Providers could be required to comply with a single standard around the use of technology – with sanctions for noncompliance and tougher restrictions on becoming an approved provider and being awarded new bed licenses – if the ideas from the workshop’s first panel discussion on technology and innovation in aged care are taken up by the Commissioners.
For over an hour-and-a-half of what Commissioner Tony Pagone labelled an “extraordinary session”, Counsel Assisting Erin Hill questioned the panel – Professor Sue Gordon (pictured above right), a physiotherapist and Strategic Professor and Chair of Restorative Care in Ageing at Flinders University; Jennene Buckley (pictured above left), the CEO of Feros Care; Dr Tanya Petrovich (pictured below right), the Business Innovation Manager at Dementia Australia’s Centre for Dementia Learning; and Daniella Greenwood (pictured below left), an aged care consultant with her own business Daniella Greenwood & Associates – around a range of issues.
The panel agreed technology has its benefits in aged care, but is often not designed to meet the user’s needs – whether residents or staff – and is a challenge to fund under the current financial pressures.
Ms Buckley – who is also a board member of the aged care industry IT council and a member of Bond University’s health care innovation advisory board – says while technology is widely used throughout Feros Care’s community programs, there is little use in their three residential facilities (they still do handwritten care notes, for example) because managers and staff don’t have the time to engage with technology.
“Funding is very tight and they are just focused on getting through their day at the moment,” she said.
She had support from Prof Gordon who argued there needs to be measures to incentivise providers to incorporate technology into their facilities.
“We’re talking about a sector where 51 per cent of aged care providers are in the red,” she explained. “So there needs to be support to basically incorporate anything.”
The panel also pointed out that technology doesn’t always produce better outcomes – Dr Petrovich noted that the Billy app can detect that a fridge door has been opened, but can’t tell if a meal has been eaten, for example, while Ms Greenwood used the example of sensor mats.
“We have had sensor mats for over 20 years and still staff have difficulty attaching those to the phone and then answering it,” she noted.
All agreed that co-designing new technologies with the user – including older people and staff – was the key to ensuring their success as well as education and training to equip both groups with digital literacy.
It was clear that the Commissioners were open to ideas on how to make this happen.
“Technology have been useful,” Commissioner Tony Pagone summed up. “Is it always? Has its limitations. Sometimes good ideas don’t get picked up, can’t get picked up and there are all sorts of problems. What do you think we should do?”
Ms Buckley agreed a standard would help in the future, but said there needs to be an understanding of how providers are using technology, for example, how many are still relying on paper-based systems, and the digital literacy of staff – and how it could be funded – first.
“We need to make sure the funding model and the pricing model of all aged care services allows an organisation to invest in technology and to invest in quality and we were lucky as an organisation in that, you know, that we have, our board has supported us to use reserves to build our technology capability. We still have some work to do in residential care in relation to client management systems but if you asked me today could I afford to invest this amount of money, if I had to start today my answer would be no, that the funding models at the moment and the pricing models of care does not allow us to innovate.”
Dr Petrovich had a simpler answer: ban nurses’ stations.
“That will go down well,” quipped Commissioner Pagone, to some laughter.
Dr Petrovich explained that she believes there is a mindset in aged care that is just not open enough to innovation.
“There are lots of solutions currently that you could use so that you do not need a nurse’s station and there are some providers who are actually going that way already,” she said. “But I think that the industry as a whole in general is risk averse and is not open to innovation in residential aged care.”
While Dr Petrovich conceded there are financial restraints, she also argued there are many innovations that don’t require a lot of investment.
Prof Gordon chimed in that this needed to be linked to prioritisation for funding, saying that Flinders had tried to apply for funding for a Cooperative Research Centre (CRC) for aged care three years ago, but missed out because the sector is ‘poor’.
“One of the main reasons we missed out was that we didn’t have enough industry money to support what we wanted to do because the industry that we work with is not rich. And we were up against energy and transport companies,” she said. “So, I think we need to take a look at all of the research, bring it together. We then need the industry to really lead what the priorities are and then we do need some solid money that sits behind doing some decent evaluations of scaleable and … interventions.”
Commissioner Pagone had one answer to this: the sector’s own research body.
“Is a solution to for us to recommend the establishment of some research body or think-tank?” he asked. “Is that a desirable thing or not a desirable thing?”
Prof Gordon agreed it could solve some of the common problems across the sector.
“I think a model like a CRC will work. But a CRC is a funded for different priorities would be how I would describe it currently,” she said.
Commissioner Lynelle Briggs did not accept that these problems were hard to solve however – and she blamed the culture and leadership in the sector for the current lack of technological take-up.
“I think all of those things are solvable,” she said.” So much of this is a cultural issue and it’s a motivational and leadership issue. We heard from Ms Petrovich about get rid of the nurses’ station, force people on their feet. Hospitals these days are using technology all the time. It’s a fundamental piece of equipment. Why is it that nurses in nursing homes or personal care workers in nursing homes don’t see this as a fundamental piece of your tools to do your job in the same way that they would see taking a temperature or recording what medications somebody has had?”
Dr Petrovich said her research shows care staff are more comfortable with their mobile phones than computers – so they are developing technology to suit, while Ms Buckley said there is a range of technology that can be used.
That led to the Commissioner to another question – if providers need to be made to improve their take-up of technology.
“Sometimes there’s a need for a bit of a nudge, meaning well, mum, have you thought about if we book our tickets for the movies online, we will get a seat rather than go in there and not get a seat,” she used as an example. “Stuff like that. In the workforce, a bit of a nudge to do something that really should be done as a necessary part of improving the quality of care, is that reasonable?”
Ms Buckley agreed there was room for a ‘nudge’ – but also gave the Commissioner a dose of the current financial reality for providers, using the list of technologies expected in an aged care facility that the aged care IT council included in its submission.
“They are suggesting that for an aged care organisation with 500 employees they’re estimating 25 to 50 million dollars spent of technology over five years, when you start to look at the systems you need to run your business, to meet the Quality Standards, the technology you put in the hands of the clients and the staff, it is quite a significant investment,” she pointed out. “And if you look at training, we are a small, three small residential aged care facilities, 180 staff, … two-hour training session just one training session would certainly be around $10,000. So if you are already making losses, and viability is an issue, just one training session is a lot to ask. So I think we need to think about understanding the true cost of operating an aged care business and make sure that funding is appropriate for them to be able to train and innovate and build capacity. I think it’s an issue that needs to be looked at more clearly.”
Commissioner Briggs (pictured above right) wouldn’t accept this argument however – implying it’s time for the sector to accept it is no longer a cottage industry.
“That’s a really good point,” she said. “When does the aged care industry realise it’s a big industry? If you have got 200 staff, that’s a big organisation and we see many of these. There are many smaller than that, but these days, if you are running any other business, you would be properly IT enabled.”
Again, the Feros Care CEO dished out some home truths.
“Absolutely,” she said, but qualified: “Can I say that with our home care package experience, there has been, I guess, criticism from media, from consumers, from politicians, in relation to the administration charges of home care packages and even charging a 10 per cent administration fee is frowned upon or has been frowned upon. The true cost of operating a business requires more than 10 per cent administration fee. For example, Deloitte’s had said that the average investment in business for technology is over 3 per cent and innovative organisations spend 7 per cent of their income just on technology innovation. We couldn't possibly do that with a 10 per cent admin fee. I think we need to understand that there’s a cost to running a business and we need to, the pricing needs to be much more mature and it needs to acknowledge that we want to be an aged care industry that can be innovative, that meets standards, more than meets standards and that we want to be innovative and provide a quality service. And that’s really does come at a price.”
Prof Gordon did have an idea for where the Commissioners could start: the aged care technology roadmap released in 2017 which (unsurprisingly) has yet to have been taken up.
“When you go back to the recommendations about digital literacy of the workforce, digital literacy of consumers, codesign, coproduction, it's all there,” she said. “So, I think actually going back to that document and taking it on board and looking at how we implement it across the whole sector would be a real positive step.”
This would need to be spearheaded by a partnership between the sector and Government as well as technology and consumer advocacy groups, she added.
“Isn't it also that it has got to be clear to the IT industry that the sector is open for business?” Commissioner Briggs replied, adding another prerequisite.
“I mean, you know, we can all start within each of our organisations building our own pieces of technology and invariably we fail because we are not experts at technology, they are,” she stated. “So, the technology industry has to embrace the opportunity and engage with organisations like the council or a CRC or whatever to actually make this stuff happen and when they do that, it seems to happen pretty quickly, in my experience. Yes or no, you’re going to say that's right.”
Dr Petrovich agreed the Government needs to provide guidelines for providers, using the example of providers who have successfully been using My Health Record to document residents’ medical records.
The Counsel Assisting also quizzed the panel on whether there should be a requirement for providers to share the outcomes of their individual research.
Ms Buckley and Prof Gordon agreed, the latter making mention of Care Search, an online site that brings together research on palliative care for everyone to access.
Ms Hill also enquired whether there should be sanctions imposed on providers if a standard on technology was introduced into the Quality Standards.
“I think it’s just 2020 and I think there should be no licenses given to people who don’t commit to a technology plan, saying this is how we are going to keep records,” Ms Greenwood said approvingly.
She then went one step further, suggesting providers only be approved if they build dementia-friendly homes.
“Why would you give a license to someone, why are we still giving licenses to people who are going to build areas for people living with dementia that we know they’re going to get distressed in?”
Ms Buckley agreed sanctions could be reasonable in the future – but repeated her argument that it couldn’t be the first step given the current financial pressures in the sector.
The Counsel Assisting also put Ms Greenwood’s idea of tighter restrictions for approved providers around technology on the table.
Again, Ms Buckley said there could be a more rigorous process, but questioned how this could implemented on a practical level.
“Our residential facilities they don’t have a sophisticated client management system, they use technology in our quality systems and our reporting systems and smart technologies and sensors but they provide a wonderful service,” she said. “So, it’s not just about technical if you have technology you are not providing a wonderful care and support. So, I don't think it’s one or the other. So, I would be careful if you don’t have that technology you are not providing the best care for our residents, that doesn’t make sense to me.”
Prof Gordon supported this argument, adding that some providers have facilities that are 50 years old which contributes to the challenges of incorporating technology as well as providing best practice care.
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