Aged Care Insite August/September 2013

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Information about Aged Care Insite August/September 2013
Health & Medicine

Published on March 10, 2014

Author: papaRACSi


Issue 78 August–September 2013 Straight to the top Meet Australia’s five most inspirational aged-care professionals A place called home Communities standing out for the right reasons

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contents EDITOR Amie Larter (02) 9936 8610 Journalist Aileen Macalintal production manager Cj Malgo (02) 9936 8772 news 04 NACA’s pre-election push Haki P. Crisden (02) 9936 8643 Graphic Design Ryan Salcedo SALES Enquiries Donna Scott (02) 9936 8673 Luke Bear (02) 9936 8703 Sam Pritchard (02) 9936 8622 SUBSCRIPTION INQUIRIES (02) 9936 8666 PUBLISHED BY Study investigates benefits and participation rates Aged-care rationing system failing elderly 36 Modified meals Tasty, nutritious options 06 A new way to track meds Who’s managing medications? 08 Caring concerns Panel calls for improved advocacy services 10 Industry recognition Awards highlight best in aged care SUBEDITOR 34 Yoga limits falls 11 Crisis looming 22 44 Breathe easier Why it’s all in the brain Researchers improve efficiency of lung treatments 13 Dementia and education UTAS launches two world-first initiatives policy & reform 16 Challenging perceptions 32 LGBTI-inclusive aged care 27 Lessons from overseas © Copyright. No part of this Study tour visits Europe and UK publication can be used or facilities reproduced in any format without express permission in writing from APN Educational Media. The mention practical living of a product or service, person 30 Engagement via art or company in this publication, Cognitive stimulation for dementia does not indicate the publisher’s endorsement. The views expressed sufferers in this S M B 0 0do not necessarily 2 0 1 3 - 0 8 - 1 5 T 1 0 : 1 1 : 0 2 + 1 0 : 0 0 R publication 1 3 1 32 Capturing the experience represent the opinion of the publisher, Alzheimer’s photo exhibit tours its agents, company officers or Australia employees. Providers face workforce challenges Tips to look after your financial health 22 Opinion: Jude Comfort PUBLISHER’S NOTE 50 Rural recruitment and retention 55 Money matters Funding and regulation won’t fix care system Tailoring layout to improve outcomes ACI’s Top 5 Inspiring aged-care professionals Increasing workforce efficiencies and effectiveness 20 Opinion: Michael Fine construction & design 24 Rethinking hospital design workforce 46 Winners revealed 54 Opinion: Barry Williams Close bonds at aged-care residences APN Educational Media (ACN 010 655 446) PO Box 488 Darlinghurst, NSW 1300 ISSN 1836-1501 Elderly emergency presentations challenge staff Proper management avoids prolonged use 12 Understanding pain Cart connects residents and specialists Ways to improve healing 40 Protocol rethink 42 Psychotropics risk Nation’s healthcare spending needs attention 14 Video-conferencing pilot clinical focus 38 Wound management 46 community 56 History in the making Over 80s tennis champ to attend world championships 57 Sensory gardens Dementia-specific spaces improve well-being technology 59 Opinion: Jeffrey Soar Emerging technologies improve quality of life 61 Senior Techies 61 Kids give tech tips to elderly Audited 9,215 Looking2012 certainty through change as at Sept for in accommodation charges? Your guide to DAP and RAD. protect your profits now... . For more information on ProviderPRO phone 1800 330 605 or visit August–September 2013 | 3

news No reason for rations NACA leads call for end to scheme that ‘limits choices and independence’ of seniors. By Amie Larter M any people are simply not receiving care or are getting an inappropriate form of it that does not meet their needs due to Australia’s aged-care rationing system, according to nursing peak body and education provider the Australian College of Nursing. Forty members of the National Aged Care Alliance, including ACN, have joined forces for a pre-election push to bring an end to the aged-care rationing system they say is leaving many elderly Australians without care. The group, which consists of aged-care advocates, health professionals and workforce representatives, called on political parties to review the system. Under the present scheme, the number, type and location of beds and services available per 1000 people is restricted by planning ratios, forcing some elderly onto waiting lists or to move away from loved ones. ACN CEO Debra Thoms said this “mismatch between the services people need and the services they are able to access removes or limits the choices and independence of older Australians”. She suggested that Australia needed “significant investments in our health and aged-care workforces, including attracting and training aged-care nurses”. Only 116 out of every 1000 people over the age of 70 get the care and services they need, CEO of Alzheimer’s Australia Glenn Rees said. “Recent reforms will lift that to 125, but what happens to numbers 126 and beyond?” he questioned. “Chance plays a huge role in whether or not you can get help to keep living in your own home or access a place in an aged-care facility when you need it.” Adjunct professor John Kelly, CEO of Aged Care Services Australia, said service providers are forced to operate in a system that can’t keep up with demand. “Providers of aged-care services are put in a position where they have to constantly turn older people in need away,” he said. The group supports the abolishment of aged-care rationing, a recommendation of the Productivity Commission in 2011. Lee Thomas, federal secretary of the Australian Nursing and Midwifery Federation, said the industry had seen some of the PC’s findings but a commitment to the whole package is needed. She called for the federal government to end the aged-care lottery by: • Providing a level of resources for eligible individuals to meet their needs however they choose to do so – in their own home or at a residential care site • Removing the regulatory restrictions on the quantity and type of services providers can offer, enabling services that are more responsive to older people’s needs and preferences • Committing to an independent cost-of-care study to support better informed decisions about how we fund aged care in the future. n Kit up for dementia care F linders University will roll out a dementia care training program in aged-care homes throughout Australia with the help of a $1.45 million federal government grant. The grant will fund the university’s distribution of the Personalising Practice Resource Kit to every aged-care facility over the next three years. This e-Learning resource will be launched through a series of 30 workshops across all states and territories, with additional assistance through web-based support. Acting head of the Flinders’ Palliative and Supportive Services Discipline, Dr Sam Davis, said the kit was designed to help staff improve dementia care by putting their knowledge into practice. “A lot of staff recognise there are things they could do better but they don’t know 4 | August–September 2013 how to facilitate those changes, so these tools will help make their jobs a bit easier and empower them to enhance the care they already provide,” Davis said. The kit, which Flinders researchers created in conjunction with seven nursing homes in Victoria, includes: • A CD of practical information and tools to help aged-care staff improve dementia care across 19 themes, including strategies to enhance independence, well-being, meaningful activities and simple environmental changes • A CD with 26 short video messages about person-centred care, as well as an accompanying training manual • A video featuring the experiences of aged-care staff who have used the kit. n

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e from just $75! Subscrib The latest news and resources for aged care professionals Aged Care Insite provides the best in original journalism and is the authoritative source of news and analysis for the residential and community care sectors. • Comprehensive coverage of a diversity of topics affecting  the Aged Care sector • News and information medical matters and product news • Analysis of the major issues facing the Aged Care sector as  a whole. • 6 issues per year • Editorial integrity and industry relevance • Keeps industry professionals up-to-date on the politics and  policy that matter • Tax deductible |

ribe ubsc S today  Comprehensive and diverse range of  topics   Independent and insightful articles making our publications essential reading   All our websites feature interactive areas where users can comment directly on the conversation and debate the topics that face your industry, today and in the future D   elivered free of charge, and you will also receive weekly online updates and special content. APN Educational Media is a division of APN News and Media, serving the education and health sectors. It has a stable of publications, which combine to cover all aspects of secondary, tertiary and further education, together with a range of related professions and careers. Using the latest technology to address this range of niche publishing markets, the company has access through its books, magazines, newspapers and the internet to virtually every teacher, university student, academic and health professional in the country. APN Educational Media has identified the importance and dynamism of the education and health sectors and is growing and adapting with these industries, working in successful partnership with a large range of educational and health institutions and industry bodies. APN Educational Media is not just covering the education and health industries - it is a part of them. SUBSCRIPTIONS Aged Care INsite agedcareinsite T: (02) 9936 8666 Campus Review campusreview Education Review edreviewau Nursing Review nursingreviewau

news A closer eye on medicines A new software function can help check antipsychotic drug use in residential aged care. But it raises questions about just who’s managing medications. By Aileen Macalintal N PS MedicineWise has teamed up with Webstercare to develop a new reporting mechanism that reviews the use of antipsychotics for the behavioural and psychological symptoms of dementia, potentially increasing the role of pharmacists and other staff in monitoring use. Lynn Weekes NPS MedicineWise CEO Dr Lynn Weekes said that whilst there is a role for psychotropic medicines in residential aged-care facilities (RACFs) there is evidence to suggest that there are instances where they are being used improperly (see “Mind the mind drugs”, page 42). Antipsychotics should be used with deliberate caution Gerard Stevens and only when the benefits outweigh the risk of harm, the CEO said. “Antipsychotics are a type of psychotropic medicine that can be used to manage behavioural and psychological symptoms of dementia,” Weekes explained. “They have modest efficacy for treating such symptoms, but also have a range of potential adverse effects and are associated with an increased risk of death – primarily from cardiovascular events and pneumonia – compared with placebo. “Their use also requires careful monitoring.” In 1995, the Senate report Psychotropic medication in Australia, recommended that 6 | August–September 2013 pharmacists become involved in the review of psychotropic medication, Weekes said. There has recently been renewed focus on this issue amidst a media spotlight and parliamentary scrutiny. Webstercare CEO Gerard Stevens said the new reporting mechanism it has developed with NPS MedicineWise includes quality use of medicines (QUM) reports, which automatically extract medicine usage data from dispensing records for review. “The design … provides the ability for retrospective analysis of antipsychotic usage over time in facilities,” Stevens said. “Webstercare’s software records … dosage changes, ceased medications or new medications.” Stevens said pharmacists – along with aged-care staff and medication advisory committees – may benefit from this new reporting mechanism. “Reviewing and actioning the reports may assist an RACF in meeting expected outcomes of the Accreditation Standards for Residential Aged Care related to continuous improvement, medication management and behavioural management,” Stevens said. “The new reporting mechanism for antipsychotic use in aged care enables ongoing analysis of antipsychotic medicine usage in a timely manner - which is also easy to use and works at the click of a button.” It should be noted that the new software function is designed to extract data on the dispensing of antipsychotics automatically and identify which residents may be using them. As Weekes explains, this means staff will have to take care to analyse the data in the proper context. “While all residents taking antipsychotics need regular review, the information in this report is primarily to assist the review of antipsychotics used for behavioural and psychological symptoms of dementia,” Weekes said. “Indications need to be checked from the care plans or resident notes if the health professional does not know why a resident is using an antipsychotic.” Stevens said the reporting mechanism should encourage the use of data and educational resources to achieve and maintain best practice. Lastly, it should also help quickly identify and prioritise residents who may benefit from review. Leading Age Services Australia (LASA) CEO Patrick Reid saw the advantage of the new functionality but emphasised the role of doctors in prescription. “The new reporting mechanism will enable pharmacists to provide information to staff working in residential aged-care facilities and aid them in understanding, analysing and effectively managing the appropriate use of antipsychotic medicines for their residents,” said Reid, who is also a pharmacist. He noted, however, that “doctors prescribe, pharmacists dispense”. “It is the doctor who prescribes the use of these medicines and it should be the doctor who monitors the ongoing use, in collaboration with the professional staff in facilities, including the pharmacist.” Reid said the announcement of the MMS function generating QUM reports seemed to indicate that the staff would be responsible for managing the use of the medicines. He questioned such a system. “Will the report highlight against a baseline? Is the use high, low or average? How does a pharmacist know the use is appropriate, as there is often no indication given with the script as to diagnosis – so how does the pharmacist or care staff judge appropriateness?” Reid asked. “The Pharmacy Guild has called for prescriptions and medication charts to have indication for us on them for years but this has been resisted. This would then be meaningful for off-label use. “Unfortunately, NPS MedicineWise and Webstercare have neglected to contact LASA for input,” he said. Reid added that any review of medicines was important, “but this area should be approached from a care team level and not in isolation”. n

news More milk, please • Ita Buttrose has called on politicians to fund an increase in research to address what she described as “the dementia epidemic”. In a speech at Edith Cowan University, the Alzheimer’s Australia national president said dementia research was underfunded in comparison with work on other chronic diseases. She said this was not linked to the quality of dementia researchers in Australia, but that there were simply not enough working on the challenges of Alzheimer’s disease and other causes of dementia. • Further weight has been added to evidence of dairy’s beneficial role in protecting bones. A study recently conducted by the Dairy Health and Nutrition Consortium linked higher dairy intake to “greater whole body mass, better physical function and a trend of lower prevalence of falls in older women”. Researchers from the University of Western Australia monitored 1456 Australian women between the ages of 70 and 85 to investigate the effects of different amounts of milk, yoghurt and cheese on muscle mass, mobility and risk of falls. Muscle mass and mobility were higher for women who had more than two serves a day, compared with women who had fewer than 1.5 serves a day. The study also showed the rate of self-reported falls tended to be lower in women who had more dairy foods, after adjustment for non-dairy protein intake. Market stress a reminder • The recent fall in interest rates has prompted COTA Australia to remind Australians of the importance of the elderly having access to sound independent financial information. Chief executive Ian Yates said the fall would make older Australians re-assess how their funds were invested as income from cash investments continued to fall. The organisation believes that older Australians would be better served with a ban on all commissions and third-party payments to all financial advisers, including accountants. Highest accreditation standards yet • A new retirement living accreditation scheme has been launched that will attempt to give residents peace of mind by making owners accountable and responsive. The Lifemark Village Scheme contains higher standards than ever seen in the industry, measuring aspects of life including services, respect of dignity and safety. Accreditation under this scheme is not compulsory, it is voluntary and industry driven. The plan will be run by BSI Australia – one of the nation’s largest auditing organisations. inbrief Buttrose: more research funding AHHA online course a hit • The Australian Healthcare and Hospitals Association (AHHA) has announced that their Palliative Care Online Training Program has reached 2000 participants. The free online training program is sponsored by the Department of Health and Ageing and is available to anyone interested in palliative care. The program was introduced in June to promote the use of the department’s Guidelines for a Palliative Approach for Aged Care in the Community Setting. An assessment has shown positive satisfaction rates from participants and a significant reach across Australia. After completing the online program, 81.5 per cent of respondents reported an “excellent” or “greatly improved” understanding of the published palliative approach guidelines. Participants said the program had helped them be more effective in their practice. Where is your super invested? At HESTA, we’re committed to helping members reach their retirement goals. After all, we’ve had 26 years of experience in the health and community services sector. We deliver our financial education and advice services in easy-tounderstand language, using real-life examples. insurance, limited financial advice (at no extra cost), super education sessions and transition to retirement options. HESTA members also have access to a range of great value products and services including health insurance, banking and financial planning. We are at the forefront of super innovation. HESTA was the first Led by CEO, Anne-Marie Corboy, our role is to inform you about your options — so you can build a better retirement savings balance, major super fund in Australia to introduce a sustainable investment option – Eco Pool – and assess fund managers on their after-tax whether you’re 25 or 65. investment returns. HESTA now has more than 750,000 members, 119,000 employers and more than $22 billion in assets. For more information visit or free call 1800 813 327. HESTA’s size means we can offer many benefits to members and employers. These include: low fees, a fully portable account, easy administration, access to low-cost income protection and death Issued by H.E.S.T. Australia Limited ABN 66 006 818 695 AFSL No. 235249, Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. For more information, free call 1800 813 327 or visit for a copy of a Product Disclosure Statement which should be considered when making a decision about HESTA products. August–September 2013 | 7

news Candidates pledge advocacy Opponents praise, criticise aged care on election panel. By Bina Brown B etter advocacy services for older Australians is an area of personal concern and one where improvements can be made, the minister for health and ageing senator Jacinta Collins has said. Speaking as part of the election panel at the recent COTA Australia National Policy Forum, Collins encouraged the industry to suggest changes to how the aged-care system deals with concerns about the treatment of residents, including where care plans are ignored. “My own thoughts … go to how we improve what I think is a fairly strong and resilient system, to better identify better advocacy services for people so we don’t see conditions we should not tolerate in care for aged Australians,” Collins said. “I intend to spend a bit more time looking at existing schemes but I would like to see a more proactive element to advocacy within the system, particularly as we will have more ageing Australians on their own”. The former social worker and carer for her elderly parents said that where the system might work for people with families, the real concern was for those without relatives to advocate for them. “Any feedback on how to strengthen our current system would be gratefully received,” she said. 8 | August–September 2013 Collins said that whilst the accreditation and systems outlined in the government’s Living Longer Living Better reform package were “reasonably robust” it was important to increase the investment and support for people needing care as the population continued to age, so further changes could be expected. She said that as well as moving to eliminate scarcity in the aged-care system, the government would focus on fostering diversity within it. The shadow minister for seniors, Bronwyn Bishop, said that only when people stopped “obsessively categorising” people according to age or sex or work would Australia be a truly inclusive society. “An aim I set down very firmly is I want it to be just as offensive to be ageist as it is to be sexist,” she said. Bishop said it was important to stop using ‘aged’ as a broad brush term, particularly when it came to talking about care. She said that although the Productivity Commission report Caring for Older Australians implied that everyone aged over 65 needed help, in reality only the “frail aged” needed assistance. “Only 8 per cent of people aged over 70 will ever need residential aged care,” she said. “Another 12 per cent will need some sort of care at home and the other 80 per cent will have a damn good time until they fall off the perch.” She added that if the Coalition won the next election, she would be a cabinet minister for seniors and a voice for the 40 per cent of the population aged 50 and above. She said there was a range of concerns for Australians in that age group, including: employment issues, from staying in the workplace longer to not having to meet discrimination when trying to find work; superannuation; private health insurance and its impact; cost of living pressures; social issues and the roles senior Australians continue to play within a household. Bishop said she also wanted to “get rid of the doom and gloom language” associated with the country’s ageing population and amend the laws that continue to discriminate against people aged 65 and above. “Living longer is something to be celebrated rather than lampooned,” she said. “It is a great cause of celebration and joy that we all live longer and longer lives. The concept of seniors is not one of ageing or aged. It is not one of lampooning people and putting them all in the same category. It is about adding aspirations for people, to value their contribution and see they are able to keep adding value and most of all to have their voice heard.” The Greens spokesperson for ageing, Rachel Siewert, said key areas of concern for the aged remained exclusion from the workforce, the low level of Newstart allowance and extending the National Disability Insurance Scheme to people aged 65 and above. n

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news Aged Care Awards celebrate champions Best people and organisations honoured. By Amie Larter F ifteen finalists over three categories were celebrated by peers and industry in early August during the 2013 HESTA Aged Care Awards at Doltone House, Jones Bay Wharf in Sydney. The event, hosted by Jean Kittson, highlighted and celebrated our nation’s best in aged care, recognising professionals who work tirelessly to improve the quality of life of ageing Australians. Lifelong volunteer Helen Williamson beat four other outstanding finalists in the Individual Distinction category, acknowledging her tireless efforts and commitment to the well-being of residents at Bankstown City Aged Care in NSW. The 78-year-old Williamson, who has raised more than $100,000 for the Bankstown facility since 1995, oversees the running of its kiosk – selling food and goods to residents and visitors. Earlier this year, she was appointed to the board of directors for the centre, to help mould its future. The Better Together Cottage Team from Wahroonga Aged Care Victoria, represented by Mary Fromberger, received the Team Innovation award for its pilot program designed to give residents of long-term facilities more independence in a homey environment. As part of the Better Together Cottage model, care staff took up the role of housekeeper – undertaking personal Left to right: Anne-Marie Corboy, HESTA CEO; Mary Fromberger, Wahroonga Aged Care; Helen Williamson, Bankstown City Aged Care; Craig Mills, RSL Care; Kylie Whicher, ME Bank; and Jean Kittson, awards MC care, support and assisting with activities. Residents were given more of a say in the way the facilities were run and where appropriate they took over aspects of the cooking and cleaning, while visiting nursing staff provided clinical expertise. The Outstanding Organisation award was presented to Queensland-based provider RSL Care. The award acknowledges a group that has made a significant contribution to aged care in Australia through development and/ or provision of high-quality care. RSL Care was recognised for its work maintaining services in the aftermath of 2013’s devastating floods. CEO Craig Mills accepted the award on behalf of the company, and explained the impact of ex-cyclone Oswald, which affected 15 of RSL Care’s 29 retirement and residential aged-care communities. The judges praised the group’s work throughout the crisis, highlighting that most of the centres were operational again within hours or days as a result of the high level of organisational preparedness among the staff. Winners shared a $30,000 prize pool, courtesy of sponsor ME Bank. n FALLS PREVENTION THROUGH TRUE FLOOR-LEVEL BEDS      Protean 3 True Floor-Level Bed Decreases falls Addresses restraints Improves OH&S for carers Minimises liability & litigation      LC Floorline ® 600 Easy to fold Easy to move Easy to store Easy to reassemble One-piece design “There is NOWHERE to fall!” Lifting Solutions 10 | August–September 2013 Gantries (Fixed/Portable) Slings Euro 200 Hi-Lo Electric Bed Auto-Contour Cardiac-Chair Comfortable, Reliable & Safe Stylish & Homely Warm & Domestic Supporting Hospitals & Aged Care since 1995 Pioneer of “True Floor-Level Nursing” Ceiling Tracking Ceiling Hoists      Daily Living Aids The LiftCare Bed Company 1300 132 736 Transfer Solutions Shower Seats Rollators Toilet Seats

news Healthcare funding crisis looms Official warns that spending will engulf whole state budgets in two decades. By John Mitchell and Amie Larter N ational media is too consumed with refugee boats and carbon taxes – when there are bigger issues at hand. That’s the view of Community Services and Health Industry Council (CSHIC) CEO Rod Cooke, who points to predictions that within 20 years under current policy, “every state government’s entire budget would be spent on health and care”. Cooke says that means healthcare deserves greater attention. “We think it is an election issue, but the elected officials haven’t woken up to the fact,” he said. He added that both major parties were focused on issues that “aren’t as pervasive as health and care. It is a crisis that we know about now, but nobody’s doing anything”. Cooke, who occupies a position between the education and health sectors, says Australia is continually “reinforcing the current paradigm of the medical model that’s sending us broke”. In order to change, he urges a move from cure to prevention, with a better focus on wellness. “It’s about shifting to a consumer-led model of care, where consumers determine what care they get and where and how,” Cooke explained. “It’s about delivery in the home and community, which is where people want it to be done, not in really expensive hospitals with really expensive super medical specialists.” Other big-ticket items on the agenda should be the ageing population and workforce, Cooke said. The health workforce is facing what CSHIC describes as a “double whammy”. It’s part of the fastest-growing and largest part of the Australian workforce; however, there are already shortages in it and these are likely to get worse with the ageing of that workforce. “The industry needs 800,000 aged-care workers over the next 20 years, as well as an extra 120,000 to 125,000 disability workers over the next three to five years and I don’t know where they are coming from because our unemployment rate is so low,” he said. “Even the number of long-term unemployed isn’t enough; even if we got everyone of them a job there’s not enough to go around.” Cooke considers the shortage more of a vocational education and training issue than a matter of higher education. He questions the high levels of funding for doctors – when most of the work is done by people without degrees – and is calling for a national promotional campaign to attract more people to VET programs. n August–September 2013 | 11

news This is where it hurts Pain, experts say, is all in the brain. By Aileen Macalintal O ur brain produces the illusion that is pain. “No brain, no pain. No body part? The brain can still make the missing part hurt,” said professor Lorimer Moseley, who develops nonpharmacological treatments for those who suffer from chronic pain. Every year, chronic pain disorders cost Australia about $35 billion. Moseley, who heads the Sansom Institute for Health Research, said pain was the result of the brain’s complex evaluative process that decides when something is so dangerous that an action is required. “I think the elderly, like the non-elderly, should understand as much as they can about pain and seek out a good coach, who can help them identify all the things that make their pain worse – these are not just activities but can be behaviours, thoughts, beliefs, relationships, grief, diet and lifestyle.” This does not mean the elderly should avoid pharmacological treatments, he explained. “Some pharmacological treatments are fantastic,” he said, “However, as a rule, medications are not a long-term solution for chronic pain. The evidence clearly shows that they don’t, on the whole, work. I would also suggest that elderly should not just go for brain-targeted treatments.” Another expert in pain, Dr Tasha Stanton, discussed the topic with Moseley at the University of South Australia’s Successful Ageing Seminar. Stanton said the question of what actually happens when a person is in pain might sound like an easy one but isn’t. “We used to think that in order to feel pain, there had to be damage to the tissue,” Stanton said. “It was also thought 12 | August–September 2013 that if there was damage to the tissue, then someone must feel pain. But neither of these is true. “There are many reports of soldiers in life threatening situations, who despite having terrible tissue damage, report feeling no pain. Or sometimes, despite having no evidence of tissue damage, people do experience pain. So this is where the role of the brain comes in.” When a tissue is damaged, she said, a message is sent up the spinal cord to the brain. “However, this is not a message of ‘pain’; it is a message of ‘threat or danger’. Thus the brain has to decide, based on what it knows about the current situation, the past experiences that relate to the current situation and many other factors, whether or not that stimuli should be perceived as pain.” The brain can read the message as “this is important, get all the information you can about this” or it can inhibit the signal – “this isn’t that important, ignore”, she said. In the case of chronic pain, the signal interpretation becomes complex. Experts such as Stanton think some chronic pain may be partially due to increased sensitivity of this system. Many things can alter the level of pain that someone experiences and two of the major pain modifiers are expectation and attention. “If you expect something to be really painful, like back pain when reaching down to tie your shoe, this does tend to result in more pain,” Stanton said. “Also, if you strongly expect that something will relieve your pain, regardless of what that something is, pain is often reduced.” She clarified that this doesn’t mean expectations of relief will drive away pain completely, but says evidence has shown that one’s natural pain relief system can reduce the level of discomfort. “Attention is a bit more tricky,” Stanton said. “Sometimes distraction can reduce pain, but sometimes attention to a painful body part can help.” At an experimental level, experts have found many ways to help reduce pain and they hope they can apply these findings in clinical settings. “For example, we know that the act of merely looking at your body part reduces pain,” Stanton explained. “However, this reduction in pain is quite small and has only been demonstrated for experimental pain. So the challenge is to transfer this to the clinical setting.” She further explained that a person’s perception of their painful body part is also important in how much pain they feel. “Some people have experienced pain relief by making the body part look smaller than it actually is – looking through backwards binoculars. The work I am doing suggests that illusions that change the size of a painful body part reduce pain.” Thus, a number of painful conditions are not necessarily reflective of the amount of tissue damage. “For example, in back pain, one might feel nervous about doing a certain activity because it hurts and thus one believes that the activity is further damaging their back,” Stanton said. “We know that our expectations, our past experiences – how scared or nervous we are and many other factors – contribute to the amount of pain we feel.” Stanton said knowing this could help someone in pain try more regular activities that they may have stopped doing. n

news A holistic approach to dementia care education has resulted in the launch of two world-first initiatives. By Amie Larter Thought leaders F acing predictions suggesting that over 1 million Australians will have dementia by 2050, the University of Tasmania has launched two world-first education initiatives – an associate degree and a massive online open course (MOOC) – both specifically dedicated to dementia care. Following the World Health Organization’s designation of dementia as the public health issue of the 21st century, UTAS conducted a national survey to ascertain knowledge of the ailment amongst care staff in facilities and the community. With results suggesting a clear knowledge deficit, researchers developed the first of the two initiatives – the associate degree in dementia care. “Understanding the trajectory and biological basis of dementia forms the basis of our programs aimed at improving the quality of care,” said the co-director of UTAS’s Wicking Dementia Centre, professor Andrew Robinson. “We recognised that there needed to be a much more comprehensive approach to developing knowledge of dementia, and that’s why the associate degree has been designed for care staff, but with family members and carers in mind as well.” The first semester of the course was launched last November. The second intake began classes in July. “We are really excited with the associate degree because for this semester, we have been able to take what is predominantly an online course and offer the foundation units as face-toface components at different locations across Australia,” course coordinator Andrea Carr said. The course is popular. UTAS has set up independent training facilities in Adelaide, Canberra and Newcastle – in addition to its Sydney and Hobart campuses. “We have had people coming from Coonabarabran to Sydney and from Kangaroo Island to Adelaide,” coordinator Carr confirmed. “The interest the course has raised and the commitment of the people in the agedcare sector is quite heartening and it’s an exciting place to be at the moment.” Students are required to complete 16 units of study for the associate degree, which is designed to be part time to cater for those with other commitments. It covers an extensive range of topics, including normal ageing, risk factors, diseases that cause dementia, pathology, stages and progression and practical care strategies. UTAS has gained approval to extend the course for an extra year, which will give students the option to complete an extra eight subjects and graduate with a full bachelor’s degree in dementia care. To complement this offering, the university has launched its first MOOC offering, Understanding Dementia – a free 11-week course that aims to provide education to the community and the aged-care workforce. The MOOC went live in July and its first iteration boasted 6300 registrants from over 30 different countries. “For us, [to reach these figures] was quite an amazing feat,” Carr explained. “When we look at online learning, we think we will gain so much from people from different backgrounds and countries contributing to discussion around their knowledge of dementia.” Professor Denise Fassett, dean of the Faculty of Health and Science, said the online course would link cutting-edge research with teaching and learning expertise. “This MOOC is designed to appeal to a broad range of students, from healthcare professionals to residential facility support staff, from health policymakers to social scientists, as well as people in the early stages of dementia and their family and friends – plus all those with a general interest in the condition.” Robinson believes the holistic initiatives will provide further career pathways for students and add value to the aged-care workforce. “Building capability and capacity will make [aged care] a more attractive area for young people to work in because they will be able to more effectively make a difference in the care provided to people with dementia,” he said. n August–September 2013 | 13

e from just $75! Subscrib The latest news and resources for aged care professionals Aged Care Insite provides the best in original journalism and is the authoritative source of news and analysis for the residential and community care sectors. • Comprehensive coverage of a diversity of topics affecting  the Aged Care sector • News and information medical matters and product news • Analysis of the major issues facing the Aged Care sector as  a whole. • 6 issues per year • Editorial integrity and industry relevance • Keeps industry professionals up-to-date on the politics and  policy that matter • Tax deductible |

ribe ubsc S today  Comprehensive and diverse range of  topics   Independent and insightful articles making our publications essential reading   All our websites feature interactive areas where users can comment directly on the conversation and debate the topics that face your industry, today and in the future D   elivered free of charge, and you will also receive weekly online updates and special content. APN Educational Media is a division of APN News and Media, serving the education and health sectors. It has a stable of publications, which combine to cover all aspects of secondary, tertiary and further education, together with a range of related professions and careers. Using the latest technology to address this range of niche publishing markets, the company has access through its books, magazines, newspapers and the internet to virtually every teacher, university student, academic and health professional in the country. APN Educational Media has identified the importance and dynamism of the education and health sectors and is growing and adapting with these industries, working in successful partnership with a large range of educational and health institutions and industry bodies. APN Educational Media is not just covering the education and health industries - it is a part of them. SUBSCRIPTIONS Aged Care INsite agedcareinsite T: (02) 9936 8666 Campus Review campusreview Education Review edreviewau Nursing Review nursingreviewau

news Within reach of the best Video-conferencing carts are bringing rural Queenslanders to specialists based in cities. By Amie Larter A video-conferencing pilot scheme is giving aged-care residents in rural Queensland access to specialised healthcare. Ouriptel is working closely with Queensland Health on a tele-health initiative that has Millmerran Centenary Retirement Village and Brodribb Retirement Village in Queensland using a mobile communications system to help improve access and outcomes for residents. Known as the aboutcoms cart, the device is an independently powered mobile gadget attached to a touchscreen PC that enables wide-view video and close up cameras for diagnostic purposes. The cart connects the nursing home staff and residents to nominated Queensland Health facilities, and it’s as easy as switching the device on, logging in and dialling into the facility with a click of a button. Once linked with the specialist, there is the option of recording the consultation and storing it securely on the Ouriptel system. Nursing homes also have the ability to share medical records with the specialist by screen sharing on the device. Cath Frame, clinical care manager at Millmerran facility, which is located in the Darling Downs region about 208 kilometres west of Brisbane, has been extremely impressed with results thus far. “Being in a rural area, telehealth practices have a lot of benefits for the residents, as well as the facility and the community,” Frame said. “They increase access to healthcare for residents, as there is no cost to the family or the resident. It is certainly something I want to look at implementing more permanently at the end of the pilot.” Ouriptel managing director Colin Hickey said the device was designed to fit seamlessly into disparate systems, and is the answer to the huge struggle for organisations to get doctors into facilities. “Aged-care facilities are struggling to get anyone to attend the aged people as a specialist because they really don’t have the time to travel to all these different 14 | August–September 2013 places,” he said. The carts address that problem. “They are made to be able to be wheeled right up to the bed, so the consultation can happen right then and there without the patient having to be moved or transported.” The Millmerran facility has for quite some time struggled to attract geriatric rehabilitation services (GRS) to its area. In the first of nine scheduled consultations for the pilot, a resident was linked to GRS at Toowoomba Base Hospital, about 90 kilometres away. “I was impressed with the first consult – it was thorough, very patient-focused and went for over an hour,” Frame confirmed. “The consultation focused on what the problem was with the resident, looking at what they had been experiencing, what we had been experiencing, current treatment plans and options we could [perform] in the facility safely.” What once required taking an ambulance out of the emergency service for a day, as well as the assistance of an enrolled or registered nurse, can now be done in a room at Millmerran – or even bedside if the resident is unable to move. Hickey explained that the alternative to the conference call for that original consultation would normally have cost the government close to $4000 – this option costs a mere $38. The company, which has quite a few aged-care facilities throughout Queensland interested in its device, is in talks with government about the potential savings and hopes to expand nationally. n

calendar 2013 • World Alzheimer’s Day • Better Practice 2013 – Perth • Parkinson’s Awareness Week • The National Nursing Forum • 4th Annual Healthcare Complaints • National Conference on Incontinence 21 September Worldwide SEPTEMBER • Prostate Cancer Awareness Month 1-30 September Nationwide 25-30 September Nationwide • Jean Hailes Women’s Health Week 2-6 September Nationwide Management Conference 26-27 September Sydney Harbour Marriott, NSW • 12th Australian Palliative Care Conference 3-6 September National Convention Centre, Canberra, ACT OCTOBER • 2013 Seniors Week Tasmania 1-7 October Statewide • National Play Up Convention 5-6 September Luna Park, Sydney NSW • Dementia + Recreation National Conference 2013 10-11 October Melbourne • National Stroke Week 9-15 September Nationwide national-stroke-week • Rotary Health’s Hat Day 11 October Nationwide • 2nd Annual Reducing Avoidable Pressure Injuries Conference 16-17 September Novotel Melbourne on Collins, Victoria • Dementia Awareness Week 16-22 September Nationwide • Better Practice 2013 – Melbourne 19-20 September Hilton on the Park, Melbourne, Victoria • Carers Week 2013 13-19 October Nationwide 17-18 October Perth 20-22 October Canberra 23-26 October Perth • Retirement Living Summit 2013 24-25 October Melbourne • Pink Ribbon Day 28 October Nationwide • Dementia + Community Care Conference 2013 30-31 October Victoria • Aged Care Nurse Managers Conference 2013 30-31 October Victoria Aged Care Nurse Managers Conference 2013 0915 0930 • National Nutrition Week 13-19 October Nationwide Welcome & Introduction Managing Your Career in the Aged Care Industry This session will provide delegates with an insight into the current and contemporary ways in which employees can manage their own personal “employment brand”, align their career goals to their current workplace, and build skills to actively manage their career progression. Recruitment and career development requires a commitment from the individual and clarity of intent. When these can be harnessed and shared, there are a number of strategies and opportunities to build career landmarks, demonstrate competence and plan for appropriate progression through the industry. Tim Biddle, Human Resources Manager, SELMAR Institute of Education; Bachelor of Social Science (Honours), Grad Dip HRM, Certificate IV in Training and Assessment 1015 “Navigating through the Apprenticeship Maze” Apprenticeships, traineeships, funding, selection, partnering, submissions, RTOs, competency, candidates & much more … an absolute maze of issues & intricacies. This session aims to clarify the landscape & enhance your understanding & choices on offer. Renee Briggs-Gordon, Business Relationships Leader, MEGT Apprenticeships Centre 1045 1115 Morning tea, networking & trade expo Engaging families in the care of residents with dementia Residents’ family members and friends can play an important role in the dementia care team. Using family carers as a resource can improve the lifestyle and wellbeing of residents with dementia, and reduce the likelihood of behavioural issues. But family members also need support and information about dementia to help them to cope with changes in their family member. In this session you will learn how to: • Educate and support families about dementia • Enlist families as sources of information about the person in care planning • Include families in daily activities within the facility Denise Whimpey, Carer & Community Education Officer, Carers Victoria • Veterans Health Week 14-20 October Nationwide 1200 “… but I didn’t start it” - Dealing with escalating behaviours Having a toolbox of professional strategies to deal with escalating, emotive or even potentially explosive situations is vital for all managers & staff working in residential aged care. Whether in dealings with residents, families, other visitors, staff or even contractors situations can unfold where words & actions become ‘heightened’. This session will provide an overview of how to meet the challenges of these situations. To list your event on our calendar page, please email details to or Linda Pye, Mental Health Nurse, RN, BA, Grad. Dip. Org. Psychology, Cert IV Training & Assessment 1245 Lunch, networking & trade expo 1345 Clinical update - ‘Funny little turn’ or epilepsy? This session will provide an epilepsy update including an overview of the importance of Epilepsy Management Plans and professional development opportunities for workers in aged care. Alison Hitchcock, Education and Training Manager, The Epilepsy Foundation of Victoria. RN, BHSc, Critical Care Certificate and Cert IV in Workplace Training 1415 “Incident” Reports - beyond completion … Even in the age of ipads, specialist software & continuous improvement, are we effectively & efficiently capturing & responding to incidents within our services. Are all appropriate ‘incidents’ recorded or are we just skimming the surface? Does it depend on who is working ‘on that shift’? An important update & discussion for an essential management/ clinical responsibility. Nan Austin, National OHS Manager, Australian Red Cross Blood Service, MB(Personal Injury), MBA(Technology Management) 1500 1530 Afternoon tea, networking & trade expo Stories from the Field (1) These unique & diverse ‘stories from the field’ are designed to engage, enlighten & motivate! 1615 Close Day One Innovative products to help people in aged care Handycup® - Virtually unbreakable easy grip cup UNI-DOS - Simple and safe daily medicine dosage system Henro-Card - Playing card holder for people with limited use of their hands Drain Bag Holders - Highly durable, autoclavable bedside hanger For more information visit Conference Program Day 1 Program - Wednesday October 30 2013 Distributed by Statina Heathcare International August–September 2013 | 15

policy & reform Breaking down perceptions Whilst aged-care residences are often in the media spotlight for the wrong reasons, there are plenty where residents, staff and visitors enjoy a close bond. By Louis White M argaret Thompson is a ‘young’ 71-year-old. Despite recovering from knee surgery, Margaret has never felt more alive than since she moved to Bupa Bateau Bay aged care residence on the NSW Central Coast. “It is like living in a home,” she says. “It has all the facilities, the staff are friendly and there are plenty of amenities.” Having moved to Australia 20 years ago from Lancashire, England, Margaret feels right at home at Bateau Bay, where she has resided for the past two years. “There are bus excursions for those that want to get out and for those that can’t there are morning and afternoon teas as well as lovely lunches and dinners,” she says. “There are plenty of activities such as shuffleboard and bingo and I would consider a lot of the staff to be my friends, as I would a lot of the residents. “My quality of life has definitely improved since I moved here.” 16 | August–September 2013 While aged-care residences are often in the media spotlight for the wrong reasons, there are plenty of aged-care homes where residents and the staff are happy. “I have worked in the aged care industry for 19 years and previous to that I was employed in the hospital system so I had a good idea of what to expect,” Michelle Parish, general manager of Bupa Bateau Bay, says. “When I arrived here four years ago I thought it was important to get the community involved and to have a coordinated activities team and program in order to get the residents up and about. “There was only one volunteer when I arrived but now we have 18 and they are essential to help get the residents moving.” There is also the case of one special volunteer – 10-year-old Charli Blackburrow – who regularly visits on Tuesday afternoons. “They love chatting with her and talking about their lives and their families,” Parish says. Charli started visiting because she

policy & reform had moved from Victoria and was missing her nanna. Bateau Bay has both high and low care facilities where there is physiotherapy and podiatry available. They have also taken an innovative approach to dementia care with the introduction of pet and music therapy, which is combined with a dementia support group for relatives, friends and the wider community. “It is important that the residents – no matter what their condition – feel like human beings,” Parish says. “We need to treat a person as a person. We want them to try to live as normal a life as possible. “We emphasise to staff to concentrate on the person not the illness.” Parish says that getting residents out and about, where possible, has a great effect on their mental state. “We have had residents go away for a few days holiday and they come back invigorated,” she says. “One group stayed in a cabin, which allowed them to cook their own meals and walk in the outdoors. It makes them feel alive again.” Parish’s views are backed up associate professor Evonne Miller from the Queensland University of Technology who interviewed 15 residents over a 12-month period at BallyCara, a residential aged care facility on Brisbane’s Redclife Peninsula. The aim of the research was to focus on specific characteristics such as individual (attitudinal, emotional, spiritual, social and health), structural (environmental, design) and cultural (management ethos, philosophy of care and caregiver attributes) that enable and support older people to be happy, actively age and have a good quality of life in residential aged care. “There is surprisingly little research on daily life in aged care,” Miller says. “We talk a lot about dementia and other illnesses, but very little about the actual experience of life in aged care. “There are a lot of negative misconceptions out there, but Australia has very strong monitoring and accreditation processes to ensure quality and compliance and the vast majority of people who work in aged care do so because they enjoy working with older people. The fact is mistreatment is very, very rare.” Miller says that her research discovered that the majority of people moved to health care after a significant decline in their health. They also lacked the energy and time associated with managing their day-to-day lives. Even basic tasks such as cooking and cleaning became difficult. Sadly, but not surprisingly, most elderly people were reluctant to move to aged care because of pre-conceived ideas about what to expect. “Two months after the move, however, 75 per cent rated themselves as enthusiastic or very enthusiastic to be living there,” Miller says. “Our initial findings show that this satisfaction with living in aged care centred on the safe and supportive environment, forming positive peer and staff relationships, and being able to easily participate in social activities.” Miller says that being surrounded by people of similar age helps them fit in more easily and an array of people to talk to helps form friendships. BallyCara enabled residents to remain independent and free, which was very important to a majority of residents. “Overall, our research revealed that residents found life easier, they were more socially active and it provided structure around their daily lives,” Miller says. BallyCara is a residential aged care facility with 120 nursing home residents comprising 40 low-care and 60 high-care, as well as 230 independent living units. “We thought it was important to broaden the scope of BallyCara to incorporate living in the community,” says chief executive officer Marcus Riley. “We spent a lot of time acquiring knowledge into what the elderly wanted to make their lives not only more comfortable but enjoyable,” he says. “We wanted to know what they wanted to do in their everyday living.” Riley, who has been at the helm for four years, says it was important to get all staff on board to ensure that everyone was working towards the same priorities. “It is important that everyone wanted to make a better standard of living for the residents that live here,” he says. “We now have set goals and priorities for the residents, which gives them something to look forward to.” August–September 2013 | 17

policy & reform Riley cites the case of an elderly gentlemen who had become wheelchair bound and could no longer undertake his favourite pastime of swimming. His demeanour had changed and he was, naturally, getting depressed. With the help of staff understanding his needs, they were able to arrange for him to swim regularly and now he is enjoying life again. “Everyone here at BallyCara is totally committed. I think that reflects in the fact that we have satisfied residents,” Riley says. Carinity Aged Care Brookfield has used the power of singing to bring joy and companionship into the residency. They have formed their own choir much to the delight of those involved. “The ‘Brookfield Songsters’ started in 2010, after some residents at Carinity Aged Care Brookfield expressed an interest in singing,” says care manager Nadia Fletcher. “The centre’s chaplain, Lyndon Niemann, also thought it would prove to be a relaxing therapy – one that would provide participants with an opportunity to socialise, keep their minds sharp, and possibly even slow memory loss. Three residents came to the first session, but numbers have grown steadily over three years to the point where there are now over 20 members. “We aim to make everyone feel like one of the family, so the ‘Brookfield Songsters’ is open to anyone who wants to participate, not just people with musical experience or excellent voices. Every resident is invited save way with salary packaging Take home as much as $4,886 more in pay each year. As a charity employee, you could receive up to $4,886 more in disposable income each year by salary packaging with Maxxia. With the Maxxia Visa Card, you can pay for everyday expenses such as clothes, shoes, groceries and bills using pre-tax dollars. So whatever your lifestyle, Maxxia could help you save. Maxxia offers: • Peace of mind Talk to a real person when you call • Convenience Manage your account online 24 hours a day • Inclusiveness Even part-time and casual workers could claim Find out how you could get more out of your salary with Maxxia Visa Card. CALL 1300 123 123 Talk to your HR adviser and find out whether you’re eligible to salary package with Maxxia. Things you need to know: Salary packaging is subject to eligibility criteria and terms and conditions (available from or by calling us on 1300 123 123), and your employer’s Salary Packaging Policy. PAYG tax rates effective 1 July 2012 have been used, fees and charges apply. Your savings may vary depending on your particular financial, taxation and welfare benefit circumstances. You should seek independent professional advice before salary packaging. Maxxia does not provide financial, taxation or financial product advice on the relative merits of salary packaging or on any other basis. Maxxia may receive commissions or rebates in connection with some services it provides or arranges to be provided by third parties. Maxxia Pty Ltd ABN: 39 082 449 036 Auth Rep (No. 278693) of McMillan Shakespeare Ltd (AFSL No. 299054). 18 | August–September 2013

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