Breaking new ground in models of care

From collaborations with the acute and retirement living sectors to the development of new workforce models, aged care providers are pioneering future models of delivering care and services. Australian Ageing Agenda presents snapshots of three initiatives to watch.

A game changer

ACH Group’s ViTA links acute, transition, rehabilitation, respite, community and residential aged care, reports Megan Stoyles.

It has taken eight years of careful research, planning, negotiations and development but leading South Australian aged care provider ACH Group recently opened a $46 million, 120-place treatment, teaching and research facility at the Repatriation General Hospital in Daw Park, South Australia.

ViTA is a game changing sub-acute service linking acute, transition, rehabilitation, respite, community and residential aged care. It will deliver re-enablement services, both empowering people to return to their own homes after short-term stays or to live more independently in long-term care.

It also aims to reduce the likelihood of readmission to hospital and premature admission to residential care.

ACH Group CEO Mike Rungie believes ViTA will change the way aged care is delivered and how staff are attracted to and trained in the sector.

“There will be swathe of ViTAs in next five to 10 years as the model will be there to be picked up. There will be a national ViTA movement to share practices and learning,” Rungie predicts.

ViTA has taken existing state and Commonwealth health, veterans and aged care funding streams and developed a facility co-located with Flinders University offering 20 rehabilitation, 40 transitional care and 60 long and short-term residential care rooms.

The architect’s brief – don’t make it look like a nursing home – has succeeded in producing a vibrant and exciting centre.

Flinders will operate the Clinical Teaching and Education Centre, which will facilitate professional practice for medical, nursing and health students in the care of older people, and opportunities for inter-professional training. The search is on for an internationally respected professor to head up the centre.

Old partnerships, new ways

Former state and commonwealth bureaucrat and consultant Jeff Fiebig and two other ACH Group staff Trudy Sutton and Leah Watkins have driven the ViTA project since its inception.

“Most organisations wouldn’t think in long-term timeframes like the eight years ViTA took; certainly Commonwealth funding requirements and state budgets don’t talk in those timeframes. But when we explained to our board and to governments, there was no resistance but encouragement,” Rungie says.

“Having defined the vision it took a long time to pull it off, but some new funding streams and programs opened up for us. However, we had to win them, and win the trust of departments, and that doesn’t happen overnight.

“Ministers at state and federal level changed during the planning period as did top departmental people, but in every instance the concept was endorsed and handed over with their support, to the incoming personnel.”

Kate Barrett from the University of Adelaide has started a two year evaluation, measuring health improvements, consumer satisfaction and use of hospital and aged care. Training of a new workforce has begun with doctors, nurses, dieticians, social workers, occupational therapists all working in teams to drive a new form of aged care, Rungie hopes.

Pinch everyone’s ideas

There is no one model, overseas or local, for ViTA. “We took various elements mainly from hospital models. What’s unique is bringing things together in one place, with some scale and flexibility over and between funding lines.”

R&D costs have been high, and Rungie and his team have had to satisfy the board and ACH Group’s partners that it has been worthwhile.

“Do we get these costs back?” he muses. “It’s hard to know, especially if comparing it to development costs of other aged care organisations. They might spend time and money acquiring other places. They may have grown their balance sheet. We’ve grown our innovation and ability to grow, attract staff and partners.”

The future – lining up the ducks

The second ViTA that ACH Group is planning won’t take eight years to get up and running but there are numerous things to pull off before it comes into operation, Rungie says.

“For example it could take three ACAR rounds to get the places we need. Funding for different programs can take different times to line up, and talks with council on land could take a while. You have to hang in, know it will take a while and never give up.”

Rungie, who has been at ACH Group for 25 years, acknowledges that big projects like ViTA “need long term leadership for projects with long-term timelines.”

ViTA meets government objectives of keeping people healthy and productive longer, paying for more care themselves and taking greater control over their lives, he says.

“I hope that the bean counters can get their heads around the fact that ViTA can save astronomically more by reducing demand for health and aged care, compared to the private equity savings of just doing things cheaper with economies of scale.”

Click here for more information on ViTA 

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Confronting a hidden stigma

Aged Care Plus Carpenter Court Centre has developed a new approach to caring for older people with mental health problems, writes Natasha Egan.

Max* lives in residential aged care a couple of hours north of Sydney in Newcastle. He comes from a socially disadvantaged background, has few personal possessions and finds it hard to relate to people. He also has a mental illness.

Even though mental health problems are high among older people and particularly those in residential aged care – in 2012, 52 per cent of all permanent aged care residents had symptoms of depression, according to an AIHW report – it often goes undiagnosed or under-treated. Challenging behaviour arising from a resident’s mental health can also make remaining in residential care difficult.

Max, however, is fortunate in that he lives at Aged Care Plus Carpenter Court Centre in Newcastle, which specialises in caring for older people who have mental health problems. The facility has been working with Max for some time as part of a new person-centred, multi-stakeholder support program addressing challenging behaviours in people with a mental illness.

As a result, Max has been becoming increasingly communicative with his Carpenter Court family, says Peter Bewert, executive manager of care services at Aged Care Plus.

Bewert points to an example from Christmas: “He brought down every single one of his belongings and put them down on the floor in the dining room. He said, ‘I don’t have any money to buy you anything but everything I do have, please let me share it with you.’

“We have story after story like that where we just see better relationships and better integration and that is what we stand for because it is about people,” Bewert says.

A new approach

The approach, which won a 2014 Better Practice Innovation award, has been evolving since initial implementation in 2011. It was developed by the centre’s manager, who is an experienced mental health clinician. It has resulted in reduced hospital admissions, increased quality of life, improved communication abilities and greater community integration for residents, says Bewert.

The model is based on the development of individualised behaviour support plans with residents, their family members, doctors, local area health specialists. It focuses on person-centred care and creating a partnership between all stakeholders, Bewert says.

“This program is very much focused on connecting to people at an emotional level and understanding the emotions of why they are exhibiting that behaviour.”

Residents can be left mentally tormented and frustrated after dealing with the root cause of their behaviour and connecting with them on an emotional level requires a highly-individualised person-centred approach, he says.

“When we can truly understand the emotions behind it then we are able to really make some breakthrough about getting some better quality of life outcomes for our individual residents and that is what we have been able to achieve.”

From a communication perspective, Bewert says it has enabled people like Max to have better relationships both at the facility and in the community.

“By managing these behaviours we reduce the stigma that goes with mental illness that is unfortunately still prevalent. We are finding that we can make better connections with the local community and have our residents as an active part of that local community.”

Seeing results

Residents are reporting a strong sense of belonging to the centre and wellbeing has increased by 10 per cent, according to the annual resident survey.

Carpenter Court has also become a provider of choice in the Hunter region for people previously labelled as unplaceable. There has been a 21 per cent increase in admissions of people with mental health problems over three years and a significant decrease in the number of residents leaving due to behaviours associated with mental health problems over the same period.

Staff are also benefiting. Bewert says they are lucky to have an experienced mental health clinician on board and says all other staff have received specific education to meet their needs and are involved in the process of developing behaviour support plans. It has resulted in them having greater confidence in their ability to meet client needs, he says.

Aged Care Plus, which is a division of The Salvation Army, has 17 residential aged care centres in NSW, ACT and QLD.  It is looking to roll out the successful model to its two other facilities that specialise in caring for people living with mental illness. It is also looking at adapting the model for implementation in all other centres.

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Nurse in the village

RDNS has partnered with Aveo to provide a range of nursing and care services into its retirement villages across Australia.

Indicative of a growing trend of delivering community care services into retirement living, Aveo, a leading operator of retirement living, has entered into a partnership with RDNS, one of Australia’s major providers of community nursing.

Through its brands RDNS HomeCare and Rally HomeCare, RDNS has been appointed by Aveo to provide in-home support and healthcare programs to residents in 22 of its villages in South Australia, Tasmania and the Gold Coast.

RDNS staff are providing a range of services to Aveo residents including home nursing care, domestic assistance, personal care, respite care, social support and complex service management, says Dan Woods, executive general manager of brand and business development at RDNS.

The RDNS’ Education and Learning Centre is also providing periodic information sessions to Aveo residents on a range of health and ageing subjects, and having a regular presence within the villages to meet with residents and discuss their needs.

Road to partnership

“RDNS and Aveo are on a similar path, albeit working from different foundations of expertise. While our core services are different, we share the common goal of wanting to see seniors live as independent a life as they can and to enjoy as much wellness and quality of life as possible,” says Woods.

“Aveo has been very clear about its intention to take a market leading position to incorporate support services, such as those offered by RDNS, into its retirement villages. Likewise, RDNS has been in a period of growth, having established RDNS HomeCare in 2012 in every state of Australia, which saw us commence providing services to an extra 5,000 clients immediately.

“It was this combination of factors and a recognition of the potential to assist each other to meet our respective goals and improve outcomes for seniors that led to early discussions for a partnership.”

Outlining what was involved in developing the relationship, Woods says the emphasis was on delivering value and benefits.

“Ultimately, Aveo and RDNS are motivated by providing benefits to residents. This meant that we started with seeking to understand what Aveo residents need and how services provided by RDNS could add genuine value to residents’ lives. Bear in mind that Aveo residents are generally well and value greatly their independent living status.

“So we spent a good amount of time working with Aveo managers, particularly operations and village managers, to understand not just what residents might need from a service or clinical point of view, but also the environment in which they lived and how RDNS’ services might best be delivered and integrated.”

Consultation, regular contact and feedback were important in the implementation process. RDNS spent a considerable amount of time getting to know the Aveo environment and this meant meeting with those at the coalface of village operations, as well as residents, says Woods.

“We gained insights through Aveo’s resident feedback and we made sure that we adhered to the village way of doing things when it came to launch and implementation.

“When we first launched into South Australia, and consequently into other states, we made it a particular point to meet with resident committees to garner feedback and insights, before launching to all residents via tailored presentation sessions.”

Encouraging responses

Woods says the feedback from both residents and staff has been very positive. “Aveo village managers and staff in general have been terrific in helping us to understand the particular environment of each village and are working closely with us to integrate RDNS services into the villages as part of Aveo’s Health and Wellness Program.”

Residents have been positive, with referrals assisting more seniors to maintain their independent life within the village.

“We are also encouraged by resident feedback highlighting that they feel good knowing that services are there as and when they require them. We are looking at ways that we might enhance aspects as the result of continuing to learn about residents and their needs.”

It’s still early days, says Woods, and already RDNS can see differences in each region in which it is operating as well as variations and unique attributes across villages within a region. RDNS is working with residents and Aveo managers to identify needs and provide solutions to those needs, he says.

“We have a number of other discussions already in train, aimed at strengthening the partnership further and providing more options for seniors in a way that is complementary to their village life and personal goals.”

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