Sudden and Complex Decisions in Aged Care

Arcare Templestowe suite IMG_1692 (edited-Pixlr)

For people either planning for their future or who are at a stage where they need the support of an aged care facility in my role as a Placement Consultant I am often able to help with complex decisions and finding the right place that suits their particular needs.

For example, a couple I helped a few years back were planning for their future as they aged. They were selling their current home and considering moving into a retirement village, using the funds from the sale of their home. However, they were concerned that in the future one or both of them may need the higher level of care afforded in an aged care home and that they would not have enough funds left to buy into an aged care home that has the standard of living they enjoy.

They needed my servicesas they were confused by the vastly differing fees and charges, with inclusions that varied from village to village. I helped them by researching the different price ranges, exit strategies and cost of entering the next level of care. I felt the best solution whereby they could transition into aged care from retirement with the least disruption and loss of capital would be a retirement complex with aged care on site. I found the few facilities that offered this arrangement and set up visits for the couple to choose the option that suited them best geographically, cost wise and to their standard.

When a new aged care facility opened in Templestowe, Melbourne in April, 2019 I placed four of my clients there that year. They were all very happy with the single storey residence, and its lovely, large suites including double suites for couples. As a Placement Consultant, it has often been a challenge to meet my clients’ requests for a double suite as not many facilities catered to couples with shared room accommodation. Thankfully the new aged care facilities being built have rooms with couples’ accommodation, opening up the options.

Moving into aged care accommodation is often an emotional and stressful time for a person and their family, as they are suddenly in a situation where there has been a fall or deterioration to the point that immediate accommodation with high-level care must be found. They are often in hospital, waiting to be discharged and their needs are such high care they can only be supported safely in an aged care facility.

This is where I can offer my services as a Placement Consultant, helping on several levels. Firstly, I interview the client to find out what is important to them and what are priorities and, as I have a good knowledge of the accommodation available, can recommend a short list of the most suitable options. Secondly, I can help with negotiating fees, often saving my clients considerable amounts. Thirdly, I can fill out all the paper work and fourthly, I have counselling qualifications and can help ease the transition for all involved.

If you have a client or family member who needs help finding suitable aged care accommodation please contact me.

 

 

 

 

A New Approach To Design of Aged Care Facilities

Aged Care Facility

An Aged Care Facility

A group of design professionals, innovators, planners and seniors came together in a charrette (a workshop devoted to planning a design or solving a problem) to look at a new way of creating aged care facilities. Rather than design just for comfort, or looks, the group aim was to design to aid longevity. Hosted by The University of Queensland and DMA Engineers, the 120 assembled experts considered this a rare opportunity for teams of people from different fields to collaborate in some blue sky thinking.

DMA Engineers managing director Russell Lamb discussed the current dischotomy.

“It’s quite restrictive. In fact, it’s probably one of the most restrictive. I think that’s one of the struggles that the industry’s dealing with at the moment, where we hear terms about ageing in place, but if you go from a retirement living facility, where it’s in most regards an apartment that younger people in their twenties, thirties, forties may be happy to live in, to when you’re actually going to an aged care Class 9C patient room. The amount of services and facilities within that room are fundamentally different.

“One of the challenges the industry is really faced with is how we can have a space which transforms over a matter of years and transforms in a way that maintains the character of the place and doesn’t become too clinical, too quickly.”

The group was challenged to create visionary, innovative and highly connected designs to meet the needs of an intergenerational community in 2050. It was noted that too often aged care facilities are cut off from the wider community by virtue of cheaper land forcing providers to the outskirts of town.

The University of Queensland’s Director of the Healthy Ageing Initiative, Professor Laurie Buys, said

“Older people are thinking and acting very differently than ever before, and we know that future generations of older people will have very high expectations about maintaining their engaged lifestyles.”

The experts gathered into groups and took part in a design competition. The chance to throw the rule book out of the window was appealing for many of the designers who were able to think more generally about how the needs of older people can be met in a hypothetical way, rather than designing to a client’s brief. A common thread emerged of physical and social connectedness, key to promoting increased choice, economic development and job creation. Designs visualized spaces that enabled older people to be creative and productive rather than just existing in places with activities to pass the time away.

 

Thanks to Aged Care Insite for information used in this blog.

 

 

Taking a Break From Aged Care Homes

family with elderly man

If a resident wants to have a break from their aged care accommodation, until very recently, the legislation only permitted permanent residents to be away from their aged care residence for up to 52 days a year for non-hospital related reasons. This is known as social leave. If they took more than the 52 days the Government did not provide its subsidy to cover the extra days and the cost was usually passed on to the resident.

The legislation has now changed in the wake of the COVID-19 pandemic. New emergency leave legislation amendments have now been adopted by the Federal Government, which are to be activated in volatile situations, including natural disasters or health epidemics.

The Minister for Aged Care and Senior Australians, Richard Colbeck, said the recent bushfires and the virus pandemic had highlighted the need to protect leave entitlements of aged care residents.

“During the COVID-19 pandemic, some aged care residents have temporarily relocated to live with family, to reduce their risk of exposure to the virus,” Minister Colbeck said.

“Most of these residents are likely to exhaust their 52 days before the pandemic passes, leading to extra costs on them or their families.”

The eligibility for emergency leave will be backdated to 1 April this year, so people impacted by the current COVID-19 crisis are not disadvantaged.

With so many changes being made by the governments during this pandemic, clients are finding my services as a Placement Consultant to be even more helpful than ever. I can advise clients as I am kept up to date with all the latest legislative changes and procedures being adopted by each of the aged care facilities within Victoria.

 

 

 

 

 

Extra Funding and Visitor Code for Aged Care Facilities

resident and nurse

The dedication and commitment of staff at aged care facilities is to be commended. There has been some bad publicity about staff unknowingly spreading COVID-19 within a couple of facilities, and that is tragic, but generally staff across Australia have done a great job with a lot more pressure than they normally carry. Many have gone beyond the call of duty with extra challenges to their already demanding roles.

In my last blog I discussed the call for an increase in visitation rights for families to aged care facilities and the extra burden that would place on staffing levels in an already strained situation. Fortunately there has been a positive response to helping families visit residents in aged care homes whilst keeping them safe. Firstly a nationally consistent code for aged care visits, The Visitor Access Code for Aged Care, was finalised and released as a guide for facilities. It was contributed to by thirteen aged care peak bodies and consumer advocacy organisations.

Secondly, the federal government has responded to the need for more financial support to assist aged care facilities stay safe with the ‘COVID-19 Aged Care Support Program’.

The government is seeking to achieve the following outcomes through this program:

  • Consumers of aged care services directly impacted by COVID-19 receive safe, quality care; and
  • The financial costs of managing direct impacts of COVID-19 are reduced for eligible aged care services.

The total funding package is $52.9 million delivered over two years. $26.45m is to be delivered in 2019-20 and $26.45m in 2020-21 to residential aged care providers (RAC), National Aboriginal and Torres Strait Islander (NATSI) providers and Home Care providers whose services are directly impacted.

The program will reimburse approved aged care providers for eligible expenditure incurred due to the direct impact of COVID-19. The grant will cover 100 per cent of eligible expenditure up to the maximum grant value.

For RAC and NATSI providers, there will be two components of funding:

  1. A base funding allocation of $20,000 plus; and
  2. An additional $2,000 for each operational bed/place.

Any expenditure which exceeds the maximum amount and other ineligible expenditure remain the responsibility of the provider.

The funding is to cover eligible activities associated with managing direct impacts of COVID-19, including the following:

  • providing additional staff to manage care in a service with residents who are either infected or isolated due to COVID-19
  • replacing existing staff who are infected or isolated due to COVID-19
  • training staff and residents/clients in infection control, and
  • accessing equipment and resources required to manage a service in an infection control environment, including linen and bedding, paper products, PPE, disinfection and cleaning agents.

Increased or replaced staff may include registered nurses, direct care staff, hotel services staff (catering and cleaning), diversional therapy and activities staff, allied health staff, maintenance staff and administrative staff.

With this swift response to and recognition of the needs of residents, their families and staffing within aged care facilities, in my role as a Placement Consultant, I hope my clients and all other residents in these facilities are now able to see their families, feel supported, safe and, above all, stay well.

 

 

Visitors to Aged Care Homes

musicforseniors690x400

The Prime Minister went on national television last Tuesday to tell aged care facilities in Australia to go easy on their lockdown measures. He said the recommendation from the national cabinet was for a maximum of two visits per resident per day in the resident’s room. He was concerned for the welfare and health of residents in aged care if they were not receiving regular visits from their families.

Several things have come to my notice as an Aged Care Placement Consultant about the situation. Aged Care Facilities seem to vary from one to another with how they are dealing with COVID-19, as mentioned in my last blog. When it comes to visitors some are in strict lockdown, others are following the government recommendations. Staff are busier than ever, as they don’t have the help of volunteers and other support services; for example, they are having to conduct all the activities to keep residents occupied.

General Secretary of the NSW Nurses and Midwives Associations, Brett Holmes, said the government needed to provide additional staff to aged care facilities so they could screen visitors before allowing them in. I agree with this and can understand the difficulties aged care homes will face in monitoring visitors, I’m aware that even at the moment where families are allowed to visit their loved ones in palliative care, in some facilities it is only for 15 minutes, yet when asked to leave they ask for another 5 minutes, then another 5 – this all takes up staff time, adding an extra burden. There will be further calls on staff time when the directive starting in May that visitors must have the up to date flu immunisation comes into effect, as this will need policing.

Brett Holmes went on to say “There are qualified nurses out there looking for work and if the Commonwealth Government wants to open up the aged care facilities, then that should be done in the safest possible way.That should also mean of course the additional resources of PPE to allow that screening to be undertaken in the same way that our public health system is responding to this risk of people from outside the facility bringing in the COVID-19.”

I have noticed when that some aged care facilities are contacting families and asking them if they are content with the precautions the facility is taking and, to my knowledge, most families are generally understanding why the facilities have taken those precautions and that it is for the protection of residents.

Last week I placed a gentleman in an aged care facility and his wife was upset that she couldn’t visit him over the weekend. As I have said before, each facility is dealing with the situation differently. The same goes for retirement villages. I am helping a client to find a suitable retirement village and one place we were interested in would not allow a site visit but also won’t allow a resident to move in unless they have seen the facility in person. Another retirement village will allow a site visit, but only one person at a time.

I am finding that only people in an emergency are now seeking aged care accommodation as they don’t want to self isolate within the facility for 14 days once they move in, they don’t like the idea of no visitors and don’t want to spend the money and make a monumental move to a home site-unseen. Trying times indeed!

 

 

How Aged Care Facilities Respond to COVID-19

Racecourse Grange entrance

With the corona virus pandemic now in Australia there are changes to how aged care facilities are able to operate.

Trinity Manor Greensborough front

In my role as Placement Consultant I help clients find suitable accommodation in aged care facilities in Melbourne. I’m currently getting frequent updates from aged care facilities on changes to their protocols. Fortunately most aged care facilities still currently taking new residents and, in some cases, respite residents. There seems to be a general requirement for new residents to self isolate for 14 days when they move into their new home. However, the need for this varies from facility to facility, with some making it mandatory for all new intakes, whilst others have made it only for those who answer positively to questions about their symptoms and/or exposure to COVID-19 or carefully check on resident’s health upon intake.

I had a client recently who I had trouble placing into a facility as she was unable to do the 14 day isolation due to memory loss. Fortunately I was able to find another suitable facility whose policy is if a new resident comes from home they will have their temperature taken and be monitored. As my client was coming from home she was accepted. However, this facility requires new residents to self isolate for 14 days If coming directly from hospital. Some facilities can no longer accept people living with dementia or people that wander as they are unable to provide care for them with the social distancing restrictions now in place.

Restrictions around visitors also vary between aged care facilities with some putting in place a total ban for visitors, with some allowance when residents are in palliative care, and others allowing minimal visitors as per the government guidelines of no more than two at a time, once a day.

unspecified-6

Most visits to inspect facilities are now virtual with a range of sophistication there; some have film crews do a professional video tour whilst others film the facility themselves. Some facilities will meet with you and show photos and some will even allow a personal tour but with strict cleanliness and health protocols in place.

Greenview Donvale bed

It is challenging keeping up with all the different protocols in the various facilities and another reason my clients find my services so helpful  as I sift through these frequent updates to keep them informed.

 

 

 

 

Aged Care Placement During The Corona Virus Pandemic

orlando aged care

As we all face the effects of the COVID-19 virus in our community, it is of particular concern in aged care facilities, where the most vulnerable people reside. Ever more draconian restrictions are being put in place in the wider community to try to control the spread of the virus. Aged care facilities are particularly at risk and so they have to be even more restrictive. The government has introduced a two person only visit limit to each resident and have restricted gathering in communal areas. Some facilities have put in even stricter limits, such as only allowing family to visit or completely locking down, allowing no visitors.

Despite the new regulations, social distancing and self isolation in the wider community, there will still be those elderly people who have a fall or get very ill with heart attacks, strokes, dementia and other health problems who end up needing to go into an aged care facility. Also, due to the self isolating or lockdown situations now being enforced there are elderly people, particularly those living with dementia, who will no longer have the level of care they need. I had three such cases last week that all required emergency placement in an aged care facility.

The first was an ‘at risk 93 year old woman’, living with dementia, alone in an apartment in Docklands,. Her son lives in the USA and her sister in law in Albury, NSW. As she now needed to move into a facility the family wanted accommodation in Albury so she could be near her sister in law. They asked me to find a suitable facility and organize the transfer. I found a suitable facility and the son had to make the decision sight unseen, trusting my judgment. With the help of a case manager and a private carer I arranged for transportation. Due to the changing directions coming from the government, the facility was changing its protocols daily which delayed her being admitted and resulted in her staying a night in Albury and the private carer taking her to the facility, where she had to start a 14 day isolation. Very difficult circumstances for an elderly lady living with dementia. Happily, she is settled and doing well.

The second was a gent with dementia living with his wife who had serious health issues. His behaviour had exacerbated and she was concerned about keeping him locked in the house if the lock-down got worse, which it has. This was a difficult process as her children thought she should keep him at home as she had signed up for ‘better or worse’.  He also had to go in without her looking at the room and undergo social isolation for 14 days.

The third was another woman living with dementia in a fully independent, serviced apartment in Carlton.  This was also an urgent situation as there is no one to go in and check on her and she is living alone and isolated with dementia. Fortunately I have been able to place her as well.

There has definitely been a rise in demand for help in finding suitable aged care.The service I provide means I source a facility that is suitable in terms of location, programmes, affordability, staffing levels, type of accommodation, services offered and outings. Because I research the facilities, visit most of them and know many of the managers I have an inside knowledge about how they operate and how suitable they will be for my clients.

These are challenging times for us all, and for an elderly person living with dementia having to move from their home it is extremely stressful. . I am grateful that now, more than ever, I can be of assistanceto ease this distress, fear and anxiety as I have a counselling qualification, which gives me the skills to really help people going through this transition.

 

Corona Virus Affect On Aged Care Staffing Levels

resident and nurseWith a resident from aged care facility, Baptist Care’s Dorothy Henderson Lodge, dying last week from the COVID-19 virus, another two residents remaining in hospital and a number of staff at the facility testing positive for the coronavirus, some of the staff are refusing to come to work.

“A number of team members have advised us they will not be coming to work at Dorothy Henderson Lodge,” a statement from the facility said.

“In the current circumstances we cannot force our team members to come to work.”

Baptist Care were able to maintain staffing levels by pulling in staff from their other facilities, other health providers and agencies. Apparently additional staff were also supplied by NSW Health.

It certainly raises concern if staff at aged care facilities were to walk off the job. The Minister for Aged Care, Richard Colbeck, said “There is no reason for staff at aged care centres to avoid going to work unless they are showing symptoms, have been in contact with somebody showing symptoms or have been specifically ordered to isolate.” at a COVID-19 summit for the aged care industry in Canberra on March 6th.

The Australian Nursing and Midwifery Federation is calling on the government to support aged care staff who take time off work if they are infected with coronavirus, but do not have paid sick leave. More than ten per cent of workers in nursing homes are casual employees and do not have access to paid leave.

Minister Colbeck said, “The advice for the aged care sector is the same advice to the general community.Australians should practice good hygiene and go about their lives as they normally would.”

Leading Age Services Australia CEO, Sean Rooney, who was at the summit, said they addressed how levels of “surge staffing” might be provided in the case of an outbreak.

To boost staff numbers, part-time staff may be asked to increase their working hours. Overseas workers, who are only allowed to work up to 20 hours a week in residential aged care, might be able to have this restriction extended. Recent graduates or students may also be able to fill in if needed.

He stated that the aged care sector’s primary concern is the safety of older Australians in residential care, and the passionate and professional workforce that cares for them.

The federal government has agreed to pay 50 per cent of coronavirus costs, which fall outside usual health budgets.

My role, helping people to find a suitable aged care facility, now has an added layer. In assessing suitable facilities I will need to be vigilant to the aged care home’s status regarding COVID-19.

 

 

Bereavement Can Be A Risk Factor

romeo-and-juliet-1

We know Shakespeare’s tragic story of two young lovers who both lost their lives through bereavement. Romeo and Juliet are the quintessential lovers, forever in love. In their tale they took their own lives due to the grief of losing their loved one, but studies have found that a bereaved person is actually at a higher risk of dying due to health problems. Following the loss of a loved one it has been found that often a person will experience increased heart rate, blood pressure and blood clotting, as well as increases in symptoms of anxiety and depression. The expression dying from a broken heart takes on a clinical meaning.

A randomised clinical trial at the University of Sydney lead by Professor Geoffrey Tofler looked at a total of 85 people and showed that it is possible to reduce several cardiac risk factors during this time, without adversely affecting the grieving process. The oldest person in the study was 85 years of age with the average age of all subjects in the study being 66.

Following on from previous studies on cardiac health risks, increased depression and anxiety after bereavement Professor Tofler noted “However, there have been no interventions to address this with the goal of lowering cardiac risk, so we aimed to provide this with an approach that does not adversely affect the grief process.”

Forty-two subjects received low daily doses of a beta blocker and aspirin for six weeks, whilst the control group of 43 were given placebos. Heart rate and blood pressure were carefully monitored, and blood tests assessed blood clotting changes.

“The main finding was that the active medication, used in a low dose once a day, successfully reduced spikes in blood pressure and heart rate, as well as demonstrating some positive change in blood clotting tendency,” Tofler said.

The investigators also carefully monitored the grief reaction of participants.

“We were reassured that the medication had no adverse effect on the psychological responses, and indeed lessened symptoms of anxiety and depression.”

Professor Tofler advocates the use of this therapy as a risk prevention strategy in those recently bereaved. He also encouraged the medical profession to give extra attention to the health of recently bereaved people,rRobson-and-Jeromeeople, as well as family and friends, who should provide social support and report any health symptoms to medical practitioners.

 

 

Opposition Leader’s Vision for Aged Care

42ebc73c350c5539425b0a5024c352cf

Pictured Leader of the Opposition, Anthony Albanese

The release in recent weeks of the interim report on the Royal Commission into Aged Care has raised responses from both the Federal government and the opposition. Leader of the Opposition, Anthony Albanese spoke this week about Labor’s response. Firstly, he reaffirmed Labor’s pledge from their last election campaign to enact a dental plan for pensioners and also spoke of funding better pay for the aged care workforce. He also said that the ACAT (aged care assessment system)won’t be privatised under his leadership.

COTA chief executive Ian Yates agreed with the Opposition Leader’s assessment that older Australians are a diverse group of people who cannot be treated all the same.

“They require a diverse policy response that addresses issues across employment, health, finance, care, welfare and industrial relations, which I expect Labor’s proposed Positive Ageing Strategy would address” said Mr Yates. He did disagree with Mr. Albanese on one point, however, the characterisation of the Federal Government’s response to the interim report with a planned single aged care assessment system as ‘privatisation’. “A single consumer-focused professional national assessment service with many local access points has been recommended for years by successive reviews and by COTA and the National Aged Care Alliance. This is an essential front door for a reformed aged care system” he said.

Mr. Albanese also spoke highly of the experiment on intergenerational aged care, as documented on the ABC program “ Old People’s Home For 4 Year Olds”. It has given him a vision for the future of elderly people who live at home with their families going to daycare with kindergarten children on a regular basis, brightening their days and, with the proven physical and mental health improvements shown in the experiment, keeping them healthier.

After all my years working in the aged care sectorI am thrilled to atlast see some positive responses coming out of this long, drawn out Royal Commission. We have heard so many sad stories so it gives me a sense of hope that governments will take a strong lead in ensuring aged care is of the highest quality, providing a positive and enjoyable lifestyle for older Australians whether living at home or in an aged care facility.