Residential Care Rights Inc. Elder Rights Advocacy files/reports/2007_08 Annual Report_web3.pdf ·...

Re s ide nt ial Care

Right s Inc . T/ A

Elde r Right s Advoc ac y

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ERA Annual Report 2007/08

TABLE OF CONTENTS

PRESIDENT S REPORT ..............................................................................................1

CEO S REPORT............................................................................................................3

THE ERA TEAM .......................................................................................................5

WHO ARE WE? ............................................................................................................6

MISSION STATEMENT...............................................................................................6

VISION ..........................................................................................................................6

THE SERVICE YOU CAN EXPECT FROM US.........................................................7

GOALS ..........................................................................................................................8

ERA S GOAL PRIORITIES..........................................................................................9

ACHIEVEMENTS AGAINST GOALS........................................................................9

GOAL 1: ADVOCACY CASEWORK.......................................................................11

EXAMPLES OF ISSUES ADVOCATES DEALT WITH IN 2007 2008 .................13

ISSUES RAISED IN ADVOCACY ENQUIRIES BY CLIENTS IN 2007 2008......16

EMERGING TRENDS ................................................................................................18

MORE EXAMPLES OF ISSUES ADVOCATES DEALT WITH IN 2007 2008.....20

GOAL 2: INFORMATION AND NETWORKS........................................................23

GOAL 3: EDUCATION AND TRAINING ...............................................................24

OUT AND ABOUT WITH RESIDENTS ...................................................................26

GOAL 4: POLICY & NETWORKING......................................................................27

GOAL 5: MANAGEMENT AND PLANNING.........................................................28

APPENDIX 1: VENUES FOR EDUCATION AND INFORMATION VISITS IN 2007 2008 ......................................................................29

APPENDIX 2: AUDITED FINANCIAL REPORTS 2007 2008 .............................32

ERA Annual Report 2007/08 Page 1

President, Sue Healy

PRESIDENT S REPORT

In 2007 8 ERA has continued to enjoy a high satisfaction rating for its advocacy and education work. Our advocates make visits to aged care facilities to support individuals with issues about their care, but many visits are to inform residents of their rights or to educate staff on rights. We are finding that the performance indicators (set by the Department of Health and Ageing) that ERA is expected to fulfil are hard to achieve with a staff of just six. However, ERA managed to visit 145 homes, including many in rural areas, during the year. Our education sessions with staff of ancillary organisations such as the Aged Care Assessment Service, are not included in the performance data although we feel the education adds greatly to their effectiveness.

There has been a major staff change during this year with an advocate of twelve years service, Steve Aivaliotis, leaving ERA to pursue other career options. Anne Weston is also intending to leave the organisation, and we wish her well in her future plans. We wish to recognise the contribution of Steve and Anne to the work of ERA and to thank them for their devotion to the needs and rights of the people they assisted.

The introduction two years ago of the position of Intake Advocate has proved to be a good way of developing the skills of incoming staff; with Debra Nicholl moving on from Intake to the position of Advocate, and Anne Maher newly employed as Intake Advocate. Continuity of skills and knowledge have been provided by long term staff Mary Lyttle, Belinda Evans and Kathleen Tripp. We thank them all.

This year ERA has placed extra emphasis on the special needs of certain groups such as people of culturally and linguistically diverse backgrounds (CALD clients), homeless people and younger people with disabilities. People living in their own homes with community packages such as CACP or EACH services have been assisted as they seek to self-manage (or family manage) their care. This is an ongoing request which is not yet achieved, and has been raised by ERA as an emerging policy issue for government.

The establishment by the state government of the Senior Rights Service (SRV) with its legal centre has improved service in the difficult area of elder abuse. Referral to and from SRV has allowed ERA to focus on its mandate to uphold the rights of people receiving aged care services, and access legal support for clients if this is required.

Our advocates are concerned about a new trend in the aged care sector that stems from lack of knowledge of the intricacies of the Power of Attorney system. People in care are at times being illegally restricted from receiving visits by close friends etc. by the relative who holds their Power of Attorney. ERA intends to investigate this issue and to inform and educate the industry, while assisting residents with their rights.


Finally, may I personally thank the committee members who meet monthly to receive reports, oversee the financial records, and support the work of the ERA staff. Their contribution is always valuable, with animated discussion taking place on emerging issues for older people.

Sue Healy President


CEO, Mary Lyttle

CEO S REPORT

This year has seen some interesting and challenging changes in the aged care sector, which have had an impact on our organisation. Some of the changes relate to new legislation on preventing abuse, developed by the Commonwealth government, others relate to the expansion of larger corporations taking over aged care homes which were privately owned. The changes to ownership in the aged care sector has often meant that we find ourselves dealing with the legal advisors of the corporation, rather than the owner or manager as we may have done previously.

At times this means the concerns raised by residents or relatives are perceived as a threat to the organisation s reputation, or a matter which may affect their staff,

leading to OH&S claims. In some cases matters become harder to resolve if a defensive stance is advised by the legal team, although in a recent instance the reasonable approach taken led to a good outcome for the complainant and the management.

Other legal issues continue to arise in regard to the incorrect use of powers of attorney by some family members, specifically in blocking access to other visitors for the resident, and asking the aged care home to enforce this. We have identified a need for education in this area so that residents right to receive visitors and family members of their choice are not denied.

The issue of medication has also remained a key concern raised with us through the year, and we have detailed several case stories to highlight the issues. This is a matter that the Minister for Aged Care, Justine Elliott, has requested a report on, and we await the findings with interest given our case experience on behalf of residents.

We have had increased concerns raised about community packages, including CACP and EACH packages. Several of these complainants have raised the issue of wanting to have self managed care, in order to both free up more money for care hours and to avoid dealing with a range of people delivering service into their home. We have raised this issue with the Minister, however it remains a challenge to implement, unless an aged care provider is open to the changes required.

New legislative changes affecting us during the year arose from several severe assaults on residents (in two states), which resulted in criminal charges. The changes, put in place by the Department of Health and Ageing (DH&AC), include compulsory reporting of abuse against residents in residential care facilities, compulsory police checks for aged care staff and volunteers, and the establishment of the Complaints Investigation Scheme by DH&AC. ERA advocates are also required to agree to a police check, as are all advocates in the National Aged Care Advocacy Program.


The new requirements have involved us in extra information and education sessions for aged care residents and staff, as well as increased assistance provided to complainants using the Complaints Investigation Scheme. Many callers have been relieved to hear of the Scheme, and to know their complaint would be investigated, and reported good outcomes. In a few instances however, residents and relatives we have assisted have raised concerns about the weight given to their first hand evidence when they reported the complaint to the Scheme. Along with the complainants, we have raised these concerns with the Commissioner for Aged Care, and DH&AC. We will be following this issue through our policy input, and will be keen to see a review of the operations of the Scheme in the near future to address issues such as these.

Staff changes and our increased education focus, especially with culturally diverse groups has been another challenge during the year. Providing support for the residents and relatives in homes facing sanctions or closure due to restructuring has also put pressure on time and our overtime budget. I wish to thank all of our staff at ERA, including Steve Aivaliotis and Anne Weston, who have worked hard to achieve the extensive education and information program across the state, while providing timely advocacy to our clients. The support of Sue Healy and all of the Committee members has continued to encourage us in our work for older people, and we thank them for their time and commitment.

Mary Lyttle Chief Executive Officer


The Advocates, left to right (top), Mary Lyttle (CEO), Steve Aivaliotis, Belinda Evans, (bottom) Anne Weston, Debra Nicholl

and Anne Maher

THE ERA TEAM

Committee Members President Susan Healy B.A., M.LIB

Treasurer Alan G. Field OAM

Secretary/Public Officer Jennifer Mary Lee LL.B, M.A.

Committee Members Isabel Mary Dean Infant Teachers Cert, Grad Dip SpEd-Early Childhood (joined November 2007)

Olive L. Paice

Ann Robertson RN DipCommNse

Juris Rozensteins

Mary Ann Lyttle B.A., M.A., Accredited Mediator

Staff Chief Executive Officer Mary Ann Lyttle B.A., M.A., Accredited Mediator

Advocates Steven Aivaliotis B.A. Accredited Mediator (resigned October 2007)

Belinda Jane Evans LL.B, LL.M, Accredited Mediator (Senior Advocate from October 2007)

Anne Elizabeth Weston Dip Ed., Accredited Mediator

Debra Ann Nicholl-Caddell Dip Comm Welfare

Intake Advocate Anne Marie Maher BA (Soc Sc), BSW

Office Manager Kathleen Tripp


WHO ARE WE? Older Persons Action Centre Inc. established Residential Care Rights (RCR) in 1990 and auspiced the organisation for its first twelve years. In November 2002 RCR became a separately incorporated not for profit association. From February 2007 RCR commenced operating under the registered business name of Elder Rights Advocacy (ERA) to better reflect our consumer group.

While RCR Inc. is the funded entity eligible to receive grant monies, ERA as the trading organisation providing advocacy, will be the source of data and will be the organisation referred to from this point forward in this document.

ERA is an independent agency funded by the Commonwealth Department of Health and Ageing to provide advocacy services for people receiving Commonwealth funded aged care services in Victoria. It is part of the National Aged Care Advocacy Program.

We also assist carers and family members who represent their interests, as well as people who have been assessed as eligible for a Commonwealth funded aged care service.

Our service is managed through a volunteer Committee of Management.

We provide a unique service to individuals through our model of advocacy that focuses on helping older people (or their representatives) to understand and exercise their rights, and to have those rights respected in the delivery of their care services.

MISSION STATEMENT Elder Rights Advocacy promotes and upholds the rights of older people receiving aged care services.

VISION To be the key provider of quality aged care advice and advocacy.


THE SERVICE YOU CAN EXPECT FROM US Advocacy In order to provide a high quality service we will:

Act in an honest, ethical and professional manner at all times.

Be courteous, fair and reasonable in our dealings.

Respond in a timely manner to enquiries.

Provide accurate information on rights.

Tell you what assistance we can provide to resolve your enquiry.

Provide information relevant to your query.

Take direction from clients in regard to the progress of enquiries, and the contacting of other parties to resolve the matter.

Work within an agreed time frame.

Discuss all possible options to help resolve your enquiry.

Communicate on a regular basis about the progress of your enquiry.

Use our best endeavours to keep clients free from physical, sexual, emotional and verbal abuse or retribution in the process of resolving an enquiry.

Access To ensure access to all consumers we will:

Provide advice and information on the telephone or in a place that is convenient to all parties.

Provide written information on rights, including information in community languages, and on tape.

We will communicate in a preferred language with the assistance of a qualified interpreter.

If our service is unable to assist to achieve the outcomes you are seeking we will endeavour to refer you to the appropriate agency.

Confidentiality We will:

Keep personal information confidential and obtain your consent to take any information to another party.

Only breach this confidentiality to prevent a serious risk or injury to you or the person receiving care, in which case we will inform you of our referral to the appropriate protective agencies.


GOALS Elder Rights Advocacy service works to a Strategic Plan developed from the goals set by the National Aged Care Advocacy Program five year Strategic Plan.

1. Advocacy To provide informed advice, support and advocacy on consumer rights to improve the quality of care for consumers.

2. Information and Networks To provide accurate and accessible information on aged care, quality, and consumer rights for the three client groups:

Consumers, potential consumers and their representatives, including those with special needs;

Aged care service providers, management and staff; and

Other industry stakeholders including the Complaints Investigation Scheme (CIS), the Aged Care Standards and Accreditation Agency, Aged Care Assessment Services and other peak consumer bodies.

To raise the profile of ERA with its client group and other relevant stakeholders in aged care.

3. Education and Training To provide quality education, consultancy and training on consumer rights and quality improvement for ERA client groups across the state.

Consumers, potential consumers and their representatives, including those with special needs;

Aged care service providers, management and staff; and

Other industry stakeholders including CIS, the Aged Care Standards and Accreditation Agency, Aged Care Assessment Services and other peak consumer bodies.

4. Policy and Networking To promote continuous improvement in aged care quality by identifying and presenting systemic policy issues arising from advocacy, education and information strategies.

5. Management and Planning To provide efficient and effective management to ensure quality service delivery and provide a secure and stable financial base for the service.

Our specific goals and achievements for the 2007 2008 financial year are reported on in the following pages.


ERA S GOAL PRIORITIES During the period we have adopted the following priorities:

Promoted our service and new service name to an increased range of clients, in both residential and community areas to increase access to advocacy.

Increased our education and information sessions in metropolitan and rural areas to increase understanding and knowledge of consumer rights in aged care services.

Continued promotion of our 1800 number to provide equitable access for all consumers.

Updated our website information and promotion.

Increased promotion to clients from culturally diverse backgrounds, including education sessions with service providers and the Centre for Cultural Diversity.

Promotion of the Cultural Care Kit, with a focus on web based information.

Participated in policy and working groups including elder abuse prevention advisory group to promote the rights of older people.

Implemented improvements in ERA services, including QA surveys to monitor the effectiveness of our program.

ACHIEVEMENTS AGAINST GOALS

Total Enquiries

2021 2141 2136

2467

2001

0

1000

2000

3000

2003/04 2004/05 2005/06 2006/07 2007/08

No

. o

f E

nq

uir

ies

Figure 1: Comparison of total enquiries over the past five years.


Geographic Source of Enquiries

73% 73% 78%

27% 27% 22%

2005/2006 2006/2007 2007/2008

Metro Rural/Regional

Figure 2: Comparison of geographic source of referral of all enquiries.

Advocates' Workflow (Time)

Advocacy68%

Policy2%

Information production

1%

Education12%

Administration17%

Figure 3: Spread of advocates time over goals in 2007 2008

Case Resolution TimeOn-going at

30/6/0810%

One week55%

One month25%

Over three months

3%

Under three months

7%

Figure 4: Time taken to resolve advocacy enquiries in 2007 2008


GOAL 1: ADVOCACY CASEWORK

Goal: to provide informed advice, support and advocacy on consumer rights to improve the quality of care and quality of life for consumers.

We maintained our state wide access to advocacy with 22% of clients from rural areas, and 78% from metropolitan regions, in line with the demographic spread. While our advocacy casework has decreased somewhat, the complexity of issues has in fact increased. Many more situations have involved several family members raising issues of concern for their loved one, as well as groups of residents and families in several homes who we have been able to assist with problems which had seemed to be entrenched.

The time overall spent on advocacy has continued as 68% of our agency workload (including travel), with an increase to 12% of time spent on education and travel. A number of our enquiries relate to an increase in special needs clients, whom we have targeted through our education and information sessions.

Other achievements during the period included:

Intake Advocate position continued with further training for the advocate to enhance support to callers.

Equitable access to advocates continued with 78% enquiries from metro, 22% rural/regional (see Figure 2).

Advocacy assistance has involved 56 CALD clients, 157 people with dementia, 15 younger people with disabilities and 71 people with other disabilities.

We had 57 referrals from CRS/CIS for advocacy assistance, and we referred 16 people for assistance.

68% of our time was spent on advocacy (see Figure 3), with effectiveness of advocacy support maintained.

55% of cases resolved in one week of advocate time, and a further 25% in less than one month (see Figure 4).

Our complex casework needing longer resolution time has increased with 7% requiring more than one but less than three months to be resolved, and 3% still open over the three month period. Some of these cases with the Complaints Investigation Scheme (CIS) have taken extensive time periods due to investigations and appeals when we have continued to support complainants.

Our advocacy QA results show a high satisfaction rate with advocacy provided, with five questions rating at 87 94% and one question at 71% (question 3). This question tends to rate lower due to the nature of the question, as we are not always able to have the complaint totally resolved for the client perhaps for factors beyond our control.

We have achieved a send out rate of QA surveys between 75 92% across the period (80% average for the year), with only 28 clients in total not sent QA surveys for a range of reasons including clients requesting to remain

Provided advocacy to 431 aged care consumers in 2007 2008.


anonymous. Generally comments remain positive, with 94% stating they would use our service again and recommend it to others (see Figure 5).

All regions of the state were reached with advocacy information and casework support offered when visiting homes.

Additional support was provided to clients using the Complaints Investigation Scheme (CIS), including support to appeal outcomes at the client request.

Promotion of advocacy through the 1800 telephone number continued, along with leaflet distribution to all aged care homes across Victoria.

Ongoing education of advocates continued with attendance of all advocates at the Aged Care Standards and Accreditation Agency s Better Practice events, a Cultural Diversity seminar, and two Elder Abuse Prevention seminars, including a seminar with the Australian Network for Prevention of Elder Abuse (ANPEA).

Advocacy Client Satisfaction Survey 2007-2008

Questions Responses

Yes No Partly

Overall were you satisfied with the way the Advocacy Service assisted you?

89.5%

2.9%

7.6%

Did the Advocate appear generally knowledgeable about aged care services?

91.3%

2.3%

6.4%

Did the Advocacy Service assist you to resolve your concern/complaint?

70.6%

7.6%

21.8%

Did the Advocacy Service assist you to learn more about your rights & responsibilities?

88.2%

6.5%

5.3%

Did the Advocate understand your needs and act according to your wishes?

86.6%

5.2%

8.1%

Would you use the Advocacy Service again or recommend it to others?

94.2%

2.9%

2.9%

Figure 5: Responses to Advocacy Client Satisfaction Survey in 2007 2008


EXAMPLES OF ISSUES ADVOCATES DEALT WITH IN 2007 2008

Improving Life at Home. Mr J called ERA to complain about the inadequate level of support provided by his Community Aged Care Package. Mr J told the ERA advocate that his wife was his primary carer. He was concerned because his wife had recently had an operation on her legs and now had considerably reduced mobility. As a consequence, she was unable to provide him with her usual level of support. He was worried that things were becoming unmanageable for both of them.

During a visit to Mr. J s home, the advocate observed Mr. J s wife crying on a number of occasions. Mrs. J indicated to the advocate that the pain in her legs was sometimes unbearable. She also noticed that Mr. J s clothing was dirty and unkempt and the house was in a state of disarray.

After providing Mr. J. with information about his rights and the help the advocate could provide, Mr. J agreed that she could call the CACP manager.

The CACPs provider was contacted, and advocate stressed the urgency of the situation for Mr. J. and his wife and the need for review of the supports delivered by the package.

Whilst not a recipient of a CACP, Mrs. J had obvious care needs which were outlined to the program manager. The manager was responsive to the situation and agreed, with Mrs. J s. consent, to refer her for an Aged Care Assessment and recommendation for a package.

In discussions with the ACAS team, the advocate explained the situation for the couple. ACAS also contacted Royal District Nursing Service and recommended a review of the current pain management strategies available to Mrs J. The CACPs program then increased the level of support available to manage the current concerns for Mr J and agreed to monitor the situation closely.

Mrs. J. was subsequently assessed by the ACAS and recommended for a Community Care Package. Mr. J. also received additional services from the CACP provider. Mr and Mrs J were able to remain at home in a much safer and comfortable situation.


Maintaining Family Relationships ERA was contacted for assistance by a community guardian for Mary, an elderly resident with dementia living in a high care home. Mary s husband of 60+ years, Jack, had become very agitated on a recent visit and been quite threatening and abusive to both Mary and a staff member who intervened. The guardian had initially placed a complete restriction on Jack s visits for a period of time until matters settled down.

The guardian was now concerned with maintaining family and emotional support to Mary, who fortunately had not had any adverse effects from the incident. The guardian was also aware of their new obligations under the Victorian Charter of Human Rights, to support family relationships. The aged care provider was concerned for the safety of Mary and the staff, and was wanting to maintain the ban on Jack visiting. They stated that Mary should go out of the home to see him.

As matters had now escalated and the provider s legal advisor was involved, the guardian sought the advocate s help to support Mary s right to have her husband visit in the home, while ensuring safety for all parties. Following extensive discussions with all parties an agreement was reached, with Jack able to resume visiting with family or friends in attendance during the visit.

Young People in Nursing Homes and Choice A staff member of a facility contacted ERA seeking advice on behalf of two younger residents living in a low care facility. The two residents like to sit up and watch television, for example, the football which finishes around 12am.

Some other residents had complained to management about the noise from the television. Management s response was to place a notice which stated All residents are to be in their rooms by 11pm, common room areas are to be closed, no televisions on and all lights switched off. The staff member felt this was unfair to the younger residents.

The advocate advised the staff member to speak to the manager about the issue and to suggest a compromise, for example, to provide headphones for television use during evenings, to respect the rights and choices of all parties. The staff member agreed to do this to support the residents, and to call the advocate if further help was needed.


Sleepless nights The daughter of a resident called to seek advice regarding her mother s disturbed sleep. A gentleman with dementia had moved into a room across the corridor from her mother s room. The gentleman was calling out in the night and this was disturbing her mother s sleep. The daughter had spoken to the Director of Nursing about the issue and was told that her mother could move to another room. The daughter felt that this was an unreasonable option.

The advocate informed the daughter her mother s rights, including her right to be fully consulted and not be subject to any pressure to move. Also of her right to have a good night s sleep, in her current room.

The advocate informed the daughter that the facility had a responsibility to better manage the gentleman s care needs and to have an appropriate behaviour management plan in place. The daughter was then more confident to approach the manager for a discussion of how this could happen.

Security of Tenure A community guardian for a gentleman in aged care (Mr B) contacted ERA for advice because the facility management wanted the resident to leave. The reason given by management was behavioural issues and the weight of Mr B (over 100 kilos). The manager stressed that it was an occupational health and safety issue for staff to look after such a large man with behavioural issues.

The advocate gave the guardian information on Mr B s security of tenure rights and also suggested that the facility could get support and advice from a behaviour consultant attached to an Aged Psychiatric Assessment Team.


ISSUES RAISED IN ADVOCACY ENQUIRIES BY CLIENTS IN 2007 2008

Figures 6 10 show the break-up of calls within five categories of issues.

Level of CareAcccess to specialised

services4%

Medication13%

Hydration / Nutrition

14%

Continence9%

Personal Care38%

Behaviour management

10%

Assessment / Care planning

12%

Figure 6: Breakup of the 354 enquiries received about care issues in 2007 2008

Consumer Rights

Other consumer

rights52%

Complaints process

15%

Choice / Decision making

33%

Figure 7: Breakup of the 287 enquiries received about consumer rights issues in 2007 2008


Administration / Fair Trading

Bonds12%

Fees / Charges24%

Security of tenure19%

Personnel / Staffing

16%

Administration / Agreements

29%

Figure 8: Breakup of the 238 enquiries received about administration / fair trading issues in 2007 2008

Environment

Food / Temperature /

Security39%

Housekeeping / Safety34%

Occupational health and

safety6%

Laundry3%

Equipment18%

Figure 9: Breakup of the 65 enquiries received about environment issues in 2007 2008


Additional Advocacy Categories

Other27%

Health system interaction

1%

Assessment16%

Access to appropriate

care18%

Alternate decision making

38%

Figure 10: Breakup of the 126 enquiries received about additional advocacy issues in 2007 2008

EMERGING TRENDS Changes to workload include a decrease in overall enquiries and advocacy cases, and an increase in time spent on education and travel. Change in our overall enquiry rate is highly likely related to promotion of the Complaints Investigation Scheme (CIS), with people seeking to have their concerns directly investigated, rather than worked through with the provider.

We faced an increase in time providing assistance to CIS complainants with information to assist the complaint to be resolved to their satisfaction. On several matters we helped with appeals to the Commissioner at the client s request and with tight time lines.

We have continued to have concerns about the need for the complainant s evidence to be corroborated before the Scheme can find the complaint substantiated. Several complainants have provided detailed information including photographs of injuries to their relatives, and remain unsatisfied when the complaint can not be upheld.

We are working through the aged care provider and their consultant to have the ongoing issues addressed in a situation which has remained of concern for over 32 months. We also attended a consultation with the Aged Care Commissioner at which complainants raised these concerns which need to be addressed in any review of the Scheme.

We have had referrals from, and been able to make referrals for legal help to the Senior Rights Victoria Service, established in June 2008. The service, (funded by the Victorian Government) provides an Older Persons Legal Centre, and is focused on elder abuse prevention, including advocacy for people in the community.


One of the major trends emerging in advocacy this year has been an increase in restriction of family members visiting residents, or situations where one family member places restrictions on other siblings or friends of the resident.

We have identified a major lack of knowledge on the part of aged care staff and providers in most of these situations, related to who has the legal authority to order such restrictions.

We have continued to clarify the specific obligations of Powers of Attorney, and the distinction between these and Guardianship, and will look at producing new fact sheets and education on these matters to ensure the rights of residents are respected.

We have also had ongoing cases from CACP and EACH clients who wish to manage their own (or family member s) care, due to the stress involved in negotiating matters with providers. This issue of self managed care is one we have raised with the Minister for Ageing, Justine Elliott, and we will continue to follow up at a policy and individual level.

One issue not showing in the data previously was the number of visits to homes for advocacy which we are now capturing in our data information. These visits for case discussions increase our presence in the home, and our ability to discuss issues of residents rights.

Cases requiring the most length of time either involve CIS interaction, or those in which we are negotiating with a large organisation on complex issues. Some of these during the year have involved CACP and EACH clients, with the complexity due to the general lack of clarity in agreements and the lack of transparency and benchmarking in the funding available for care.

Many clients have not in fact been given copies of their agreement as required, only a care plan document, and gaining access to details of funding allocated to their care has been problematic. It is clear when we ask for information that some providers do not have good systems for showing costs and the allocation of care hours, and also try to reduce hours arbitrarily.

These issues arise even when the client s need for care hours has not increased or changed. They appear to be based on providers stating they cannot stay within budget, even though they have agreed to provide the services in the written agreement with the client. In these situations the power imbalance between care recipient and provider is worse, as the person faces the threat of residential placement if care is withdrawn. We are assisting people who wish to take these matters to the Complaints Investigation Scheme, as well as raising these issues at a policy level with the Department of Health and Ageing.


MORE EXAMPLES OF ISSUES ADVOCATES DEALT WITH IN 2007 2008

Bill s Story We received a call from Bill s daughter, about her father who lives in an aged care home. Bill has Alzheimer s and, over a period of five weeks was moved three times between a hospital and two different facilities. He found these changes very distressing and his behaviour reflected this so he was prescribed a combination of anti-psychotic medications, Risperidone, Haloperidol and Avanza. Upon entering permanent care Bill s family informed the facility of the practical methods they had been using before his hospitalisation to successfully help their father feel more at ease and to lessen his agitation. As Bill has Macular Degeneration in his left eye, it was important that he be approached from the right hand side to avoid him responding with agitation. Football videos, family photographs and favourite food all helped to settle his mood and minimize his confusion.

The family made repeated requests to the Director of Nursing (DON), for the anti-psychotic medication combination to be discontinued as they could clearly see a decline in their father s condition and an increase in his hallucinations, level of agitation and frequency of falls. The advocate discussed Bill s rights and how the family should be involved in his care through consultation with the staff (and GP) about his needs including medications. With this information, Bill s daughter was able to approach the staff to raise further concerns, and was advised that the advocate could attend a meeting if requested. Senior staff at the facility reassured the family that they knew what they were doing and that the family should not worry .

Six weeks after Bill went into permanent care his daughter received a phone call from the DON who told her to take a deep breath and brace yourself . Bill had thrown a chair through a window, no-one was injured but he was now locked in the courtyard for everyone s safety. An ambulance had been called and Bill was going to be taken to the nearest psychiatric unit. When the ambulance arrived the officers refused to transport Bill without a Division 1 nurse accompanying him due to his being so heavily sedated. On arrival at the Psychiatric unit the Haloperidol and Avanza were immediately ceased.

Support was provided to Bill s daughter at a meeting held at the psychiatric unit. Following discussion with the family and review of his medication, Bill returned to the facility three weeks later with an updated behaviour management plan and no anti psychotic medications. Bill then settled in again safely, with staff using the strategies identified.


Understanding Cultural Needs Anna was a 78 year old European woman who had been living in a nursing home for about six months. She only knew a few words of English. The move to residential care had been very unsettling for her. She had had a leg amputated and had limited use of one arm. She also had dementia.

Anna s family was very concerned because the nursing home had told them that the resident had to move to a psychogeriatric facility due to her incessant calling out and singing in her own language. A few residents claimed they were disturbed by the noise. Staff often used sedating medication which the family said turned the resident into a zombie . The family did not want Anna moved, as the nearest psychogeriatric facility was many kilometres away and moving there would result in Anna s husband no longer being able to visit her regularly.

The advocate attended a meeting at the facility with the family, the Director of Nursing (DON), a psychogeriatrician and a social worker, to discuss Anna s needs and her care plan. It became clear that not all staff followed the resident s continence management plan, and behaviour management plan, and they did not always spend time attending to her social or emotional needs. Because of her calling out, staff left the resident in her room for most of the time. The DON said that staff were too busy to implement the behaviour management plan.

It became clear that neither the psychogeriatrician nor the social worker agreed with the proposed need for a move to a psychogeriatric facility, and in fact felt that the resident was capable of being cared for in a generic nursing home. They were also critical of what they saw as the inappropriate use of chemical restraint. The advocate discussed the resident s security of tenure rights and her right to have the agreed care plan followed. An action plan was negotiated, including:

A review of the resident s care plan and medication in consultation with her GP and the psychogeriatrician.

A commitment from the DON to obtain training for staff in relation to residents with dementia, particularly those from a different cultural and language background.

A commitment from the DON that she would ensure staff followed the care plan and the behaviour management plan.

After a few weeks, the family reported that all chemical restraint had been stopped, that staff were responding to the resident s requests to be taken to the toilet, and were spending more time with the resident and had learned a few Hungarian words. Staff also wheeled her into a common area where she could see other residents and the garden. They reported that the resident was much less anxious and that her calling out had diminished significantly.


John s Story John was a resident living in a nursing home and suffering from dementia, who frequently became agitated, with staff responding to this agitation by giving him Haloperidol. John s daughter told the advocate that her father mostly became agitated when he needed to go to the toilet and staff did not respond to his buzzer, or if they did respond, they told him he had to wait as they were too busy to take him to the toilet. He then became wet or soiled and felt demeaned. All of this triggered the agitation. On several occasions, the daughter arrived at the facility to find her father completely saturated and agitated, and with staff about to give him Haloperidol. At other times it was clear that John became agitated when he was in pain and staff did not respond to his requests for pain relief, or if they did respond, they took a long time to get him any analgesia.

The advocate spoke with the Director of Nursing (DON) and said that the resident s daughter was very concerned about the adverse impact the situation was having on her father s physical and mental health. The advocate stated that she felt the facility s failure to adequately meet the resident s care needs was a form of abuse. The DON said she had not realised the severity of the problem and that the RN had reported to her that the Haloperidol was necessary .

The DON acknowledged that failing to respond to the resident s requests for toileting or pain relief was unacceptable and agreed to investigate the matters herself. The daughter also decided to change her father s GP and the new GP withdrew the Haloperidol after reviewing the resident. Following her investigation of the concerns, the DON discussed the new care plan with the advocate and John s daughter to ensure his needs were met.


GOAL 2: INFORMATION AND NETWORKS

Goal: To provide accurate and accessible information on aged care, quality and consumer rights.

We have adopted several strategies this year to promote our information and education sessions to homes with a general mail out of information and promotion to all Victorian facilities, plus a second targeted mail out in the eastern suburbs (97 homes), and informal visits to facilities. This has been a successful way to plan information sessions and ensure information about consumer rights and advocacy is widely available.

We also attended a large industry expo with over 2000 attendees to promote our service to aged care providers, staff and students working in aged care.

Continued promotion of service through information distribution (17,887 items) and delivery of advocacy to clients.

Our website enquiries have increased, with 132,121 hits.

Promotion to CALD clients continued with 780 NACAP leaflets in other languages distributed and 88 Cultural Care Kits sold to aged care homes for staff. Education sessions to CALD groups continued, including rural multicultural providers.

On telephone information requests we provided information to 3 ATSIC clients, 181 CALD enquirers, 26 younger people with disabilities, 88 with other disabilities, and 306 on behalf of people living with dementia.

Promotion of service to CACP clients in education sessions.

Information strategy continued see Figure 11 below.

Information Product No. distributed in 2007 2008

NACAP Leaflet 11,529 NACAP Leaflet in other languages 780 Cultural Care Kit 88 It s Your Right: Living In An Aged Care Facility 1,670 Rights In Practice: Working In An Aged Care Facility 573 Fact Sheets 616 Charter of Residents Rights and Responsibilities and other DH&AC information

2,631

Total 17,887

Figure 11: Information products distributed in 2007 2008

Provided information to 1,366 enquirers in 2007 2008. This included the distribution of 17,887 items of printed information products and Cultural Care Kits.


GOAL 3: EDUCATION AND TRAINING

Goal: to provide quality education and training on consumer rights and quality improvement to consumers and staff of aged care.

We have provided advocacy support to residents in a number of facilities facing closure or sanctions during the year. Both of these events are distressing for residents and families, with concerns about the continuity of care in both situations.

We have also continued to focus intensively on education outreach as required by our performance indicators, although we remain somewhat under resourced to reach the absolute target of homes to be visited. We have achieved 121 resident sessions and 64 of staff education sessions, with approximately a quarter of all sessions in rural areas. Informal visits for six months totalled 18, and systemic education including seminars to industry groups totalled 26 with attendance of 389 staff and 73 consumers at these sessions. These sessions include presentations to ACAS, PGATS and elder abuse prevention presentations arranged by us with several homes attending.

While these systemic education sessions are not in our performance targets, they are a vital part of industry education as we frequently have clients referred by both groups when they are facing security of tenure issues. Other education on abuse prevention for aged care staff is a part of our proactive strategy to protect residents rights. These sessions are provided on request from aged care homes or groups of homes, often involving larger numbers of their staff (recently 40+ staff in a regional town).

All sessions are evaluated and we collect data on homes visited and numbers of staff attending. We would usually plan visits to several homes in the regional/rural areas of the state when we are out and about for education sessions, as well as doing informal visits to other homes on the way. We continue to believe such education should be part of our performance targets due to the value it has in protecting residents rights and the follow up calls and referrals for resident advocacy we receive from staff.

Provided 204 education and information visits state wide in 20072008.

Participants included:

Residents and potential residents 2,368

Family carers 240

Allied health professionals 2

Industry / staff 712

Other community or government organisations 10

Others, including students 12

See Appendix 1 for list of venues for education and information activities in 2007 2008.


Note: approximately 20% of advocacy clients are from rural areas, following on our education sessions and promotion as reported above.

Consumer/family education sessions continued with 2,608 participants, 80% in metro and 20% rural areas.

Education for aged care staff continued with 712 staff attendees in sessions with a similar split between metro/rural regional areas.

Our education QA survey results show high satisfaction with our presentations, 90 97% on most questions.

We have continued to target special needs groups, with nine CALD facilities visited for education to June. Further targeted visits are planned for the coming year.

We have also provided education sessions at a number of homes providing care to people who had been homeless, or from extremely disadvantaged backgrounds and who have no family, or limited contact with family members (e.g. Wintringham, Corpus Christi, and Brotherhood of St Laurence clients.) This group of providers are often very proactive in contacting us on behalf of residents to ensure their rights are upheld, and we have been able to work with them to ensure good outcomes for residents.

Education sessions with APAT and ACAS staff in various areas of Victoria.

Participation in education seminars for industry staff, with industry legal advisors.

Carer respite centre forums with CACP clients and carers.

Education in rural area for CACP staff.

Various CALD groups education sessions (including Chinese).

We tried several strategies to promote our education sessions to homes with a general mail out to all facilities, plus a targeted mail out in the eastern suburbs (97 homes), informal visits and cold calling of homes.

We also presented at a large seminar (260 attendees) for diversional therapists with a focus on residents rights.

Rural Visits

South West Victoria A mid year education trip to south west Victoria proved to be very enjoyable for the advocate and was very well received by all who attended. The trip began in Geelong and looped back to Melbourne via Casterton near the SA border, with many facilities visited.

Residents and staff were happy to discuss issues and seek advice from the advocate. Many residents expressed their satisfaction with the services they received, while a few commented on the issue of privacy. They felt this was a problem associated with living in a small community where staff, residents and family members had known each other for years. Other residents however spoke of feeling like valued members of the wider community, as they were still able to participate in local events like a recent fund raiser for farmers who lived in other not so lucky areas of Victoria.


OUT AND ABOUT WITH RESIDENTS


GOAL 4: POLICY AND NETWORKING

Goal: To promote continuous improvement in aged care quality by identifying and presenting systemic policy issues arising from advocacy information and education strategies.

Other systemic work included:

Attended a meeting with the Minister for Aged Care, Justine Elliott, on behalf of National Aged Care Advocacy Program.

Researched and provided written aged care information for the Fitzroy Legal Manual.

Key stakeholders alliances continued and developed with participation in working groups, including Department of Human Services working groups and the Elder Abuse Prevention Working Group.

We have been part of The Wicking Project, auspiced by Wintringham Aged Care, piloting a model of aged care services for clients with acquired brain injury who would not normally be able to find aged care placement.

Consultation with the Project Officer of the People from Ethnic Backgrounds in Commonwealth Funded Residential Care report, auspiced by Australian Polish Community Services.

Attendance at conference of the Australian Network for the Prevention of Elder Abuse.

Consultation on a Phd thesis on Elder Abuse Policy in Australia written by Assoc Professor Gerry Naughtin

Consultation on Elder Residents and The Law, written by Rob Philips and funded by Victoria Law Foundation.

Membership of the Australian Centre for Evidence Based Aged Care (ACEBAC) board.

Membership of Alzheimer s Australia (Vic) board.

Continued updating for new reporting format for 2007/08 including discussion of new performance framework and review of data coding with all staff to ensure consistency.

Continued teleconference with NACAP managers, and with DH&AC central office to improve program consistency.

Meeting with DH&AC state office managers re changes to CRS and program issues.


GOAL 5: MANAGEMENT AND PLANNING

Goal: To provide efficient and effective management to ensure quality service delivery and provide a secure and stable financial base for the service.

Our increased focus and time on education and travel has provided some challenges this year, due partly to time (and staff) constraints. We do however enjoy the opportunity to be out and about in regional and rural areas particularly, meeting residents, families and staff. These trips are generally planned for 1 2 nights, with several facilities booking education sessions over a 2 3 day period. This increased focus on education involves all ERA staff in planning delivering and evaluating education, with four advocates involved in delivering sessions, including one part time staff member for four days per week. (See attached list of areas visited during the year.)

Achieving this level of travel and education, while maintaining a response to advocacy requests, given our changes to staff and some extended staff illness (covering 14 weeks over the period), has been a major outcome for the year.

We faced major staffing changes during the period with the resignation of a long standing advocate (of 12 years service) in October 2007. Our policy of employing an Intake Advocate in the past two years has, however, given us the opportunity to appoint internally into the position. Ongoing funding levels to cover our operations at the level of service delivery required also remains a challenge, with our budget in deficit at the end of the year.

We have continued to provide relevant training for advocates (some with a CALD focus) during the year. All advocates attend the Aged Care Standards and Accreditation Agency s Better Practice event each year, which provides an update on innovative practice issues in aged care.

Our Committee members are a highly valued group who contribute to the strategic direction of the organisation, as well as becoming involved in policy input, both internally and in the wider aged care sector. All of them are volunteers, who contribute their time to promote the rights and needs of others in the community and we thank them for their support of the organisation and staff during this year. Several of our Committee members, Sue Healy, Olive Paice and George Rozensteins, have been with the organisation for over ten years. Sue for much of that time has served as President, Olive bringing the residents perspective to our meetings, and George has been with us since our inception in 1990, great contributions which have been appreciated by all of us.


APPENDIX 1: VENUES FOR EDUCATION AND INFORMATION VISITS IN 2007 2008

Abberfield Aged Care Facility, Sandringham

Alawara Retirement Village, Bendigo

Alawarra Lodge Inala Village, Blackburn South

Alexandra House, Bendigo

Altona Meadows Aged Care Facility

Amaroo Lodge, Euroa

Amberlea Aged Care Facility, Drouin

Amity at Newcomb

Amity at Sunshine

Amity at Windsor

Anzac Hostel, Brighton

Armitage House, Wonthaggi

Ashby, Lower Templestowe

Ashley Terrace Aged Care Facility, Reservoir

Avonlea Grange Hostel, Mentone

Ballan & District Soldiers' Memorial Bush Nursing Home and Hostel

Baptist Village Baxter, Frankston South

Bayside Hostel, Mordialloc

Bellhaven Hostel, Preston

Belvedere Aged Care, Noble Park

Benetas St John's Park, Mooroolbark

Benetas Gladswood Lodge, West Brunswick

Benetas St Laurence Court Hostel, Eaglehawk

Bridgewater Aged Care Facility, Roxburgh Park

Brighton Gardens Aged Care Facility

Brookfield Park Aged Care Facility, Traralgon

Burwood Hill Aged Care Facility, Burwood

Cabrini Residential Care, Ashwood

Canterbury Private Nursing Home

Claremont Home Inc., South Melbourne

Clevedon Terrace Hostel, Heidelberg

Clovelly Cottage, Boronia

Coronella Retirement Village, Nunawading

Corpus Christi Community, Greenvale

Crossard Court, Cowes

Cumberland View Hostel, Wheelers Hill

Darley House, Heidelberg

Domain By The Bay, Mt Martha

Doncaster Melaleuca Lodge

Dowell Court Hostel, Ivanhoe East

Edgarley Home, Casterton

Emmy Monash Home, Caulfield North

Eventide Lutheran Homes, Hamilton

Fairway Hostel, Sandringham

Fernhill Mercy Hostel, Sandringham

Footscray Aged Care

Fred Combridge House, Northcote

Fronditha CACPs, Templestowe

Fronditha Clayton Aged Care, Clayton South

Fronditha Thalpora Aged Care Services, St Albans

Glen Waverley Nursing Home

Glendale Aged Care Facility, Werribee

Glenlyn Aged Care Facility, Glenroy

Good Shepherd Aged Care Services Inc., Abbotsford


Gracecourt Hostel, Kew

Graceland Manor, Elsternwick

Grandridge Lodge, Mirboo North

Hallam Private Nursing Home

Harbourside Lodge, Portland

Hazeldean Nursing Home, Williamstown

Heywood Rural Health

Hilltop Aged Care Facility, Preston

Homewood Residential Care, Hallam

Isomer Retirement Home, Lysterfield

Jack Lonsdale Lodge, Sebastopol

Karingal Centre, Belmont

Kelaston, Wendouree

Kingston Gardens Aged Care, Springvale South

Kirkbrae Kilsyth Hostel

Knoxville Hostel, Knoxfield

Latrobe Regional Hospital Nursing Home, Traralgon

Latrobe Valley Village Hostel, Moe

Leopold Lodge, Leopold

Lexington Gardens, Springvale

Lovell House Hostel, Caulfield North

Lynbrook Aged Care Facility, Lynbrook

Lynch's Bridge Aged Care Facility, Kensington

Margery Cole Aged Care Facility, Traralgon

Mark & Dina Munzer Community Residence, Caulfield North

Maryville Nursing Home, Geelong

Melaleuca Lodge, Cowes

Mother Romana Home, Kew

Nazareth House Hostel, Camberwell

Neerim District Soldiers Memorial Hospital Nursing Home

Noel Miller Centre, Glen Iris

North Western District Private Nursing Home, Tullamarine

Northern Gardens Aged Care Facility, Coburg North

O'Mara House Aged Care Facility, Traralgon

On Luck Chinese Nursing Home, Donvale

Ottoman Village Aged Care, Broadmeadows

Providence Hostel, Bacchus Marsh

Ranelagh Gardens, Mt Eliza

Ravenswood Aged Care Facility, Reservoir

Reg Geary House, Melton

Regis Sandringham Gardens

Regis Shelton Manor, Frankston

Regis Waverley Gardens, Dandenong North

Rice Village Nursing Home and Hostel, Marshall

Riddell Gardens Aged Care Facility, Sunbury

Rochester Hostel

Ron Conn Nursing Home, Avondale Heights

Rose Lodge, Wonthaggi

Ruckers Hill Aged Care Facility, Northcote

Sacred Heart Homes Avonsleigh Terrace Community, St Kilda

Samarinda Lodge, Ashburton

Sambell Lodge, Clifton Hill

Sea Views Manor, Ocean Grove

Sherbrooke Private Nursing Home, Upper Ferntree Gully

Siesta Private Nursing Home, Moorabbin

Sir Eric Pearce Aged Care Facility, Richmond


Sir William Hall Hostel, Heidelberg West

South Port Community Residential Home, Albert Park

Springvale Private Nursing Home, Springvale

Springvale Residential Centre, Springvale South

St Catherine's Nursing Home and Hostel, Balwyn

St Joseph's Hostel, Hawthorn

St Joseph's Nursing Home and Hostel, Northcote

St Leigh Private Nursing Home, Sandringham

Strathdon Community, Forest Hill

Sumner House, Fitzroy

Sunrise Private Nursing Home, Mulgrave

Sutton Park Assisted Aged Care, Melton

Tannoch Brae Hostel, St Albans Park

Tarcoola Residential Aged Care Service, Shepparton

Templestowe Grange

The Excelsior Aged Care Facility, Shepparton

The Homestead Nursing Home, Wallington

Trewint Nursing Home, Noble Park

Trinity Garden Aged Care, Melton

Twin Parks Aged Care Facility, Reservoir

United Aged Care 75 Thames Street, Box Hill

United Aged Care Condare Court, Camberwell

Uniting Aged Care Kalkee Community, Belmont

Uniting Aged Care Strathdon Community, Forest Hill

Victoria Manor, Coolaroo

Viewhills Manor, Endeavour Hills

Waratah Lodge, Sandringham

Warrawee Community, East Bentleigh

Wattle Lodge, Brighton

Western Gardens Aged Care Facility, Sunshine

Whittlesea Lodge

Willowbrae Melton

Woodleigh Aged Care Facility, Preston

Wyndham Lodge Community Aged Care, Werribee

Yarralee Residential Aged Care Facility, Kew

APPENDIX 2: AUDITED FINANCIAL REPORTS 2007 2008

RESIDENTIAL CARE RIGHTS INCORPORATED

FINANCIAL REPORT FOR THE YEAR ENDED

30 JUNE 2008

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