www.insitemagazine.co.nzMedia Kit 2013

www.apn-ed.co.nzHEALTH PUBLICATION

MEDIA KIT 2013 MEDIA KIT 2013

Belle HanrahanSales & Marketing

Manager

+64 4 915 9783

+64 4 471 1080

belle@apn-ed.co.nz

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February/March

Retirement villages as a business

www.insitemagazine.co.nz | April/May 2012 9

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After 60 years of marriage, five children, 13 grandchildren, and the most productive vegetable garden in the

district, Bruce and Fay decided they needed a change. Their four-bedroom house was too large, their neighbours had moved on years before, the children were scattered across the country, and the once-prim garden was starting to look like a tropical rainforest.

The couple made the decision to move into a retirement village. They loved their villa with all-day sun; they loved the storage space and the spare room for their grandchildren. They loved the dishwasher. Bruce played lawn bowls daily. Fay particularly enjoyed watching the young gardener trim her roses.

Life felt easy – and it carried on that way until one morning Fay looked at Bruce and it was obvious something was very wrong. Bruce had had a stroke. Then after three weeks in hospital, Fay realised she wasn’t up to giving him the help he needed at home, and government home support wasn’t going to cut it. Bruce was going to have to go into care.

After 60 years of waking up next to each other, eating their toast together and moving through their days together, the couple were separated. They had lost their whole way of life. They were devastated.

Bruce and Fay’s story isn’t new. Unfortunately, it’s one of the realities of growing old. Fortunately, it’s also the type of scenario that retirement villages have become increasingly good at dealing with.

There has been a shift from what might be called a lifestyle retirement village model – a place with lovely grounds, an indoor pool, and a communal bar for mobile, independent older people – to a care-focused community offering a range of services and support that can be tailored to suit the individual should they require them. Residents can receive as much or as little care as they need.

In the case of Bruce and Fay, with the help of their retirement village, they were able to trade in their two-bedroom villa for what is called a care apartment. These are large single-bedroom apartments with all the mod-cons. They often have an outdoor space, so people like Fay can grow their tomatoes. There is enough room for a decent number of belongings so the place feels like home. Most importantly, Bruce can access the care he needs without feeling like he is in an institution, and without losing the day-to-day contact with the woman with whom he has spent his life.

Bruce and Fay could be anywhere in New Zealand. They are an example of the

kind of scenario we are faced with every day. They are the types of people that have caused operators to think outside the square and do more for people’s wellbeing than simply providing the right medicines.

Of course, this isn’t always the best solution, and it’s not the only solution. Some people prefer to move to rest homes and hospitals where they know they are being closely monitored and supported. The kind of solution provided to Bruce and Fay is just one example of how we can care for our older people in an era where all providers need to be flexible.

Retirement villages based on care are the way the majority of the retirement industry in New Zealand is moving. Operators are challenging themselves, and the general feeling is that what they can offer should be limitless. Retirement villages in the future may even have the capability to provide hospital-level care to people in their own homes within the village.

Securing funding for such care is another story. It is difficult to do because DHBs have been resistant to funding care in individual retirement village units. From their perspective, it is hard to monitor and audit care that is so disparate. They also want

FACility vs CAre: What is driving the retirement village industry?NOrAH BArlOW considers the changing nature of retirement villages.

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In this issue we consider the commercial aspects of the management and operation of retirement villages. With input from leaders within the sector and the RVA, and experts on everything from diff erent

business models to banking, share portfolios and syndicates, we deliver current and considered news items, feature articles and opinion pieces on the business of running a retirement village.

April/May

Long-term care needs

6 June/July 2012 | www.insitemagazine.co.nz

Only the best for the baby boomersJUDE BARBACK looks at what is happening in design and innovation of New Zealand retirement villages.

Many believe 1948 was the perfect year to be born. With their teenage years untrammelled by the threat of war and defined by an era of free love and Beatlemania, 1948 babies came to expect

life to be somewhat rosier than those born a decade earlier. Leading the baby boomer generation, they bought their homes at a time when housing was cheap but set to sky-rocket, leaving them with plenty of money and an expectation for the good things in life.

This year, 1948 babies turn 64. They are the next purchasers of retirement villas and their expectations are unlikely to wane now. With money in their pockets and discerning tastes, it comes as no surprise that the retirement village industry is growing. Statistics New Zealand estimates the number of New Zealanders aged 75 and over will more than double from 250,000 to 516,000 over the next twenty years.

John Collyns, executive director of the Retirement Villages Association (RVA), says there are currently just over five per cent of people aged over 65 living in a retirement village. It is, as he puts it, a “boutique market”. However, RVA members are reportedly building units at a rate of five to six per cent each year, which given these recessionary times is a clear indication that retirement villages is a growth market.

UNDERstANDiNg thE MARKEtRetirement village operators are faced with a demand to build more villas, but in an effort to remain competitive, must also meet demands for quality. Consequently, the architects and design companies working with village operators need to be well informed of what older people need and want in their accommodation.

Lifetime Design Ltd, a not-for profit organisation established by CCS Disability Action and supported by the Government, is a design company that prides itself on knowing its market. General manager, Andrew Olsen, says it is important to understand the end-user.

“Baby Boomers are the ‘me’ generation,” says Olsen. “They have spent their lives improving their world, they have high demands of their

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NEw BUilD: MAstERtON MAstERpiECE

in 1986, the first retirement village of Masonic Villages trust was opened in Masterton. At the time of construction, space was allocated within the village for a residential care facility. however, the residents at the time, who were mainly in their mid- to late-sixties and in good health, declared they didn’t want such a facility on-site, such was their keenness to sustain a perception of long-term independence.

Fast-forward 25 years and perceptions have changed. the sixty-somethings are now in their eighties and nineties, and the prospect of an aged care facility next door has much more appeal, as they begin to recognise their declining independence. Couples, particularly, were quick to see the merits of having a continuum of care in place for them. the trust set about acquiring an existing aged care provider in Masterton in order to meet the emerging demands of residents, as well as to stake out a larger presence in aged care with the district health board.

As the acquired facility was over 100 years old, questions began to arise about whether it should be modernised or rebuilt on land purchased next to the retirement village. the residents and staff were overwhelmingly in favour of the latter, and consequently, construction began in 2008 for a new care facility next to the existing village. the new facility officially opened in June 2010.

Choosing to rebuild gave the trust the opportunity to provide a range of different accommodation options. in addition to care rooms (all with ensuite bathrooms), six care suites, including kitchenette, lounge, and ensuite, were included in the design as well.

warick Dunn, who has been chief executive

of the trust since 2004, says as an existing provider, they were able to draw on their own experience when it came to the planning and design phases of the build.

“we had a fairly good idea what intending residents wanted from a new care facility,” he says.

A number of meetings with staff and architects also proved to be useful in informing practical design elements. it was from these meetings that important details were incorporated, such as allowing adequate room in the toilets and shower rooms for greater accessibility. Consultation with staff helped with the design of staff facilities, including rest rooms and common areas, ensuring they were well appointed, with plenty of storage space.

A new-build approach also provided the opportunity to incorporate technological advances, such as ceiling-mounted hoists in some bathrooms.

Dunn says the project went very smoothly. he puts this largely down to the decision to contract a project manager to oversee the build. the trust also refrained from making any adjustments during construction, which also helped to keep the project on time and on budget.

Th is issue of INsite focuses on issues surrounding long-term care. Looking across the spectrum from hospitals to home health, we seek to address the widely-held concern of providing quality care in the

face of funding shortfalls. With opinions sought from all corners of the sector, including residents, caregivers, managers and policy makers, we strive to expose the real needs at the heart of long-term care.

June/July

Design innovation in aged care

www.insitemagazine.co.nz | April/May 2012 11

Mdts crossing boundaries in aged careJude BARBACk looks at

ongoing research into the effectiveness of a multi-

disciplinary team approach in aged residential and

home-based care.

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Meet doris*. doris is 96 and occupies one of the four palliative care beds at althorp private Hospital in tauranga.

now meet those who provide her care: a specialist doctor and a nurse supplied by waipuna Hospice, a social worker from tauranga Hospital, the althorp nursing staff, and the patient’s gp. together, they form a team responsible for the provision of care for doris.

Theirs is a multi-disciplinary team (Mdt), comprising a wide range of clinical specialities, and according to althorp general manager ginni Cashell, is hugely effective. Such a team could potentially include general practitioners (most likely geriatrics specialists), nurses, nurse practitioners, pharmacists, nutritionists, carers, and allied health professionals such as physiotherapists, occupational therapists, speech therapists, and audiologists. Social workers are also included when necessary.

Mdts have long been a part of secondary care for older people. dr elizabeth Spellacy, senior gerontologist from tauranga, says Mdts are integral to the whole speciality.

“You cannot provide specialist services for older people without working as a multi-disciplinary or inter-professional team,” she says.

However, in other settings, namely the aged residential care arena, community settings, and in home-based care, the concept and workings of Mdts is not as well integrated.

The Aged Residential Care Service Review, carried out by grant Thornton new Zealand ltd and published in September 2010, recommended Mdts as one of four proposed models of aged care. The review found that through the close integration of health services, this approach makes it possible to improve the resident’s experience, improve provider coordination, and reduce unnecessary services and costs. indeed, Mdts in aged residential care seem to get the ‘thumbs up’ from every angle.

The proposed model is founded on a raft of research, including an article in leading medical journal Gerontologist (46:227-237 (2006)), which says, “long-term-care patients have multiple needs, requiring a complex set of services provided by many individuals with different training. There is a general perception among many health care providers and health policy makers that interdisciplinary teams are better able to coordinate and provide such services, resulting in better health care and outcomes.”

Mdts In ARC: An eMeRGInG suCCess stORydr Michal Boyd, nurse practitioner for waitemata dHB, believes there is huge potential for Mdts to have a positive effect in aged residential care facilities. Building on the Residential aged Care integration programme (RaCip) evaluation research at waitemata dHB

INsite brings innovation and forward thinking to the fore in this issue devoted to design developments in the aged-care sector. We seek the opinions of architects, engineers and interior designers to bring informed

content to our wide readership. We discuss success stories from abroad and their applicability to New Zealand’s care homes, hospitals and retirement villages. Most importantly, we ask “what’s next?” for this aspect of aged care; we challenge popular conceptions and encourage innovative thinking.

August/September

Nutrition and diet in aged care

16 August/September 2012 | www.insitemagazine.co.nz

infection. Increased physical activity levels can also be a factor, particularly for those

with dementia, who may ‘pace’. “Their nutritional needs might

also be more complex due to co-morbidities such as diabetes, heart

failure, kidney disease, or cancer or because there are specific

barriers that prevent a person eating normal textured foods, such as stroke, lack of teeth,

Parkinson’s Disease, and so on,” says Philpott.

identiFyinG MAlnutRition

Research suggests that as the onset of nutritional problems is often gradual, it can be hard

to detect. Malnutrition can be identified in older people by a number

of signs, including muscle wasting (sarcopenia), loss of subcutaneous fat, skin

bruising, flaky dry skin, and oedema.Malnutrition can be serious for older people,

increasing their risk of infection, decreasing muscle function, and potentially leading to breathing and heart difficulties. Poor wound healing, memory loss, and fatigue are other known consequences.

Oceania Living has a nutrition and hydration policy in place to help monitor weight loss. It also details criteria for referral to a GP or dietitian based on low body weight. Oceania is also currently trialling weight monitoring assessment spreadsheets in order to assist with risk assessment and intervention plans.

One such device used by many organisations is the Malnutrition universal Screening Tool (MuST), used in residential and community settings, and increasingly, in acute settings. Although fairly complicated for the uninitiated, including tables that allow scoring of BMI and weight loss percentages, MuST is said to take less than five minutes to complete and includes clear treatment plans, depending on the level of risk identified.

Oceania dietitian Jessica Bowden says food and fluid monitoring is undertaken if there is food refusal. This is also documented by caregivers in the resident’s clinical notes.

wHAt cAn Be done ABout it?Philpott says there has been little research into the nutrition care in new Zealand aged care facilities until recently. She says one study yet to be published confirms what dietitians suspected – that the energy and nutrient content of ‘small’ serves in aged care are not

eArlier this year, Dietitians new Zealand expressed their concerns about the prevalence of malnutrition in

new Zealand’s aged care facilities.This isn’t the first time such claims have

been made. Concerns about malnutrition in older people have been voiced for many years. More recently, in 2010, several Members of Parliament and various news media pounced on a report commissioned by Whanganui District Health Board that identified malnutrition as a health challenge of aged care. At the time, the new Zealand Aged Care Association was quick to point out to those accusing aged care providers of poor quality care that malnutrition was a clinical challenge and not the result of a deficiency in care.

Yet concerns like those expressed by Dietitians new Zealand persist. Regardless of the cause, it remains undisputed that the risk

of malnutrition increases with age and therefore, is

an issue worthy of concern for new Zealand’s residential aged

care facilities. Why is malnutrition a problem

among older people? And what can be done about it in the aged care setting?

wHAt iS MAlnutRition?To pare the issue to its core, malnutrition is commonly defined as when an individual does not meet his or her nutritional needs. In older people, it tends to refer to under-nutrition, resulting from a decreased intake of protein, energy, vitamins, and minerals.

Older people tend to be more susceptible to malnutrition due to a number of factors brought on by the ageing process. Alterations to the senses, particularly taste, smell, and sight can also have an adverse affect on food intake. Dentures and reduced saliva flow resulting in a dry mouth is another common factor.

nutrition expert, Gaye Philpott, says compared to healthy older adults, those living in aged care are nutritionally more vulnerable because they may have small or poor appetites. They may have increased nutritional needs caused by wounds or ulcers, or illness, such as

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MAlnutRition: Are residents at risk?

insite consults expert opinions to understand why malnutrition is of such concern in aged care facilities and what can be done about it.

In this issue of INsite we place the microscope on an area of key concern to aged care – nutrition and diet. With relevance to all areas of the sector, we share advice from qualifi ed experts, best practice

examples, product information and research trends. We aim to provide a comprehensive overview of this hot topic, with an emphasis on encouraging discussion and debate from the readership.

October/November

Infection control and wound care

20 August/September 2012 | www.insitemagazine.co.nz

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“cultural diversity of both staff and clients also

contributes to communication problems in the workplace”

A recent Close Up report hailed aged care workers for doing ‘God’s work’ for very little fi nancial reward, but can God’s work really be done by people struggling to read clients’ charts or give out medications? Jude BARBAck reports.

Statistics can be alarming. Th ose resulting from the 2006 Adult Literacy and Life Skills survey are certainly unsettling. Th e

survey showed that 1.1 million new Zealanders (that is 43 per cent of adults aged 16 to 65) have literacy skills below those needed to participate fully in a knowledge society. Over 80 per cent of those people are in the workforce.

We’re not just talking about reading and writing here. Workplace literacy and numeracy is about a whole range of skills, from accomplishing a task, to communicating, to working within a team, to adapting to new technology and approaches. In general terms, literacy skill issues reveal themselves in lower productivity and higher error rates and can be a barrier to learning new things.

tHe AGed cARe woRkFoRceWhen these statistics are extrapolated into a workforce that is typically low paid, older, unqualifi ed, and marginalised through part-time hours and shift work, it is no surprise that literacy concerns are high among those working in the aged care sector.

A Careerforce survey supported by the new Zealand Home Health Association confi rmed that the major skills shortages for community support workers lie in the areas of literacy and numeracy.

Australia is facing similar problems with its aged care workforce.

“Th e shortage of staff means recruitment is often unskilled labour with no previous training or qualifi cation or people returning to work after long absences from the workforce. Cultural diversity of both staff and clients also contributes to communication problems in the workplace,” says Rod Cooke, chief executive offi cer of Australia’s Community Services and Health Industry Skills Council (CSHISC).

Th e Australian experience shows that initiatives such as the Workplace English Language and Literacy (WELL) programme, administered by the Department of Innovation, Science, Research, and Tertiary Education can be eff ective.

“Employers are well aware of the need for workplace literacy, especially around documentation, communication, information technology, and workplace health and safety. Literacy might require a signifi cant investment of time and money, but there are direct benefi ts,” says Sue-Ellen Evans, a WELL broker for CSHISC.

While those of non-English speaking

backgrounds were reportedly appreciative of the training, they weren’t the only ones to benefi t. Th is was the experience of uniting Church Homes in Western Australia.

“Reading a material safety data sheet, writing up an incident report, understanding a risk assessment matrix – there is scope for improving literacy levels in aged care,” says training manager Margaret Antonucci.

tAcklinG woRkplAce liteRAcyTh ere is certainly scope for improving literacy levels here in new Zealand, too, and it is pleasing to note many similar programmes have been established to help target this problem, not just in aged care, but across many sectors.

While the primary and secondary education sectors have initiatives in place to tackle literacy and numeracy from an early stage, improving literacy in the new Zealand workforce falls mainly on the shoulders of the industry training organisations (ITOs).

In 2007, the Industry Training Federation (ITF) partnered with Business nZ, the new Zealand Council of Trade unions, and Workbase (the national centre for workplace literacy and numeracy) to produce a blueprint for addressing workplace literacy issues: Key Steps Forward for Workplace Literacy.

A number of initiatives arose from the blueprint, including the ITO Literacy and numeracy Good Practice Project, which was funded by the Tertiary Education Commission (TEC) and helped establish resources to support ITOs embed literacy and numeracy into industry training.

cAReeRFoRce’S AppRoAcHCareerforce has been one of the standout ITOs in addressing literacy concerns, which is reassuring given the high level of literacy skill gaps in the health and disability sector workforce.

In 2007, Careerforce established the Integrated Workplace Learning Project, a TEC pilot to integrate literacy and numeracy learning and industry qualifi cations within on-site workplace training. Th e aim of the project is to enable workplaces to develop the infrastructure necessary to ensure that literacy learning takes place as a natural part of on-site training.

Th e scope of the project encompasses ‘literacy, language, numeracy, and learning’ (LLnL) to better refl ect the needs of the sector. Th e focus is to

the long road to literacyhelp build workplaces’ capabilities to deliver the national Certifi cate in Community Support Services (Foundation Skills) Level 2 as well as (Core Competencies) Level 3.

Careerforce’s eff orts appear to be paying off . Many organisations have now established training teams that look closely at their resources, training, and assessments to ensure they are supporting the development of the trainees’ LLnL needs.

Careerforce is continuing its literacy crusade – although reduced funding from the TEC Embedded Literacy and numeracy funding pot is a blow to their mission. Th is year, $100, paid on a monthly basis, is available for each trainee who completes both a pre- and post-literacy assessment. Trainers and assessors must attend a one-day professional development workshop that looks at adult education principles and techniques and how to administer the national Literacy and numeracy Tool.

SkillS HiGHwAyAnother useful tool aimed at addressing literacy and numeracy concerns is the Skills Highway programme. Managed by the Labour Group, Ministry of Business, Innovation and Employment, the programme was initiated in 2009 to champion the benefi ts of workplace

educAtion & tRAininG INsite homes in on the in-depth topics of infection control and wound care in this issue. Medical research and expert opinions are given alongside practical case studies and advice. We look closely at new research

emerging in this fi eld to bring readers up-to-date information on providing the best possible care in all areas of the aged-care sector.

December/January 2014

Trends in home health

18 August/September 2012 | www.insitemagazine.co.nz

TOM IS 88. A widower, he lives by himself in his own home and generally copes very well, but struggles with the cooking side of things. As a solution, his family arranged for a ‘Meals on Wheels’ service, which bring him his main meal at midday during the week, allowing the weekends as an opportunity for Tom to either go out for his meal with family or friends or gain confidence in cooking for himself. His son, a farmer with access to ample home-kill meat, regularly supplies Tom with frozen mince and sausages, which he cooks for himself in the evenings and weekends. upon enquiring once how Tom was finding the meat, his son was dismayed to hear Tom’s response: “The first four days are good. By the fifth day, I feel a bit queasy.” It transpired that Tom was letting the mince defrost slowly on the kitchen bench, and rather than wasting food, would still eat the fifth portion even when it disagreed with him.

Tom’s situation is not uncommon. Food is often a tricky part of living alone in old age, particularly if you are suddenly faced with catering for yourself after years of having a spouse do it for you. Misjudging the use-by date of food is just one aspect. Of more concern is that older people living independently may not be meeting their nutritional requirements. How is this relatively understated problem to be addressed?

tHe ReSeARcH SHowSIt may be understated, but the evidence is there to show that this is a very real problem for older new Zealanders living independently at home.

Researchers Carol Wham and Jennifer Bowden investigated the perspectives of single-living new Zealand men aged 75 to 89 years towards healthy eating. The study, published in 2011 in nutrition and Dietetics, found that half the participants were at high nutritional risk, with eating alone emerging as the most common nutritional risk factor, despite reliable support networks. Limited finances, a lack of personal transport, poor nutritional knowledge, and cooking skills were also found to be barriers to healthy eating and meal enjoyment. Wham and Bowden suggest that community programmes need to identify those at nutritional risk and provide them with knowledge and skills as well as promote meal sharing.

In another study led by Wham, involving over 50 independently living people in their eighties, it was found that a third of

participants were at high risk of malnutrition. The research, which was published last year in Journal of nutrition Health and Aging, showed that the major underlying factors associated with being at nutritional risk were low self-rated health, disability and social factors such as, loneliness, losing a spouse, or being born outside new Zealand.

Wham concludes that strategies are needed to identify early on the risk factors leading to poor nutrition. Again, there is the suggestion of engaging older people at nutritional risk to share meal preparation and dining experiences.

It sounds good in theory, but how is such a strategy to be implemented among the quiet masses of elderly people in their homes, cooking for themselves? How are people like Tom, who may be making poor choices with regard to food preparation, to be assisted by community programmes?

AddReSSinG tHe pRoBleMSue Pollard, chief executive of new Zealand nutrition Foundation (nZnF), agrees this is a difficult area to address. She says there appear to be gaps of knowledge about nutrition among many older people and those who are responsible for their care.

“We need to reassess what education needs to be delivered – to the older people in the community, their carers, and their families,” she says.

Pollard puts the gaps down to a general lack of accessible resources. The nZnF has undertaken a number of initiatives over the years to generate awareness, including distributing book marks and brochures with key information and holding seminars in various parts of the country.

One such resource is a brochure, Good Food, Safe Food for Older People, that includes information on how to keep food safe by outlining the four Cs: Clean, Cook, Cover, Chill. The brochure, which also includes ideas and meal suggestions for older people to help with gaining and maintaining weight, was produced by nZnF in partnership with MAF Food Safety and Auckland District Health Board.

However, Pollard says it is difficult to know what sort of impact these strategies are having or even whether the messages are getting through to people.

Geography appears to be a problem here. It seems that where an organisation or individual driving an initiative is based is often where the programme will begin before it is rolled out to other areas in an ad hoc manner. This is unlucky for the older people who happen to live independently outside the areas where resources are made accessible. Had Tom received the Good Food, Safe Food brochure, would he have then realised he should defrost his meat in the refrigerator and consequently have avoided illness?

Obviously, the ‘what if?’ game could be played all day; there are no blanket solutions here. Even national campaigns cannot ensure the entire population is educated. However, they may go some way to help address the task at hand.

Take Senior Chef, for example; a free, eight-week cooking course designed specifically for people aged 65 and over, who live alone or with one other person and who want to improve their cooking skills, confidence, or motivation around cooking. Senior Chef is a Canterbury District Health Board initiative. It was developed and is co-ordinated by the DHB’s Healthy Eating, Healthy Ageing project, which is run by two registered dietitians and a nutritionist who are based at the Princess Margaret Hospital in Christchurch. The project receives funding from the Ministry of Health.

While its roots are in Canterbury, Senior Chef is slowly being rolled out across the country. The courses are also run in Hawke’s Bay, Blenheim, Timaru, Dunedin, and the West Coast, and according to demand, will expand to other areas.

The courses are delivered in small groups with one session each week involving nutritional education and a hands-on cooking class followed by a shared meal with the food cooked that day. Participants get to keep the Cooking for Older People recipe book, which

nutrition and diet can often be an area overlooked by older people living independently at home. Jude BARBAck looks at what resources are available to keep people healthy in their homes for longer.

nutrition at home

“older people living independently may not be meeting their nutritional

requirements.”

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work from ground level up in an eff ort to expose a wide range of concerns aff ecting home health providers, including training, turnover, funding, quality and consistent care provision. Th is issue is designed to engage with the sector, seeking opinion, feedback and ongoing discussion.

Booking Deadlines 2013

IssueBooking and material deadline* Published

February/March Retirement villages as a businessVol 6 issue 3

28 January February

April/May Long-term care needsVol 6 issue 4

21 March April

June/July Design innovation in aged careVol 6 issue 5

23 May June

August/September Nutrition and diet in aged careVol 6 issue 6

18 July August

October/November Infection control and wound careVol 7 issue 1

19 September October

December/January 2014Trends in home healthVol 7 issue 2

26 November December

2013

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AGED-cArE & rEtirEmEntAGED-cAGED-c

We’ve got your industry covered i www.insitemagazine.co.nz

design innovation

in aged care

June – July 2012 | vol. 6 issue 5

Human rigHts commission report causes a stir

dementia care: more tHan

treading Water

27 i conferences

rva and nZaca conference previeWs

2 i neWs

17 i education & training

6 i focus on:

25 i intervieW

resident speaks out: WHen disability Hinders cHoice

Overview INsite is a bi-monthly magazine at the heart and soul of New Zealand’s aged-care, retirement and community care sector. INsite is more than just a news bulletin; it gets to the core of relevant issues, seeks opinion and encourages debate. Relaunched in 2012 with six titles focused on key industry themes, a new format and

more pages, INsite’s role as the voice and ear of the sector has been enhanced. Th rough its close ties with industry associations and attendance at conferences, INsite provides extensive coverage of the issues that are important to the sector. INsite reaches the decision makers. It is targeted at owners and managers of New Zealand aged-care facilities, chief executives, fi nancial offi cers, directors of nursing, government departments and decision makers directly involved in the aged-care and retirement sectors.

CirculationWith a circulation of more than 3000, INsite is targeted at the sector’s decision makers: » owners and managers of aged-care

facilities; » directors of nursing; » fi nancial offi cers; » government departments.

INsite is received by every: » retirement village; » rest home; » aged-care hospital; » sector organisation; and » government agency in

New Zealand.

It is also placed in the hands of the major industry associations: » the New Zealand Aged Care

Association; » the Retirement Villages

Association; and » the New Zealand Home

Health Association.

Role in the marketplace

INsite is actively involved in the aged-care, retirement and community care sectors. Th e title’s in-depth reporting on key issues and regular attendance at conferences ensures it delivers the most up-to-date, informative and relevant information to its readers. INsite provides the sector with relevant news, fast and up-front, both in print and online.

Jude BarbackEditorINsite

+64 7 575 8493

+64 21 0275 9357

+64 4 471 1080

editor@insitemagazine.co.nz

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2 August/September 2012 | www.insitemagazine.co.nz

☛ Got An opinion? Have your say online at www.insitemagazine.co.nz

newsnewS in BRieF

» AGed cARe woRkeRS tAke StRike Action employees of Aranui Home and Hospital recently took industrial action in pursuit of fair pay following months of failed negotiations. the strike follows the release of the recent Human Rights commission report, which exposed the low levels of pay for aged care workers.

» wAikAto ReHAB SeRvice waikato dHB has implemented a personalised rehabilitation service to help older people recover in their homes following a stay in hospital or admission to an emergency department.

» MetliFecARe deAl GoeS tHRouGH At lASt After much tweaking of the initial proposal, shareholders voted through the $216 million deal to expand the Metlifecare operation by merging with vision Senior living and private life care Holdings.

» FouR-yeAR ceRtiFicAtion Bupa’s parkhaven care Home recently joined the relatively small number of care homes in new Zealand with four-year certification status following a recent audit.

» oldeR people StRuGGle to AFFoRd HeAltH inSuRAnce national health insurer, Accuro Health insurance, is challenging the Government to provide tax rebates for older people who can’t afford their own health insurance.

» pin And pASSwoRd SecuRity the case of a recently imprisoned caregiver and her husband, who had stolen a large sum of money from a 99-year-old rest home resident, highlights the need for older people to take care with sensitive information such as pin numbers and passwords.

» ReSeARcH FRoM ARound tHe GloBe

» AuStRAliA: new report shows healthcare system will struggle to keep up with the growing ageing population.

» uSA: comprehensive new review on international dementia research has been published.

» uk: Groundbreaking new study published on the causes of osteoarthritis.

JuSt undeR 70 members of the new Zealand nurses organisation (nZno) and the Service and Food workers union nga Ringa tota (SFwu) employed at Aranui Home and Hospital recently took industrial action.

the strike follows the recently released Human Rights commission’s report exposing low levels of pay for residential aged care workers.

negotiations between union members and employers for fair pay have been happening since october last year. the majority of Aranui rest home care staff are paid the minimum wage of $13.50, and over the past 11 years, have only had increases when the law has been changed to increase the minimum wage.

nZno industrial Advisor, Rob Haultain, says Aranui is a good example of the ‘slavery’ depicted in the HRc report.

“these workers are shown little respect for the complex work they do or the fact that they are the core of the employer’s business.”

waikato District Health Board has introduced a personalised

rehabilitation service to help older patients who have been in hospital recover faster. The Supported Transfer and Accelerated Rehabilitation team (START) aims to support their recovery in their own homes.

START is similar to the Canterbury DHB programme following the earthquake.

The teams are made up of community and hospital specialist older person’s nurses. When a person over 65 presents at a Waikato emergency department, the team supports that patient so he or she doesn’t need to be admitted into hospital. They also provide post-operative care at home so older patients can return home sooner.

Patients are set individual rehabilitation goals and the team works intensively with the patients and their

peRSonAliSed ReHAB

SeRvice FoR oldeR wAikAto pAtientS

families in their own homes to achieve these goals – sometimes up to four times a day, seven days a week.

START currently operates in Hamilton, Thames/Hauraki, and South Waikato. Suitable clients are assessed to have a potential for partial or complete recovery with home rehabilitation within six weeks. Their home has to be an appropriate and safe environment for the client and the team to work in.

Health Minister Tony Ryall believes it is a good example of partnerships between primary and hospital health care.

“Integrating health services between hospitals and health professionals in the community not only makes sense, most importantly, it is better for patients.”

The initiative is in line with the Government’s plans to invest an extra $40 million into home-based support services over the next four years.

Aged care workers strike

26 August/September 2012 | www.insitemagazine.co.nz

country lodge in Matamata

Resident chitchat...with les and Jean williams

insite: How long have you been residents at Country Lodge?Jean: We have owned a chalet here for nine years and then we moved into an assisted living apartment, where we’ve been for three and a half years.

insite: What prompted you to make the move into retirement/assisted care living?les: When they fi rst started building the chalets here at Country Lodge, we bought one off the plan – a two-bedroom home. We watched it getting built. We chose the site ourselves, opting for one with a sunny, north-facing position.Jean: We sold our own home, making the decision to move while we could enjoy the benefi ts of living in a new, warm house, and maintaining our independence. We have our own car and we are still very involved with our community.les: Years later, when the opportunity came up to move into a nice, north-facing apartment within the assisted living part of the Country Lodge complex, we jumped at the chance. As we were getting older, we thought it would be a good move to have more assistance on hand, if and when we need it.

insite: Was it a diffi cult decision to make? Jean: not at all. We both agreed that it was a good decision to make before we really had to.

☛ Got An opinion? Have your say online at www.insitemagazine.co.nz

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nearly a decade ago, les (93) and Jean (89) williams sold their family home and moved into a new two-bedroom chalet at country lodge in Matamata. they now reside in an assisted living apartment at country lodge, from where they speak to insite about their experiences of assisted care living.

les and Jean williams

insite: Did you consider many alternative options?Jean: not really. We were familiar with the chalets and we liked the idea that there were options down the line as we got older. We love the apartment we are in now, especially because it is sunny. We are happy here.

insite: What role did your immediate family play in this decision process? How do they feel about you living in Country Lodge? Do they live nearby and do you see them often?les: We have four children and two grandchildren. All but one of them lives overseas. One lives in Athenree. Th ey were all very supportive of the move into Country Lodge. I suppose it gives them peace of mind to know we have security here.

insite: What do you value most about living at Country Lodge?Jean: A while ago, Les had a fall and by pushing the help button on the wall, within minutes, we had help on hand. Th e network was in place. Within the half hour, Les had seen a doctor and was taken care of. It is a comforting thought that we will be taken care of when the need arises.les: And above all else, this place gives us security.

insite: What do you enjoy about the lifestyle here?Jean: It suits our lifestyle here. Th e midday meal is provided now we live in an apartment. We get the other meals ourselves, but we can use the services here if we want. We still drive our own car places, but if we wanted to, we could use the Country Lodge van to go shopping in town twice a week – once to the main centre, to banks etc., and once to the supermarket.les: I love the sunny, warm apartment. We still choose what we want to do each day. You can live life as you please – either participate or don’t. Th e choice is yours. Sometimes, we go on group outings in the van. We have many friends here. Also, you have all the privacy you want. People don’t invade your space.

insite: What are the downsides of living in a retirement complex?Jean: I suppose you can’t choose your neighbours and other residents. You live a little way from the shops, but then the van takes you there twice a week, so that’s OK.

insite: What advice would you give to anyone considering making the move into retirement living or a care facility?les: Do it in good time. Make enquiries early so you get to choose. Remember, you can still be part of your community when you live in a retirement set-up.

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In every issueIn addition to focusing on six major themes, INsite has a core of regular fixtures, including: ‘Spotlight on ...’A section dedicated to relevant issues including education and training, therapies, falls prevention, infection control, palliative care, dementia and more.

‘A day in the life ...’ An insight into the lives of everyone from caregivers to chief executives, residents to retirement village managers.

‘On the soapbox’ Opinions sought from experts on relevant news items.

‘Last word’ Giving sector leaders the chance to air their views on the current status and direction of aged care in New Zealand.

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PFE

dentist dR Jon MAHoney discusses why it is important for older people to look after their teeth.

FROM MY EXPERIEnCE, dental care among the elderly tends to get put on the backburner as more serious health issues begin to take precedence. In light of this, dental care should not be overlooked, as this could be a source of general health problems. Gum disease can directly cause cardiovascular disease (which may lead to heart attacks and strokes) and diabetes.

As the average life expectancy of the population increases and the quality of dental treatment improves, people are managing to retain their own teeth for longer. Consequently, we have to take extra measures to maintain a high level of oral awareness to prevent the most common types of dental problems, such as tooth decay and gum disease, from rearing their nasty heads.

Spotlight on... dental care for the elderly

BRuSH youR teetH FoR two MinuteS twice A dAy. there are no excuses for not brushing your teeth twice a day. i hear the excuses daily: “i haven’t got time” or “i use mouthwash instead”, and sometimes when patients tell me they do brush twice a day, i often question which end of the toothbrush they are using! the key to good brushing is to:

» take out any prosthesis you may be wearing

» concentrate on just brushing; do not multi-task.

» use a pea-sized amount of fl uoridated toothpaste, such as colgate total®, on a medium/soft-bristled brush. this can be an electric or a manual toothbrush

» brush every single surface of every single tooth, including the area where the tooth meets your gum.

» those who have missing teeth need to take more care to brush the teeth adjacent to any gaps.

Follow the above points correctly for at least two minutes twice a day, and your mouth will be a much healthier place.

FloSS youR teetH At leASt once A dAy. purchase a Reach® Access® Flosser from your local supermarket for increased ease of use. if you have a dental bridge, use oral-B® Super Floss® to keep it clean.

look inSide youR own MoutH. to see if you are cleaning properly, assess your mouth in a mirror before and after brushing. plaque (bacteria) is visible to the naked eye (furry looking) when it is not removed. pull your upper/lower lip away from your teeth and inspect the area where your teeth meet your gums. if after a week of improved cleaning your gums still look red and they readily bleed when brushed or you can’t get rid of the plaque with your toothbrush, visit your dentist/hygienist.

keep youR dentuRe cleAn. By keeping your denture clean, you are less likely to suff er from bad breath and fungal infections. My advice for cleaning your denture is:

» rinse the denture thoroughly after every meal and remove debris with a soft brush, soap, and warm water (ideally, over a basin full of water, in case you drop it)

» in the evening, clean your denture thoroughly with a soft toothbrush and denture cleaning paste/solution such as Steradent®.

» do not soak your denture in a hypochlorite-based cleanser

» remove your denture overnight and leave in cold water.

viSit youR dentiSt eveRy 6–12 MontHS. Most dental problems are preventative, and getting into the habit of regularly visiting the dentist instead of visiting them when there is a problem will more likely result in less pain, less cost, and fewer visits in the future.

Jon’S winninG tipS FoR BetteR oRAl HeAltH

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”Brush every single surface of every single tooth, including the area where the tooth meets your gum.”

24

20 February/march 2012 | www.insitemagazine.co.nz

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like many governments around the world, the National government is

committed to supporting our elderly to stay in their homes for as long as they can.

And if an older person moves into residential care, then we want them to be safe and happy that it is the right choice for them.

When we took office in 2008, there had been mounting public concern around issues of poor care in some rest homes.

one of our first actions was to begin improving the auditing and monitoring of resthome services.

We have introduced spot auditing of rest homes, and require audit results to be published in plain English on the Ministry of Health’s website. Family members and older people can now see and compare audit results of resthomes online.

We also introduced new rules that require auditing agencies to be approved by an international agency, and that is to improve their accountability at the same time as looking at ways to reduce duplication in auditing.

These tougher conditions will improve the auditing itself and improve transparency and confidence in the way resthomes are audited.

regular, personalised assessments for people living in aged residential-care facilities are being progressively introduced throughout the country.

People living in these facilities will have their health comprehensively assessed at least every six months.

We are supportive of the aged residential-care sector, and we recognise that there have been shortages of appropriately qualified staff. We have just added aged residential-care nurses to our voluntary bonding scheme, and 25 per cent of nursing graduates who registered interest in the scheme in 2011 are either currently working in, or intending to work in, aged care.

In 2009, we put an extra $72 million over four years into improving and supporting rest home nursing supervision and we have provided extra specialised training for 300 aged care nurses.

We know with the ageing population and the trends we’re already seeing that demand for dementia services will continue to increase. In Budget 2011 we put an extra $44 million over four years into dementia care, which is expected to deliver almost 200 extra dementia beds in the next two years.

And moreover, dHBs have been required to pass through aged residential care’s share of increases to dHB funding.

As we look to the future, we need to recognise that we are doing our planning on the back of the worst economic downturn since the 1930s, and we need to be responsible with taxpayer funds to ensure there is some certainty for future services.

The Aged residential Care Service review has been a vital tool in planning for the future. This major project was, and its follow up continues to be, a collaboration by the aged residential care sector, dHBs and the Ministry of Health to help plan for the future.

By 2026, almost a million New Zealanders will be over 65 years of age and the number of New Zealanders over the age of 85 will increase from nearly 50,000 to more than 125,000.

Planning is essential because populations are shifting. The Ministry of Health estimates that a third of dHB populations will shrink, a third will stay the same, and a third will expand significantly.

People’s expectations are also changing. People want greater choice and an assurance of quality and safety. They want a more personalised service that meets their individual needs.

Clearly these trends will have a huge impact on the demand for aged care services. our ability to meet these demands will depend on two things: how prosperous we are as a country, and how well we use our resources.

The immediate focus is on new models of care that can achieve better services within existing resources, and aged-care workforce training.

It is important that the government continues to work with the sector, the ministry and dHBs to make sure we can meet projected needs in future.

last word... tony ryall, minister of health

i have worked as an activities coordinator for rest-home-level care at Frances Hodgkins retirement Village in dunedin for 17 years. over this time, I

have gained great experience in putting together an interesting and diverse programme, catering for the needs of residents on an individual and at a group level.

ongoing training is offered with activities seminars held annually for ryman Healthcare staff and monthly meetings and in-service training at our village.

A day in my life at work consists firstly of organising and ensuring I have everything in place to carry out an effective programme. Communication with others on duty including the nurse manager, activities and care staff and the chef are all important so that the day runs well and maximises resident participation.

I start the programme each day with a half-hour newspaper-reading session, thus giving residents local and world news as well as informing them on what is organised for the day.

Mornings include a ‘triple A functional fitness’ exercise session, encouraging fitness and strength at a safe level. They are 30 minutes long and are held twice a week. other physical activities include bowls, boccia, petanque and walks outside. Floral appreciation, gardening, baking and craft are

scheduled during the month as well as quiz sessions and team quizzes.

Spiritual needs are met by organising weekly church services covering five different denominations; ministers also visit individual residents by appointment.

The Public Library offers a fabulous service, choosing books to satisfy the individual needs of residents. I issue these books weekly and also oversee a book group, which is run by two wonderful ladies who come to the village every month to share books and interesting topics on travel, art, gardens and movies with the residents.

Van outings are very popular and at least two are on offer each week. We go to many destinations and all residents are given the opportunity to go out. Scenic outings to various locations are organised as well as meal outings to hotels, fish and chip lunches, shopping trips, visits to gardens and private homes, and picnic teas to watch cruise ships leaving the harbour. Short outings in the car are also available.

Entertainment takes place once or twice every week and the bookings are generally made at the beginning of the year. There is wonderful variety including piano, classical, country and western, easy listening, sing-a-long, school choirs, dance groups, preschools, multicultural groups and drama. The entertainment brings added diversity to the

programme and is very uplifting, making people happy and creating a lovely atmosphere around the rest home.

We have several larger functions during the year with village barbeques, a family fun day, birthday celebrations, mid-winter solstice, Christmas parties and larger entertainment events.

to add to the organisation and implementation of the activities programme, there is also time spent on documentation, recording, creating care plans and ongoing evaluations.

I aim to encourage a good level of independence for residents within a safe environment, always looking to their individual needs and wishes.

It is busy, with never a dull moment, but it is a very satisfying job that I love.

a typical day in the life of... liz blackliZ black, an activities co-ordinator at Frances hodgkins retirement village in dunedin, shares a typical day at work.

22 June/July 2012 | www.insitemagazine.co.nz

On the soap-box... John CollynsEach issue, INsite seeks opinion on a contentious issue concerning aged care and retirement.

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I am pleased that some DHBs are conducting trials to see if the benefits of retirement village operators providing home-based support services are a reality. Experimentation with service delivery and assessment of the impact is to be encouraged. Where results are positive, I want other DHBs to learn from that. Mr Collyns has ably set out the potential benefits. DHBs need to weigh those against potential disadvantages, such as extra costs of contracting with many more service providers.

HOME-BasED suPPOrt sErvICEs IN rEtIrEMENt vIllagEs

Todd Jenkins’ article in the February-March 2012 issue of INsite kicked off an interesting debate – the undoubted benefits to residents if their retirement village operator contracts to their District Health Board (DHB) to provide home-based support services (HBSS) directly. As far as Metlifecare Greenwood Park is concerned, the case is well and truly proven – there are demonstrable benefits to residents, the DHB, and the operator when the operator holds a contract directly with the DHB. Sadly, apart from a few villages in the Bay of Plenty and one or two in Lakes DHB and the Taranaki DHB, the other DHBs seem in some sort of denial on this topic.

The RVA has researched member villages in the Hawke’s Bay and Waikato DHB areas to find out who receives HBSS and what the benefits would be for a change of policy. We estimate that around 18 to 20 per cent of residents receive HBSS from a variety of external agencies (six or seven organisations in the Waikato, for example). The majority of visits are made on Mondays, Wednesdays, and Thursdays between 8.30 am and midday. A small number of calls are made in the afternoons and a handful at weekends. Around half those calls are for an hour, with another 20 per cent around two hours.

Yet, we all know that assistance is needed at any time of the day or night – not just conveniently on Monday mornings – and is usually for relatively small blocks of time.

BENEfIts tO tHE DHBJust what are the benefits to the DHB if an operator were to provide the HBSS to their residents directly under contract? An obvious one is slowing the move to a rest home and the related cost of subsidy – operators note that they will be able to provide a detailed and consistent level of HBSS as they are on hand 24 hours a day. One village quotes four examples of residents who could have been cared for in their apartments but are now in a rest home – three on a subsidy and one privately.

Each resident used to have outside agency-contracted hours, but when they were assessed for a higher needs level, the village was told by the NASC the residents could have more hours added, but the problem was the night care and the times between the carers’ visits.

Had the village been allowed to provide the contracted care, they could have managed on a package of, say, four hours a day when their staff are on-site and could have responded to night care, toileting, and so on, as part of the package. This would have been a lot cheaper for the DHB and better for the resident.

Another obvious benefit is reduced travel times and related costs. Agency contracts will have an allowance for travel times; their profits are maximised when they are able to manage

rEsPONsE frOM HON JO gOODHEW, assOCIatE MINIstEr Of HEaltH aND MINIstEr Of sENIOr CItIzENs

the travel times efficiently. If retirement village carers look after the residents receiving care, staff time would be used efficiently and the cost of travel minimised.

BENEfIts tO tHE rEsIDENtThere are a great many benefits for the resident if their village operator were to provide HBSS under contract to the DHB.

Not the least of these is the question of choice – why can’t residents choose to have their village as a provider? They have chosen to live with the village, a decision based on the village’s reputation and the ongoing care they may require, but when they need HBSS care, as one manager put it, “oops, no we can’t provide that service, sorry – you need a stranger to come in!”

Residents prefer to be looked after by someone they know, and the village staff members are available and well known to residents.

Villages tell us that on “many” occasions, carers have not arrived to provide their personal care or prepare them for bed, etc. Villages have incident forms notifying them of agency carers who have mostly not turned up at all; a few say the carer stayed ten minutes instead of the allocated 30 minutes.

As retirement village-based carers will have short distances to travel between residents, their punctuality will also be improved.

Not all agency staff members record their visits, what they did, and so on, and as many of the residents have memory loss, they are unable even to advise the village if their carer has been, let alone what they did. A village-maintained central record of individual residents’ care needs would improve the quality and consistency of care.

Villages believe that their provision of HBSS will be superior to the status quo, as they have supervising staff on duty to monitor their residents and staff at all times. Currently, there is limited supervision of the care provided by the agency carers – the agencies react to concerns and complaints, like the ambulance at the bottom of the cliff. The village manager, who is on-site, is ultimately responsible for the quality of the residents’ care and can quickly deal with issues should they arise.

The village has relationships with their residents’ GPs when they liaise with the village, and as a result, there is no privacy issue. Villages obviously already have a relationship with the residents’ families.

Residents discharged from hospital with a home support package would not ‘fall through the gaps’ during the time it can take for the referral to get to the HBSS provider and for that provider to make the initial care-planning visit.

If the HBSS is managed by the village, there are staff on-site who can receive the resident back into the village (even at 5pm on Friday) and arrange for the services to be implemented the same day, as there would already be home support staff on-site providing to other village residents.

BENEfIts tO OPEratOrsThe principal benefit for operators is being able to provide a complete package of care to their residents, while the residents continue to benefit from the HBSS provided as of right by the DHB.

Operators also note that the issue of security exists as well, with unidentified agency staff coming into the village. In apartment buildings, there are large common areas that are an extension of the residents’ homes. Operators (and residents) are uncomfortable with strangers wandering through these areas.

Villages know the capabilities of their staff and residents and can far better match the sometimes very complex needs of the resident to their staff’s skills. We are told that some agency staff are ex-employees whom villages would not re-employ because they do not have the honesty, reliability, or work ethic to be on their staff. Yet these people are looking after the village’s residents via an agency and the village cannot supervise or performance manage them, thereby putting the village’s reputation at risk.

WHErE tO NOW? The pressure on health funding, even at the modest level of HBSS delivery in retirement villages, suggests that a change in policy for many DHBs is long overdue. Direction from the Ministry and Minister of Health would be valuable, and we are slightly encouraged that some DHBs are conducting trials to see if the benefits we’ve identified are justified in reality.

It’s time DHBs stopped avoiding the issue and allow contracts to provide HBSS to qualified retirement village operators so they can extend their continuum of care into the village itself.

John Collyns is executive director of Retirement Villages Association

32 August/September 2012 | www.insitemagazine.co.nz

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the Human Rights Commission’s (HRC) report, Caring counts, Tautiaki tika revealed discrimination and breaches of

aged care workers’ fundamental human rights.The HRC used its inquiry powers to examine

equal employment opportunities (EEO) in the aged care sector and gathered evidence from 886 participants over 12 months in 2011 to 2012. The EEO Commissioner, Judy McGregor, who was responsible for the report, worked unpaid six-hour shifts for several days in an aged care facility in January this year.

The report says the reliance of all new Zealanders “on the emotional umbilical cord between women working as carers and the older people they care for at $13-$14 an hour is a form of modern day slavery”.

There has been much comment about Judy McGregor’s use of the word slavery, with some pooh-poohing the phrase and calling it an exaggeration.

Perhaps not surprisingly, nZnO agrees with Judy McGregor entirely. Caregivers perform punishing work for extremely low pay – that’s slavery. Even the Oxford Dictionary concurs: a slave is a ‘person who works very hard without proper remuneration or appreciation’.

The 48,000 caregivers who care for our elders’ every need are among the very lowest paid in new Zealand. They are (almost all) women, who after working as carers for 20 years and more are still getting the minimum wage, women who are described by the multinationals who employ them as “unskilled”. These caregivers are women who invest a huge amount of mental and emotional energy into

loving our mums and dads and then go home at 3pm or at 11pm or at 7am and do the same for their own families – and they do it for around $450 in the hand a week.

In her foreword, McGregor says, “A much repeated comment up and down the country when the Commission undertook its field work was that the value we place on older people in new Zealand society is linked to the value we place on those who care for them.”

That’s a sentiment we at nZnO share. I can’t help thinking that in all our years working with and advocating for caregivers in the aged care sector, it is the fundamental reason why we have not yet been successful in securing decent pay and conditions for these most valuable workers.

It is only in relatively recent years that we have, as a nation, given up our collective responsibility as extended families to share our homes and labour with our ageing parents and grandparents. Of course, there are many reasons for this, economic and social, but the fact remains that we have abrogated our collective responsibility for our elders.

Could this be the reason why we allow workers in the aged care sector to be treated as modern day slaves? Are we so ashamed of ourselves that our elders and those who care for them have become invisible and unworthy of our respect?

The work these women do for our elders is based on trust, mutual respect, dignity, obligation, and reciprocity. nZnO suggests that these are the very attributes required to

make the changes needed to properly value our elders and to properly value the women who care for them.

It is time for us as a nation to learn again to respect our elders, to respect and value those who care for them, and to come to terms with the reality that looking after our frail and dependent parents, grandparents, aunties, and uncles is not a job we are equipped to do. We have an obligation to make sure they are cared for with dignity by skilled carers who are valued properly.

The Human Rights Commission has spelled out the solutions for us. The ten recommendations acknowledge that to care for our mums and dads, we must care for their carers – and the only way for us to achieve that is by working together. That means government, rest home providers, DHBs, unions, rest home residents, and workers coming together in trust and with a sense of obligation to eliminate the modern day slavery that has been ignored for so long.

What does that change look like? Well, we know it needs to start at the top. Government will show real leadership and fully fund the changes that need to be made. DHBs and residential aged care providers will be obliged to use that money for pay equity, training, and staff retention. unions, residents, and workers will be valued, empowered, and energised. A cultural shift will have occurred.

Our elders and the workers who care for them deserve respect. When the HRC report recommendations have been implemented, we will know that they have it.

the Government is carefully considering the Human Rights commission’s report on their inquiry into equal employment opportunities in aged care. Many of the recommendations in the report are consistent with the current initiatives and directions already set by the Government.

For example, care staff in government-subsidised aged residential care facilities are already required to undergo foundation skills training in aged care within six months of their

appointment. the same will apply to workers in home-based support services when the new mandatory Home and community Support Sector Standard is rolled out over the next two years. the new standard will also result in a more consistent application of safety standards for home and community-based care, as well as more reliable, readily available consumer information on providers, similar to that which already exists for aged residential care facilities.

the Government has also introduced spot audits of aged residential care facilities, third-party accreditation of aged residential care auditors, and a new comprehensive clinical assessment tool that will provide robust information to help assess quality of care. Summaries of audit results are now available

online with an easy-to-interpret traffic light system and work is under way on a similar system for home-based care providers.

we also acknowledge the importance of ensuring sustainable home-based support services in areas where significant travel is required to care for older new Zealanders. the Ministry of Health will be working with district health boards to ensure that arrangements are in place with providers to address this.

this year, we will invest more than $1.4 billion in aged care and we have increased spending by an average of almost four per cent per year since 2008, despite difficult economic circumstances. the challenge for the Government is how best to balance the many competing demands for additional funding in the aged care sector as the population ages.

ReSponSe FRoM Hon Jo GoodHew, ASSociAte MiniSteR oF HeAltH

last word... nano tunnicliffpresident of the new Zealand nurses organisation (nZno), nAno tunnicliFF, says the nZno welcomes the recent release of the Human Rights commission’s (HRc) report.

“ModeRn dAy SlAveRy” in tHe AGed cARe SectoR

20 February/March 2012 | www.insitenewspaper.co.nz

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Q&A with... Rosemary Westley

INsite: What was your reaction when you learned you had taken the 2011 Village Manager of the Year title?Rose: I was shocked that I had won, especially being from a small village up against other multimillion-dollar villages. I was really thrilled that all the hard work and changes that had been put into the village had been recognised.

INsite: What do you believe is your key to success with regards to managing Rosewood Park?Rose: My key to managing Rosewood Park successfully is being honest, and keeping up good communication, which includes listening to what our residents and the village owners want and need. Being innovative, using initiative, and always thinking of ways to improve. Keeping within budget is a must as well, especially in these economic times.

INsite: I understand you brought about many changes at Rosewood Park. What changes did you make, both practical and cultural?Rose: I have raised the awareness of Rosewood Park throughout the community by marketing the MiLife brand. With our empty villas I create a warm and inviting atmosphere that gives people a true sense of being at home in our village. My floristry knowledge and experience have given me skills in landscaping and colour and a flair for design, which I have used in the gardens at Rosewood Park. I have made our residents feel like they “belong” here and that MiLife Rosewood Park is “their” home. It is a community within a community. It doesn’t matter what nationality or religion you are or have, you are welcome. I have created a lovely atmosphere here that visitors and residents alike frequently comment and compliment me on.

INsite: What inspired these changes?Rose: I saw opportunities to create a better atmosphere for the residents, and to enhance and improve the management of the village. From past experience in various business fields, I have learned that the environment that you live in is very important to your wellbeing. If where you live looks pleasing to the eye, and is clean and tidy with happy people that care and listen, then you have created that “quality of life” that is desired. It goes a long way to a happy and healthy existence.

INsite: I read you were once a florist. What led you from flowers to village management?Rose: I had always enjoyed working with people and creating stunning arrangements for people to enjoy, whatever the occasion. Listening to

then see, once they are settled in, how happy and stress-free they are, it is worth every little bit of hard work.

INsite: What are the biggest challenges and frustrations of managing a village?Rose: It is always hard seeing when a resident is at the stage when they need to move into 24-hour care. This is tough for everyone in the village as we are all part of a large family. Possibly one of the hardest things is when my client is desperate to come into the village, but they haven’t sold their own home. Sometimes their house has been on the market for a year. INsite: What advice would you give to a new village manager just starting out?Rose: Listen to what the owners and residents want and need for the village. Then research, get advice, and work within the budget. If you are ever unsure, check with your head office/CEO.

INsite: What do you see as the biggest challenges the retirement and aged care sector are currently facing? How do you think these should be addressed?Rose: The biggest challenge is the downturn in the market; many find it a struggle to sell their home at a price that enables them to come into a village with some savings as well. I believe more pressure needs to be put on real estate agents as they hold much influence over the house prices, and how the market goes.

INsite: What are your leadership philosophies?Rose:

Treat others as you want to be treated »Have passion and love what you do »Always look for ways to help people »Have determination »Learn business skills and have a good »understanding of businessHave compassion, time, patience and »tolerance and learn to listenBelieve in yourself. »

INsite: Who or what inspires you?Rose: The desire to make people happy and give them a good quality of life inspires me. In the back of my mind I always ask myself “would I like that?”

INsite: Outside of work, how do you most like to spend your spare time?Rose: I enjoy spending time with my family and friends. I also love doing home improvements, gardening, reading, watching movies, and travelling. And making the most out of every day is a big thing for me.

INsite catches up with Rosemary Westley, manager of Rosewood Park Retirement Village and winner of the 2011 Village Manager of the Year title.

“Ask yourself: why not become a provider and give your residents better care and earn a little revenue at the same time?”

what people want was always paramount. Often the client would express the reason why they are giving flowers, which would in turn allow me to understand and create something suitable for the occasion. Becoming the manager of this retirement village has allowed me to put to use many of the skill I developed as not only a florist, but a small business owner.

INsite: What aspects of village management do you enjoy the most and find the most rewarding?Rose: I love seeing joy on the faces of my residents which comes from creating a new garden, or putting on a nice afternoon tea. Making a person feel appreciated, wanted perhaps and even listened to, when the world is such a busy place, is very important to me. I love selling villas, meeting new potential residents and showing them everything we have to offer them at Rosewood Park. My clients more often than not will tell me their story, and why they feel the need to look at coming into a village. When I can fulfil their dreams and wishes, and

www.insitemagazine.co.nz | February/march 2012 19

up close and personal with... rosemary Westley

let’s snoop around... ocean Shores retirement villageJudE barback gets a chance to snoop around a retirement village in the bay of plenty.

it is morning-tea time at ocean Shores and a cluster of staff are enjoying a cuppa in the sunny, spacious office area. They are a pleasant bunch

headed by Sandy Quigley, who has managed the village for the past five years. As Sandy gives me a tour of the village, I note their friendliness extends to all the staff and residents I encounter.

Sandy herself is very approachable and has an easy manner. She has had a varied career, including working in the military and insurance broking. She is clearly a “people person”; as she points out, every position she has held has involved people.

ocean Shores retirement village, sold several times in the time Sandy has been manager, is now owned by Lend Lease, an Australian-owned company who own and operate five New Zealand villages and 65 Australian villages. Sandy says Lend Lease’s introduction of many policies and procedures, while tedious at times and responsible for far more paperwork, has provided a good point of reference, a source of ‘back-up’. There is a particularly strong focus on health and safety, with regular staff meetings on this topic and staff involvement in workplace inspections. Sandy points proudly to the Safety Passport certificate on her office wall – testament to a course she completed online.

Health and safety is an interesting aspect for retirement villages. Sandy says that while adherence to New Zealand laws is important, it goes further than that in retirement villages due to the needs and frailty of some of the residents. It is a fine line because, with many people living independently in villas and apartments, you don’t wish to trespass too much on their personal space and freedom; at the same time, the onus is on the retirement village to ensure their residents’ safety.

despite being under the umbrella of such a vast organisation, Sandy says she can still bring about change in her village. She shows me the new computer suite and the barbecue area near the bowling green, which are products of Sandy following through on residents’ suggestions.

Sandy says she confers regularly with residents, listening to what they want from their village. Most of this happens on a formal basis, through meetings with the residents’ committee, which consists of eight residents (of some 280) who are elected each year.

But Sandy also receives input from residents on an informal basis too, which I saw first-hand. on our tour we encountered dorothy, who asked Sandy about getting some red cushions for the newly renovated lounge. “I love the chairs, but it all lacks colour,” she says, before interrogating Sandy on how much budget might be available for cushions. The residents’ pride in the village – their home, after all – is endearing. Sandy says it is common for residents to have their say on the facilities and the appearance of the village. Apparently they can be particularly opinionated on the grounds and garden – something I have heard other managers say too.

In many ways it is the residents who run the

village. I was fortunate enough to happen upon the entertainment committee having their meeting. They were in the midst of planning all manner of fun activities for the months ahead, including a garden party, a residents’ morning tea, and free trips courtesy of travel firms.

It is clear that there is plenty to keep them entertained. Carol, a member of the committee and resident of two and a half years, loves living at ocean Shores. “The people are fantastic,” she enthused. “And the security is wonderful. you can sleep soundly at night in the knowledge you are safe. We have plenty of fun. And the facilities aren’t too bad either,” she jokes, with a twinkle in her eye directed at Sandy.

Carol is right though: the facilities are far from bad. ocean Shores is comparable to a resort with its bar, restaurant, newly renovated lounge, hair salon, pool and spa area, gymnasium and so on.

Although clearly intent on providing a great lifestyle for residents, the care aspect is there too. I met Jane, a registered nurse and the emergency response supervisor, who manages a team of five registered nurses. one nurse is always on call to respond to emergencies. Although these tend to be of a medical nature – cardiac problems, falls, skin

tears – Jane and her team need to be prepared for everything, from birds getting trapped in a villa to evacuation in the event of a tsunami.

on a more day-to-day basis, the emergency response staff serve an important function in addressing the health concerns of residents as well as providing an ear to listen to them.

“Sometimes they just want a chat,” says Jane. “And sometimes we need to help manage their pills or keep family informed of health issues or treatments.” Nurse Vivianne was running the drop-in clinic during my tour, where three people were waiting to be seen. Among them was another dorothy, who described the clinic as “very convenient”. In fact dorothy was a keen advocate for ocean Shores in general. “I’ve been here longer than I’ve been anywhere,” she said. “I would recommend it to anyone. The [staff] are helpful, kind and co-operative. And I feel safe here.”

It was the second time in ten minutes the safety and security aspect of village living emerged and it reinforced for me how vulnerable people must feel as they get older. According to rVA surveys, safety and security are top priorities for residents.

The combination of feeling safe, comfortable, cared-for and sociable is obviously working for residents at ocean Shores. Sandy points out a series of photographs taken of residents with Santa Claus and among them is Linda Hopkins, who has just turned 104. I am staggered to learn that Linda lives in a villa and still cooks her own meals and I can’t help but think that village life makes a strong case for longevity.

of course many residents are far from hitting the century mark and I meet a younger bunch in the restaurant: a gaggle of women and one long-suffering man reading a Countdown catalogue. They are enjoying morning tea and a chinwag. “We’re the information table,” announces June, “Not the gossip table!” and they all giggle. Clearly it is a regular social event enjoyed by close friends. When quizzed further, June admits there is more to ocean Shores than her mid-morning cuppa. “This place has a real sense of warmth, space and friendliness that you don’t always find at other villages,” she says with a degree of smugness.

It is, after all, about keeping things “comfortable and fun for the residents”. Sandy is mindful of keeping things affordable for them too. This is made particularly difficult with things beyond the village’s control, such as council rates, which Sandy describes as “crippling”. The council does not cover expenses for residents that they do for people outside of retirement villages, such as a burst water pipe, for example. I felt indignant about this issue, but although the rVA has apparently looked into it, Sandy seemed resigned that it was unlikely things would change.

If there are other niggles in the operation of ocean Shores, they weren’t visible during my visit and I left feeling impressed with the immaculate grounds, the demeanour of the staff and the verve of the residents.

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