aged care

 by Gillian Robinson

Governing Boards and Diversity

Boards of any organisation should be well placed to provide strong and transparent governance. This means the members of the board all need to understand the organisation structure, strategy, finances, client base, market changes and employees for the context in which they are operating.  This includes knowledge of behaviours, culture and ethics. The behaviours of all organisational board members gets reflected in employees to set the culture within the workplace which is experienced by the clients and those advocating for them, their family/whanau and friends.

The skill of judgement is necessary for board members to base decision-making on a set of agreed standards or a clearly defined constitution, organisation vision/mission or philosophy.   To have a progressive Board, there is the need to recruit board members with greater skills than already exist within the board. This ensures progressive diversity of thinking and culture based on more than gender and ethnicity.  A greater diversity is needed to also include creativity, innovation, current commercial practice knowledge, information givers and information seekers to increase depth of conversation and concepts being explored.  The Board member profile could do well to include these attributes, abilities and skills. Collectively they need to advance the organisation purpose, vision/mission or philosophy in a way that meets client current and future needs.

Boards are not the place for the faint-hearted or those at the end of career who simply ‘want to give back’ who may base todays decisions on yesterday outdated models.  Diversity will become a more visible part of boards with the introduction of the new Health and Disability Service Standards later this year.  While they are currently in draft, it seems clear the final version will require more diversity within boards. This will include increased desire for Maori representation and inclusion on Boards.  As American diversity advocate and activist Verna Meyers says, “Diversity is being invited to the party, inclusion is being asked to dance”.

If Maori representation isn’t part of your board make-up, it may be advantageous to look at forming relationships with local Iwi who fit the attributes needed to fit your board member profile. All Board members will need to be available, ethics driven, commercially aware and able to contribute.  The Board Chair will need to show these same attributes and also provide consistent innovative, clearly communicated strategic leadership.  The Board as a whole will also need to be agile in their response to unplanned events.  2020 and the emergence of COVID-19 reminded us of this.  It appears 2021 and into the foreseeable future will also present the need for agile thinking and innovation. I suggest now is the right time to review how your board is made up and how effectively they perform.  How can this be improved in your organisation?  

in News
 by Gillian Robinson

Bench-marking – Aged Residential Care

his New Zealand designed web based (on-line / in-the-cloud) Bench-marking and quality management system from Healthcare Compliance Solutionhttp://www.hcslqms.co.nz/s Ltd allows you to:

  • Bench-mark in real-time – specific to resident type, event type, date and time of day.
  • Have automated default reports to save you time analysing your data trends and patterns
  • Drill down into your data easily to identify opportunities for continuous improvement
  • Complete your internal audits online and have the corrective actions auto-populate into a corrective action log
  • Log and manage adverse events
  • Bench-marking of adverse events against other aged care providers
  • Support evidencing an active Health & Safety programme is in place
  • Log and manage infections – automatic outbreak registers
  • Bench-marking of infections against other aged care providers
  • Log and manage your complaints with time-frame, investigation and response prompts
  • Dashboard view options for level of care and any chosen 3 monthly time-frame review
  • Dashboard view option of adverse events or infections
  • Logs (event registers) appear with individual events in one colour when open and change to another colour when the event is closed. This allows you to see quickly the status of events. 
  • Use in conjunction with your current policies / procedures or update to the HCSL site specific created policies and procedures. 

Your organisation policies and procedures and related documents (if created by HCSL) are also accessible through the Facility Documents tab on the left of the screen for remote anytime, anywhere access.  The keyword search option on the policies and procedures in addition to precise indexing and coding of documents makes it very quick and easy to locate information for staff to reference.

You can also upload your own documents for confidential safe storage.

This is what Rhonda Sherriff, NZACA Clinical Advisor says about using the HCSL QA system:

“I am very happy to endorse your system as the information is invaluable for CNMs to analyse the data/information and make informed decisions on best practice and innovation to decrease hazards, improve outcomes, and mitigating factors for resident welfare. I’m pleased you are delving into the data to the level you are, as it’s time saving for sites in many respects, and so easy to dice and slice the information to get the trends. CNM’s used to spend hours just writing up the collective information before the analysis, so hugely time saving”

To view a brief video explanation of the system click here. This programme has been operating in NZ Aged Care since mid 2016 so now has many thousands of pieces of data to compare yourself against.  

To find out more contact us here.

 

Making monitoring your service remotely in LIVE time easy!

in News / Quality Assurance system
 by Gillian Robinson

Quality Management Systems

The below question and answer were published in the New Zealand Aged Care Association industry ‘In-Touch’ newsletter (19th February 2016).

Question: A member asks “if we purchase a comprehensive quality management system from a provider how assured are we that the system will meet full compliance, come certification and surveillance audit time, as requirements and compliance expectations change frequently?

NZACA Clinical Advisor Answer: “You should be purchasing a complete quality management system that will comply with the Health and Disability Standards specifications, health and safety requirements and meet DHB/ARRC contractual requirements.

The provider of the system would normally initially tailor the full quality management package to reflect accurately the site specifications, H.R. component, and best practice guidelines, after consultation with the owner and management on site. These documents need to be site specific. The provider will normally contract to the site, which sets out obligations between the provider and the site management.

The contract will include the full review and updates of policies and procedures on a bi-annual basis, unless specified more frequently, to keep documents accurate and reflective of best practice. There may be an educational element provided within the contract as well, to benefit staff knowledge and skills. There is normally a good document control system in place and cross referencing of information where required.

Quality management systems are reliant on the skills and knowledge of the site personnel working with them, the way the system is managed and the outcomes/reviews, content and information extricated from the use of the system to improve quality care provision/outputs. The documentation system is reflective of the people using them, and the depth to which documentation and information is created, analysed and utilised for improvements.

Auditors on site rely on the provision of robust up-to-date policies and site adherence to them. Partial attainments can sometimes result from staff deviating from, or not following, their sites actual policies or processes as outlined in their quality management system.”

Where can you get such a system? 

Here at Healthcare Compliance Solutions Ltd we provide the services described above and noted as being optimal for achieving excellence in care and audit outcomes.   To see a brief video about the Aged Care software update and now in use by over 3,800 users in NZ, click here. 

Request a no obligation consultation here.  

in News
 by hcsl

HCSL Aged Care Software user feedback

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:
  • I like the layout of the LTCP and being able to load and access documents in the one programme.
  • At the end of the month the stats are all there done without me having to calculate; the system does that itself, love it, I print off the bar graphs for the staff to see each months results with the related information written up to show the story behind the data
  • The advantage of having HCSL software in our facility means enabling quick access to residents records for more coordinated, efficient care and securely share information with residents and other clinicians. Holly Lea is in the process of having most of the documentations online. Moving to electronic significantly improved our archiving processes and the need for physical storage space for paper records is also significantly reduced. Being able to search for a file or document from the computer rather than manually dig through a filing cabinet saves time for all of us.
  • Know it is kiwi made and covers aged care in NZ requirements
  • Analysis of data and logs for complaints and incidents
  • Ease of access and user friendly
  • Log in pages are bright and cheerful.
  • Everything is in one spot and easy to access.
  • Audit system, ease of use, easy access to forms.
  • Its clear and easy to use.
  • The Long Term Care Plan (LTCP) is much more concise, great feedback from the care staff, easy to read and understand.
  • Able to compare to the average when reviewing falls or infection rates.
  • Ability to analyse present the information e.g falls.
  • I like the ease of use – the easy to generate reports – everything being in a logical order that ties in very well with the paper files
  • Used correctly the system does pass audit, meets all the requirements of the MOH Standards.
  • Receiving the continual updates we know we always have the most updated material available to meet our MOH requirements
  • This is a central point for data gathering. We have the potential to have most information on line.
  • The system is new to our team, it is still getting established here. We are finding it quite easy to use.
  • Its web based which means I can look at it anytime and am fully up-to date always with whats happening
  • The audits are detailed, and clear
  • The bench-marking is great and easy – saving time – great reporting
  • All of it, Everything on the website is easy to find and I like the bench-marking.
  • I don’t think we utilize enough of the paperwork some things I am discovering now after 5 years of using it!
  • I like the simplicity of the software.
  • I like that it is integrated with quality documentation.
  • I like that it is cloud based.
  • I like the flat fee for use, rather than a fee the number of devices (tablets).
  • The ease of uploading resident photo and easy layout
  • Ability to easily track trends in adverse events.
  • The straight forward user friendly interface, the data analysis, the way corrective actions populate straight to the corrective actions log,
in Testimonials
 by hcsl

Bethsaida Resthome, Hospital and Retirement Village Testimonial

We are very pleased to have recently been granted 4 year MOH Certification! No corrective actions and three Continuous Improvements.

This follows on from a fully attained Partial Provisional Audit that was required prior to opening our two new wings earlier this year with no corrective actions.

Make no mistake!  HCSL policies, software and support have played a major part in these accomplishments.  The HCSL software we use means we have easy access to information in real time.

I started working with Gillian of HCSL shortly after I took on the role of Facility Nurse Manager at Bethsaida Retirement Village six years ago. The facility was not using Healthcare Compliance Solutions policies at the time and perhaps this was reflected in the previous audit results.

Gillian is always responsive to emails and phone calls which is critical when timely advice is required.

The HCSL regular newsletters are interesting with relevant and up to date information on issues affecting aged care.

Gillian is a lovely person to deal with. She is thoughtful, professional, pragmatic and I have always found her to be keen to help, with practical advice on any issues that might arise in the management of a retirement facility.

I thoroughly recommend HCSL to all aged care facilities.

 

Tracy Holdaway RN BN

Facility Nurse Manager

Bethsaida Retirement Village

August 2019

in Testimonials
 by hcsl

Mandated minimum nursing hours – will it work to ensure safety and productivity?

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.

in News
 by hcsl

What does a Physiotherapy programme look like in Aged Care?

Prior to contracting a Physiotherapist, or as part of your Physiotherapy service review process, you should consider what your goal is in having physiotherapy input.  These should include key values such as Meaningful Outcomes for residents.

We asked Jessie Snowden of On The Go Physio what should felt was important for a Physiotherapy programme to which she offered the following:

For us this means we carry out thorough assessments, find out what is important or meaningful to the resident, their whānau and how this impacts their functioning in the aged care environment. Our input with people can range from rehabilitation to a previous level of function.  This may be intensive physio input for a few weeks, to ensuring someone is safe and comfortable with appropriate seating and pressure care at the end of life (which could be one visit only).

This level of assessment means that you need to ‘budget’ for 40-60 minutes (sometimes longer for complicated admissions) of physiotherapy time for a new assessment and possibly longer if they are needing to make referrals, liaise with other services and family. Follow up visits will be shorter. It is recommended that if you have a set number of hours per week that your staff and the physiotherapist are clear on expectations and priorities. If you only contract 2 hours per week it is not fair to have 10 new assessments on your ‘urgent’ list!

Some facilities have a set standard of 6 monthly reviews of all their residents. Although we do undertake these if asked, it is often more meaningful to use physiotherapy skills for those residents who may improve with input, or who your staff need assistance with due to functional decline. We suggest  if a 6 monthly review is wanted, then the RN is able to carry this out by considering if there have been changes in mobility, falls rates or other physical changes affecting function. If not then your physiotherapy dollar could be better spent on residents with clear rehabilitation needs or declining function.  The key goal here being to optimise mobility and maintain as much independence as possible.

Once the Physiotherapy service is up and running you can expect your physiotherapist to provide a clearly written assessment and a clear treatment plan, including either a discharge comment or a review date. Ideally you will maintain data related to Physiotherapy input and be able to see clearly if your allocated time is meeting the needs of your staff and residents.

Finally consider which residents will be eligible for physiotherapy assessments. If you are funding a Physiotherapy service you may choose to extend this to your hospital level and rest home level of care residents but not to independent studio units/apartments as these residents will usually be eligible for DHB funded services. Some DHBs will happily provide physiotherapy to rest home level of care residents and some put guidelines around who they will see. Depending on your DHB and care philosophy you may choose only to fund Physiotherapy services to hospital level of care residents or to extend this to rest home. In our company we work with aged care facilities who operate under both of these models and the key is to have it clear to both your Physiotherapist and staff who are completing referrals.

Spend your dollar wisely!

A final note here. Physiotherapists are highly skilled healthcare professionals who will be an asset to your team. The days of Physiotherapists spending all their time on walking programmes are long gone and you should set your expectations high for a physiotherapist who will add quality of life to your residents and cost benefit to your organisation. To use your physiotherapist wisely I strongly recommend you have the expectation that your care staff will have time to walk with people who are safe to do so.  We also encourage you to employ or allocate a Physiotherapy assistant hours into your roster to implement Physiotherapy plans. For information on using Physiotherapy assistants please look at an earlier article here .

This article was kindly contributed by Jessie Snowdon – Director of On the Go Physio. On the Go Physio provide physiotherapy services to over 20 facilities in Christchurch and Moving and Handling training to many more facilities and the CDHB.

in News
 by hcsl

Disaster Management should include security measures

This is a good time to be reminded that disaster management or your security policy may need to be extended to include management of threats, both internal and external to your organisation.  During the past years I’ve been personally involved with facilities where a resident entered the facility with a fire-arm, an intruder break-in during the night with a fire-arm, and another where intruders who entered the facility went into an occupied residents room. This last case related to intruders who had allegedly held-up the local bottle store earlier that same day.

Things happen which we don’t expect and we must be prepared as best we can.  It’s impossible to cover every possible eventuality but when events such as the shootings in Christchurch occur, it’s a reminder to ask are we doing enough?  For example, staff security rounds should be strictly enforced and documented to verify these were carried out. If you have surveillance cameras, where are your blind spots? If it’s the staff car park for staff going off duty late at night, improvements are desirable for staff safety. What about your processes for visitor verification? 

Security isn’t just about the people and environment but also about assets and information.  These should all be detailed in your policy documents.

HCSL are currently updating the security policies we provide ARC services to include reduction of risk from internal and external threats. This includes a procedure for lock-down. Let’s hope we never need to use it! 

For those of you wondering about how to debrief with your staff as a means to support them, there are some great resources available here.  For more resources on supporting others in relation to disaster type events, go here. 

in News
 by Gillian Robinson

ANZAC day commemoration

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.

 

 

 

in News
 by hcsl

Models of care and addressing Isolation

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.

 

 

 

in News