|We asked a random group of clients for their responses in relation to using HCSL Aged Care Cloud based software.
What do you like best about the HCSL software and your current use of it? Below is their responses:
HCSL Aged Care Software incorporates quality and risk, bench-marking, internal audit management systems as well as clinical functions) and how to use them. These systems have all been audited numerous times for ARC provider Certification with maximum four year outcomes being achieved where the system is fully implemented. Tried and testing; pre-approved audit compliant.
Please click on the following links (the blue words below) to watch videos which describe the functions of the HCSL Aged Care cloud-based aged care software.
Gives you a general over-view of the key Dashboard and Resident clinical management functions available as at December 2019.
Guides you in how to upload or change a resident photo within their online profile
Guides you in how to add, view or search resident progress notes.
The HCSL system functions are able to be used in their entirety or some care providers use only the policies and procedures with the dashboard for quality and risk management; while others use the full system including the care planning and progress notes.
We have several care provider sites currently who have become paperless using the HCSL system in conjunction with Time-target, Medimap or 1chart and InterRai. The mix of paper based and IT based depends on your site, the IT skills of your staff and their access to computers. There are a range of service options available depending on what suits your current circumstances. To find out more about the service level options available click here
We continue to add features to evolve the system in response to changes in clients and industry needs. This evolution is intended to be an ongoing process and we look forward to your feedback and ideas. Each change is considered on the basis of how it can be used by clients to ease their workload, streamline and save time while giving useful information.
If you would like more information on the services which are available click here.
If you would like to receive our HCSL Aged Care newsletter which is published every 6-8 weeks, email us on email@example.com with your contact details. This is also the email address if you have any further questions on HCSL software and services.
The question of whether mandated minimum nursing hours would work has been asked previously. The workload of care and nursing staff is frequently discussed with staff reporting they are pressured for time to complete all the necessary duties assigned. The Nursing staff have different but over-lapping functions to care staff. When reviewing your staffing, it’s important to include a number of factors into any review when looking at the productivity and efficiency of your team.
We suggest you look at not only leadership and skill-mix, which are vital for safe services but also consider other factors. These can include the location of high acuity needs residents within your service. With an increase in the use of dual beds, the mix between rest home and higher acuity hospital level of care are now intermingled and not specifically allocated to one area of the building. This means the Registered Nurses providing clinical monitoring and oversight may have to spread their attention to a much more fragmented and broader geographical area in your service than was previously the case.
The location of resources and time spent looking for items of use and equipment could be minimised if more thought was put into the design of new facilities and the locating and management of replenishing stores for ready access by staff as and where they need them. Who does the running and fetching could also be considered in work roles so staff with high end clinical skills are spending the bulk of their time on performing functions specific to their role and skill. Not doing tasks that could be better delegated to others.
After the recent sudden closure of a care facility in Australia without apparent planning or communication with families, there has been outrage that such a thing could happen. The “Queensland Premier Annastacia Palaszczuk announced her Government would order fixed nurse-to-resident ratios in state-owned aged-care facilities.” The ABC news report (19th July 2019) goes on to say “at least 50 per cent of staff having contact with residents in 16 publicly run aged-care centres to be nurses.” I don’t know if by nurses they mean Registered Nurses only and not Enrolled nurses but I can’t help wonder if this alone will ensure safety.
One year on from Simon Wallace (NZACA CEO) reporting on staffing shortages, we haven’t seen any improvement it would seem! In New Zealand an increasing proportion of our Registered Nurses have come to New Zealand to practice with no prior working knowledge of aged care services. They frequently have limited aged care related experience to conduct the complex assessment and clinical management of high acuity residents in a residential care setting. This is not to diminish their value as we can’t provide the services needed otherwise.
What I’m trying to highlight in the current circumstances is, we’re frequently seeing nurses set up to fail or provide less than safe care as they simply don’t have the experience in this specialised field of nursing. I recall conversations in the early 1990’s predicting a massive nursing shortage. It appears that in the time-span between then and now, we haven’t addressed this issue.
We welcome comments and suggestions of how this could be addressed here in New Zealand before we end up in the depths of a staffing crisis which halts care.
On the 25th April each year we remember those who went before us to fight for the protection of others. While emphasis is often on those who died in service to their country, it’s also a time to remember those who returned from war changed and altered forever by the experiences they’ve had. Not just for the soldiers going and returning to war but their family.
The mother who describes holding her son as he heads off to the front line. Embracing him, breathing in his smell which a mother knows so well. Holding her head against his chest hearing the beat of his heart wondering if she’ll ever be able to hold him and hear his heart beat again. Feeling the harshness of the fabric of his uniform and wondering what other harshness he’ll encounter.
The soldier as a member of a family, not only left grieving mothers behind but were sometimes already parents themselves going off to war leaving wives and children behind. All family members impacted in their own way from their own perspective of events. How does a wife or child accept the decision of the men in their life going to war, to do ones duty leaving children wondering why they were being deserted in favour of the uncertainty of battle? Those children then growing older day by day until the time they themselves are in their 80’s and find themselves still welling up in tears at the memory of the day their father left to go to battle. Not understanding but seeing the change in the father who returns, different, distant and ill from the effects of sand breathed into his lungs while stationed in Egypt. The soldier returning, having nightmares of horrors seen which cannot be unseen or forgotten. Limbs and body intact but emotional scars and ongoing adverse health issues. Not all wounds are visible.
I visited the Gallipoli exhibit at the Museum of New Zealand ‘Te Papa’ (our place) in Wellington with my mother and sister. I was mesmerized and deeply affected by the raw emotion depicted in the models created for the exhibit by Weta Workshop. The image of this nurse, Staff Nurse Lottie Le Gallais who was on board the hospital ship Maheno which set out from Wellington. She’d hoped to catch up with her brother but the model shows the anguish of the moment she receives her returned letters to him saying “killed, return to sender”. I can’t imagine the strength needed to sustain such pain amidst the anguish of war but still carry on to serve those needing care.
I live in Christchurch and after the recent terrorist attack resulting in the death of 50 people, we’re seeing and feeling the result of war-like destruction of life. You see it in the faces of those closely affected. The internal pain of senseless loss.
A time to ponder on the Anzac values of courage, compassion, commitment and comradeship and see if they are reflected in our own organisations as relevant to care services. This Thursday, 25th April, Anzac day is a time to reflect and be grateful – lest we forget.
Since the emergence of residential care facilities in New Zealand, the models of care have continued to change, but are they changing fast enough? The clinical needs of residents have escalated and so the way services are provided must also reflect a change in practice to meet changing resident needs. A common theme being reported among older member of our communities is that of isolation and depression. Isolation, according to the Collins dictionary relates to separation, withdrawal, loneliness and segregation.
I was fortunate to visit Greece recently which is reputed to have a larger proportion of older adults than most other EU countries. Gerontology is derived from the Greek words geron, “old man” and -logia, “study of” so it made sense to discuss models of care with families and health care professionals including pharmacists. I discovered there are few residential care services in Greece and those that do exist are found mostly in Athens rather than the islands. Families provide the majority of care with ‘family’ being noted as the key foundation to Greek society. Grandparents are frequently living within the extended family with the younger generations and taking responsibility for caring for their grandchildren. The economy is poor and social networks are heavily relied on to provide support.
From my observations, conversations with others, and literature, the older adults of Greece are kept actively engaged in the community. They are frequently involved in running family businesses if they are not relied on for supporting the needs of their children or grandchildren. Family networks remain strong and when interviewing people about how older adults will be cared for, the automatic assumption is that family will provide that service. Dr Elizabeth Mestheneos told me that approximately 1% of their older population may well be in residential homes. There are Open Care Community centres in virtually every Local Authority which are called KAPI. There are also Help at Home services and Day care centres in some Local authorities.
The models of care and workforce capacity currently in place in New Zealand are unlikely to meet increasing demands so change is needed. The aged care sector could lead change as new models are developed, trialed and advanced. Multiple studies confirm these new models need to include holistic, consumer directed services. Not only meeting physical needs but also social connections and the opportunity to be involved in meaningful activities that contribute to others. This also includes some use of technology to support connections with others. While they are of assistance to some, there is no substitute for human connection, person to person, face to face. The experience of ageing, social network supports, funding models and the context in which care and support are provided certainly differ from country to country.
In New Zealand residential care settings we have activities / recreational programmes which support inclusion and engagement. Being involved in meaningful activities are also key factors in contributing to a sense of well-being. I observed older adults in Greece undertaking meaningful activities in the community like feeding the communal cats of Kos or looking after grandchildren, continuing to run a second hand open-air shop to add to the family income or playing games with friends games. Groups of older men often congregated outside cafes for conversation, coffee and playing cards or board games. A Menzshed story reflects on how one New Zealand community are attempting to address the gap ageing can create in the life of some men. While funding is different in NZ to Greece and the family network is more often scattered geographically in New Zealand, there remains more opportunity to include community. The care setting could also be enhanced more by reflecting the smaller numbers of people we are used to living with in the family home, rather than the larger numbers in some care facilities. A model that more closely reflects the life patterns our community members have been used to, with them directing how these continue into the latter years of life with the goal of ageing in a healthy way, optimising body, brain and social networks.
Mattresses aren’t just something to lie on but if not maintained and cared for appropriately, also have the potential for causing harm.
As I travel a lot for work, I have the opportunity to test many different mattresses, all with varying degrees of comfort. This reminds me how difficult it must be for those who may be suffering painful joints to get a good night’s sleep. Appropriate mattresses are not only required to reduce pain from positioning discomfort but also reducing risk to residents. This include ensuring the mattresses are of a suitable standard and fit for purpose.
I’ve seen a number of mattresses which had hardened and torn linings and were well past being able to provide much comfort or an appropriate degree of pressure support. Some had masking tape used in an attempt to cover splits in the mattress cover. Others had holes in and were badly stained from exposure to body substances. As the residents in care are becoming frailer, with increasing acuity, the need for ensuring appropriate pressure support is crucial to preventing pressure injuries, maintaining comfort and maximizing the opportunity for good sleep.
There is the potential for old and in poor condition mattresses to be a potential source for infection transmission. For those of you operating newer facilities, this may not yet be an issue. For older facilities, part of stock and resource control should include mattress stock checks to verify they are in fact still fit for use. When conducting checks, determine the mix of mattress types you have and speak with your supplier about a replacement programme should this be necessary. As mattresses differ, so do beds and it’s important to make sure the mattress you use is appropriate for the particular bed type and size.
When reviewing your mattress stocks and purchasing new mattresses you might like to think about the following factors:
- Only purchase from reputable suppliers. Review the manufacturer’s instructions for use to ensure they include verification of cleaning instructions and ask about preventative maintenance. This may include staffing training e.g. via the use of online training videos or instruction booklets.
- Make sure you record the date of purchase and do your best to track each mattress and pillow to maximize warranties and make plans for replacement. Add the item to the facility cleaning schedules for regular cleaning and drying of exterior surfaces which should be durable, water-repellent and quick drying. They should also be seamless, if possible. When there are seams or edges, much sure these are situated away from resident skin contact to prevent absorption of liquid into interior and increased friction.
- All seams must be tightly closed and sealed. Masking or packaging tape is not appropriate for sealing. When mattresses become worn and tear, you might like to have a supplier representative review to see what options are available for repair or replacement.
- When reviewing the condition of mattresses, inspect all mattress surfaces, covers, seams and zippers for proper function and damage including wear, tears, splits, cracks, punctures, permanent odours and stains. If visible contamination from body substances are present, determine appropriate steps (eg. replacement or repair).
- To support longevity of mattresses, remind staff not to place any furniture or sharp objects on mattresses. Protect the mattress with mattress protectors only if advised by the supplier this is appropriate. A number of pressure support functions in mattresses may be adversely impacted by the use of additional mattress coverings to do check.
- Cleaning and disinfection must be considered in relation to mattresses, covers, wedges, cushions and pillows which are all classified as non-critical medical devices. Clean and low-level disinfect according to the manufacturer’s instructions between different resident use and when visibly soiled. Some mattress covers are removable for laundering so remember to verify which ones can be cleaned separately.
- Remove damaged or stained items from service and report these in your maintenance book or to the Manager. Follow manufacturer’s instructions for use and disposal of damaged mattresses, covers, and pillows, and in accordance with infection prevention and control guidelines.
- Ensure when using alternating therapy type mattresses that there is a process in place for a shift by shift verification that the pressure is maintained at the current level for the individual resident utilizing that mattress. If you plan to use an air alternating topper pad on a mattress, ensure it’s suitable for the mattress as depending on heights and size, it may not be appropriate.
Harm prevention can also be supported with advances in technology such as Pressure Monitoring sensing devices to ensure appropriate pressure distribution. I’m not aware of anyone who can rent or lease out Pressure Mappers in NZ. However Cubro have one that they can bring onsite to facilities for training and education. Make contact with your supplier to see if they can assist if this could be useful for you.
Also remember that other devices used in beds should be checked as well to ensure they are still safe and appropriate for use eg; wedges, rolls, pillows, seat cushions, mattress covers (where these are appropriate for use), bed sensor monitoring pads. For reading on how to choose the best mattress option for your needs go here.
For more related information view here.
Article compiled by Gillian Robinson (RN, BN, Lead Auditor) for Healthcare Compliance Solutions Ltd.
Workplace culture is a term bandied around a lot but what does it actually mean and how can it be measured? When I ask staff at facilities during training sessions what they see their point of difference is, they frequently reply saying ‘we’re friendly’, or ‘we care’ or ‘we provide a homely environment’. While these are all nice to have, they would actually be expected as a basic standard. They are not specific and not anything different to the care facility down the road.
Mary Barra, Chairwoman and CEO of General Motors (GM) states that at GM, they prefer to talk about behaviours rather than culture as behaviours can be changed very quickly and are apparent straight away. She talks about the need for rapid change with the inclusion of technology and advancements in artificial intelligence being used more frequently. While those are starting to be present in some aged residential care settings, what is true of both GM and aged care is rapid change and the need to adapt quickly. This isn’t going to happen by accident and needs clear direction, guidance, leadership and engagement of all those involved.
Mary Barra also refers to bringing products to market that bring people freedom, rather than talking about cars or transportation. She focuses on the outcome for their clients. What is the key outcome you’re wanting to provide for those in your environment and how is that defined in your values? How is it implemented by your staff and how do you measure success on those outcomes?
A managers oath as I’ve mentioned before is a good place to start in defining the governance or leadership direction of organisations. Values and key performance indicators (KPIs) or quality objectives / measures need to align to this.To ensure consistent progress regular review of those KPIs or quality measures needs to occur and acted on according to the outcomes. Policies and procedures to guide consistent best practice are an important part of ensuring clear direction for staff while setting parameters for performance. Information reduces confusion and promotes change. Practice creates confidence not only in the staff but also in the resident and those observing their care.
When balancing the clinical needs, requests and preferences of each resident in-conjunction with their right to choose, a number of factors need to be taken into consideration. We all recognise that theory and practice can change over time so when I asked Liz Beaglehole (Registered Dietitian) her professional view on this topic is, she offered the following:
The recommendation for older adults with diabetes in aged care facilities with stable diabetes is to provide an unrestrictive diet as much as possible. The notion of a ‘diabetic diet’ is outdated due to the increased risk of hypos and unwanted weight loss.
This is very individual however, a frail 80 year old woman with diabetes will likely have no diet restrictions however an obese 70 year old who may be otherwise stable would benefit from a more restrictive diet. Advice from a dietitian for individuals is recommended.
Overall, guidance from the resident about their wants is probably what determines the diet provided. This may be in accordance with recommendations or not.
Generally, the medications should be fitted to the usual eating pattern of the resident. In aged care facilities there are regular meals and generally balanced carbohydrates over the main meals (assuming good food intake) so usually this is fine. If someone has a reduced food intake, and is on insulin then a unrestrictive diet would be best.
For my menu planning I tend not to plan any special diabetic options on the cycle menus. I may include a low fat / low sugar dessert option if sites request, but generally my philosophy for aged care is not to restrict foods!
Liz is involved with a PEN (practiced based evidence in nutrition) review of the question ‘Do institutionalized, older adults (65 years of age or older) who closely follow a diet prescription have better control of their chronic disease (e.g. diabetes) than those who do not?‘ This is due by the end of March so further practice updates from this review may be available then. Liz noted that generally the evidence suggests there are no benefits with a prescriptive diet vs a more liberal one.
Those of you who are members of the New Zealand Aged Care Association (NZACA) may be aware that we (Healthcare Compliance Solutions Ltd) have been contracted by the NZACA to develop what is known as an Industry Body Customised Food Control Plan (FCP). This is to be approved by the Ministry of Primary Industries (MPI) and made available to all NZACA members. This customised plan comes under section 40 of the Food Safety Act and has been developed with the intention of streamlining audit process for Age Related Residential Care providers to use. There is an extended date for registering under this plan. 31st March was the date noted for registration however for this process, the date for completion of the registration process for use of the Industry Body NZACA FCP will be 31st May 2018.
Instead of registering with the local Council, those members who are taking advantage of the national customised food control plan will register directly with Ministry of Primary Industries. What is being worked towards currently is for this plan then to be audited by your Certification Designation Auditor Agency auditors in conjunction with your other audits. It is our understanding that the deadline for registering with MPI has changed to take the Food Control Plan approval into consideration so please check with NZACA to verify when you need to have your registration completed by.
How far have things progressed currently? We have submitted the draft of the customised plan to MPI for approval. The content of this plan goes beyond the standard Food Control Plan as it will need to also meet Certification and ARRC funding agreement audit criteria. This is designed to be an all in one set of documents so that as noted, it assists with the streamlining of audit. We understand this approval process could take 4 – 6 weeks with a period of refinement if necessary and finalising of the documentation to follow, before a Gazette notice would be published. This notice is necessary to proceed with association members using the Industry Body customised FCP as part of their other certification audit processes.
A huge thank you to Liz Beaglehole (Registered Dietitian) from Canterbury Dietitians who assisted at short notice with the reviewing of documentation contents which form part of the FCP.
There is work to be completed behind the scenes in an attempt to align audit time-frames which are not the same for all providers so while the intent is clear, the reality of achieving what we are setting out to do, is yet to be confirmed.
We support the work of the NZACA and were very pleased to be able to support the age care sector in this way. We undertake to do what we can to support this process to a successful outcome. NZACA will be updating their members as we work through this process. If you are not a member, this may be a good time to join to take advantage of just one of the benefits they offer to support their members.
If you would like further support with the implementation of your Food Control Plan, please feel free to contact us.
How friendly are nurses? I would generally say nurses are very friendly however we frequently see articles in nursing journals of bullying in the workplace.
I pondered this while attending the Global Speakers Summit in Auckland recently. I was over-whelmed by the friendliness of the speakers there, many of whom are very well known internationally. It was a level of friendliness I haven’t observed at the many nursing conferences I’ve attended and certainly gives an opportunity to reflect and see how this can be improved.
I asked a nursing colleague about this and asked her for her opinion. Her response was ‘that’s why speakers are successful and nurses struggle. The lack of genuine connection and sharing.’ She went on to say ‘nurses have been eating their young for years‘. She added that nurses would do well to build each other up and celebrate success not labour struggles.
At the Speakers Summit, I don’t recall a single time when a person walked in my direction without a smile and stopping to exchange pleasantries. Some of these people I knew or had met previously but many were first time encounters. Their responses went beyond pleasantries and extended to engage in a conversation that created connection and sharing and a sense of belonging. A pleasant change and one I hope we can do more to foster in nursing. Surely our patients and their families would benefit hugely if we can all be a little more compassionate and patient, and show genuine interest in each other.
A colleague offered the following explanation as to why nurses rush and lack apparent friendliness at times. ‘Nurses jobs have become about the task and the paperwork , with fewer nurses looking after more patients. And whilst there are still some who manage to make time to connect with those in their care, there are many more who are on a treadmill running from task to task. Many of these nurses are then given students to look after and they do their best to make it a great experience in difficult circumstances. That rushing and being task focused doesn’t do the best job of mentoring and teaching and doesn’t support the best possible care which otherwise might be achieved. Perhaps if the health care system had more nurses and less management you would see a lot more friendly nurses.’
How do we as a collective ponder and plan for change to improve not only the outcomes of what we’re trying to achieve as nurses, but provide a much more enjoyable workplace for all those in it? Remembering that in residential care, the workplace of nurses and care-giving staff is also the home of residents needing support.