Published on March 10, 2014
Issue 75 February/March 2013 National agenda The biggest election issues facing the industry See page 20 Robots help with dementia care See page 16 Practical tips for mobility See page 31
2 | February/March 2013
contents EDITOR Amie Larter (02) 9936 8610 firstname.lastname@example.org Journalist Aileen Macalintal email@example.com production manager Cj Malgo (02) 9936 8772 firstname.lastname@example.org 04 CHIEF SUBEDITOR Richard Jenkins (02) 9936 8643 email@example.com Graphic Design Ryan Salcedo firstname.lastname@example.org National SALES manager Luke Bear (02) 9936 8703 email@example.com SUBSCRIPTION INQUIRIES (02) 9936 8666 firstname.lastname@example.org PUBLISHED BY APN Educational Media (ACN 010 655 446) PO Box 488 Darlinghurst, NSW 1300 ISSN 1326-0472 Cover Design by Cj Malgo Images APN Australian Regional Media & Thinkstock News 04 Australia Day honours Practical living 31 Maintain movement 06 Carers face financial 34 Tai chi benefits © Copyright. No part of this publication can be used or reproduced in any format without express permission in writing from APN Educational Media. The mention of a product or service, person or company in this publication, does not indicate the publisher’s endorsement. The views expressed in this publication do not necessarily represent the opinion of the publisher, its agents, company officers or employees. Practical ways to improve mobility Two respected health campaigners disadvantage Learning from China Reforms needed for long-term security 38 Link: Culture and food Catering to multicultural needs 08 Breaking new ground 34 Quakers Hill nursing home to be rebuilt 10 Information shortfall Navigating the aged care maze New Victorian post-grad course 13 Confronting incontinence New exchange to assist staff 14 Diabetes study Testosterone boost unlocks benefits 16 Robot technology trials Help for dementia patients 18 Alzheimer’s diagnosis Clinical focus 42 Fear of falling Rebuilding confidence 44 Hospital in the home An acute care alternative 12 Training boost Quick online test PUBLISHER’S NOTE 30 57 Congratulations to the winner of the Aged Care Insite’s Reader Survey iPad mini: Carol Allen from Victoria Workforce 46 Opinion: Michael Fine A genuine care culture 47 vetAWARE course Education on veteran mental health 49 Looking after yourself Tips for the year ahead 50 Filling the gaps Is community care in crisis? 52 Spirituality in healthcare New training for nurses 19 Expos and events Community 53 Couples and care Keep your diary up to date Policy & reform 20 Election focus A 70th anniversary celebration 54 Virtual walking program Putting aged care at top of agenda The 20,000-step trek around Australia 24 Opinion: Tapan Parekh Changes to payment structure 26 2nd Annual Aged Care Summit 55 Soothing sounds 28 Elder abuse Technology 57 Keeping mobile Harp therapy calms residents Preview what to expect Are assaults on the rise? Audited 9,215 as at Sept 2012 30 Caring for Aborigines Understanding their culture 38 Custom-built for industry needs 60 Data management How important is information? The Whiddon Group knows about quality – they won a 2012 Better Practice Award for their emergency preparedness, response and recovery strategy. Visit www.accreditation.org.au www.agedcareinsite.com.au February/March 2013 | 3
news Work elderly with honoured Photo: National Australia Day Council Two people who have worked tirelessly in aged care were recognised in the Australia Day awards. Amie Larter reports T his year’s national honours list saw two of the nation’s most respected health campaigners recognised for their contributions to the sector. Ita Buttrose, national president of Alzheimer’s Australia and vice-president emeritus of Arthritis Australia, was named Australian of the Year. And Emeritus Professor Ian Maddocks, a palliative care specialist from Flinders University, was named Senior Australian of the Year. Buttrose was awarded the top honour for her landmark media career as well as her long commitment to improving the health and education of all Australians. She has for many years campaigned to improve the plight of older Australians and been involved with promoting awareness of dementia, Alzheimer’s, arthritis, breast cancer, HIV/AIDS as well as prostate cancer. 4 | February/March 2013 Upon receiving her award, Buttrose confirmed that she saw this as an opportunity to change what she considered to be “ageist attitudes in our society”. She was clearly touched by the award, stating: “This is one of the proudest moments of my life and I’m truly honoured.” Buttrose was part of stellar group of nominees for the top award, which included businessmen Kerry Stokes and Harold Mitchell, Tasmanian adventure teacher Andrew Hughes and long-time cancer researcher Adele Green. Maddocks, an internationally renowned palliative care specialist and long-term advocate for world peace, has advocated improved care for the dying since 1980. He was the first chair of palliative care at Flinders University, the first president of the Australian Association for Hospice and Palliative Care and first president of the Australian and New Zealand Society for Palliative Medicine. When speaking to Aged Care Insite, Maddocks said he was humbled to receive the award, hoping that it would continue to raise the profile of palliative care. “I think people are recognising the value of palliative care in the Australian community and we are seeing increasing need for good care of people who are dying.” Now aged 82, Maddocks, who continues looking after patients as a palliative care physician, shared what he enjoyed the most about his career. “I think it’s the opportunity to meet with people in their homes and work with the family to see the death go well. It’s often a source of great awe but great satisfaction and even beauty,” he said. “The family feel that they have done a good job that their loved one has quietly slipped away in the place he or she wanted to be and it has gone well – so that’s a great satisfaction.” Still keen to promote his area of work, Maddocks believes that there needs to be wider community awareness of what palliative care can do, and training for everyone who is working with dying patients. “That’s just not specialists in palliative care but people who are working in other areas because any of us working in medicine may need to look after somebody that is going to die and we all need to know how to do it well. “It ought to be a central part of medicine and it hasn’t been. I think we still have a way to go to help people stop trying to achieve impossible results with futile treatments and accept that death is happening and help people to do it well.” n
news www.agedcareinsite.com.au February/March 2013 | 5
news Tax and super push for carers Superannuation is tied to paid work and predicated on someone working full-time across a lifetime and most carers won’t have that type of work trajectory. Unpaid carers who save the nation up to $40 billion are being financially disadvantaged, says the Sex Discrimination Commissioner. Amie Larter reports A ustralian carers who have long absences from paid employment are being penalised by the current tax and superannuation systems, says the Sex Discrimination Commissioner. A recently released report, Investing in care: Recognising and valuing those who care, has highlighted necessary reforms to address the financial disadvantage for unpaid carers. Sex Discrimination Commissioner Elizabeth Broderick says that carers, most of whom are women, are having to make choices that mean they won’t be as financially secure in retirement as they otherwise would Commissioner Elizabeth Broderick have been. “Superannuation is tied to paid work and it is predicated on someone working full-time across a lifetime and the fact is that most of the carers, in fact nearly all of the carers, won’t have that type of work trajectory,” she said. “Those that take out time to care will 6 | February/March 2013 have an impact on their promotional prospects but also on their ability to generate income and particularly income of a higher level.” Broderick called for a shift in policy framework – moving towards a focus on caring over the life trajectory rather than just on caring for children. “We need initiatives at the other end of life where we are caring for our elderly relatives,” she said, adding that the changes need to be made sooner rather than later. “Our caring responsibilities are becoming more expansive, not less, with the ageing of the Australian population.” Hoping to kick-start the discussion on how to best value underpaid work, the report outlines 11 options for reform drawn from research of systems and schemes from 24 countries around the world. The report looks at a range of possible mechanisms for change, including caring credit schemes, superannuation payments for those receiving carer’s payments or paid parental leave and a needs-based assessment for carers to determine what needs they require to help them care and not be disadvantaged. “Australia needs to seriously examine the suitability of these types of schemes,” Broderick said. Carers Australia has been an advocate for the recommendations contained in the report for many years, and its president, Dr Tim Moore, hopes the report will provide strong impetus for governments to introduce new reforms. “Despite the fact that governments have begun to recognise the significant contribution of carers, there is still a very long way to go to redress the socioeconomic disadvantages inherent to the caring role,” he said. “To put the contribution of these carers in context, in 2010 Access Economics estimated the replacement cost of unpaid care at $40.9 billion per annum.” The main recommendations in Broderick’s report include: • The introduction of a careers assessment to evaluate a carers support needs • A carer’s card to be given to those identified as having significant caring responsibilities to be used to access service and entitlements. • Fair Work and National Employment Standards amendments to ensure flexible work arrangements and conditions. • Enhanced leave entitlements for unpaid carers. • New mechanisms to support unpaid carers in the workplace. • A nationwide campaign to promote the positive contributions of carers. n
news Health a top election T he Australian Nursing Federation (ANF) is calling for health to be a top priority leading up to the federal election on September 14. ANF federal secretary Lee Thomas said they are calling on all the parties “to make safe patient care for all Australians a top priority at the election”. “As a result, the ANF will be seeking urgent representations with all major parties Lee Thomas issue, says ANF as well as key independents to put our health platform to them and asking that they commit to the ongoing delivery of safe patient healthcare for the Australian community,” she said. One of the major issues that the ANFs health platform must address, said Thomas, is the predicted shortage of 109,000 nurses and midwives by 2025. Other big issues include the current shortage of 25,000 nurses in the aged care sector, the underemployment of nursing graduates and health budget cuts across the states and territories. “These are serious issues which impact the ANF’s growing 225,000 membership, as well as the whole of the Australian community,” Thomas said. She said that the ANF is the professional and industrial voice for nurses, midwives and assistants in nursing in Australia. “As a major stakeholder in the health, aged care and the industrial and professional arenas, the ANF will be working hard throughout this election campaign to ensure all parties listen to our concerns and commit to safe patient care this election.” n ADVERTORIAL Don’t give your money away, roll over! You’ve earned your super so, when the time comes, make sure that you get to enjoy every cent of it. This means making the most of what you have. One of the ways you can do this is to make sure you have only one super account. That’s because super funds charge fees. So, the more accounts you have, the more fees you’re likely to be paying. And if like the average working Australian, you have extra super accounts, the multiple fees could be eroding your retirement nest egg. Plus, you’re losing the chance to earn future compound interest (interest earned on interest) on any fees saved, which helps grow your super over time. So, rolling over — or consolidating — your super into one account makes sense and it could mean more money to retire on. Simply follow these simple steps! 1Find your lost super One in two Australians have lost super with billions of dollars just waiting to be claimed. It’s worth doing a quick check at ato.gov.au/superseeker and unclaimedsuper.com.au if you’ve ever had more than one job, changed your name or address. 2Gather your super account details Find statements for all your super accounts or call each of the funds you’re with and ask for your member number and account details. 3Know your benefits While you’re talking to each fund ask them what benefits — such as insurance — you’re receiving through them. Compare the benefits and fees to work out which fund suits your needs best. Complete one form for each account you’d like to roll into HESTA, along with a copy of certified identification (ID) documents for each fund you want to rollover. We’ll get things moving, although your other fund(s) may contact you to confirm the rollover. 5Get your ID certified All copied pages of original proof of ID documents need to be certified as true and correct copies. This is very important to protect your super account(s) and to ensure that there isn’t a delay in processing your request. Details about acceptable ID and those people who are authorised to certify documents are outlined in the rollover form. For more information on HESTA, your health and community services industry super fund, visit hesta.com.au or free call 1800 813 327. 4Fill in the form Download a rollover form at hesta.com.au/consolidate or free call 1800 813 327 for a copy. This material is issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No. 235249, Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321 . Information provided is of a general nature. It does not take into account your objectives, financial situation or specific needs. You should look at your own financial position and requirements before making a decision and may wish to consult an adviser when doing this. This information contains H.E.S.T. Australia Ltd’s interpretation of the law but should not be relied upon as advice. For more information, free call 1800 813 327 or visit hesta.com.au for a copy of a Product Disclosure Statement which should be considered when making a decision about HESTA products. www.agedcareinsite.com.au February/March 2013 | 7
news Bigger, safer home for Quakers Hill A little over a year since a fire destroyed a nursing home in Quakers Hill in Sydney’s northwest construction has started on a much larger facility. Gary Barnier, managing director of Domain Principal Group (DPG) one of the nation’s largest care providers, led the groundbreaking ceremony with the NSW Minister for Ageing and Disability, Andrew Constance, and Fire and Rescue Commissioner Greg Mullins. The new Quakers Hill Nursing Home will be about three times the size of the previous facility, covering an area of 6300 square metres. “Today is a momentous day for us and for residents of Quakers Hill as we begin to rebuild this facility that will serve as a vitally needed home for our older generation,” said Barnier. “The new home will be one of the state’s most modern aged care facilities and cater for the needs of residents now and in the future. It is a $25 million project that we hope to have up and operating on the first quarter of next year.” It will have 79 single and 24 double rooms, as well as a dementia wing. These can house up to 127 residents. The new home will be fitted with the latest fire equipment, such as fire sprinklers, smoke alarms and fire panels. Other local dignitaries at the ceremony early this month including leader of the opposition and NSW local member for Blacktown John Robertson, state MP for Riverstone Kevin Conolly, Quakers Hill police commander, Acting Superintendent Lynelle Rodwell, and Blacktown City Councillor Mark Holmes. Quakers Hill community members, emergency representatives, and the home’s operators also attended, as well as some of the families of the residents of the home. “Construction will create around 150 fulltime jobs. Once the new home is rebuilt, it will employ up to 130 staff,” Barnier said. Fair Work gives Qld tick of approval Q ueensland aged care businesses have strong compliance with workplace obligations, according to recently released findings from the Fair Work Ombudsman. The books of 205 retirement villages and nursing homes were checked last year to ensure employers were paying workers correctly and complying with pay-slip and record-keeping obligations. The industry had been targeted during an education and compliance campaign due to a large number of employee complaints. Of the audits completed, inspectors found 197 employers were compliant with workplace obligations while seven recorded contraventions. Out of the seven businesses with contraventions, three had only record-keeping contraventions while four had underpaid 55 employees a total of $8800. Non-compliant employers were instructed by Fair Work inspectors about their obligations, and were assisted to voluntarily rectify issues. Fair Work Ombudsman Nicolas Wilson said the campaign increased employers’ awareness of workplace laws and the resources available to assist them. “We are very pleased with the rate of high compliance found in this campaign,” he said. “But it is important that businesses in this sector continue to be proactive to ensure their ongoing compliance with workplace laws.” Workers or employers seeking support can contact the Fair Work Ombudsman at www.fairwork.gov.au or call 13 13 94. n 8 | February/March 2013 From left: Kevin Conolly, Andrew Constance, Gary Barnier and John Robertson, break ground as construction begins for the new Quakers Hill Nursing Home The fire in November 2011 killed 11 residents and many others were treated for smoke inhalation. A man who worked as a nurse at the home has been accused of deliberately lighting the fire. He has pleaded not guilty to the murder of 11 people who died as a result of the blaze. n
news Profit margins squeezed • Researchers have found that regular consumption of aspirin can be associated with an increased risk of neovascular age-related macular degeneration (AMD). Results from a study conducted by the Centre for Vision Research at Westmead Millennium Institute for Medical Research (WMI), a close affiliate of the University of Sydney, suggest that patients that take aspirin more than once a week have a greater risk of developing AMD. Research was conducted over a period of 15 years with a total of 2389 participants, 257 of whom were regular aspirin users. According to results, 63 people from the 2389 had developed incidences of neovascular AMD. Professor Paul Mitchell, director of WMI’s Centre for Vision Research said that the cumulative incidence of neovascular AMD among non-regular aspirin users was 0.8 per cent at five years, 1.6 per cent at 10 years, and 3.7 per cent at 15 years. Among regular aspirin users, the cumulative incidence was 1.9 per cent at five years, 7 per cent at 10 years and 9.3 per cent at 15 years, respectively, indicating that regular aspirin use is significantly associated with an increased incidence of neovascular AMD. This increase was about 2 ½-fold, after accounting for potentially confounding variables. • Preliminary results from the 2012 Bentleys Aged Care Survey has revealed a greater need for reform to encourage probability in the aged care sector. The survey of providers, showed that while they have improved their financial capacity to protect consumers through improved liquidity management, profitability continues to lag. “With an ageing population continuing to place increased demands on aged care, it is imperative providers safeguard their long-term financial viability so they can continue to operate well into the future,” said Bentleys director and aged care specialist Heath Shonhan. This year’s survey identifies an average net profit margin of 7.8 per cent, well below 2005/06 levels of 9.95 per cent. www.agedcareinsite.com.au Banks move on fairness • The release of the revised Code of Banking Practice by the Australian Bankers’ Association is a positive step towards giving older Australians more confidence in banking, says COTA Australia. The code sets the standards that customers can expect in regard to fairness, transparency, behaviour and accountability. COTA chief executive Ian Yates said that older people in particular often feel banking systems marginalise and ignore them, so the new commitment to tell people about no or low fee accounts if they hold concession cards could really benefit the elderly. “Anything which encourages financial institutions to give people relevant information in an easy-tounderstand form is a step in the right direction and will save customers money.” Yates believes that along with reforms to bank complaints processes, a more compassionate and proactive approach to customers suffering financial difficulty will greatly improve the banking experience for older Australians. inbrief Aspirin may affect eyesight Cheaper hearing aid • Scientists and entrepreneurs Professor Peter Blamey and Dr Elaine Saunders, owners of Melbourne-based hearing aid company Blamey Saunders hears, have developed a hearing aid they say may outperform most conventional devices for less than half the price. Aware of the cumbersome nature of the bigger manufacturers, Blamey and Saunders opened their own business when their new technology was slow to be embraced. Using technology developed for Australia’s bionic ear and many high-end Bluetooth headsets, the new hearing aids are simple to use and can be bought over the internet. The developers say these new devices remove the need for complex prescriptions and technical solutions, easily customised to suit customers without the need for appointments. The company says customers can purchase the hearing aids and customise them for less than $4000 a pair, a large saving compared with the higher-end products that can retail for up to $14,000. February/March 2013 | 9
news It’s not easy when we realise that a loved one needs residential care, but help is available. By Amie Larter Heather Hill Making care a W ith Easter just around the corner, nursing homes and similar facilities can expect an increase in inquiries as family members visit relatives and witness elderly people struggling to cope at home. According to Heather Hill, managing director of Heather Hill Pathways, more often than not it’s the special occasions – Easter, Christmas and birthdays – where people are confronted with the frailty of loved ones and generally it is the same time that local nursing homes are bombarded with a surge of enquiries. “Family members are often going back to stay with mum and dad or grandma and From my experience, the client goes into the nursing home and settles in really well but the family are the ones that are really upset. 10 | February/March 2013 family decision grandpa to celebrate a particular event and this is when the warning bells go off that they are simply not coping,” Hill said. “When I have spoken to the managers of the various facilities they generally will say to me that they get a flurry of phone calls coming in after Easter and Christmas and it is family members that are calling them to get information on basically what’s available and discuss what they can do.” This lack of access to information about aged care options and pathways inspired Hill to create an independent aged care service offering advice and support to help families successfully navigate their way through the aged care maze. Heather Hill Pathways, based in Queensland, is the first aged care organisation to bring together the expertise of a range of nursing, law, financial planning, mediation and counselling professionals to provide an integrated service for clients and families. “We offer advice and help families to explore all of their options, make sure they get any benefits, subsidies or services that they are entitled to, and give them piece of mind that they have made the best possible decisions under the circumstance.” Brian Herd, a partner at Carne Reid Herd Lawyers, has been a practising solicitor since 1983 and was keen to come on board as the organisation’s leading legal professional. “For a long time now we have seen that there was a real need for other professionals to be involved in the process before we could walk away from a client knowing that we had given a truly complete solution to their problems,” Herd said. Hill, who has been running a nursing agency that specialises in aged care for the past 10 years, said that from what she had seen, the company holds a unique place on the market. “We haven’t found somebody that takes this holistic approach that says ‘It’s not just a client going into a nursing home it’s a whole family that is impacted by this’. “From my experience, the client goes into the nursing home and settles in really well but the family are the ones that are really upset. “They are the ones that we need to be putting just as much attention on to help them through that transition.” n
news www.agedcareinsite.com.au February/March 2013 | 11
news Post-grad course boosts training A new one-year course offers nurses the chance to fill in any gaps in aged care knowledge. N urse graduate Emma Dunlevie has a clear and distinct passion for her work. In fact, when asked about her career prospects, she said she was not sure but would be happy as long it involved “working in the aged care sector and making a difference”. Dunlevie is one of 25 graduate nurses who have recently completed LASA Victoria’s 12-month Aged Care Graduate Nurse program run by Leading Age Services Australia (LASA). This is the first group of graduates to complete the course, which is funded by the federal government. LASA Victoria is the peak body for aged care services in Victoria. The program involves seven weeks of training spread out over a year and includes study days, leadership and accreditation courses as well as the development of industry specific clinical skills. High care, low care, palliative care and dementia specific care were just a few of the different types of nursing areas covered by the course. “The curriculum included pressing topics such as palliative care, behavioural and psychological symptoms of dementia, politics and leadership,” Dunlevie said. “These subjects are pivotal for nurses working in aged care yet are silent in many undergraduate curriculums.” As part of the program, graduates were employed in a supported environment at one of LASA Victoria’s aged care provider’s facilities. This contributed 12 credit points to a Masters of Nursing (Aged Care) at Monash. “All the nurses have developed relationships with peak aged care bodies and personnel throughout the entire program,” Dunlevie said. Dr Pamela Johnson, nurse placement programs co-ordinator at LASA Victoria believes the course offers a unique opportunity to students looking to start a career in aged care. “Our program provides advanced theoretical and clinical learning experiences, which is now becoming paramount in understanding the complex co-morbidities now seen in frail older people,” Johnson said. “Aged care offers a complex and challenging career – one that can offer truly rewarding experiences and excellent career progression opportunities.” Chief executive of LASA Victoria John Begg praised the nurses on their completion of the program. “Congratulations to the first group of graduate nurses who have entered into this program ... who can now use their advanced skills in aged care for the benefit of our ageing community and the workplace,” Begg said. “Over the next 40 years the number of persons aged over 65 will increase dramatically and the age group over 95 even more so. “Many of these older Australians will rely on professional care delivered by a vibrant and capable workforce; one that we must start building today to enable this care to be available.” n Dementia Tas Dementia Tas is an independently owned and operated business offering training & consultancy to the Aged Care & Disability sectors as well as the General Community Training sessions for the first half of 2013 can be viewed on the website To book a consultation or to discuss how to deliver customised, cost effective training in your workplace or community Contact Ros: P: 0438 024 169 E: email@example.com www.dementiatas.com.au 12 | February/March 2013 or visit the website
news Exchange gives help with incontinence By Aileen Macalintal B y 2030, cases of incontinence are expected to rise to 6.5 million Australians – with women being more likely to be incontinent than men. In light of this, the Continence Foundation of Australia has developed the Australian Continence Exchange (ACE), a confidential online chat site to support health professionals caring for those with the disorder. “ACE is a central online resource designed to assist health professionals achieve best practice in continence health management,” said the foundation’s CEO Barry Cahill. The forum (continencexchange.org.au) is moderated by health professionals who can answer questions privately. “ACE provides access to research reports and clinical guidelines from a broad range of sources,” Cahill said. Staff can download resources, chat about patient care, and access the latest continence research findings. “It offers a platform for professional development opportunities and provides opportunities for health professionals to share knowledge and ideas via the online forum,” he said. “Aged care workers can connect with physiotherapists, nurses, pharmacists and other health professionals at a time and location convenient for them. “The strength of ACE is its ability to connect health professionals from www.agedcareinsite.com.au diverse backgrounds to help improve the standard of continence care in Australia.” Conversations relating to incontinence are often considered taboo, especially when one talks about personal problems in dealing with these issues. “Health professionals with improved knowledge about incontinence feel more confident discussing the topic and raising it with patients, thereby helping to destigmatise the issue,” Cahill said. “It’s a great resource for health professionals who don’t focus on continence as a core issue, but who need to deal with people seeking help for incontinence – which affects 4.8 million Australians – 1 in 4 over the age of 15,” he said. Incontinence is more dominant than people with asthma (2 million), anxiety disorders (2.3 million), and arthritis (3.1 million). The primary goal of ACE is to connect workers from a diverse range of backgrounds, and from this boost knowledge about the subject in the wider community. For those who are suffering from incontinence there is an online forum where individuals can anonymously discuss issues with others in a similar situation. See continence.org.au/forum. n February/March 2013 | 13
news Study confirms garlic’s health benefits R esearchers at the University of Adelaide have found that aged garlic extract reduces blood pressure in adults with hypertension, which affects about 30 per cent of adults around the world. Aged garlic extract’s benefit on blood pressure may be compared with that of front-line prescription medications, the study found. The work was led by Dr Karin Ried from the University of Adelaide and the findings recently published in European Journal of Clinical Nutrition. It suggests that the plant is an “effective and tolerable treatment in uncontrolled hypertension, and may be considered as a safe adjunct treatment to conventional antihypertensive therapy”. Since 2006, Ried has been researching the health benefits of garlic, which is known for its blood pressure-lowering properties. Results show that systolic blood pressure significantly dropped by about 12 millimetres of mercury among those who took two capsules of aged garlic extract daily. The effect is said to be similar to the effect of commonly prescribed anti-hypertensive medicines. On the other hand, the systolic blood pressure of those who took one capsule of garlic extract a day showed changes similar to the placebo effect. The two-capsule group’s reduced systolic blood pressure is significant as it lowers the risk of cardiovascular disease. Ried is the research director at the National Institute of Integrative Medicine (Melbourne). “More than 3 million Australian adults suffer from high blood pressure, or hypertension, which places increased strain on their heart, and increases their risk of heart attack or heart failure,” she said. A general practitioner and coinvestigator, Dr Oliver Frank, said he was pleasantly surprised by the results. “While our study focused on using aged Testosterone link to diabetes A boost of testosterone may unlock benefits of treating men with type 2 diabetes. The University of Melbourne together with the University of Adelaide are seeking men to join the study that looks at treatment through testosterone supplements and a weight-loss program. About 1500 men aged 50 to 74 are being sought for the $4.8 million study in Victoria, NSW, South Australia and Western Australia. “We know that as men get older and gain weight – especially when they become large around the belly – they often suffer from reduced testosterone levels,” said University of Adelaide Professor Gary Wittert, who leads the study. 14 | February/March 2013 garlic extract as an adjunct treatment to conventional medications, there is evidence to suggest that people who are newly diagnosed with hypertension could try it as an initial treatment under medical supervision, and see what results they get. “These results provide more robust evidence supporting the use of garlic extract as a safe and effective adjunct treatment for hypertension that has few known side-effects. “Hypertension can be tricky to treat, and we end up prescribing as many as four medications in some instances in an effort to get a patient’s condition under control while managing any adverse effects. “The ultimate goal for patients is to achieve blood pressure as close as possible to normal with the fewest medicines, and the fewest adverse effects,” he said. However, Ried said that it is important to note that the study used high potency formula of aged garlic extract. “Aged garlic extract has fewer sideeffects than fresh garlic and allows better standardisation of dosage than other types of garlic supplements, such as garlic oil and garlic powder,” he said. Aged garlic extract is available in pharmacies and health food stores. n “Lower testosterone has many implications for men’s health, such as reduced motivation to exercise and lack of sexual function. It is also closely associated with type 2 diabetes, which is an enormous health burden for Australia. “By giving testosterone supplements in that critical pre-diabetes stage, and by putting them on a dedicated weight-loss program, we expect to see sustained reductions in weight and a reduced chance to develop type 2 diabetes,” Wittert said. The company Weight Watchers will provide a free online weight-loss program for men who sign up for the study. The study will be conducted over at least two years of the participants’ lives and could have a range of other health benefits for those who take part, said Associate Professor Grossmann (University of Melbourne Austin Health) who is leading the research in Victoria, together with Dr Carolyn Allan from Monash Medical Centre. n
news www.agedcareinsite.com.au February/March 2013 | 15
news Robots at our service Trials by two universities involving advanced technology are aimed at increasing the emotional wellbeing of patients with dementia. By Aileen Macalintal and Amie Larter L a Trobe University hopes to improve the lifestyle of mild dementia sufferers through engagement with specially designed robots. Set to commence in February, a trial in Melbourne will involve each of the robots being placed in the home of a dementia sufferer for two weeks. The trial has been described as a world-first by researchers. Participants’ and carers’ responses to the robots will be measured, and surveys conducted before and near the end of the trial. The director of the Research Centre for Computers, Communication and Social Innovation at the university, Associate Professor Rajiv Khosla, is the lead researcher for the trial. He said the robots are the first of their kind to be used therapeutically for mild dementia sufferers. “They can talk, sing, dance, play games, tell the weather and read the newspaper,” Khosla said. “They include innovative services like reminiscing with dementia sufferers, sending mood based emails and supporting caregivers to remotely manage activities of dementia suffers.” Provided by NEC, Japan, elderly people will be able to interact with the robots through voice or a touch panel with large buttons. “We believe these robots will help the dementia sufferers to gain confidence in daily life and reduce feelings of uselessness,” Khosla said. “They could revolutionise the way we look after older people with dementia. The social robots are already breaking technology barriers and are set to provide more sophisticated and emotionally engaging services to help our senior citizens become more independent and resilient.” 16 | February/March 2013 Wendy Moyle with Gerry
news Meet Gerry Meanwhile, Griffith University’s batterypowered robot called “Gerry” is also designed to improve the quality of life for people with dementia. It is already being well-received, while still under trial. High-tech, yet user-friendly, Gerry is a portal for communication between patients and family members. It has a screen that is about the same size as a human head, displaying the face of the user on Skype. That is why it is also called “Skype on wheels”. As people with dementia see their loved ones on screen, they are often inquisitive about “how the family member got into the robot”. The research project is lead by Professor Wendy Moyle, director of the Centre for Clinical and Community Practice Innovation at the Griffith Health Institute. “Men have often shown interest in how the robot works and move,” said Moyle. The family member can remotely access the robot through software on their computer, so somebody does not have to be there to operate the robot. “The robot moves according to the family members’ commands,” said Moyle. “Gerry will normally manage a one-hour conversation and movement. He requires a short period of powering up after each session, around 30 minutes.” Gerry can also help increase people’s understanding of the common condition that is dementia. “We have added additional features to Gerry so that he captures emotional responses and then the researchers use additional software to analyse the responses,” said Moyle. “This is a second generation robot. It is the only one of its kind outside of Europe. It was developed as a tool for health professionals to communicate with each other or with clients. “We saw the potential to use it with people with dementia who are often isolated from their family and have limited communication with the outside world.” However, the robot technology still has glitches. “While we have had great outcomes from our testing, there are a few challenges that we would like to see ironed out before the robot is marketed for use with this population,” said Moyle. One big challenge they are preparing for is the overheating of the robot during summer, when Australia’s weather is scorching hot. Aside from problems with the heat, which could affect the electronics, the researchers are working on other features. “The team is working with the developer and engineers at Griffith University to add additional features that would assist to make the robot even more user-friendly,” said Moyle. “We have added additional videomonitoring equipment, and an external modem. Also we are working on adding additional sensors so that the family or user can see more readily obstacles within the nursing home environment.” Robin Pickworth, lifestyle manager for the RSL Care Talbarra Retirement Community near the Gold Coast, says that technology often scares the residents but this device offers them a great way to easily connect with family members. “We are very excited about the forthcoming trials,” Pickworth said. n At Bunzl, we are working closely with our preferred and trusted healthcare suppliers to deliver market leading brands to professionals in hospitals, aged care facilities and other organisations. We offer product supply solutions and a service oriented consolidation and distribution service, by means of one order, one delivery and one invoice. Our team of clinical specialists can support staff with outcome-based education to optimise patient and resident care. Major partners include: One Order, One Invoice, One Payment. Visit www.bunzl.com.au or call 1800 655 152 www.agedcareinsite.com.au February/March 2013 | 17
news Online test near for Alzheimer’s Professor Lizzie Coulson By Aileen Macalintal a simple online test may help detect the onset of Alzheimer’s, say scientists at the Queensland Brain Institute at the University of Queensland. Professor Lizzie Coulson said her research team have identified how the disease impairs the cholinergic basal forebrain, one of the brain regions that involves memory and attention. This area’s degeneration may be seen and tested while undertaking tasks such as navigation. “Our recent discovery suggests that we now know which part of the brain is used for one part of our test, the part of the brain where current drugs are directed.” With this, the test could be used to measure if the current drugs are improving the cognitive tasks. The online navigational task is a helpful tool along with the existing tools that clinicians use, said Coulson. 18 | February/March 2013 “This or other tests could, in the future, be used as a preliminary screen before more expensive and directed tests are performed. Longitudinal studies are most easily done if they are quick and cheap – which this test should be, and done either by a general practitioner or even, one day, in your home over the internet or iPad, rather than a specialised memory clinic.” The tests seem relatively easy as volunteers navigate a simple arena on a computer monitor touchscreen. “The subject has to draw a path from a start position on the circumference of a circle to a goal within the circle,” said Coulson. “It is the brain’s ability to do spatial gymnastics that we are testing, to remember the end point, as well as how many trials it takes to get the task. “Currently in Australia, we are placing test subjects’ results in groups according to other clinical diagnoses (normal cognition, mild cognitive impairment, or AD) in order to determine what the normal variation is in each group. “Then in the future we hope to be able to say someone is likely to be in that group based solely on their score. This may also depend on the person’s age and so we need to test many people to know the boundaries. “In the Czech Republic they have already done the test on many people and have a good idea of the group variations and boundaries, but we need to validate that Australians fall into the same groups,” Coulson said. She is collaborating with a team from the Czech Republic, who developed the human recall navigation tasks. The QBI team is currently validating the findings in humans after examining cognitive changes in rodent models. The paper Lesions of the basal forebrain cholinergic system in mice disrupt idiothetic navigation was published in the journal PlosOne. The study was funded by the Queensland government’s National and International Research Alliances Program and the National Health and Medical Research Council of Australia. The diagnosis tool could be widely used as early as 2015, said Coulson. n
calendar 2013 FEBRUARY • Ovarian Cancer Awareness Month 1-29 February ovariancancer.net.au • NSW Community Care Forum – Living and ageing well 20 February Australian Technology Park, Sydney • 4th Annual Dementia Congress 21-22 February 2013 Melbourne, Victoria iir.com.au • 2013 Tri-State Conference & Exhibition 24-26 February The Sebel Albert Park, Melbourne vic.lasa.asn.au/event/tristate2013 • Spark of Life Week 11-17 March dementiafoundation.org.au • Brain Awareness Week 12-18 March brainfoundation.org.au • Think Arthritis & Osteoporosis 16 March Royal North Shore Hospital, St Leonards arthritisnsw.org.au • The Australian Pain Society 33rd Annual Scientific Meeting 17-20 March Royal North Shore Hospital, St Leonards arthritisnsw.org.au • ACN Nursing and Health Expo WA 7 April Perth Convention and Exhibition Centre rcna.org.au • 12th National Rural Health Conference 7-10 April Adelaide nrha.org.au • Understanding & Implementing Your ACFI WA 8 April Perth, Western Australia frontlinecaresolutions.com/ understanding_ACFI 18-19 March acevents.com.au/ agedcare/#1 • DonateLife Week 24 February-6 March donatelife.gov.au MARCH • National Epilepsy Awareness month 1-31 March epilepsyaustralia.net • Southern Cross Care Seniors Expo 7 March scrosswa.org.au • Behaviours – opportunities for change 7 March dementiacentre. com.au www.agedcareinsite.com.au • Effective Care Plans & Case Conferencing WA 9 April Perth, Western Australia frontlinecaresolutions.com • Leadership in Nursing 21-22 March Melbourne, Victoria ausmed.com.au • World Parkinson’s 11 April Worldwide parkinsons-qld.org.au • AAG & ACS Rural Conference – Living and belonging 21-22 March Orange Ex Services Club agedservices.asn.au • ACN Nursing and Health Expo VIC 21 April Melbourne Convention and Exhibition Centre, Victoria rcna.org.au • Arthritis Awareness Week 26 March arthritisaustralia. com.au • ACN Nursing and Health Expo QLD 28 April Brisbane Convention and Exhibition Centre, Queensland rcna.org.au • 2nd Annual Aged Care Summit APRIL • April No Falls Day 1-7 April Statewide, Western Australia iccwa.org.au/node/124 February/March 2013 | 19
policy & reform Pushing ageing onto the agenda One of the most important issues in the election has to be caring for older Australians and how we will deal with a rapidly greying population. Louis White reports T he plight of the world economy is a hot discussion topic right now, as is what to do if China and India continue to look to Africa for mineral resources. But the big topic is really the future of elderly Australians and it needs to be addressed urgently. The aged care system is coming under increasing pressure as a result of demographic, social and economic change. The number of people receiving aged care services is expected to increase by about 250 per cent over the next 40 years, with some 3.5 million people (10.3 per cent of the population) expected to use care services by 2049-50. As a result, the federal government has undergone a thorough examination of the aged care system providing $3.7 billion over five years through the Living Longer, Living Better package. In the past four budgets the government has allocated a total of $52.3 billion to aged care funding with $9.1 billion alone allocated in 2012-13 to residential care services. The increasing prevalence of dementia and other age-related chronic illnesses is projected to result in growing demand for more complex services. At the same time, a relative fall in the number of informal carers will mean that older people will be more reliant on the formal aged care system for the support they need. Other issues facing the sector are workforce training and recruitment, regulatory burden and changes to accommodation payments. There is also pressure for the system to be more flexible and responsive with older Australians wanting more choice and control over the services they receive and to be able to remain in their own home for as long as possible. To provide more and better services, the system will need to attract more skilled workers and provide greater incentives for capital investment. “In this election year it is important that politicians 20 | February/March 2013 from all parties consider aged care as an important policy area,” says John Kelly, chief executive officer of Aged and Community Services Australia (ACSA). “While the Prime Minister and the Minister for Ageing have outlined a long-term path of reform beyond this electoral cycle, sustainability of the industry is vital. Viability is always raised at policy discussions and the sector is anticipating the minister’s announcement on workforce may have some ramifications for smaller providers, particularly in rural and remote areas.” Recruiting staff ACSA is the national peak body representing notfor-profit and faith-based providers of residential and community care, and housing and support for people with a disability and their carers. Currently, 700,000 older Australians depend on care and support provided by ACSA members in the metropolitan, regional, rural and remote regions across Australia. “Other issues facing the sector are workforce training and recruitment, regulatory burden and changes to accommodation payments,” says Kelly. “The Coalition has played its cards close to its chest and has not revealed details of any policies. Aged care may be on the minds of many families, but it is hard to draw media attention to it, unless there is a case where someone wants to highlight a grievance. “It is easy for politicians from both sides of politics to claim that the aged care agenda is not one that warrants as much attention as the carbon tax, boat people or the mining tax. But politicians are in a position of leadership. They should, as Winston Churchill did, lead. They are in a position to take issues to the community. “The public’s attitude to important issues can be influenced over time if people are educated and wellinformed. The reality is that aged care will be sought by more people with higher needs in the future as life expectancy increases. We must all consider how these services will be paid for in the short and long term.” The aged care industry comprises residential aged care facilities, home care and nursing services,
policy & reform retirement villages, independent living units and seniors’ housing and of course the elderly themselves. The Australian Patients Association (APA), the nation’s peak patient advocacy organisation, states that there are so many issues facing Australia’s ageing population that the situation requires more action, less talk and certainly less committees. “Last year the Gillard government announced aged care reform package initiatives, which include $256.4 million to build a system for the future through a new Aged Care Reform Implementation Council,” says Michael Riley, APA national director. “The council’s mission is to drive the development and implementation of reform establishing a new Aged Care Financing Authority – a new gateway for services to help older Australians be more informed and better move through the system, as well as introducing quality regulation with increased powers to handle consumer complaints. “But we have heard little since this announcement about what has been achieved or actioned by the Aged Care Reform Implementation Council. “The Coalition has yet to announce how it would tackle the aged care crisis – poor facilities and care, not enough trained staff, poor perception of aged care facilities – if it won power,” says Riley. Call for action The APA is an independent not-for-profit organisation dedicated to championing and protecting the rights and interests of patients, and improving overall patient care and health outcomes. “From the point of view of the APA, many facilities and providers have an image and reputation problem,” Riley says. “There is a stigma with aged care in Australia that people in many facilities are not adequately cared for. “We need to deal with an ageing population, long waiting lists for the better-aged care facilities, sub-standard care at many facilities, malnourished and over medicated patients in many facilities, poor patient/ staff ratios and poorly trained aged care staff. “Rather than the government set up more reviews and committees, how about they establish aged care safety inspectors – trained and independent experts – who go into aged care facilities unannounced and conduct patient care, staff expertise and facility standards audits. This would see the standard of care improve overnight and the poor operators weeded out of the system. “If the Australian government established standards inspectors this would be a great first step to restoring the public’s confidence in the sector. “After all, if we can have Worksafe inspectors why don’t we have similar inspectors for hospitals and aged care facilities?” Riley raises a very interesting point. There are often complaints about the standard of food (see breakout), quality of care, upkeep of facilities and the level of staff in facilities. More and more elderly people would rather stay at home and receive care but most can’t afford it. They receive the minimal services such as getting fortnightly help with cleaning and gardening but rely on surviving family and friends to help out with meals and other daily chores. Amana Living St George’s Home in WA knows about quality – they won a 2012 Better Practice Award for their ‘Windows to the world’ program bringing the world to residents through technology. Visit www.accreditation.org.au www.agedcareinsite.com.au February/March 2013 | 21
policy & reform The general manager of Wendy’s Home Services, Alannah Norman, says that maintaining enough good staff to support both residential and in-home care for older people will be a major challenge for this year. “For consumers, hopefully 2013 will see navigation of the aged care system become clearer and more user-friendly.” Wendy’s Home Services is a smallto-medium sized organisation based in north-west Sydney that has about 250 staff and operates throughout the west and north-west suburbs as well as the Blue Mountains. The company has been in business since 1995 and delivers between 3500 to 4000 hours of care a week. “The best way to cope with the rising demand for aged care is no secret,” Norman says. “Giving people the support they need to keep their independence at home is one of the ways rising demand for aged care will be managed into the next decade. “Funding this care to the level needed will be the challenge, and will be helped by maximising on-the-ground support and taking a good look at the savings that can be made in the administration and nonservice elements of aged care.” Staffing too remains a big issue and will continue to remain so unless the federal government tackles the situation in a 22 | February/March 2013 positive and pro-active manner. Roma Dicker, residential aged care project officer for CareSearch at Flinders University, says there is currently a documented shortfall of registered and enrolled nurses within the aged care sector. “This is expected to worsen with the expected retirement of many nurses currently working in the sector, the difficulty recruiting nurses into the sector and projected increase in demand for aged care between now and 2050. “Not only is the population ageing, with the oldest of the baby boomers now approaching retirement age, but our nurses are also ageing,” says Dicker. “In 2009 the Australian Institute of Health and Welfare workforce statistics show that the average age of registered and enrolled nurses working in residential aged care facilities (RACF), was 49 years, with 33 per cent aged more than 55 years. “This means a significant part of the RACF workforce will retire in the next 10 years, taking their skills and experience with them. “There are well-documented concerns about the skills and knowledge of the current workforce, particularly in the areas of palliative care, pain management and care of people living with dementia. The high workload of staff working in aged care, limits the opportunities for students to obtain clinical placements and graduate positions.” Rural and remote areas Of course, country resources are even more limited than the city says Sacha Etherington, owner of medical recruitment agency Health 24-7. “The shortage of medical services in regional and rural areas is one of the biggest issues facing the aged care sector. “It is hardly surprising people living in rural and regional areas have worse health outcomes than those in cities. With the ageing population, the problem is only going to become worse for Australians living in regional area,” says Etherington. “Medical staff will be under pressure to work harder and longer hours as the demands on services increase. However, we may see more doctors and nurses do locum shifts in regional areas, as they reach retirement age and opt for semiretirement. Hospitals and aged care facilities are also starting to recruit more nurses from overseas.” The multitude of issues facing the industry and our elderly will only increase with each passing day. There has never been a more important time to tackle all the issues one by one. n
policy & reform Put flavour back into meals We all love our food and nothing heightens the senses more than the smell of a deliciously cooked meal about to be served to us. Unfortunately, in some aged care facilities, this is not something that is experienced. Food is very important as the sense of smell and taste is associated with memories – mostly fond ones of family, good times and happiness. The standard and quality of food in aged care facilities has been a debate for some time. “Australian aged care providers should elevate the importance of food in the daily lives of those in their care,” says Mike Vanderkelen, director of Infotech Marketing and Communications. “I propose this based on my personal exposure to feedback I am receiving from my mother, a 93-year-old who 12 months ago relocated from the family home to a newly built and very comfortable aged care facility in metropolitan Melbourne. “As someone who enjoyed cooking at home all her adult life and who has had the good fortune to be exposed to a range of cuisines, her only concern is with the ‘taste’ of the meals that are presented to her. “Having experienced some of those meals when I visit her I can only endorse her sentiment that while they may be nutritious, they are lifeless and take the pleasure away from eating. Garlic, fresh tomatoes and salads for example seem to be ignored in a kitchen that harks back to overcooked lunches in a school refectory. www.agedcareinsite.com.au “Interesting, tasteful food is as important for one’s sense of well-being as it is for sustenance, whether someone is 9 or 90, especially as aged care residents have little choice most days about what, or where, they eat.” Aged care providers will argue that cooking for big numbers on limited budgets doesn’t help their cause in providing nutritious meals but as Jamie Oliver and others have shown, you don’t need a lot of money to cook simple flavoursome meals. “We face a challenge to convince aged care providers and the chefs or contract catering companies they employ that even if the food they serve meets good nutritional standards, there’s nothing wrong with flavour and visual appeal,” Vanderkelen says. “They don’t seem to understand that an interesting, flavoursome meal, perhaps accompanied by a glass of wine, can be the highlight of a resident’s day. In that sense they are out of step with a society which, through initiatives such a Stephanie Alexander’s school gardens program teaches young children the importance of fresh food, and an aging population for whom the growth in culinary diversity has been an enormous influence in recent years, thanks to travel and a multi-cultural environment. “Other than in rare circumstances, I cannot see the justification for the use of tinned vegetables in Australia where we enjoy a diverse, year-round produce, let alone overcooked and tasteless food. Good food can stimulate both the memory and the taste buds, giving the elderly interest and pleasures.” February/March 2013 | 23
policy & reform Residents’ payment structure Providers need to understand the proposed changes to accommodation fees, especially with interest rates being low. By Tapan Parekh 24 | February/March 2013 L changes ast April, the federal government announced its 10-year, $3.7 billion Living Longer, Living Better (LLLB) aged care plan. A key outcome was the establishment of the Aged Care Financing Authority (ACFA), which was tasked with advising the government on a methodology to determine accommodation payments for residential aged care facilities. The review was always going to be a significant task, and towards the end of last year, the government put forward a series of proposals, following recommendations received from ACFA. The proposals include: • A three-tiered accommodation payment methodology set by reference to a Daily Accommodation Payment (DAP) and a maximum permissible interest rate (MPIR). • No retention amounts on lump sum payments (Refundable Accommodation Deposits, or RADs). • Residents having the option of using a mix of DAP and RAD. • From April 1, 2014, prices for both DAPs and RADs will need to be published by providers and will also be included on a central My AgedCare website to allow consumers to compare prices. • DAP and RAD prices will be agreed between the resident and the provider – and can be lower, but not higher, than those published. • A 28-day “choice of payment” period where the resident can change their mind. Pleasingly, ACFA and the government appear to have arrived at a reasonable methodology that is much simpler than that provisionally floated, but in what will be a fundamental change, aged care providers will be required to offer a resident the option of making their accommodation payment via either a RAD or a periodic DAP. Providers are now faced with a number of transition and application challenges. First and foremost, they will need to evolve to a dynamic model for evaluating the use of DAPs and RADs. This change will also require the development of much more flexible financing arrangements that will allow providers to draw on funds if an incoming resident opts for a DAP instead of a RAD. The move to RADs de-links the connection of accommodation bonds to residential property prices and links them to monetary policy (given RADs are
policy & reform determined by reference to the MPIR). This could have a significant impact on the RAD liability and therefore on a provider’s balance sheet. Over recent years, the MPIR rate has been decreasing as evidenced through the chart. A lower MPIR results in a higher RAD and a higher MPIR results in a lower RAD. Comparing the average historical MPIR of about 9 per cent to the current rate means the value of a RAD will be reduced. In the current low interest rate environment, the methodology proposed appears to create a disincentive for the use of RADs. This is because, by accepting a RAD from a resident, the provider will be forced to generate a return equivalent to the MPIR from the use of the funds while constrained by prudential requirements relating to RADs. We estimate that these and other requirements will mean that a provider will only be able to invest the funds from the RADs in investments that, at a maximum will generate a return of 6 per cent. This disincentive on the use of RADs also seems evident when it comes to insurance costs relating to RADs. ACFA has proposed that the level of RAD charged not take account of the cost of RAD insurance. This effectiv
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