We’ve powered through the first half of the year; over 150 days since the Royal Commission’s preliminary hearings have passed, and nothing is slowing down for the Industry. July 1 meant the launch of the new Aged Care Quality Standards as well as the new Charter of Aged Care Rights. The July Royal Commission hearings from Darwin, Cairns and Regional Victoria covered access to care and family, informal and unpaid carers, of course meaning another big month of news coming out of the hearings. The issue of food in Aged Care once again became a focus with Maggie Beer bringing the topic back into focus; New Zealand is watching the Australian Royal Commission closely as they consider their own Aged Care systems; and finally some of the biggest news of the month with a Queensland facility suddenly shutting down, leaving residents stranded. Let’s leap into the news for July.
AGED CARE QUALITY STANDARDS
July 1 saw the launch of the new Aged Care Quality Standards, which combine all previous standards into a single set. Aged Care Commissioner Janet Anderson PSM says the new standards ‘raise the bar’ for Aged Care as well as ‘strengthen[ing] the focus on consumer centered care’ and continuous improvement. Minister for Aged Care and Senior Australians, Senator the Hon Richard Colbeck, declared in his new standards press release that they would ‘improve transparency for senior Australians and their families, as well as making regulation clearer for Providers’. The new Quality Standards have been in development since 2018 and were developed via consultation with the industry, including Providers and people working in Aged Care; residents and their families, experts and Industry bodies.
A transition period to the new standards that began on July 1 2018, officially ended on July 1 2019, and with it the additional ACFI subsidy, the Quality Care Fund that originally began on September 20 2018. You can read about the Quality Care Fund rates in our 2018 ACFI Rates article here.
There are some transitional arrangements to assessment and monitoring during the initial period of the new Standards being in effect. The Aged Care Quality and Safety Commission has prepared a fact sheet and further information on what Providers need to know during this period here.
All Aged Care Providers will be measured against the Standards from July 1 2019. For a breakdown of changes that have happened since January 1 2019, you can read a great breakdown here. You can view the new Aged Care Quality Standards here and find the resources here.
NEW CHARTER OF AGED CARE RIGHTS
July 1 also saw the new Charter of Aged Care Rights come into effect, replacing the previous Charter’s Aged Care rights and responsibilities. Like the standards, the new Charter places the consumer at the centre of care. For more information, you can find a booklet developed by the Department to support understanding of the new Charter here, and a Poster to help promote and raise awareness of the Charter here.
AN-ACC TRIAL
The Department of Health reached out to the industry in July to find Residential Aged Care Providers to trial a proposed assessment framework – the Australian National Aged Care Classification (AN-ACC) to replace ACFI. Providers were to have submitted their applications by July 31, with the trial scheduled to start in late 2019. The trial will test the external model of assessment, as well as refine the workforce processes and training. You can read our wrap up on the AN-ACC, and the myths and facts surrounding the timeline for the implementation of a new funding tool here. For more information on the tool you can visit the Government’s website here.
ROYAL COMMISSION
The Royal Commission held hearings in Darwin, Cairns and Mildura in regional Victoria in July. The focus of the hearings were Access to aged and clinical care and carers for older Australians.
As a part of the clinical care focus for older Australians both in Residential Aged Care and those being cared for at home issues such as oral care, pressure injuries and ulcers, and diet were raised. An additional day was added to the hearings in Darwin as the Commission continued to hear statements concerning the clinical care of Residents; with references to the demanding role of Nurses and Carers with limited time and the need to increase Aged Care staff. A Pharmacist researcher, Dr Janet Sluggett, advocated for ‘embedded’ Pharmacists at Aged Care facilities in order to provide better pharmaceutical services, quality and clinical care.
The topic shifted to the role of carers in the home, with the belief that the current Australian Aged Care system will heavily rely on family members and unpaid carers in the future, as the population continues to age. The complexities, pressures and struggles of being a carer was highlighted by a number of witnesses; as well as the lack of access to respite care, guidance or carer support from Government processes.
Background Paper 6, Carers of Older Australians, was released by the Commission in late July.
A recent study based in America has found that Residents returning to care after a hospital stay have a high risk of developing preventable health issues once they have returned. The Royal Commission hearings have suggested a similar pattern in Australia, with Residents released from hospital too early or without an updated care plan communicated – highlighting a gap in communication between hospitals and Aged Care facilities that needs to be improved.
Access to care in remote areas was also discussed in the Darwin hearings, during the same week that NAIDOC 2019 took place. Statements were provided by witnesses concerning the extreme lack of access to care services in remote locations and highlighting the importance for Aboriginal Elders to be able to stay on country and with their community. A new toolkit has also been developed by the Federation of Ethnic Communities’ Council of Australia (FECCA) that helps culturally and linguistically diverse (CALD) aged care recipients to share their stories with the Royal Commission. For people who do not speak English as a first language or who have lost English language skills, the toolkit enables care recipients and their families to understand the process and the making of a submission. The toolkit means that CALD aged care recipients can write, record or phone their stories in their own language. You can access the toolkit here.
With early August came a week of hearings in Brisbane, and September sees the start of the three hearings to be held in Melbourne. You can keep up to date with the hearing dates and topics 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.
RESPITE CARE
The July Royal Commission heard the issue of the scarcity of Respite Care being available for Aged Care recipients receiving care from family members and unpaid carers. Respite Care is considered essential for carers and limited access appears to be an increasing issue. The Commission heard from a witness in July that Respite Care for her or her mother would not be available ‘unless someone dies’. The shortage of Respite Care has also been blamed on its use as a ‘try before you buy’ system, limiting the spaces for those carers who need a break. Advocacy group Carers Australia has requested the Government fix the lack of shortage of Respite Care places before the final Royal Commission report is released.
HOME CARE
Updates to Home Care pricing and information transparency came into effect on July 1, expanding on the late 2018 requirements for Home Care providers to publish their pricing information. Home Care Providers are now required to publish their pricing in a new standardised home care pricing Schedule on the My Aged Care website. In addition, a full price list and service information needs to be published with further information to be provided to both new and existing clients. Since the introduction of compulsory fee reporting, Home Care prices have been reduced – a result of the new transparency, according to an independent retirement planner, Peter Tyndall.
Home Care in Australia continues to face issues with increasing demand, with over 53,000 people receiving interim packages at lower levels than their requirements, and wait times continuing to sit at more than 12 months. Leading Age Services Australia (LASA) CEO Sean Rooney has stated that LASA data suggests that those receiving the interim packages ‘often pass away or enter hospital or residential care’ before ever getting access to their correct package.
FOOD IN AGED CARE
The food served in Aged Care has been a consistent topic of interest for quite some time, and came to the forefront of the news in July when celebrity chef Maggie Beer spoke at the Royal Commission. Speaking about her purpose behind establishing the Maggie Beer Foundation in response to seeing both ‘great and terrible food in Aged Care’, Ms Beer expressed the importance of good food as well as flavour. She also highlighted that in her opinion the new standards did not include a standard for food quality, and that Residents should be able to provide feedback on their food. Ms Beer’s appearance at the Cairns Royal Commission hearing followed a discussion with three chefs, and statements that $7 per Resident per day was not enough to provide appropriate, quality food. At the other end of the scale, an increase of $16 per Resident per day was considered perfectly sufficient to supply high-quality, flavoursome food. Dieticians and nutritionists also spoke at the hearing, expressing an urgent need to improve food in Aged Care in Australia, stating that currently Residents are ‘malnourished and they’re starving to death’. Malnutrition is caused by a number of factors in Aged Care, including dental issues, dementia-related difficulties and lack of assistance to eat. A Tasmanian project is already addressing malnutrition in Aged Care facilities by developing nutritional strategies that involves the whole organisation. Dr Emma Lee, a senior research fellow at the Wicking Dementia Research and Education Centre, is currently working on a 2 year study that is based on a whole-organisation intervention, educating all team members of nutrition. You can read the trial information on the study, Meaningful Engagement in Nutritional Understanding: Best Choices for Aged Care (MENU) here.
QLD HOME SUDDEN CLOSURE
Some of the biggest news to come out of July was the sudden closure of a Queensland facility that meant Aged Care Residents were left stranded as a search for emergency beds took place. In early July, it was reported that food, patient records and medication were all stripped from the facility after a dispute over money between the Village owner and the Aged Care contractor providing the care. Reports of the distress that the situation caused for the former Residents included Residents not being provided with the level of care required, despite some staff staying behind to assist. Emergency services were also called to assist with the evacuation. LASA CEO Sean Rooney expressed his support for the work of the emergency services and the local facilities who all assisted with accommodating the Residents; whilst calling for the Government to consider funding issues in the investigation of the situation.
The abrupt closure and emergency evacuation of residents saw the situation referred to the Brisbane Royal Commission hearings in the first week of August, as well as an independent inquiry announced by Minister for Aged Care and Senior Australians, Richard Colbeck. You can read the Terms of Reference for the inquiry here.
QLD INQUIRY
The Queensland Government’s own inquiry into Aged Care, End-Of-Life and Palliative Care and Voluntary Assisted Dying is still underway, in July proposing legislation that would require all Queensland Aged Care Providers to publish staffing information publicly. The proposal has sparked strong responses from peak bodies Aged & Community Services Australia (ACSA) and LASA. ACSA has agreed that there is need for conversation and change in this space, but has asked the Queensland Government to speak with Aged Care Providers and consider the risk of confusion with the federal Government already examining staffing ratios. LASA have expressed that there are a number of factors that need to be considered in the discussion of staffing levels in Residential Aged Care. This follows a poll conducted in Queensland in late 2018, that saw almost 80% of Queenslanders supported legalising voluntary-assisted dying for those who are terminally ill.
A Palliative Care expert also spoke to the inquiry in July, who shared that there will soon be a large number of older Australians who will need assistance in dignified deaths, and that Australia is not currently prepared for this. As reported in our June Industry Update, Victoria introduced new assisted dying laws, the first time in over 20 years that voluntary assisted dying has been legal in Australia.
PHYSICAL & CHEMICAL RESTRAINTS
Once again, physical and chemical restraints in Residential Aged Care was a big topic in the industry, with a new study that reviewed Facility medication records published in July. The Lead Author, Macquarie University’s Dr Kimberley Lind, stated that the study of the records show that doctors were not following guidelines, showing that some Residents had been medicated with antipsychotic drugs for more than 200 days, when the guidelines for recommended antipsychotics state they should only be for a maximum of 12 weeks. You can view the study, Duration of Antipsychotic Medication Use by Aged Care Facility Residents With Dementia, here. You can read the most recent updated changes to the Government legislation on minimising the use of restraints here.
FUNDING
To funding news, The Aged Care Financing Authority (ACFA) have released the 2019 ACFA Annual Report on Funding and Financing of the Aged Care Sector. The report, covering developments, issues and challenges that affect industry, has found that overall, financial performance in the Aged Care sector is declining. A decrease of 12% of Providers making a profit was reported, down from 68% in 2016-17 to 56% in 2017-18. The report also shows that expenses for Residential Aged Care Providers had increased by 5.3%, increase in income 1.7% in comparison. The most recent StewartBrown Report released in June showed that over 45% of Residential Aged Care facilities were operating at a loss. The National Director of Uniting Care, Claerwen Little, has expressed her belief that as a result financial challenges, that Providers will be unable to meet the standards of quality services and care – leading to a ‘perfect storm’ in Aged Care. Ms Little highlighted that it is crucial that the Government addresses the current funding issues and takes action.
DEMENTIA
To our Dementia update for July, and a wonderful boost to dementia research has come with $21M being injected by the Government into research projects for risk reduction, prevention and tracking of dementia. The second leading cause of death in Australia, the need for investment into research and development of treatments and prevention is significant. You can read a list of the funding scheme recipients here.
Dementia Australia has welcomed the new Aged Care Charter of Rights and the new Aged Care Quality Standards, stating that they would benefit people living with dementia living in care. However, Dementia Australia also delivered a report to the Aged Care Minister Richard Colbeck with dementia-specific responses to each standard, based on what people living with dementia want included in their care. The guide, Our Solution: Quality Care for people living with dementia includes recommendations from a human rights-based perspective and Dementia Australia CEO Maree McCabe has called on the Federal Government to implement the proposed solutions.
New studies have revealed some interesting ways believed to improve cognitive decline. A study by the University of South Australia has found that just 10 grams of nuts per day led to improved cognitive functioning, as well as better memory, and the study authors are hopeful that this information could be useful to fight off dementia. You can read the study here. To another interesting study from Macquarie University, and research has shown that older men who utilise a range of Community Care services appear more likely to have a better memory than those who do not. The data from the research is currently being analysed, with a full paper on the study findings to be released later in 2019.
The preliminary results of a study that was hoping to demonstrate a program that helps to prevent falls in people with dementia have shown that the program did not make a difference. The study aimed to explore an intervention strategy involving visits from an Occupational Therapist and Physiotherapist, as well as education and guidance for carers. Unfortunately, the initial data from 12 months of the program running suggested that it did not prevent falls, however it was reported that the visits brought enjoyment.
And finally for our dementia update, there is an opportunity for Home-based Carers to participate in a new study, which aims to teach Carers to use music therapy to help with symptoms such as agitation that people living with dementia face. The study, Home-based family caregiver-delivered interventions for people living with dementia, aims to research the effectiveness of music therapy in the home, with the intention of ‘[reducing] the burden and [improving] the quality of life for the carer’. You can find out more about participating in the program study by contacting homeside-australia@unimelb.edu.au or call Dr Imogen Clark, the study researcher, on (03) 8344 4449.
RURAL, REGIONAL & REMOTE NEWS
In wonderful news, a small South Australian town is working on regional workforce issues itself. It has been widely reported that the Aged Care workforce needs to double – at least – by 2050, with rural and remote communities facing additional challenges. In response to this, the town of Loxton in South Australia, with a population of 4,500, has been offering free training and scholarships for people interested in working in Aged Care. Partnering with a Registered Training Organisation, locals from the town are trained in their Certificate III in Aged Care (the Certificate III in Individual Support), with theory and training taking place at the local hospital and clinical placement taking place in Aged Care. The program initially ran in 2018 with 9 students, 7 of which are now working in Aged Care locally.
The Royal Commission in July with its focus on access to care highlighted the lack of Residential Aged Care services in rural and remote areas of the Northern Territory. The Royal Commission heard that the distance that needed to be travelled to reach these areas, plus the higher rate of older Australians in need of Aged Care Services (one in five people over the age of 50 may need Aged Care services, equating to 13 times the national average) has led to unmet needs in the Northern Territory. The Darwin Community Legal Service also shared their concern with the media of the serious lack of services in the Northern Territory, and the unlikelihood of private Providers establishing services in the areas. This issue is amplified with the Northern Territory having limited access to Home Care packages and less than half the number of Residential Aged Care places per capita compared to the other states and territories in Australia. At this stage, the Royal Commission will not be holding any hearings in the remote Northern Territory.
ABORIGINAL AND TORRES STRAIT ISLANDER AGED CARE
As we have seen, the Royal Commission’s July hearings discussed access to care in Australia, and the lack of services in remote areas leading to Aboriginal elders being taken away from their families and country. In early July, the Minister for Aged Care and Senior Australians Richard Colbeck announced that $20M will be delivered to build a new Aged Care service in Nhulunbuy in East Arnhem Land. The construction for the new facility is believed to be commencing in February 2020, with a practical completion date set for April 2020. Community Services Provider, Australian Regional and Remote Community Services (ARRCS) will be competing the new facility, a few years after its original announcement in 2016.
A joint second announcement on the same day from the Minister for Health, Greg Hunt, and former Minister for Aged Care, Ken Wyatt, now the Minister for Indigenous Australians shared the delivery of $5.6M for research into healthy ageing of Aboriginal and Torres Strait Islander Peoples. The research intends to ‘address the need for culturally-informed research’, and explore prevention, early intervention and treatment.
Launch into Work, a ‘pre-employment’ program run by Australian Unity specifically targeting the employment of Aboriginal and Torres Strait Islander peoples, creates pathways for careers into the Aged and Disability Care sectors. Running for 10 weeks, the program aims at building skills for people who have had no previous experience in the sectors, as well as aiming to work towards addressing issues such as the shortage of the Aged Care workforce, employment in rural and remote areas and the ability to provide culturally appropriate care for Aboriginal and Torres Strait Islander peoples. The first program participants will graduate in August.
STAFFING RATIOS
In addition to the news from the Queensland inquiry into Aged Care of the proposed legislation for all Queensland Providers to publish staffing information, was the news that Aged Care facilities in Cairns appear to have some of the lowest Nurse-to-Resident ratios in Queensland. Based on recent audit results, the Queensland Nurses and Midwives’ Union expressed concern about the understaffing of facilities across 30 electorates. To Parliament, a Private Members Bill, Aged Care Amendment (Staffing Ratio Disclosure) Bill 2019, mirroring the 2018 legislation, introduced to the Federal Parliament in July by South Australian Independent Rebekha Sharkie. Requiring all Aged Care Providers to publicly release their staffing ratios, the Bill has garnered support from The Australian Nursing and Midwifery Federation (ANMF). Calling on all politicians to support the Bill, the ANMF stated the legislation was crucial, and would bring about ‘much needed transparency’ to the Aged Care industry. In addition, Ms Sharkie introduced the Aged Care Quality and Safety Commission Amendment (Worker Screening Database) Bill 2019, which proposes that all people working in Aged Care as both volunteers and staff would be required to undergo screening and registered on a National Database, that would be managed by the Aged Care Quality and Safety Commission.
NATIONAL AGED CARE MANDATORY QUALITY INDICATOR PROGRAM
From July 1 2019, the National Aged Care Mandatory Quality Indicator Program became compulsory for all Government Subsidised Residential Aged Care services. All Aged Care services from this date forward will be required to collect, and provide the following data to the Department of Health:
- Pressure injuries
- Use of physical restraint
- Unplanned weight loss.
You can read further on the requirements to meet the National Aged Care Mandatory Quality Indicator Program here, and the amendment to the legislation here.
TECH & INNOVATION
To tech and innovation in the Aged Care space, and a South Australian startup company , Care Konnect, have developed a social platform for Aged Care Residents. The platform encompasses instant messaging, a live feed with updates and also allows care staff to update family members on Residents, as well as Residents being able to submit complaints. Currently there are three Providers using the platform in Adelaide and Care Konnect look to expand into Victoria, Australia and collaborate globally in the future. You can learn more about Care Konnect here.
Now to Victoria, and a Geelong based startup has developed a non-invasive way of monitoring falls, and if a fall takes place, sending a signal out for help. Imagine Intelligent Materials uses graphene, a form of inexpensive carbon, which can detect falls or slapping and sends a signal to small receivers that connect to the internet. Imagine Intelligent Materials aims to target its sensing floors to the Aged Care market.
For Home Care tech, Perth-based company HomeStay, who provide technology to support older Australians living at home, have been appointed a reseller of Essence Security Systems technology that will ensure better care is provided. The technology uses data analysis and sensors to determine routines, movements and as a result sense irregularities in a home that may be cause for concern. ‘Intelligent Home’ intends to provide information to ensure more focused, quality care, minimising unnecessary care and enhancing responsiveness. The Personal Alert System (PARS) scheme, which is another alert system available to people who need an additional sense of security by being able to press an alert button from a pendant in case of an emergency, has just had its rebates cut in South Australia.
A new app launched by the Sydney Local Health District’s Public Health Unit, FluCARE (the InFLUenza outbreak Communication, Advice and REporting app) is assisting with the management of flu outbreaks in Residential Aged Care facilities. The aim will help staff recognise and then quickly respond to, signs of a flu outbreak to ensure immediate responses and therefore containment of the flu. The app is currently being piloted for 12 months. You can read more about the project here.
And finally for tech, a new device that helps to prevent pressure sores has been proving very effective to keep Residents in a beneficial sleeping position. The device is a fluidised positioner, filled with viscous fluid mix to support the body during positioning. A recent study found that the positioner maintained the correct shape and supported Residents to maintain the position they need to be in to reduce pressure sores, compared with the standard pillows that are generally used.
ELDER ABUSE CONFERENCE
From July 22 – 23 the 2019 Elder Abuse Conference was held in Brisbane, with the 2019 theme being Rock the Boat: a challenge to the status quo, drive change and ‘drive action to end elder abuse’. A number of resources from the Conference panels and presentations have been compiled and are available here.
AGEING STRATEGY NEEDED
A post made on Facebook by an Australian Aged Care worker went viral in July. The post details a ‘day in the life of’ a person who works in Aged Care, covering the workload and reality of the difficulties of working in Aged Care. Within the same fortnight, the Royal Commission heard from a Clinical Consultant Jennifer Abbey that working in Aged Care was both terrifying and sad. Dr Abbey shared that she believes staff suffer as they care for people who may be ‘living a life of hell’, and have neither the time or expertise to help, or know that there is very little they can do to help at all. A national ‘Ageing Strategy’, as opposed to an Aged Care sector, that would focus on a holistic approach to ageing well has been called for by Australian experts, including LASA CEO Sean Rooney.
HAWAIIAN THEMED BIRTHDAY FOR THERAPY DOG
Bethlehem Aged Care Home’s therapy dog, Angel, had her 11th birthday celebrated with a Hawaiian themed party in July. A Golden Retriever, Angel has been visiting Bethlehem for 3 years, and is close to retirement so her party was a very special one. Pet-friendly Aged Care is growing in demand, with a great deal of value for Residents such as sensory benefits, social interactions, and even reminiscence therapy.
That’s all for this month! We are taking a short break from our Industry Update and will be back in a month to update you on what’s been happening in August & September!
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LISSIE LYONS – CHAMPION OF EDUCATION & MARKETING Author |
