The New Zealand Council of Christian Social Services (NZCCSS) represents services for older people provided by six churches – Anglican, Baptist, Catholic, Presbyterian, Methodist and Salvation Army. These deliver social services at over 500 sites throughout the country – not only for older people but also child and family services, housing, addiction, community development and employment services.
The NZCCSS conference in Auckland this month focussed on services for older people and took as its theme Valuing People- Living Well. The majority of the 100 participants were on-the-ground workers in residential and home care, plus representatives of sponsors and the odd out-of-scope attendee, such as myself.
It was an opportunity to hear from a very wide range of presenters, including the CEO of the Warehouse Group, the government’s Chief Science Advisor, DHB and care service managers and a representation of researchers. There were learnings for everyone – managing a care workforce and ensuring that every worker is well trained; innovations in dementia care; use of technology to maintain independence; medication safety; advanced care planning and palliative care; working with a culturally diverse population. And that is not an exhaustive list.
Two sessions especially caught my eye. Two women with extensive experience in the aged care sector talked about interRAI – Experiences of the benefits and challenges from a residential and community provider perspective. I have written about interRAI previously in this blog so I was interested in the grass-roots experience. It was somewhat sobering. Once back from interRAI training, “real” world challenges soon became evident. Initial and ongoing assessments of individual clients are time-consuming (up to six hours for an initial assessment needed within three days of admission, and even a re-assessment taking 3-4 hours). In the real world there are shortages of trained registered nurses and high workloads. In one facility there had been several trained RNs but all but one left at the same time, leaving all the interRAI work to one person and no training places available for several months. The demands made on RNs led one to wear a “DO NOT DISTURB” notice while doing assessments, as all interruptions prolonged the process. Another facility introduced “off the floor” days for nurses to catch up on assessment work, putting pressure on rosters. There were also complaints where facilities had their own assessment systems which they felt were working well and which GPs were used to.
But there was also recognition of the benefits of interRAI. Standardisation of data on the aged care service is beneficial. It is comprehensive and makes it easier to create better care plans. “I like the concept, but it is hard to keep up to date” said one speaker. “I have not heard of anyone getting it (interRAI) all right without sacrificing care” said someone from the floor. Will interRAI achieve its potential when everyone is trained and everything is up to date? That was a question left hanging.
Another new idea in the social services field is individualised funding. This already operates in the disability area through Presbyterian Support (Enliven) Northern. It is being introduced in home care for older people on a pilot basis by Presbyterian Support Otago, working with the Southern DHB. This system gives individuals control over funding for services as assessed by a NASC (needs assessment service coordination agency). Enliven can help develop plans and budgets and provide support with paperwork. In effect the client (plus family members if appropriate) becomes the employer of their care workers with the responsibilities of employers. Individualised funding gives people more choice about how they are supported in the community – more control and autonomy. It can be especially appropriate for people living remotely, or with special cultural considerations. Greater self-management reduces the cost and makes the care funds go further. This approach is used in several countries overseas, but is very small scale in New Zealand and probably daunting for many people.
I have not mentioned the contribution to the conference from the authors of a CCSS research project also entitled Valuing Lives – Living Well. This tried to assess the special “edge” which faith-based services bring to aged care. I will leave that for another time.