It is no secret that the Aged Care Industry is in a state of flux.
Post The Royal Commission’s final report into Aged Care Quality and Safety, and in the midst of a global pandemic, the challenges facing the industry seem to be compounding, rather than getting better. So what is the solution?
Let’s jump into the conversation between Adjunct Professor Kylie Ward FACN, CEO of the Australian College of Nursing, and our own Graham Russell as they share their insights into the future of Aged Care and how technology can help us build a genuinely people-centric system.
Graham Russell:
My name is Graham Russell. I’m the Managing Director of HSC Technology Group. We are an ASX-listed technology company that provides assistive services and technology solutions to the aged care sector.
Today, I’m very excited to welcome a special guest. I’m not going to do her any justice. But she’s originally a nurse and has done a master’s degree. She is now an Adjunct Professor, she is also the current CEO of the Australian College of Nursing. And she also has been an advisor to a number of government departments, not just locally, she’s worked with the Royal Commission and so forth. And we’re very fortunate to have Kylie Ward joining us today to talk around about some of the challenges we’re facing in the aged care sector. Oh, hi, Kylie, how are you?
Kylie Ward:
Good, Graham. Thanks for that introduction. It’s a pleasure to be here.
Graham Russell:
The aged care is obviously in the press every day. And you’re right across and working across all the sectors. And I know it’s a big question. But I’d like to ask, you know, what do you feel is the biggest challenge now currently facing the aged care industry? And you know, what do you think that we can do about it?
Kylie Ward:
Yeah, you are starting off with the big questions. There are so many challenges facing the aged care sector, I think, first and foremost, we’ve got an informed consumer. I think that the world has changed from you know, 50 and 100 years ago, where people who are becoming older, Australians are expecting more, they’ve got more access to technology and information. And I think that they want to age and grow older in a different way to perhaps what we’re used to. And I’m not sure that the sector has kept up. And certainly, years ago, when the sector shifted from a clinical model of care to a social model of care, they stripped out all of the essences of the medical but particularly nursing profession, but didn’t really understand the complexities and comorbidities of why people went into residential aged care facilities.
And Graham, I’ll start by saying that residential aged care facilities used to be called nursing homes. And that’s because they were always staffed by nurses and people required a certain level of nursing, as well as all of the lifestyle elements of where they needed to live. So you know, we’ve got not enough staff, we’ve got the care delivery not meeting expectations, we’ve got under-resourcing not only in the human resource component, but financially.
And I think as Australia, as a leading first-world nation, we need to rectify this urgently and we need to allow people to grow older, whether it’s in their home or in a facility with dignity and grace, and provide them the care that they deserve with increasing vulnerabilities and comorbidities.
Graham Russell:
And Kylie, I concur as that I found exactly the same thing, like being in the space, sort of, I suppose, on the tools with the technology on the ground is that I suppose at the time it says it is your right, it was a nursing home, and I suppose initially is that there have been some positive shifts that I’ve noticed is that we’ve moved from nursing as far as patients to now as residents, which has been positive, but I didn’t say it’s gone so far as is that we don’t have that qualified nursing staff on the floors that are actually identifying some of these challenges and issues.
And so we’ve got this skill gap that and, you know, I’ve mentioned before is that I’ve seen a lot of nurses leaving the sector. And I think, you know, from what I’m seeing report-wise, is that, obviously staff engagement at an all-time low, and they’re saying is that like one in five nursing staff are looking at resigning? Because I think the average age of nursing in aged care is around at 55. Is that what you’re seeing as well?
Kylie Ward:
Yeah, the average age of a nurse, you know, a decade ago used to be 47 and then it reduced to 44. So we’re actually doing quite well because GP’s at 55, surgeons were in their 60s. So the profession as a whole is sort of around that mid-40s. But then, who’s working in aged care is, you know, a little bit of an older demographic. And Graham, you know if I may, you mentioned that I’m a registered nurse and very proud to be and certainly very proud to be the CEO of the Australian College of Nursing and so we’re always looking nationwide at the whole country and the health needs of the country wherever they need care deliberate and really, whether you’re working in the hospital’s residential aged care in the communities, the life of a nurse, or a clinician now unless you’re in maternity, or in paediatric, she will be looking after people who are at that gerontological stage of nursing. So it’s a really important area that all nurses and all clinicians understand that they need to be educated about.
But I got my first job in a nursing home, Governor Phillips Nursing Home when I was 25, which is more than half my life ago, and was a nightingale kind of, you know, residents lived there, but oh patients at the time, but they’re in that ward concept. So it’s been great to see the accommodation changes and the evolution over time. But the staffing never changed. And in fact, it deteriorated significantly, where some providers were more worried about property development and real estate rather than good clinical governance. And what that meant for nurses like myself, and even 10 years ago, I was still working, doing agency shifts in aged care to keep my skill set.
You used to be able to have strong visibility of the people that you’re caring for. And then they build these great buildings, which is fabulous, but they don’t accommodate the staffing. And so as a registered nurse, you’re walking into wings and floors and all of your residents behind closed doors. But when you’re the only registered nurse on for high acuity residents and maybe 30, or 40, but the facility has only you and there’s 100, 200 people living in those facilities, one call takes you away from the care that you need. And that’s a real challenge.
So whilst I really am pleased, and we’ve given evidence in the Royal Commission and Senate inquiries, I’m pleased to see that this government is going to implement 24/7 wonders on every shift. But that’s only an absolute baseline, that will not be enough for sustainability long term. And those people requiring care will deserve much more. But so will the nurses and the clinicians working in this space. And so, you mentioned skill and skills mix. My background was in intensive care, training. And so that served me very well in aged care that I had that high skill set to then take into the aged care sector, because you don’t have another colleague around you to bounce any ideas off.
And I think that this is one of the things that people don’t realise it’s quite isolating, it’s lonely, you’re talking to the GPS, or other professionals during the day, but they will come in and out in the care that they deliver. And maybe even at the end of their day, you’ll talk to a GP about some care, but the communication is challenging. It’s certainly why technology becomes so important and how in any role that a nurse has in aged care, they’re going to be absolutely in demand to support the residents and their families. They’ll only be staffed for the number of residents, but we will be talking to relatives and friends and loved ones. And all of that is very important and are giving everybody peace of mind. So a nurse isn’t a nurse. I think some people think that we’re portable, and we’re a numbers game, I absolutely dispute that. We need to be highly skilled and highly trained to someone early in their career couldn’t possibly be compared to somebody who’s got a wealth of experience. And that’s the challenge when one in five nurses are going it’s likely to be those with an enormous amount of experience. And that’s a huge concern for everyone.
Graham Russell:
Yeah, definitely. What’s one thing is that we saw so many recommendations out of the Royal Commission. But in particular, how the sect that really did need to implement technology. And I think that really alludes to the point that you’re making Kylie is that you’re right, we’ve moved from the patient to that more resident environment, which I’m a big fan of, you know, obviously people want their privacy. And this also improves residence safety, but it limits the level of visibility. And I think that’s where technology can play in and what we’re trying to obviously facilitate and educate the sector about it is that how we can use IoT sensors and small sensors to give some visibility of what’s actually happening for each resident, but also respecting the dignity.
So like, we don’t believe in cameras, for the very littlest things like we put, for example, a vibration sensor on the toilet. And so that helps us obviously indicate how many times the resident has been in the toilet for helps us obviously, identifying to the care teams that this resident might have a UTI or also may have been constipated. And so, you know, before we hit to a level of delirium, which is you’re saying with only one experience care nurse on staff might miss some of these things. You know, we’re just saying like, you know, we’re going 10 storeys high and three-storey blocks and all sorts of stuff. You know, that compliance piece becomes very concerning, I think, for all involved.
Kylie Ward:
Yeah, what I love about what you’re doing is, you know, nurses were highly trained, you know, we’ve all got master’s postgraduate qualifications. We’ve seen at the Australian College of Nursing, I thought that we might have were a college we graduate, you know, 10s of 1000s of postgraduate nurses in their studies, I thought that that might have decreased over the pandemic. And in fact, in some of our education streams like immunisation, we got a tenfold increase. And I was just so humbled at the ability of the nursing profession not only to step up and do their civic duty through the pandemic, but get educated at the same time to be able to deliver for the communities that they serve. So with a highly skilled, highly educated workforce, but very limited numbers, what we need is the environment to be as enabling as possible for that skilled professional.
And we know that most of the workforce at least 70% are made up of assistance or unregulated health care workers, we would like to see them regulated, because for the most part, most of them are doing a brilliant job and should be getting access to training and should be having some governance, the Royal Commission did show not every, everyone working in aged care is doing what they’re supposed to do. And it did expose the neglect that’s happening. And then those people should be on a register and shouldn’t be employed anywhere else to protect all communities.
But the importance that technology brings is that as a registered nurse, what I want for myself working in this environment and every registered nurse to be able to, I think, let me take one step back, why would somebody go into nursing as compared to any other clinical profession or any other profession that is offered in society. So those people who choose to do nursing, we go into nursing, because we want to make a difference, we want to help people probably at their most vulnerable, and we’re very driven by a life of service and caring and compassion.
So consumers expect us to be competent, that there’s nothing exceptional about tha. We should be doing our job, what makes nursing the most hope, always the most respected and highly regarded ethical profession is the extra that we give, that the extra personally that we bring to our roles to our profession. And that requires time to sit with a resident, to sit with their family to hold a hand to shed a tear, to listen to educate, to support. And in residential aged care, as in anywhere, we’re working with people who maybe have fully functioning, cognitive ability, but quite often do not. There’s cognitive impairment, dementia, there are all sorts of different elements going on. And that assessment and monitoring and maintaining as healthy a lifestyle as possible is very important, but not when you’ve got no assistive technologies to support you.
And we’ve not enough workers in aged care, we have to move to technology to be able to give us the prompts. And also working with the caregivers, they’re doing the absolute best they can but that Certificate Three training only allows so much and then so as a registered nurse or as a registered licenced professional. However, we can be supported to make sure we don’t miss anything, we provide care, that everything in the back room and the engine room is enabling us to do our jobs so that our interface of the communication that we give not only to residents and their families is paramount. The last thing anyone wants to do when they sign up and study to be a nurse is sitting at the desk doing tonnes of paperwork or being worried about what we’re missing out on.
Graham Russell:
And I think that’s part of my concern, I suppose, part that we feel, you know, we believe in what we’re doing around the purpose or we’re trying to do as assist is that we’re seeing that nearly on. And I don’t know if you concur, but we’re seeing nearly about 23% to 30% of each shift is actually spent taking notes and writing information down which is obviously important around the care plans and information so that can be passed through from, you know, from shift to shift. But we see that through technology, that we can actually autonomously collect some of that information and automatically pass it through. Like I think I’ve shown you… showed me the colour of that sensor that we put under the leg of the bed that replaces bed mats, it proves dignity, but it monitors how well the client sleeps anytime they’re getting out of bed. You know, how long they’ve been away from the bed and so forth.
And it helps obviously, you know, preventing falls and so forth. Having that data collection which is automatically collected stops having so many like you know, “How did you sleep last night?” “How many times you’ve been to the toilet?” And we, I think providing the data supports the care teams to make, you know, better care plans and more educated decisions, and then removes the necessity of having to take those notes and spend that actual more meaningful time, as you mentioned it.
Kylie Ward:
Yeah, there are some really good points that you make. And I’m going to try and remember them all Graham and dissect them, because I’ve always been a really strong champion of nursing informatics and the digital platform and you know, as you know, the board of the Australian Digital Health Agency. So, you know, yes, notes are important.
But the trouble is, when you’re writing notes, to appease accreditation, or in a risk-averse way of what can go wrong, that becomes cumbersome and 30% of your time that really eats at the… I think the moral and ethics of why a nurse turns out to work or any clinician, now I’ll just use my colleagues in medicine, you know, nurses and doctors have worked together for you know, at least 100, a couple 100 years, we know how to work together, we have our clinical language, and bedside handover has been proven to be highly effective, it’s in the language and in the conversation.
So recording is one element, but doesn’t have to take up so much time and anything that can be done to alter that is vitally important. So for example, I’m really wanting to challenge the standardisation of nursing terminology, a lot of databases and systems and point of care solutions that are developed are generic, but it makes a nurse tick every box and not every box needs to be ticked for every resident. And so what we’re really wanting is that person-centred care where we can tailor our care plans in our assessment, but that we shouldn’t have to fill in what we don’t need to, or that we can modify and adjust as we pick up deterioration. But, when your time is spent just going through process to tick a box to meet an accreditation standard, we’ve got it flipped around the wrong way.
And so from my perspective, it needs to be starting with the person that we’re caring for, and then work backwards, and then how every member of the health team, whether it’s our allied health, you know, professionals or medicine or nursing, that we can all have access to the information. The one reason that I’ve always loved working in residential aged care, as opposed to the acute sector. And while one of the… when I left the acute sector is you build relationships. So if employers can concentrate on retaining their workforce, what we love, and unfortunately, nurses are paid less like there’s gender and pay disparity and a million reasons why this sector is not attracting people.
But for the brilliant clinicians in our spec for nurses that do work in this sector, that we’ve got relationships, so you don’t have to log in Ward nursing or other nursing, you usually like having to get to know a full case history, then every day you turn on to your shift. Beauty is that we often have a really good extensive understanding of the dynamics of the people that we’re caring for and their family, you know, this wealth of tacit knowledge, that then helps with our…
Graham Russell:
You get that continuity of care, which is so important. So important
Kylie Ward:
The relationships, that’s, you know, meeting someone new and they change every shift in different sectors is quite challenging. But for a lot of us who stayed in aged care, or were committed to continuing to work in this sector was around the quality of the value of work, because nurses have not been respected in their pay and conditions. For the most part, so what, why do nurses come and why do people work in this sector? It’s because we’re fundamental, you know, all professionals that work in this sector, fundamentally good people who want to make a difference.
Graham Russell:
It’s a greater purpose absolutely, looking after our most vulnerable. I think the technology needs to align with that same process. Like I’m coming obviously as from a technology aspect, but the thing is, it’s not about putting more buttons and boxes and so forth. Like when a resident moves into residential aged care. In a lot of cases, they don’t need a lot. But unfortunately, so as we deteriorate, the technology link can be added. So for example, like we do a number of things like with dementia wandering, for example, we have a tag that’s embedded in the clothes.
So if we have a person with dementia wandering, risk is if they go to an exit door, we’ll send an alert to the care teams. So that’s sort of an example of not having to be everywhere, but using technology to assist. Another one that she has a lot is like time-sensitive medication. So if the medication card hasn’t come in within one and a half metres of you by 10 am, because you need your insulin or you offer them whatever is that will send an alert to the care team to say we may have a miss medication alert. So what we’re trying to do is not be like a blunt object, but it’s around using the technology to support the acuity of the client as they move forward.
Kylie Ward:
Could I comment to that, Graham, because what you’re doing is brilliant, because I don’t think people have any kind of idea unless you work in this sector, how many interruptions a nurse gets, or particularly when you’re at the medication trolley, the facilities are put in jackets like you’re, you know, you’re a work person at a worksite, like the big orange jackets, medication to stop that interruption. And when you’ve got that kind of interruption when you’ve got risk of mistakes and adverse events, but you just can’t concentrate sometimes. So anything that is put in place to assist is vitally important and is desperately needed.
And I want to go, I’ll just go back a step in my experience as a nurse and nursing leader and all the roles that I’ve had, as a director of nursing and you know, senior roles as an executive in this sector. The majority of falls and the highest vulnerability that I would say anecdotally of where a person is at risk is in the bathroom. And no matter how many times I’ve looked and assessed data, particularly to falls, and skin tears and, you know, everything that comes from that is often when a resident is trying to save our time, because they know we’re busy and trying to get themselves into the bathroom. So all of that sensory equipment is vitally important. Because even with your assistance in nursing, or caregivers or, however, what you call, you can’t be everywhere at once. And so to have that kind of sensory information or predictive technology that assists us.
The other thing that is so outdated that I’ve been concerned about for decades now is the buzzer system, and we brought this on ourselves, you know, it used to be a bell, not in my time. But then we put the buzzer system in and said, if you need me buzz me, having no idea how demanding the shift would get. And that’s actually a taxi rank system. So when somebody buzzes, and I go to them first, I have no idea if they just need a book handed to them, and somebody else has had a fall. And so as a nurse, you’ve got no ability around…
Graham Russell:
I’m either having a heart attack, or I need a blanket.
Kylie Ward:
Correct, you’re just the first cab off the rank, you’re just answering as you go. And you know, I’ve done some analysis on buses, you can answer in 30 seconds, because someone’s buzzing while you’re still there, or 45. So that is not helping the residents or consumers, not giving their family peace of mind and definitely just exhausting the workforce. That is how they’re trying to manage a buzzer system.
So not only the technology that is, that you’re developing and providing is so vitally important, but the analytics that comes with it. Because otherwise when you’re the only registered nurse on and not even every shift, who is providing analytics, otherwise, you’ve got to take that home and do that in your own time, as well as your education and development. So the importance of getting those analytics and how to use the data and then to get the trends and see maybe where staffing should be allocated or where resource allocation should go is absolutely tremendous to see this, that we’re really at this cycle of evolution of enabling clinicians and people to get on with their job.
Graham Russell:
And thanks for calling. Whenever we’ve got a few minutes left, and we’ve just got a few questions. And one of the questions that’s come up from Jared was “Where do you think the industry is really in terms of adoption of technology? And where do you think it should go from there?”
Kylie Ward:
Jared, you’re asking me the tough questions. The reality is that, whilst I mean, I’ll go back to the 44 standards that were in place. I know that we’re about to do changes with accreditation, but they were legislated which forced people to employ acting coordinators, which will probably be RNs and put all of this monitoring into how to get the money, rather than how to deliver the care and have the money support.
So what I think the industry needs to do is actually flip and focus and we’re not really at the moment it is employer or dependent or organisation dependent and I think that this should be where some of the baselines come in, for recruitment for retention for the best value in a values-based healthcare system for the best use of resource whether that be dollar or people.
Then I think that we need to set some baselines because what we have is variation and realistically what the Royal Commission maybe did or didn’t show, but what the media Aged Care has got, you know, the reputation about the aged care sector is not where we want it. And the reality is there are some providers, and definitely people doing excellent work. And I think that we need to showcase that there are really great examples there. But the variance is too great. And we need to get that bottom end, and really look at full adoption of technology as a baseline, you know,
Graham Russell:
We found with some of the providers like the early adopters that have been utilising our solution, they’ve actually been finding the technology is actually helping to retain a truck stop.
Kylie Ward:
I was about to say when you’ve got a supply and demand driven system, where nurses now are in great demand worldwide, I’ve just come from overseas. But before COVID, the World Health Organisation and the International Council of Nursing were saying that there was an estimated 6 to 7 million worldwide shortage of nurses by 2030. Now that’s come out to be more like 13 to 15 million. So the reality is this sector in our country, are going to be competing, you know, as in the UK, England alone has almost 40,000 registered nursing workforce shortage, 10% of the registered nurses first world and third world countries are struggling.
So what is Australia and the aged care sector doing to be an employer of choice, and often a nurse, some nurses will leave because and you know, anyone in this sector will leave because they’ve had enough. But realistically, often, they’ll need to go to another employer to get the respect that they deserve. So I would be saying if you owned an aged care facility or on a board or a leader, get the technology to support the staff to do the job they want so that they can feel satisfied.
Graham Russell:
Well, we’re also finding the executives are seeing the data down as a point because obviously themselves as being a key personnel, there’s that personal risk for the executives. And so this data has also given them some visibility of actually what’s happening, because they really don’t know what’s going on on a day to day basis. And that’s been part of the biggest challenge.
Kylie Ward:
Use the data as a carrot, not a stick. The last thing, any, when you’re the one running around is to hear that you’re doing things wrong. I think if we can wait, we’re doing the best we can under the circumstances we have. And we sit the data down. And if I was an executive in this area, and I get, you know, a group of clinicians in and say, right, this is where we are, how can we be where we want to be and have a, you know, a good open disclosure, kind of a good governance and say, because everyone wants to do a good job, otherwise sectors, people that don’t basically get them out of the aged care sector, they shouldn’t be there. But for those that want to often, we’re just tested, we’ve been pulled in too many different directions. So use it in terms of that innovation and opportunity. And you know, not to shame or highlight what’s not happening.
Graham Russell:
Yep. Well, Kylie, I know we’ve just hit 30 minutes. And I could literally talk to you for like hours. Like to be honest, I’m blown away, super impressed with all of your feedback today. And I’m really very grateful for your sharing it with our audience. I know you’re the pioneer out there. I know that you’re doing all the heavy lifting and so forth, as a propeller-head at the back end here trying your best. As I mentioned, my sister’s a nurse, and we’re very keen and supportive of what you’re doing. I just want to say thank you very much for being a part of this podcast today. But I know there are a few questions there from a few other people we didn’t quite get to, but I’ll respond to those. But just want to say thanks very much, Kylie.
Kylie Ward:
Graham, you know, thanks. Thank you for having me. Thank you for all of the questions. I’m focused on you, but I can see them coming through. We nurses, you know, the largest professional, I’m a nurse, I’m going to champion but I’m also going to champion for everyone who works in the aged care sector, whether it’s in you know, in the kitchen, the cleaning, the carers, all of us licenced professionals. But we need, we need people like yourself, we need this as a whole of expertise to come in and to deliver the care so that for any one of our loved ones, they get what they deserve. So thank you for what you’re doing and for everyone in this sector. You know, we all have a part to play to make it something that we can be very proud of.
Graham Russell:
Very true. Thanks very much, Kylie. Have a great week and we’ll talk soon.
Kylie Ward:
Half an hour work fast. It’s been a pleasure.
Graham Russell:
Thanks everyone very much for coming along.
This Special Edition of our Aged Care’s Big 5 Challenges webinar series was recorded last 27 July 2022. Follow us on LinkedIn for more announcements on our future webinars.
