Alzheimer’s Australia Dementia Conference in Melbourne

The 17th Alzheimer’s Australia Biennial National Dementia Conference is being held in Melbourne right now from 17th to 20th October. The title of the Conference is “ Be The Change” – the conference aims to inspire delegates to explore more innovative and creative ways to improve the quality of life and support of people, of all ages, living with all forms of dementia. Being very involved in the aged care sector, as an Aged Care Placement Consultant, I look forward to the ongoing changes and improvements as a result of this conference.

I was very impressed by the great line up of Keynote Speakers that include:

 Dr. Susan Koch, who is currently involved in a project to develop an Australian Community of Practice in Research in Dementia (ACcORD) to improve health outcomes for people with dementia and their carers; Professor Sam Gandy, an international expert in the metabolism of the sticky substance called amyloid that clogs the brain in people living with Alzheimer’s disease; Naomi Feil, developed the now world renowned Validation method and has written two books and numerous articles on the method; Scientia Prof Henry Brodaty AO, one of the world’s leading researchers in dementia, a clinician, policy advisor and a strong advocate for people living with dementia and their carers and Ita Buttrose, National Ambassador of Alzheimer’s Australia, having served as National President from 2011-14, and a former Australian of the Year (2013), she has had a long interest in health and ageing.

 

Dr. Piers Dawes from the University of Manchester is giving the Libby Harrick’s Memorial Oration. Dr. Dawes oration explores the relationship between hearing impairment and cognition, looking at the implications for hearing loss as a biomarker for cognitive well-being and also as a causal contributor to cognitive decline and poor quality of life in older age.

At the Conference research, being jointly undertaken by the University of Melbourne, Dementia Australia and Assistance Dogs Australia, on the affect of assistance dogs on people with early onset dementia was discussed. The research so far has shown that assistance dogs help to relieve loneliness, anxiety and depression for their owners with early onset dementia and gives them the experience of responsible dog ownership. Another bonus is the help they give to carers and family by providing the extra support. This research continues until next year.  I look forward to seeing the final research findings which may be of help to some of my clients who are seeking suitable aged care accommodation.

Greater Transparency About Aged Care Facilities Leads to Consumer Empowerment

It seems that aged care provision is at a cross roads. An article in a series on aged care published in the Sydney Morning Herald in September looked at deregulation. According to the article National President of Dementia Australia, Graeme Samuel says he is “very much in favour” of deregulating the aged care system. He believes that only consumer empowerment will improve it. He says that before this can be achieved the government’s accreditation agency must make some changes, such as introducing more rigorous standards in their accreditation system and the government should allow the Aged Care Complaints Commissioner to have the power to publish the names of aged care facilities that have complaints upheld against them. Drawing from his experience as the former head of the Australian Competition and Consumer Commission he stated “It’s so obvious. When you start doing that, the consumers are empowered and they’re only ever empowered by transparency and accountability, which was the fundamental mantra of what we did at ACCC.”

Another of Mr. Samuel’s concerns was the lack of hard information to allow elderly people to make sound choices when they select an aged care facility. “People are bombarded with marketing information, whether it’s accurate or not. It’s all huff and puff.”  He claims that selections are made based on this marketing and once they are in the facility and find out it’s not suitable they can’t change easily. Aged Care Minister Ken Wyatt acknowledges the problem, saying “I accept that with consumer-directed care what you have to make available is the information relevant to each facility … we should be transparent … and I acknowledge that we don’t do that with aged care.”

As an Aged Care Placement Consultant I am in a position to have access to a lot more information about aged care facilities than most consumers are able to know.  That is the reason I am able to help people to find a facility that suits their particular needs, the depth of knowledge I have of each facility and also the ability to properly assess their needs and wants for their future home.  However, I am in agreement with Mr. Samuel that there needs to be much greater transparency and accountability within this sector to enable elderly people to make a sound selection.  I know, perhaps better than most, how important it is for someone going into an aged care home to get it right. After all, this is their home for the rest of their lives.

Government Stats on Aged Care Provision

Statistics now available from the Australian Institute of Health and Welfare paint an interesting picture about aged care services. Statistics on aged care for 2016 indicate that the number of aged care places is increasing, with 1.4 times as many places over the last ten years from 2006 to 2016. As an Aged Care Placement Consultant these stats simply prove what I have already witnessed, the number of elderly people needing aged care is noticeably increasing.

Occupancy rates tell us how close to full capacity the care system is, so it was interesting to note that residential care had the highest occupancy rate for 2015/16 financial year at 92% . Transition care at 88% was next, followed by home care at 83%. Occupancy rates are calculated by adding together the total number of days that all people spent in care during the year, then dividing that number by the total number of places that were available. The stats around occupancy rates for residential aged care is concerning but information that the highest number of builds in the building and construction industry recently has been for aged care residential facilities does give some comfort.

65% of aged care services were run by not-for-profit organisations in 2016. A trend emerged that most of the privately-owned aged care services were in cities whilst in remote areas services were predominantly government run.

Although aged care services can be delivered by any of the following:

  • government organisations,
  • not-for-profit organisations
  • private companies

the Australian Government contributes towards the costs of care for most aged care places. Around 95% of government spending in aged care comes from the Australian Government, with state and territory governments providing 5%.

So, what are the figures?

The governments spent approximately $17 billion on aged care in 2015/16.

69% of this figure was spent on residential aged care.

Expenditure on residential care was 2.7 times that spent on home care and support.

The break up was – $11.5billion on residential care, $4.3 billion on home care and support.

The government recognises that aged care provision is a growing area with an ageing population. In my role wthin the industry, helping people find suitable aged care accommodation, I hope that the required quality and quantity of residential aged care will be provided well into the future.

New Concept For Dementia Aged Care Residence

Artist’s impression Korongee Village

The Netherlands are leaders in innovation in aged care and the dementia village, De Hogeweyk, based there is to be the model for a new residential facility being constructed in Hobart.  The Korongee dementia village in Glenorchy, Hobart will be designed to recreate real-life experiences for people with dementia. The fifteen six-bedroom homes will be set within a small town featuring streets, a supermarket, cinema, café and gardens, with residents wandering freely within a safe and supported environment.

The residents of De Hoeweyk dementia village live longer, eat better and take less medication and it is hoped the same health benefits will be seen in residents at this new Australian facility. The environment within the houses will be more relaxed, with casually-dressed health professionals and residents free to wake up and move about in their own time, free of institutional routines. Residents will live alongside people of like backgrounds, experiences, interests and skills.

A New Zealand aged care provider is also looking at developing a village based on the Hogeweyk design.  They have engaged Aged care specialists Ansell Strategic to undertake a feasibility study for the development of a dementia village in Invercargill. Funding systems and staff-to-resident ratios are among key challenges with the Netherlands model using two carers per resident.  “New Zealand has a similar mixed aged care funding model to Australia, where residents and the government both contribute to the cost of care, said Rosie O’Dowd, assistant analyst “Comparatively, the Netherlands operates under a more tax-financed system, allowing for residential aged care models to be developed based on optimal community modelling rather than a focus on efficiency, scale or aesthetics.”

Korongee village is a partnership between not-for-profit aged care provider Glenview, industry superannuation fund HESTA, social financing organisation Social Ventures Australia (SVA) and the Commonwealth Government. Only many levels, this is the way of the future in Aged Care provision.

As an Aged Care Placement Consultant I await, with great optimism, the opening of this new concept in dementia care in 2019.

 

2017 Budget Announcement Good News For the Aged Care Sector

Pat Sparrow CEO Aged & Community Services Australia

Aged and Community Services Australia said it was pleased government had heeded advice about avoiding further cuts to aged care funding in the 2017 Federal Budget just announced by the Treasurer, Scott Morrison, on Wednesday night. CEO Pat Scott said  “The steady as she goes approach outlined in this Budget is necessary while the Legislated Review and ACFI reviews are completed. Industry and the government will then be able to have a sensible conversation on how aged care funding, including those from the public and private purse, can be structured to ensure our older citizens receive the quality of care they deserve.”

 

The Aged Care Guild had launched a campaign that called on the government to rule out further cuts and welcomed the Budget decision to maintain current levels of funding for aged care. “Funding stability means elderly Australians and their families can be assured that resources will be maintained” said CEO Cameron O’Reilly.

 

Whilst the aged care sector breathed a sigh of relief at the lack of an announcement on aged care funding cuts, they were delighted that the long-running debate on the role of government in helping to establish an age care workforce strategy was finally acknowledged with the Treasurer announcing  $1.19 million over two years to establish and support the taskforce. The industry led aged care workforce taskforce will explore options to improve productivity in the aged care workforce as well as contributing to the development of a strategy which includes regional and remote areas. This is being funded from within existing resources of the Department of Health. It is part of a broader workforce package of $33million also in the new budget, to help aged care and disability service providers in rural and regional areas.

 

Aged and Community Services Australia, which had sought $2 million for a taskforce in its pre-Budget submission to government, also welcomed the announcement of this initiative. “ACSA has been instrumental, with other provider peaks, in advocating the need for such a strategy,” said CEO Pat Sparrow. Along with the Aged Care Guild, Leading Age Services Australia, Catholic Health Australia and Uniting Care Australia ASCA have already developed a framework and all agreed that an industry-led taskforce is needed to develop a workforce strategy.

 

As I observe the affects of government support and cut backs to the aged care sector in my role as an Aged Care Consultant I am pleased to see a positive position from the government in this year’s budget announcement.

 

 

Butterfly Model For Dementia Introduced to Australian Aged Care Homes

Butterfly houses are expanding in Australia. The Butterfly model, designed to help people living with dementia to be more relaxed and decrease the use of psychotropic medication and difficult behaviour, incorporates changes in the environment and a more inclusive approach from staff, understanding emotional intelligence, as well as giving purpose to residents living with dementia.

The Dementia Care Matters Butterfly Household Model of Care was introduced to Barrunga Village in Port Broughton, Adelaide in July 2016 and Salvation Army Aged Care Plus homes in Cairns and the ACT – the Aged Care Plus Centre in Chapel Hill,  Mountainview and the Aged Care Plus Centre in Narrabundah.

Walls are painted in bright colours, as dementia patients have a diminished view of colour and this seems to also brighten the environment. There is closer interaction between staff and residents who share the space together, sharing meals and social interaction. The workers no longer have separate areas and are called house members. Medication is kept in resident’s room in a locked drawer so dispensing medication becomes a private matter. Workshops and training is given to workers to support them with tools to meaningfully engage socially with residents. Through helping out with chores around the residence, such as cleaning and gardening residents gain a sense of purpose.

Results have been positive so far, with a marked decrease in difficult behaviours, falls and need for psychotropic medication and residents are feeling more relaxed. The Salvation Army will now roll-out the Butterfly model to more of its aged care facilities across Australia.

The model was first developed in the United Kingdom and has spread to Ireland, Canada and now Australia. It is a new culture of care that comes from focussing on a model of emotional intelligence. Having worked for 20 plus years  in the Aged Care field and gaining a Diploma of Aged Care, a Diploma in Diversional Therapy and a Diploma in Community Services Management I have a keen interest in any programs that assist the elderly and those with dementia gain more from life when living in aged care facilities.

 

Enquiry Into Elder Abuse Recommendations for Aged Care

The Australian Law Reform Commission on the Enquiry into Elder Abuse with regard to Aged Care found that two of the areas highlighted by stakeholders needing improvement were transparency and accountability. As an Aged Care Placement Specialist these recommendations are especially critical to my clients, who are moving into aged care facilities.  The Commission is recommending that aged care providers be required to report certain types of abusive conduct, which become ‘reportable incidents’, to the Aged Care Complaints Commissioner with the Commissioner’s office taking on an oversight and monitoring role of the aged care provider’s response to the incidents of abuse. This complements existing functions of the Aged Care Commissioner and enhances safeguards, improving responses by the aged care providers.

Stakeholders also wanted enhanced employment screening for people working in aged care and looked to the working with children checks as an example. Currently aged care workers are required to have a police check, but the Commission noted that not all workplace conduct that could be of concern will be identified in a police check. The Commission proposes that any findings made against a worker from the ‘reportable incident’ scheme and other disciplinary findings, would be ‘flagged’ when a person applies to work in aged care. It also proposed that unregistered aged care workers, such as assistants in nursing and personal care workers, be subject to a code of conduct, bringing them into line with professionals such as Doctors and Nurses already subject to codes of conduct.

Another area for reform that was raised by stakeholders was in relation to restrictive practices or interventions that restrict the rights and freedoms of movement of a person. The primary purpose of using these practices is to protect the person or other people they are around from harm. Some of the practices reported were people being locked in a room or ward, physical restraint like clasping or holding a person’s hands or feet together, mechanical restraints such as being tied to beds or chairs and chemical restraints such as sedatives. Of concern was that restrictive practices are sometimes used as a means of coercion, discipline, convenience or retaliation by staff or other support people. They are most often used on people with an intellectual disability or cognitive impairment who exhibit what has been described as ‘challenging behaviours’ (eg: striking themselves or others or wandering). The Commission concluded that the use of these practices can be abusive at times.

The Commission proposes that these practices be regulated through a legislative framework that would apply to residential aged care. They should only be used to prevent physical harm, and only to the extent necessary to prevent the harm and before enacted require the approval of an independent decision maker, such as a senior clinician, and that the practice only be used as prescribed in a person’s behaviour management plan.

The Commission is now taking responses to its recommendations and final proposals will be published in August 2017.  In my role I inspect many aged care facilities and most are well run with the residents’ best interests at heart, so I look forward to seeing these reforms that will help to ensure that all facilities treat their elderly residents with the utmost care and respect.