ATSI

ACMA new approach to Agency Staff making huge difference in outcomes

Agency Staff are a fact of life in the health and aged care arena, So rather than fight it , ACMA has been advising clients to embrace the use of agency staff be developing a new concept in the orientation and team building process

For years now, the use of agency staff to back fill sick leave or simple roster shortages has been seen a a costly, and detrimental process that can adversely effect resident outcomes. There is no doubt that the use of agency staff is financially more expensive however it doesnt need to be costly to the morale of staff nor to the team approach to care.

ACMA have been working with clients and local nursing agencies to develop an effective group orientation process that improves work performance, creates a better team enviroment and improves resident outcomes.

The new approach has been designed to have as many staff from nursing agencies who are regularly rostered or who could be rostered to a facility, undergo an orientation given by the facility management. Agency management also attend the session so that they can gain a first hand insight into the practical administration of a service. Staff are introduced to the organizations clinical systems, operational expectations, given overviews of documentation processes, incident reporting, mandatory reporting , medication administration, and work care.

The focus is on team building and welcoming agency staff, rather than begrudgingly accepting them at the beginning of a shift.

Working with facility staff in parallel to have a better understanding of the need for agency staff and how to say ‘Thank you for coming”, rather than the negative attitude so often seen.

This process was discussed during a quality review with AACQA assessors on the Central Coast of NSW last week, and was very well received as an innovative approach to an old problem. By working with the agency staff and management, there is a better chance of reducing costs not just in wages but in on costs as well

Peter Vincent

Peter held the position of Director of Nursing with ECH in Victor Harbor from July 1994 to March 2001. He was appointed as the first private sector CEO for a ’For Profit’ group in SA in 2002 until 2005.

In 2006 Peter formed Aged Care Management Australia an independent aged care consultancy that has been operating at a national level since that time, and now employs 6 staff, with a new office in Victoria.

ATSI

THis is probably the best Tesitmonial we have ever recevied

The past 7 weeks we have been working on the Central Coast NSW.  A facility that had cultural issues, and needed help in maintaining compliance.

2 weeks into the contract and the entire clinical management group left the building with a minues notice.   ACMA was asked to effectively take control of a facility until a full audit to accredit was completed.   We had to take the staff on a journey with us, to get them back to the point where they were in control.

This was a note left for us when we left the building.

Peter Vincent

Peter held the position of Director of Nursing with ECH in Victor Harbor from July 1994 to March 2001. He was appointed as the first private sector CEO for a ’For Profit’ group in SA in 2002 until 2005.

In 2006 Peter formed Aged Care Management Australia an independent aged care consultancy that has been operating at a national level since that time, and now employs 6 staff, with a new office in Victoria.

ATSI

What has driven our success in maintaining compliance

I was recently asked what has driven our success in protecting compliance for our clients.  Why have we been able to recover complex issues of non-compliance and sanctions or to prevent them for occuring in the first place?

The answer has several layers.   Firstly I have surrounded myself with an expert group of dedicated staff.   People with proven expertise in the clinical and operational arenas and who don’t settle for minimum standards.

Secondly, when we are invited into a facility, we work along side facility staff.  We arrive when they do, we go to hand overs, we listen to how they work and what the issues are ad understand the operational systems they have in place ( or not ).

Thirdly and most importantly, we don’t focus on the compliance framework.  That is we don’t focus on simply achieving that minimum standard.

We identify the relationship between the skills and knowledge, the clinical pathways and resident outcomes.  We track documentation trails, backward from an incident or outcome, then identify where the system falls down. Then we link our audit process to capture the systems to ensure that the appropriate roles and responsibilities, skills and knowledge are linked to the pathway in question.

For example,  in one facility there were a number of residents who were palliating.  On the wednesday before a long weekend, I asked what steps had been taken to ensure the staff had the resources to provide quality palliative care over the weekend and was assured by the facility manager that everything would be in place by the weekend to ensure residents needs were met.

On the saturday of the long weekend, my clinical team spent time in the facility.  this is what they found.

  • Only 2 out of four residents palliating had current palliative care plans that provided end of life management directives
  • Orders had been provided by all GP’s for appropriate anlgesia and midazolan, but none had been ordered in advance from pharmacy so the there was a signficant time laps in provision of analgesia.
  • There was only one Niki pump to share between 4 residents, and no attempts had been made to access others.
  • Personal care was not being provided because additional staff had not been rostered to meet the needs of the residents. The Registered Nurses did not believe they had the ability to assess chnages in clinical need and request more staff.
  • There was no progressive documentation in the progress notes that any care had been delivered.
  • Families and residents were distressed.

If we apply our approach to this scenario and work backward, we will find;

  • Lack of skills, knowledge and appropriate management experience by the Facility Manager for not personally ensuring these resources were in place
  • Lack of skills and knowledge in the clinical staff ( Registered Nurses ) for not personally ensuring at the beginning of their shifts that there were sufficent supplies of medication and several more Niki pumps
  • There was a lack of understanding in clinical practice in maintaining appropriate documentation during the shift.  Again skills and Knowledge.

So in regard to maintaining compliance, the facility has potentially failed outcomes 1.6 Human resource management, 1.7, Inventory and equipment,  2.3 Education and staff training, 2.4 Clincial Care, 2.5 Specialized nursing care needs, 2.8 Pain management, 2.9 Palliative care,  3.4 Emotional support. 3.6 Privacy and dignity. Had the facility been subject to an assessment contact they would likely have been sanctioned.

Our success in preventing these issues from arising, is to work with the staff, listen to them and to train them to make better decisions.  Its really quite simple, but it takes time and committment from the orgnaization to make it happen.

Peter Vincent

Peter held the position of Director of Nursing with ECH in Victor Harbor from July 1994 to March 2001. He was appointed as the first private sector CEO for a ’For Profit’ group in SA in 2002 until 2005.

In 2006 Peter formed Aged Care Management Australia an independent aged care consultancy that has been operating at a national level since that time, and now employs 6 staff, with a new office in Victoria.

ATSI

Is this a Game Changer for future development. What will happen to current Balance sheets if licensing moves to consumers

I have long held the view that residential care needs to move to deregulation.  A system that allows providers to develop business cases to support new development that is non reliant on the annual lottery of ACAR.   One of the barriers has been that current providers hold the value of bed places on their balance sheets. ( Even though there was no cost to them in obtaining the licenses, there is a value at the point of sale. ) So if we move to a deregulated system, where the is no ACAR ( as is now the case for Home care), where does that leave the industry.

The extract below is taken from budget commentary and are not my personal views.  However the context of the these views need to be discussed

The government has backed the Tune Review recommendation to put residential aged care places in the hands of consumers, the 2018-19 Federal Budget shows.

The Government will provide $300,000 to explore allocating residential care places to consumers rather than providers, according to the Budget handed down by Treasurer Scott Morrison last night.

The government said it provided in-principle support to putting residential places in the hands of consumers, which is a key feature of the Aged Care Roadmap and a recommendation of the 2017 Legislated Review of Aged Care led by David Tune.

The analysis will assess the potential impacts on consumers, providers, the financial sector and any changes to the system that may be required. It will also pay special attention to how the change would impact rural and remote areas that have limited choice and competition, according to the announcement.

The government announced the aged care budget would grow by $5 billion over the next five years, which is in line with recent trends of around an additional $1 billion of aged care expenditure annually.

Among measures announced in the budget package are 13,500 residential places, 775 Short-Term Restorative Care places and $60 million in capital funding for new residential places in the 2018-19 Aged Care Approvals Round.

The new residential aged care places combine targets for 2018-19 and 2019-20 according to the budget papers, which show 7,300 fewer residential places in 2020-21 than what was tabled in last year’s budget.

This year’s budget estimates 204,700 aged care places at the end of this financial year, which falls short of the 209,700 target in last year’s budget papers.

The new residential care targets for 2018-19 are 210,100 (down from 216,900) and 217,000 for 2019-20 (down from 224,600).

As part of measures to minimise its risk in guaranteeing refundable accommodations deposits, the government said it would go ahead and introduce a compulsory retrospective levy on residential services, where defaults exceeded $3 million in any financial year.

The Tune Review and the Aged Care Financing Authority both recommended that providers should pay toward the Accommodation Payment Guarantee Scheme.

The measures, which will cost $4.8 million over two years, also include developing strong prudential standards for bonds held by providers and raising government’s capability to better reduce the likelihood of a claim and protect the growing pool of refundable payments, currently around $23 billion.

Mental health, palliative care, remote

Responding to the long-standing concerns around a lack of access for residents to psychological care, the budget provides $82.5 million over four years for mental health services for aged care residents, along with $20 million over four years to trial nurse-led mental health services for people aged over 75 experiencing social isolation and loneliness.

The budget also contained $32.8 million over four years for a trial to improve palliative care for aged care residents but that initiative is contingent on state and territory governments matching the funding.

The government will also provide capital grants to the value of $40 million over five years for aged care facilities in regional, rural and remote communities.

Elsewhere in remote aged care services, the government will provide $105.7 million over four years, including $32 million from within the existing resources, to support the National Aboriginal and Torres Strait Islander Flexible Aged Care Program for residential and home aged care services in remote Indigenous communities.

Peter Vincent

Peter held the position of Director of Nursing with ECH in Victor Harbor from July 1994 to March 2001. He was appointed as the first private sector CEO for a ’For Profit’ group in SA in 2002 until 2005.

In 2006 Peter formed Aged Care Management Australia an independent aged care consultancy that has been operating at a national level since that time, and now employs 6 staff, with a new office in Victoria.

ATSI

Could Oakden Happen Again – Aged Care Industry Needs to Recognize Indicators of Non -Compliance and Risk

The shameful events that occurred at the Oakden nursing home rightly sent shock waves throughout the community.

But we are fooling ourselves if we think such appalling mistreatment of our most vulnerable isn’t happening today – or will continue to do so in the future.

The severe compliance outcomes of the Oakden aged care service – and the severity of the issues identified – not only shocked the community, but also the industry, quality and compliance agencies and governments across the country.

It exposed the risks that occur (including to human life) when the gap between governance and compliance – the pure lack of skills and knowledge at all levels of management from the board room to the ward room – goes unchecked.

Oakden is not an isolated case in failing compliance outcomes.

There have been – and will continue to be – facilities that fail to meet compliance outcomes to a far greater degree unless we recognize the failings of the accreditation monitoring system.

Currently across Australia there are 32 facilities with notices of non-compliance and five facilities issued with sanctions– this clearly demonstrates my point!

In SA, there are 11 facilities listed as non-compliant.

I have long believed that the process of compliance monitoring does not come close to identifying the risks to a client’s health and wellbeing, nor the quality of skills and knowledge of the staff who care for our elderly at governance level in sufficient numbers to meet their purpose.

Having worked in the industry for more than 40 years, I can state unequivocally that it is the failure of those private owners, Boards, CEOs and executive managers who fail to understand and question the standards of care being delivered in their name,  and the lack of governance systems in place to provide the answers, that are to blame for predicaments like which occurred at Oaken.

All too often we see the wrong people with the wrong skill sets undertaking roles that they are not trained to undertake.

It is time to set higher levels of training requirements for our care workers – Certificate 3 is not good enough, nor are the academic levels that we accept for our carers.

 

It is time to have more robust examination of the skills and actual clinical outcomes achieved by our registered and enrolled nurses.

Failure to do so will again be at the peril of the most vulnerable in our community.

 

 

ACMA operates as an independent nurse advisory service specializing in compliance

 Peter Vincent is a 40 year veteran of the aged care sector and in Principal Consultant of Aged Care Management Australia.  Contact 0403 949 006  peter@acma.net.au

 

 

Peter Vincent

Peter held the position of Director of Nursing with ECH in Victor Harbor from July 1994 to March 2001. He was appointed as the first private sector CEO for a ’For Profit’ group in SA in 2002 until 2005.

In 2006 Peter formed Aged Care Management Australia an independent aged care consultancy that has been operating at a national level since that time, and now employs 6 staff, with a new office in Victoria.

ATSI

Prevention is more cost effective than the cure

Aged Care Management Australia ( ACMA ) has been engaged by a NSW based provider to assist with managing compliance. ACMA director and principal consultant Peter Vincent says his group was recently approached to provide support in maintaining compliance and mentoring facility staff.

“Following the initial contact, 4 days ago, we will have staff on site from Monday morning. This is one of our key services to clients in preventing issues of concern from escalating to formal non-compliance and sanction. We have a 100 % success rate in dealing with these types of scenario Peter said”

In these instances, the use of a recognized nurse advisory service in a preventative mode is far more beneficial and cost effective than waiting until issues escalate sanction. ACMA provide highly experienced clinical staff including nurse educators to work with facility and organizational staff to remedy issues of clinical and operational governance and ensure compliance is maintained and sustainable.

For further details contact us via our web site www.acma.net.au

Peter Vincent

Peter held the position of Director of Nursing with ECH in Victor Harbor from July 1994 to March 2001. He was appointed as the first private sector CEO for a ’For Profit’ group in SA in 2002 until 2005.

In 2006 Peter formed Aged Care Management Australia an independent aged care consultancy that has been operating at a national level since that time, and now employs 6 staff, with a new office in Victoria.

ATSI

ACMA Successfully gains Approved Provider status for new Home care provider in SA

ACMA has maintained its 100% success rate in developing and submitting applications for new providers. Our latest client in South Australia has gained approval to deliver home care and flexible care, with the application process proceeding without requests for additional information from the Department.

Our success comes from understanding the business model of the applicant, working with them to develop solid business and financial modelling, staffing structures and complete infrastructure services such as operating policies, procedures, resident and staff contracts.

 

Peter Vincent

Peter held the position of Director of Nursing with ECH in Victor Harbor from July 1994 to March 2001. He was appointed as the first private sector CEO for a ’For Profit’ group in SA in 2002 until 2005.

In 2006 Peter formed Aged Care Management Australia an independent aged care consultancy that has been operating at a national level since that time, and now employs 6 staff, with a new office in Victoria.

ATSI

Aged Care Management Australia Appointed to the national ‘Aboriginal and Torres Strait Islander Aged Care Service Development Assistance Panel’

Director and Principal Consultant Peter Vincent has confirmed that Aged Care Management Australia (ACMA) and their partners Hodgkison Architects and Henson Lloyd Chartered Accountants have been appointed to the national ‘Aboriginal and Torres Strait Islander Aged Care Service Development Assistance Panel’ for the next 3 years.

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Peter Vincent

Peter held the position of Director of Nursing with ECH in Victor Harbor from July 1994 to March 2001. He was appointed as the first private sector CEO for a ’For Profit’ group in SA in 2002 until 2005.

In 2006 Peter formed Aged Care Management Australia an independent aged care consultancy that has been operating at a national level since that time, and now employs 6 staff, with a new office in Victoria.