time, where visiting dogs, cats, birds and even some permanent resident chickens have been a large part of Facility life. But a new, and much larger version of pet therapy has come to a Victorian Facility in Geelong, Multicultural Ages Care Services (MACS). Equine therapy at MACS means that Residents get visited by Beau, a horse who is guided through the Facility. You can see some pictures of Beau hanging out in the Facility in the MACS newsletter here!

That’s all for this month but check back in with us next month for another industry update!

 

Kelly LISSIE LYONS – CHAMPION OF EDUCATION & MARKETING
Author

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