INDUSTRY UPDATE – MAY

As we enter winter and almost the halfway point of our 2019, another busy month has passed by with a great deal of news for Aged Care. The federal election was held and although there was no change in Government, a new Minister has been appointed to the sector. The Royal Commission held its third hearings in Sydney; and a great deal of media coverage and news came out of this as a result. The topics of dignity of risk, and the complexity of policing physical & chemical restraints have been discussed at great length. Workplace culture was again a conversation point, and as always, technological developments in the Aged Care space continue to come to light. Let’s look back on the election month of May and what it meant for the industry!

NEW MINISTER FOR AGED CARE

The May 2019 Federal Election did not bring with it a change to the Government; but it did mean a new Minister for the Aged Care sector. Senator for Tasmania, Richard Colbeck was named the new Minister for Aged Care and Senior Australians, alongside his roles as Minister for Youth and Sport. Formerly the Assistant Minister for Agriculture and Water Resources, Senator Colbeck begun his appointment by planning to continue delivering on the Royal Commission results, ‘to ensure the Australian community has confidence that their loved ones are receiving high-quality care and respect.’

Leading Aged Services Australia (LASA) CEO, Sean Rooney, had previously appealed to Prime Minister Scott Morrison to elevate the Minister for Aged Care and Senior Australians to Cabinet, but this has not occurred despite the sector campaign. The Minister for the National Disability Insurance Scheme (NDIS), Scott Robert, will be joining the cabinet.

Former Aged Care Minister Ken Wyatt, has moved into a new role of Minister for Indigenous Affairs.

ELECTION WRAP UP

Concerns around the lack of focus on Aged Care and creating a better system for the sector leading into the Federal Election were openly expressed by the peak bodies in May. Council on the Ageing (COTA) Australia CEO Ian Yates declared it was a failure for both parties to exclude Aged Care from the Leaders debate held on 8th May, and Aged & Community Services Australia (ACSA) released a media statement to express disappointment that their 5 points to action prior to the Royal Commission have been all but dismissed.

Although Labor announced their intentions to improve the system, the party was criticised for not intending to boost the wages of the Aged Care workforce, the second most underpaid sector (after pledging to increase the wages of the first, the Childcare industry).

Post the election, along with the changes to Minister, came the announcement of an independent agency that will run under the Government and be responsible for Government Services delivery, including Aged Care programs – Service Australia. Modelled after Service NSW intending to make Government service delivery easy, the initiative will fall under the care of the Department of Human Services.

You can read the Government’s Administrative Arrangements Order here.

ROYAL COMMISSION

A busy month for the Royal Commission, with the Sydney Hearings occurring on the 6 May – 8 May 2019 and 13 May – 17 May 2019. The focus on the Sydney hearings was back on Residential Aged Care, with attention on caring for people living with dementia.

The hearings involved a number of witnesses sharing their stories and lived experiences of dementia care in Residential Aged Care; with physical and chemical restraints and dignity of risk two very prevalent themes throughout. We’ll explore these topics later. Government policy, with issues and concerns for people living with dementia was described as not adequate at all; dementia advocates highlighting that dementia support is being based around end of life care, as opposed to living. A call for a focus on encouraging dementia education was also made, with the Commission hearing of workloads that cannot be completed within shifts, inadequate training for caring for people living with dementia and the topic of staffing ratios once again entered the conversation.

Announcements of the next hearings were also made; with the next location to be held in Broome from 17 June – 19 June 2019; focusing on ‘care in remote areas, unique care needs of Indigenous Australians and issues of access and inclusion’. This will be followed by a Perth hearing from 24 June – 28 June, ‘centring on person-centred care, advanced care planning and palliative care services’. Finally, hearings in Darwin (8 July – 12 July) and Cairns (15 July – 17 July) will both focus on ‘care in residential, home and flexible aged care programs and examine access for veterans, rural and regional issues and quality of life for individuals in care’.

The Royal Commission released three background papers in May, bringing the number of background papers to four, following the February release of the first. The May papers cover Changing demographics and dynamics of aged care; Understanding dementia treatment, care and its physical and social consequences and Restrictive practices in residential aged care. You can read the Aged Care Guide’s summary of the three background papers 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.

UNDERSTAFFING

A frequent subject of the recent Sydney hearings was understaffing in Aged Care, and the controversial topic of staff-to-resident ratios. An issue that divides the industry, the Australian Nursing and Midwifery Federation (ANMF) has been one of the lead campaigners for mandated staffing ratios in Aged Care since 2018. Aged Care Advisory firm Ansell Strategic have recently entered a submission to the Royal Commission, in relation to its investigation into fixed staffing ratios in Aged Care Residential facilities and their practical application. Ansell Strategic have stated that for the Australian system, they do not believe that fixed staffing ratios would be appropriate for a number of reasons. Including the ANMF and Flinders University’s modelling of costs and benefits report (you can read this here) in the investigation, Ansell Strategic highlighted that they completely supported the ANMF in that the workforce is ‘under-resourced, inadequately trained and undervalued’. Managing Director Cam Ansell stated that staffing ratios was a ‘simple solution’ to a ‘very complex problem’. You can read the submission here. The ANMF shared a media release following the Ansell Strategic report, although not directly addressing it, to clarify any potential misinformation.

For an interesting take, The Conversation has broken down data sourced from the Aged Care Financing Authority (ACFA) Annual Report on Funding and Financing of the Aged Care Sector, July 2018 report, that you can read here, stating that 2 out of 3 Aged Care facilities are understaffed.

DIGNITY OF RISK

Another big subject for the Sydney Royal Commission hearings in May was the topic of dignity of risk. Dignity of risk was legislated in the Aged Care Act 1997. Standard 1 of the new Aged Care Quality Standards is ‘Consumer dignity and choice’; with requirement (d) stating ‘each consumer is supported to take risks to enable them to live the best life they can’. The Commission heard from experts who have highlighted the need to balance quality of life, with ensuring duty of care.

A Sydney Dignity of Risk forum was also held in May, which saw a number of experts speak – including Professor Joseph Ibrahim who also spoke at the Sydney Royal Commission hearings – on ‘Balancing Dignity of Risk and Duty of Care’. The Weekly Source reported that a big takeaway from the forum was for Aged Care Leaders to ‘be proactive about embedding a culture around dignity of risk’. Future forums will be held by Ansvar Risk.

A recent bill was passed in Queensland (the Criminal Code and Other Legislation Amendment Bill 2019) that means that people can be charged for ‘failure to supply the necessaries of life’ – which Aged Care 101 has highlighted as a potential dignity of risk issue. You can read their thoughts on the legislation and weighing up dignity of risk versus duty of care here.

PHYSICAL & CHEMICAL RESTRAINTS

Physical and chemical restraints in Aged Care were another big feature of the Sydney Royal Commission hearings, especially with the focus of the inquiry on the care of people living with dementia. Case studies were presented to the Commission with witness testimonies given by family members of people in care. You can read some of the case study summaries here and here or find the full witness transcripts on the Royal Commission page. Witnesses working as nurses in the Aged Care industry also gave evidence at the hearings, giving insights into the issues of understaffing, lack of education and the need for diversional therapy in facilities. The concern of understaffing was highlighted as no excuse, but could be a reason why chemical restraints were used as opposed to alternative options. Alzheimer’s Disease International chair Glenn Rees, an international dementia advocate, shared his concern that the new regulations surrounding physical and chemical restraints could continue to leave interpretation open to discretion.

From July 1st 2019, Residential Aged Care Providers will need to fulfil several conditions, including that assessment is completed by an approved person, and alternative options have been tried prior to physical or chemical restraints – with restraints being the very last resort. You can read the Quality of Care Principles here.

HelloCare have released an interesting breakdown on if consent is required when prescribing psychotropic medications in Aged Care, which you can read here.

NEW STANDARDS CONCERN

Following on from the use of physical and chemical restraints in Aged Care, the new Quality standards have come under fire from experts who are concerned that there was a ‘lot of looseness’ surrounding the use of restraints under the new principles.

Trepidation has also been expressed about the standards, coming into effect on 1 July 2019, by the Aged Care workforce who are worried that more stress will be added to roles they are struggling to keep up with.

There had been some speculation with some guidance material and new related rules that were still to be finalised 6 weeks from the new standard implementation date that the transition period to the new standards may be extended. The Governance in Aged Care Conference in late May confirmed that all Providers will be assessed against the new standards from 1 July, with the 12 month transition period ending and no ‘soft’ introduction.

RISING CONCERNS FOR FLU SEASON

Last month we reported on the rising concerns of the early outbreak of the flu, with a prediction that the 2019 flu season would claim up to 4,000 lives – the elderly most at risk. May continued to see an alarming rate of influenza cases diagnosed, with South Australia along recording 12,339 cases by the middle of the month, with 17 deaths reported, 13 of whom were Aged Care Residents, and 18 Aged Care facilities closed as a result of the flu. NSW reported in the week up to 19 May that 10 Aged Care Residents had also died from the flu.

A recent study has reported that flu vaccination practices in Aged Care facilities need to be improved to assist with controlling outbreaks and their duration. Examining the use of antiviral prophylaxis for influenza outbreaks in residential aged care facilities in NSW, Australia studies flu outbreaks reported to NSW Public Health Units for the period 1 June to 31 October 2015.

May 2018 saw the introduction of the mandate that all Government-subsidised Aged Care Providers must provide free flu shots to all employees working in facilities. The mandate came on the back of a horror flu season in 2017, with 1,100 flu related deaths. The mandate did not make the flu vaccine compulsory for employees.

TECHNOLOGY

A big month in technology in the Aged Care industry in May, starting with great success for Australian companies winning multiple awards at the recent seventh Asia Pacific Eldercare Innovation Awards in Singapore. Among the winners was Melbourne based Aged Care platform hayylo, who we reported on in our March Industry update, who received the award for the Best Smart Care Technology in the Solution category. You can read a list of all the Australian category winners here. Congratulations to all winners, finalists and entrants on their work for the industry!

IRT Aged Care facility, Kangara Waters, in Canberra undertook a two week trial in May of a very new service – a driverless shuttlebus. Intended to enable Residents to be transported around the facility grounds to easily visit other Residents or access the village services or amenities, the shuttlebus can seat up to 6 passengers, includes an access ramp and uses satellites and lasers to navigate and stay clear of any obstructions. A guide acting as a chaperone is still present on the shuttle, that reaches a top speed of 10km per hour, in order to keep in line with ACT laws. The trial intends to determine how the shuttlebus can be used to improve quality of life, independence and reduce social isolation in Residents, with data collated and findings to be presented to the Government and industry bodies to assist with any future policies or programs.

In other tech news, a Leukemia survivor has created a ‘smart bed’, that intends to help prevent falls and pressure sores, with hopes that it can assist those living in Aged Care among others who have been hospitalised, have insomnia or find it difficult to get out of bed without falling. 25-year-old Nikhil Autar started a social enterprise, Get To Sleep Easy, with his invention; the Smart Inclining Bed, a mechanism that sits on top of a bed, using motors and air inflation to assist people in getting up. It also has an app that accompanies it – ‘Centered Around You’ – which assists with monitoring breathing, heartbeats and alerts families or care teams if something isn’t right, including an identified risk of a pressure sore. A very exciting new tech that could be extremely beneficial to the Aged Care industry.

For our last tech update for the month, an educational tool that utilises virtual reality to help improve empathy and understanding for carers of people living with dementia has been having a wonderful impact on the lives of Residents. A development by an American not-for-profit education provider Second Wind Dreams, the VR simulation helps people to understand what it may be like to experience dementia from a physical and psychological perspective. Encouraging empathy and understanding, these VR experiences are then used to inform person-centered care. The program is currently in use by over 40 organisations across Australia, and across the world in over 20 more countries. Churches of Christ in Queensland, who secured the first Australian device and have been running the program since 2017, have reported improvement in care and a reduction in the use of antipsychotic medication among residents.

MOBILE EMERGENCY

In April, we had news of a mobile response unit designed to contain flu outbreaks – and this month, we see another exciting new mobile initiative; a mobile emergency unit. Currently being developed by the Western NSW Local Health District’s 2019 Nurse of the Year, Melissa Hanson, the intention of the mobile emergency department is to save Residents from trips to hospital emergency departments, which can be an ‘upheaval’ for Residents. Titled the ‘Residential Aged Care Emergency Department Equivalent Mobile Service into local Residential Aged Care Facilities’ project, Mrs Hanson is working with the Western NSW Local Health District and Dubbo Hospital’s ED, and will soon be on a scholarship to visit New York’s Mount Sinai Hospital, which has the inaugural model of care.

PALLIATIVE CARE

National Palliative Care Week was held this year between 19 – 25 May by Palliative Care Australia (PCA). As a part of the week, PCA undertook a survey on planning end of life options, finding that of the 1000 participants, although 79% thought it was important to voice their end of life preferences to loved ones, only 25% had had the conversation and a very low figure of 6% had spoken about them with a doctor. The survey also uncovered the reasons why these numbers were so low, such as people feeling they were too young, not currently sick or didn’t want to upset their families. Palliative Care Week aims each year to raise awareness to such conversations. Online resources are available through the End of Life Directions for Aged Care (ELDAC) website.

Further news in Palliative Care this month; with Australian experts contributing to a new textbook, the Textbook for Palliative Care, launched in Berlin in May. The textbook aims to look at Palliative Care ‘as a science, clinical practice and art’, covering ‘physical, psychological social, and existential or spiritual’ aspects by a number of authors and experts, such as HammondCare Clinical Consultant Professor Rod MacLeod, who is one of two international editors in chief.

RURAL HOUSING

A new report has been released by Horizon Housing, a not-for-profit charity who provide high quality sustainable housing solutions, that has found that older Australians living in a remote Queensland region are not provided with sufficient housing, help or advice about ageing in place. Funded by the Queensland Department of Communities, Disability Services and Seniors, the report, My Home, My Place, shared that more than 96% of the report participants wished to age in place, however rural regions are not able to provide the support to allow them to do so. Horizon Housing CEO Jason Cubit hopes that the research presented in the report will highlight the need to develop ideas for future accommodation for older people in rural and remote areas, as well as emphasising the issues to the Government to plan for future Aged Care programs in these areas.

SPIRITUALITY IN AGED CARE

Meaningful Ageing Australia, the national spiritual care and ageing peak body, has received $544,000 in funding from the Government in May to assist Providers reaching their spiritual care obligations under the new standards. The funding will be used to roll out two national programs, develop a series of short films, and run an awareness campaign on spiritual care in an Aged Care environment. A care guide, Frailty and Spiritual Care has also been developed by Meaningful Ageing Australia, and is available to members of the body for free. The guide assists care staff to incorporate spirituality into their care of frail Residents.

In further news for spiritual care in Aged Care, a leading Australian researcher on ageing and spiritual life, Reverend Adjunct Professor Elizabeth MacKinlay, will address the 8th International Conference on Ageing and Spirituality in October this year. Professor MacKinlay will speak at the conference on the topic of ‘Ageing and frailty: a spiritual perspective of the lived experience’.

BUYBACKS

Compulsory ‘buybacks’ are now in effect in Queensland, following legislation set in 2017 that means Retirement Village Operators are required to ‘buy back’ village units that have not sold after a ‘reasonable’ time – regulated in QLD, Vic and SA as 18 months. For Aged Care, these states are also moving towards the ‘Aged Care Rule’ (Victoria already has), where when a Resident has moved to a facility from a village, the operator will pay their Daily Accommodation payment (DAP), up until the home is sold. The money paid will come out of the Resident’s final payout once the unit has been bought.

CCTV IN AGED CARE FACILITIES

CCTV in Aged Care facilities has been a huge topic recently, and it has recently been reported that retailers are seeing an increase in the number of ‘spy cameras’ purchased by people afraid for their families living in Aged Care despite the many legal ramifications to consider. The concerns and the reported increase in sales are speculated to be the result of stories coming out of the Royal Commission.

As covered in our April Industry Update, a trial of CCTV cameras in a number of South Australian facilities will be installed and rolled out later this year. Lasting 1 year, the trial is a Government investment of $500,000 and managed by a third party contractor – Care Protect.

NATIONAL VOLUNTEER WEEK

The 2019 National Volunteer Week was held from the 20 – 26 May, celebrating Australian volunteers who provide time, support, expertise and care to industries such as Aged Care. Volunteering Australia’s 2019 theme was ‘Making a World of Difference’, which was also celebrating 30 years of National Volunteering week. Many Aged Care Providers around Australia celebrated their volunteers in various ways, sharing stories, their impact and thanks. You can read some beautiful stories shared by the Australian Ageing Agenda here and the Aged Care Guide here.

AGED CARE WORKFORCE NEWS

In our April Industry Update, we reported on the release of the academic report undertaken by the Work and Family Policy Roundtable, that called for ‘urgent reform’ of the working conditions of Aged Care workers. This month, workforce news continues to be a big topic.
Early May saw the announcement from the Government of $34M to be invested in funding to establish a research institution to investigate and explore new ways that education, training and delivering care to Aged Care Providers can be provided. Peak body ACSA welcomed the funding announcement; but highlighted that other significant actions need to be urgently taken in the sector, including the 5 urgent priorities listed in their Election Statement 2019.

May’s Royal Commission hearings in Sydney also heard evidence from people working in Aged Care who shared their experiences of caring for people living with dementia. The Commission heard that it was common for staff to start shifts early, and work overtime (unpaid) in order to be able to complete their workloads. A recent survey, the National Aged Care Survey 2019, involving 2,775 participants working in Aged Care, revealed that a great deal of concern from those working in Aged Care is the lack of staff to provide the care required to Residents.

Member for Mayo, Rebekha Sharkie, who introduced the Staffing Ratio Disclosure Bill to parliament in 2018, has committed to introducing another Private Members Bill to Parliament to create a national database and comprehensive screening program for Aged Care workers.

AGED CARE TRIAL OF UNI STUDENTS LIVING IN FACILITY

An Australian-first trial will study the impact of University students living in Aged Care facilities on the quality of life of Residents. With the intention of having mutual benefits, the trial will involve 6 University of the Sunshine Coast students living in decommissioned rooms at the Cooinda Aged Care Centre in Gympie (the rooms are no longer fit for Aged Care, but otherwise liveable). With similar arrangements occurring in Holland, Germany and the United States, the trial will mean the students will have significantly reduced rent, and are expected to volunteer their time with Residents on a social basis.

A clinical study will run alongside the trial to measure the effects that the additional socialisation has on Residents.

In further interesting news for intergenerational studies, Australia’s very first school built within an Aged Care complex was opened in late May. The Southern Montessori School has been built at the Kalyra Woodcroft Age Care complex in Morphett Vale, South Australia. Also to be the subject of a study by Flinders University – to measure the impact on the quality of life of Residents and the ‘psychosocial and cultural outcomes’ on both Residents and students – the school and facility will hold a range of classes together and intends to open up greater interaction between both generations.

TELSTRA AUSTRALIAN BUSINESS WOMAN OF THE YEAR

Inspiring news for the Aged Care industry, with the 2019 Telstra Australian Business Woman of the year named as Natasha Chadwick, is the CEO of NewDirection Care Bellmere. NewDirection Care is an innovative Aged Care facility that is modelled on a community township, focusing on the individual and specifically developed for people living with dementia or those with complex care needs. The ‘microtown’ model aims to give freedom and independence to Residents, whilst being part of a community – just like a town. You can read further on NewDirection Care Bellmere here. Congratulations on this wonderful achievement.

DOORWAYS INTO MEMORY

Recently there have been some beautiful stories coming from Aged Care facilities to do with…doors! A few Australian facilities are exploring initiatives to bring joy to their Residents by using their room doors as a way to share memories of their past, or make their rooms feel more like home. Not-for-profit Aged Care Provider, The Viet Vets Keith Payne VC Aged Care facility in Toukley, New South Wales has overhauled the doors of their Residents with images of the occupants from when they were younger. Created with the assistance of The Wall Sticker Company to bring old photographs to life, the images are selected by the Resident and their family and displayed as a full image on the doors to their rooms.

But that isn’t the only door-related initiative – a Netherlands-based company, True Doors, has landed in Australia. True Doors creates door decals that replicate the image of actual doors, intended to assist with removing a clinical feel that a plain door may have, and hopes to assist Residents living with dementia in particular to feel more at home and potentially help with identifying their personal rooms.

St Francis Aged Care in Orange has also adopted the innovation by personalising doors, with an additional touch of modelling them closely on the doors of Residents’ previous homes, with the intention of prompting memory. Beautiful stories all round!

 

Kelly LISSIE LYONS – CHAMPION OF EDUCATION & MARKETING
Author

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