goldenopportunity - white paper

AUSTRALIA

Golden OpportunITyHow information technology can rejuvenate Australia’s aged care sector

© 2009 KPMG, an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International, a Swiss cooperative. All rights reserved. Printed in Australia. KPMG and the KPMG logo are registered trademarks of KPMG International. Liability limited by a scheme approved under Professional Standards Legislation.


Foreword ..................................................................................................2

Executive summary ..................................................................................3

Introduction ..............................................................................................5

Coming of age – staying healthier, living longer. .....................................6

How can broadband and information technology improve the delivery of aged care services in Australia? .......................................9

The opportunity for government? ..........................................................12

Can information technology tackle ageing? ...........................................13

What can we look forward to? ...............................................................15

How does Australia move forward? .......................................................20

Conclusion ..............................................................................................22

Bibliography ............................................................................................23

This white paper was developed by:

Contents

� Golden opportunITy


On behalf of Church Resources and KPMG we are delighted to share with you this white paper, which investigates the opportunity technology provides to rejuvenate Australia’s aged healthcare sector.Over the past few years, our two organisations have been involved in a collaborative project with other partners to scope, design and implement ConnectCare.

ConnectCare is a ground-breaking initiative designed to help small not-for-profit aged care facilities improve their level of care, effectiveness and efficiency through broadband and information technology. The project is supported by funding under the Federal Government’s Clever Networks program.

Through ConnectCare we have learned a great deal about the needs, challenges and opportunities of implementing information technology in the residential aged care sector, particularly in smaller and non-metropolitan locations. This knowledge is gathered through:• feedback and collaboration with industry, sector and government leaders• collaboration with and feedback from four ConnectCare pilot sites• independent qualitative research undertaken with aged care facility CEOs

and managers.

This white paper allows us to share some of the knowledge and insights we have gained throughout the project as well our broader learnings acquired through years of assisting the aged care sector.

Church Resources has championed the benefits of broadband and IT in the not-for-profit sector for many years. We passionately believe making relevant technology more accessible, affordable and easy to use can be a catalyst to reinvigorating this critical sector to help meet the aged care needs of today’s and tomorrow’s senior Australians.

KPMG’s dedicated Aged and Community Care industry group provides regular forums for industry with unique insights from our in-depth experience and thought leadership. Our capabilities are widely used to help enhance the effectiveness and efficiency of aged care and community services delivery and to assist organisations and agencies to deliver better quality client outcomes.

KPMG has been a long standing leader and adviser on broadband in Australia, including working with the federal government on elements of its National Broadband Network policy.

We share our ideas in the hope it will promote further discussion and adoption of practical solutions to help the sector take advantage of this historic opportunity. Any feedback and ideas are most welcome.

Fr Michael Kelly SJ Malcolm AlderFounder and Special Counsel Partner, Digital BusinessChurch Resources KPMG

Con Koulouris Kathy OstinDirector, ICT and Telecommunications Partner, Aged Care Sector LeaderChurch Resources KPMG

Foreword

Golden opportunITy �


Aged care facilities play an increasingly important role in the final years of the lives of many Australians. We have succeeded in helping people live longer. The question now is how can we help them live better?This white paper discusses the golden opportunity which exists today for broadband and information technology to help transform and provide a major boost to residential aged care facilities in Australia.

This paper does not aim to provide ‘the answer’ but seeks to act as a catalyst for increased dialogue and action across the sector. Our intent is to contribute constructively to ideas and discussions held by key industry leaders, staff, carers and consumers as well as government policy makers.

The aged care sector provides a critical service, both for our elderly citizens and their families and loved ones, who reach a point where this is the only care option left. However its costs are relentlessly increasing.

The number of people requiring aged care has been rising exponentially over the last 10 years in keeping with the trends of our ageing population. The majority of residents are aged 75 years and over and those aged over 85 continues to increase as a population of the total as well as absolutely. As residents have grown older and frailer, the level of assistance required is also steadily increasing1.

Along with demographic trends, other significant pressures on residential aged care emanate from changes in the marketplace, government funding models, facility operations and workforce pressures.

Executive summary

1 Ageing and Aged Care in Australia, Older Australia at a Glance, 2007 & AIHW 2007.



Assisting the sector to take advantage of broadband and IT, while not solving all the myriad challenges, can provide residential facilities with tangibly increased capacity to manage limited resources more effectively and free up staff to deliver enhanced care. In short, technology can play a major role in helping administrators, carers and the many health care providers involved in the sector to improve efficiency, quality of care and importantly, improve the experience of both residents and staff.

As well as efforts within the sector and by industry, there is an exciting opportunity for government to help champion the development and uptake of IT in the aged care sector. Apart from the benefits for ageing Australians and their families, there can be significant payback for government by increasing both transparency and efficiency within the sector at a time when the number of Australians requiring services is ballooning. By consciously leveraging its already significant investment in the National Broadband Network and eHealth, the government has an opportunity to provide a visionary and transformative boost to one of the frailest and most vulnerable sections of our community.

Some aged care facilities and the people within them, have already made positive progress in implementing IT. However, for the most part, the sector has found this step to be an extremely difficult one, particularly in small and regional facilities where resources are stretched and IT expertise is limited. In the vast majority of Australian aged care facilities, the reality is that the level of technology is minimal. Typically, a small number of unconnected computers are shared across an entire facility. Often, staff are not proficient at using them to their full capacity, furthermore many residents have limited or no access to computers.

Yet, increasingly, societal expectations are challenging this paradigm. If residents are not requesting computer access, their family members are. It is a vicious cycle. The facilities know they can benefit from IT implementations, but finding the time, resources and expertise to make it happen, is a major barrier.

Some of the biggest challenges for implementing broadband and IT innovations in the residential aged care sector are discussed in this paper. They include: lack of integrated solutions, availability of IT management and support, funding, outdated equipment and operations, staff computer skills and capabilities, change management and remote and regional infrastructure.

It is the strong view of Church Resources and KPMG that connecting aged care facilities with high speed broadband and an integrated suite of technology applications, services and devices, will provide a substantial and tangible benefit to their operation, their employees and most importantly, their residents.

There are a wide range of technology solutions that are relevant to the sector, many of which are being piloted or have been rolled out within pockets of the Australian market. These technologies include wireless infrastructure and devices, aged-care specific applications such as payroll, rostering, clinical and financial solutions as well as communication technologies that improve experiences for both residents and carers. Depending on how facilities set up their systems, they can also offer widely available internet access, email and low-cost video conferencing to their residents.

This paper does not purport to have the solution for every residential aged care facility to harness the opportunity offered by broadband and technology. However, the collective experience of Church Resources and KPMG – both through roles in the ConnectCare project, as well as our substantial experience in aged care IT implementations – has led us to believe passionately in the potential opportunity.

By promoting discussion, encouraging innovation and participation, sharing learnings and importantly, supporting facilities to adopt and showcase broadband and IT solutions, all stakeholders in the aged care sector can collectively work to improve the quality of life of older Australians, now and in the future. There is indeed a golden opportunity.

As well as efforts within the sector and by industry, there is an exciting opportunity for government to help champion the development and uptake of IT in the aged care sector.



Aged care – where are we now?Whether run by private, community, government or church organisations, providing a high level of care delivered in a compassionate way, has been a focus of the aged care sector for many years.

As more of our ageing population live independently for longer, staying in their homes until the last years of their life, the people entering our nursing homes are now frailer. Many are humbled by their loss of independence and control, and are fearful of the future. Their health problems are more complex than ever before and most will spend years being dependent on others for basic needs.

Spend time with those who work in aged care and you will witness acts of humble kindness, quickly finding most go into the sector wanting to make a difference – wanting to make life better. That said the pressure on aged care facilities has lifted dramatically. Many are stretched to breaking point as they strive to improve efficiency, meet regulatory demands, service complex medical needs and provide quality time and comfort to their residents in the final stages of life.

While the future of aged care becomes increasingly complex, the basic human needs of the men and women who are cared for remain the same – physical, emotional, social and spiritual.

Nearly a quarter of a million Australians call aged care ‘home’According to the Australian Institute of Health and Welfare, on 30 June 2008, there were 175,472 operational aged care places across Australia. Total government expenditure for aged care during financial year 2008 was $8.3 billion, including $6 billion for residential subsidies and supplements. The estimated budget for financial year 2009 was $9.3 billion. This is a sector whose costs are relentlessly increasing. They provide a critical service, for our elderly citizens but also their families and loved ones, who reach a point where this is the only care option left2.

In June 2008, there were 2,830 aged care facilities, with the main providers of residential aged care services religious organisations (29 percent), private providers (28 percent), community based providers (17 percent), charitable organisations (16 percent) and state and local government (10 percent)3.

Introduction

2 Australian Institute of Health and Welfare, (2008)3 Department of Health and Ageing, (2008) (percentages have been rounded up)

A question of faith?Australia’s unique reliance on faith-based aged care provisionIn April 2009, Hammond Care CEO Dr Stephen Judd spoke profoundly on the way social services are delivered in Australia. Specifically, Australia’s reliance on Christian charitable groups, is “absolutely unique in the Western world”. Dr Judd explained that prior to the Second World War, everything we now call “social services”, including aged care, was mostly provided by Christian charities.

After the war, governments in Australia decided to increase their funding to existing charities rather than growing their own departments and services. This had a profound impact on “the character and nature and size of charities and non-profit organisations in Australia, compared to the UK or, indeed, the US” and he argues, is one of the key reasons why Christian charities dominate in Australia in a way they don’t elsewhere.

Residential aged care is an explicit manifestation of this, with Christian and other faith-based organisations providing majority substantial portion of aged care services in Australia.

There are many benefits from social services being provided by a faith community, such as a church group. However, it would be fair to say that as a sector driven by social good, it is not surprising that there has not been a strong focus on leveraging technology to improve productivity.



Coming of age – staying healthier, living longer

The impact of these figures on Australia’s remote and regional areas will see an increasingly top-heavy population pyramid revealing less than two people of working age for every person aged 65 years and over. Through advancements in medical technology, personal healthcare awareness and public health initiatives, Australians are becoming healthier, more active, and therefore living longer than previous generations.

Projected older Australians�

Furthermore, as more elderly Australians opt to retire to regional coastal areas

for a better quality of life, the demand for residential care in such locations will increase disproportionately. It is a great irony that the healthier we become and the longer we live, the more pressure we place on the aged care system.

Increasing levels of assistanceWhen individuals eventually reach a point where they can no longer care for themselves, residential care becomes the only viable option. The number of people requiring aged care has been rising exponentially over the last 10 years in keeping with the trends of our ageing population. The majority of residents are aged 75 years and over. The proportion of permanent residents who were aged 80 years and over increased from 64 percent in 1998-99 to 71 percent in 2005-06.

As residents have grown older and frailer, the level of assistance required has also steadily increased since 19986.

4 Australian Bureau of Statistics cited in Ageing and Aged Care in Australia (2008)5 Australian Bureau of Statistics cited in Ageing and Aged Care in Australia (2008)6 Older Australia at a Glance, 2007 & AIHW (2007).

The Australian population is ageing. Over the next 50 years this deep shift in demographic forces will transform the dynamics of Australia’s population and propel change within our aged care sector. Around two million Australians are aged 70 years or older. That’s 9 percent of our population. Four percent of the population are over 80 years of age. The proportion of Australia’s population aged over 70 is expected to rise to 13 percent by 2021 and to 20 percent (around 5.7 million people) by 2051.4

As residents have grown older and frailer, the level of assistance required has also steadily increased

65-69 70-74 75-79

2009 2014

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In 2006, more than 70 percent of residents needed assistance with:

• communication

• personal hygiene

• understanding and undertaking living activities

• bowel management

• mobility

• meals and drinks, and

• toileting

This is not surprising given the associated increase in the number of people with dementia, which is projected to increase from 220,000 in 2007 to 730,000 by 2050 (Older Australia at a Glance, 2007 & AIHW 2007).

The consequential increase in pressure on staff and resources is real and unrelenting.

Key pressures on Australian aged care facilitiesAlong with these demographic trends, other significant pressures on residential aged care emanate from changes in the marketplace, government funding models, facility operations and workforce pressures.

Facility Operations• Ageing workforce• Skills shortage• Trends in volunteering• Productivity drivers• Recruitment & retention of staff• Consolidation

Demographics• Ageing population• Rising co-morbidity rates• Increasing incomes & wealth• Changing religious beliefs

Government Policy• Duplication between State

& Commonwealth Reform• Changing funding models• Introduction of ACFI• Advocacy & social

inclusion challenge• Senate enquiry

Competitive Environment• Consolidation of highly

fragmented market• Increase in market share by

private for profit operators• Slow down in low care• Increasing need for high care

Factors impacting Aged Care

Factors impacting aged careSome of these pressures are discussed in detail below:

Changing marketplace expectationsAged care providers are under pressure to provide increasingly diverse care services to meet the needs of today’s ageing population and expectations of baby-boomers in the years ahead. This includes more flexible residential care services, such as accommodation for couples as well as a range of home and community care programs to support older Australians and their carers to be more independent at home and in the community.

Facility consolidation and corporatisationAlthough overall places have increased for aged care, the number of actual facilities has declined by 4.7 percent from 3,015 in 1998 to 2,872 in 2007. This is due to consolidation within the sector, including a dramatic decline in the number of very small facilities.

The number of people with dementia is projected to increase from 220,000 in 2007 to 730,000 by 2050



7 Church Resources Trust 20088 Hogan Report 2004

Facilities with over 40 beds have increased to around 66 percent and facilities with more than 100 beds have increased by 121 percent since 1998. At one level, this consolidation may help to yield economies of scale. However, smaller facility closures are most likely to be in regional areas. The result of this is that residents need to move further away from family and friends, increasing the stresses and challenges this physical and emotional dislocation brings to all involved.7

Declining and ageing workforceOne of the critical issues in aged care is the declining and ageing workforce. The challenge of both recruitment and retention of skilled staff is exacerbated by low levels of remuneration in the sector.

In residential care, the share of direct care provided by registered and enrolled nurses has declined. The use of personal care assistants, by contrast, has significantly increased. These changes reflect both the growing shortage of nursing staff and the development of more efficient workforce structures. With this greater reliance on personal care assistants comes a need to improve the skills of these workers.8

Spiraling costs and funding pressuresAs stated earlier, government expenditure for residential aged care continues to spiral.

The Productivity Commission report titled Trends in Aged Care Services: some implications (2008) cited Richardson and Martin’s 2004 report, stating: “The amount of documentation necessary to comply with various regulatory requirements affects how workers allocate their time”. The administrative requirements are seen as reducing the time available for staff to provide services that enhance the quality of life and care of residents.

Indeed, the premise for moving from the RCS classification system to the new ACFI model was to reduce the amount of paperwork. It moved the industry to an electronic platform. As described by the Department of Health and Ageing (DOHA) “…the ACFI places a greater focus on essential documentation related to resident care rather than documentation for the sake of documentation obligations.”

The extent and upward trend of pressure on operations and staff in aged care facilities is clear. As a result, we need to use all means possible including technology, to improve services and efficiency in this sector. In an era when broadband and related technologies have revolutionised how we do so many things – work, entertainment, shopping and mobile communications, the time has come to utilise this technology to enhance health outcomes, particularly in the aged care sector.



How can broadband and information technology improve the delivery of aged care services in Australia?

In short, technology can play a major role in helping administrators, carers and the many health care providers involved in the sector to improve efficiency, quality of care and most importantly, improve the daily experiences of both residents and staff.

Ultimately, technology can also assist governments to manage spiralling sector costs.

Improving efficiencyAged care facilities must be efficient. In a revenue constrained environment, providing quality care in the face of workforce shortages and rising costs means inefficient operators are challenged to make a profit. Due to the way funding works, any inefficiency also negatively impacts directly on funding and hence the bottom line – a double whammy.

A 2003 study from the University of Queensland’s Centre for Efficiency and Productivity Analysis suggests that if all Australian residential aged care facilities were to operate on a notional ‘best practice’ frontier, and restructuring occurred to realise opportunities for improved economies of scale, there could be efficiency gains of around $1.6 billion.

Some providers have achieved substantial productivity gains through investing in better technology and restructuring their activities. Adopting technological advances can provide a tangible and substantial boost to the level of both productivity and efficiency within facilities, from the way that meals are prepared to the way clinical care is delivered to residents.

In the same way that ICT has delivered major productivity improvements to governments, private enterprise and consumers, the adoption of broadband and related technology by aged care facilities will give this sector the potential to work smarter using their increasingly stretched resources more effectively.

Enhanced care deliveryTechnology has great potential to make the delivery of care more efficient and effective as well as more compassionate. Specifically, technology can shift a substantial amount of staff time from arduous paperwork to resident care and enable a whole range of information management and clinical capabilities to help make care delivery more streamlined, more appropriate and importantly, less intrusive.

Similarly, telemedicine can make the treatment of residents more convenient and help them access specialised medical assistance in a more timely manner.

Assisting the aged care sector to take advantage of broadband and IT, while not solving all the myriad challenges, can provide residential facilities with tangibly increased capacity to manage limited resources more effectively and free up staff to deliver enhanced care.

10 Golden opportunITy


Clinical applications can enable care providers to more effectively co-ordinate, dispatch and track medications. Whether it is in transitioning a resident from home or a hospital to a nursing home, or balancing clinical interventions with the need for dignity and quality of life, IT systems that facilitate rapid access to relevant information, can make a real difference.

Improving resident quality of lifeAlthough the financial drivers for technology adoption in aged care are improved efficiency and quality of care delivery, the same infrastructure, applications and services can have a profound impact on improving the quality of resident life.

An example of this includes enabling older people to stay in touch with relatives or participate in major family events via low cost video conferencing. Something as simple as email can have a profound emotional impact. Unlike phone calls, email messages can be saved and treasured.

Access to internet applications can help broaden interests at a time when they have traditionally been shrinking. Internet browsing, research and learning, programs such as Google Earth, chat room conversations as well as online games including Solitaire, can all enrich residents’ lives.

There is also tremendous scope for volunteers to have more regular and convenient online interaction with residents who don’t have their own family.

Golden opportunITy 11


What if... You could bring on back the good times?“Technology can improve the quality of life for people. Prior to care, one of our residents was a great golfer – a four or five handicap. He hadn’t been able to play for some time and was very down about it. Wii has proven to be a great substitute. He’s found something from his past that he can still do and get enjoyment from. Can you imagine the difference that makes?”CEO, aged care facility Regional <100 beds

What if...you could create more time for care?“Think of your 82 year old Mum. She’s given so much and now, after much angst, she’s living in an aged care facility. She has a single room with an en-suite bathroom. The staff caring for her come across as fantastic. They’re attentive, respectful and caring. However, they don’t have much time for her – they’re too busy trying to meet the expectations placed on the facilities from the Government, families and residents. They usually spend the majority of their time completing endless streams of manual paperwork – incident reports, client records, Medicare forms. It’s not just that these tasks are incredibly taxing on their time. They remove them from the human element of their role.” CEO, aged care facility Church Resources ConnectCare pilot site

1� Golden opportunITy


The opportunity for government?Championing information technology innovation to transform the aged care sectorThere is an exciting opportunity for government to help champion the development and uptake of IT in the aged care sector.

As well as the benefits mentioned earlier, there can be significant payback for government by increasing both transparency and efficiency within the sector at a time when the number of Australians requiring services is ballooning.

By consciously leveraging its significant investment in the national broadband network and eHealth, the government has an opportunity to provide a visionary and transformative boost to one of the frailest and most vulnerable sections of our community.

National broadband infrastructureOn 7 April 2009, Prime Minister Kevin Rudd announced the government’s intention to undertake Australia’s largest ever national infrastructure scheme. Up to $43 billion will be invested over 8 years to build and operate a National Broadband Network (NBN), aiming to deliver super-fast broadband services to Australian homes and workplaces using a technology known as Fibre to the Premises (FTTP).

This proposed broadband technology, along with IT advancements, has the potential to revolutionise the delivery of IT infrastructure, applications and services to aged care.

It can make IT more accessible, more affordable and importantly, easier for facilities to implement and use. This is especially important to smaller facilities, or those located in regional or remote parts of the nation. Associated programs can assist the sector to develop and promote take up of specific applications and services across the sector.

The government’s national broadband infrastructure vision can help shape the future direction of Australia’s aged care sector.

eHealth and eBusinessThe Australian Government will play a critical role in the advancement of the aged care sector through eHealth and eBusiness initiatives.

A key element of ensuring the complex medical needs of residents in aged care facilities are met is through the active sharing of medical records across aged care and medical providers. A major obstacle in the compilation of correct and complete resident records is that after visiting a resident in an aged care facility, GPs typically take their hand written notes away with them.

Improvement in the care of residents, in particular for medication management and future diagnosis, will result from ensuring aged care facilities maintain complete resident records, which can be electronically linked and shared accurately and instantaneously with GPs, health professionals and pharmacies.

In a broader sense, eHealth has been promoted as a way to greatly enhance both the quality and the timeliness of available healthcare information, delivering substantial benefits to clients, healthcare providers and the healthcare system as a whole.

The National eHealth Strategy, developed in December 2008, saw Australia’s Health Ministers devise a strategy that aspires to develop a world class eHealth capability providing new options for how Australians manage their own health and interact with the health system across geographic and health sector boundaries (DoHA 2008).

The government’s initiative of eBusiness for Aged Care is set to allow aged care facilities and the aged care assessment teams (ACATs) to electronically sign and submit aged care forms, using the Medicare Australia eBusiness Gateway.

Golden opportunITy 1�


Can information technology tackle ageing?

The key challenges in implementing IT in the aged care sectorSome aged care facilities and the people within them have made positive progress in implementing IT. However, for the most part, the sector has found this step to be an extremely difficult one, particularly in small and regional facilities where resources are stretched and IT expertise is limited.

In the vast majority of Australian aged care facilities, the reality is that the level of technology is minimal. Typically, a small number of unconnected computers are shared across an entire facility. Often staff are not proficient at using them to their full capacity. Most residents have limited or no access to computers.

Increasingly, societal expectations are challenging this paradigm. If residents are not requesting computer access, their family members are. However there is a vicious cycle. The facilities know they can benefit from IT implementations, but finding the time, resources and expertise to make it happen is a major barrier.

Some of the biggest challenges for implementing broadband and IT innovations in the residential aged care sector are:

Lack of an integrated IT solution and understanding of sector needsAged care facility CEOs regularly site integration as the ‘Holy Grail’. Those who have made significant investments in IT to date are quick to highlight the shortcomings of off-the-shelf IT solutions and solution providers.

The sector perceives that most suppliers over-promise and under-deliver. In particular, facilities of all sizes and budgets describe supplier training as inadequate. In part, this is because CEOs believe suppliers do not understand aged care, and are not empathetic to the on-the-ground realities of the sector including an ageing workforce, the dominance of part-time and volunteer workers, low technology confidence and English often being a second language.

IT management and supportWhile larger aged care facilities (i.e. those exceeding 1,000 beds) have a skeleton IT staff and generally deploy their own IT applications and facilities, the majority of smaller facilities rarely have a dedicated IT manager and, in general, only have limited, disparate IT systems.

Often management and nursing staff are required to spend valuable time managing IT systems, despite their lack of expertise or time to adequately evaluate or implement systems and services. Support is an issue in regional locations where IT contractors may be located at a significant distance from the facility and are not available when problems occur.

Funding IT investments requiring significant capital outlay are beyond many facilities. Innovative IT solutions and funding models have the potential to act as a catalyst to sector transformation.

Outdated equipment and operationsExisting IT infrastructure in facilities, including software and associated hardware, is ageing along with their residents. With limited cash reserves and funding, IT maintenance and systems upgrades are considered unaffordable, with the health and well-being of the residents taking precedence.



Staff computer skills and capabilitiesIT competency and literacy, even at the executive level, varies widely. The number of aged care facility staff members that have an adequate knowledge and skill-base on computers is small. This lack of skills increases the level of anxiety staff feel towards IT infrastructure programs. Cost and time constraints incurred in IT change management and staff training can deter some facilities from moving forward with technology enhancements.

Change managementOne of the greatest challenges faced by those involved in IT implementation across the aged care sector is the fear of change from the staff’s point of view. There are often significant changes in work practices brought about by new IT systems and commitment is required from both management and staff to successfully facilitate change.

Embracing technology enhancements within aged care requires a dedicated change management approach, including appropriate communication, training and support for staff. Most aged care facilities lack the resources and expertise to do this, unassisted.

Remote and regional infrastructureThere have been major broadband access and price issues for many aged care facilities, particularly those in regional and rural locations. Although the government has made an impressive commitment to building a high speed broadband network across the country, the final output won’t be realised for almost a decade. During this period, some aged care facilities will continue to face broadband infrastructure challenges. There are also issues surrounding the installation of hardware and ongoing support to aged care facilities outside metropolitan areas.

The challenges discussed above are not insignificant, however, it is important to note that some of these will reduce with time. For example, computers become even more powerful, software applications have become more sophisticated and the advent of the internet and fast broadband networks have made it possible to change the way people work.

Over time, new residents and staff alike will be ever more computer literate. They will expect the standards they have experienced in their homes or previous employment to be available in residential facilities as a matter of course.

Fortunately, both hardware and software prices can be expected to continue to become cheaper in real terms as they have on a sustained basis for many years now. There are also other trends in the IT sector which provide good prospects for the more effective and cheaper use of technology, for example, cloud computing and Software as a Service (SaaS). In the shorter term, other changes are driving the effective use of technology, including last year’s changes to the ACFI funding model.

“Professionals in healthcare are universally dedicated to providing quality care. They want to spend more time with their clients and less time in record keeping. And whatever their location, they need better information and they need it immediately at the point of care”.Intel Digital Health



What can we look forward to?

Connecting to careConnecting aged care facilities with high speed broadband and an integrated suite of technology applications, services and devices will provide a substantial and tangible benefit to their operation, their employees and most importantly, their residents.

There is a wide range of technology solutions relevant to the aged care sector, many of which are being piloted or have been rolled out within pockets of the Australian market. These technologies include IT infrastructure and devices, aged-care specific applications such as payroll, rostering, clinical and financial solutions as well as communication technologies that improve experiences for both residents and carers. Depending on how facilities set up their systems, they can also offer widely available internet access, email and low-cost video conferencing to their residents.

Some aged care technology solutions which have the potential to make a significant and positive impact on the efficiency, delivery of care, quality of resident life and staff engagement within residential facilities include:

Electronic prescribingAn electronic prescription system can positively enhance the awareness and outcomes of medication delivery, including more accurate and timely medication data for staff.



Computerised care plansIllegible pro-forma documents with limited fields will be a thing of the past as computerised care plans drive the way in which aged care facilities proactively manage their residents’ care. Such technologies can also generate professional management reporting, helping to ensure that Resident Classification Scale entitlements are correct and the facility receives the appropriate level of funding. Multiple devices, including bedside touch screens and mobile handheld devices, will bring the input and retrieval of up-to-date resident and other clinical data to the fingertips of carers and health professionals.

Sector specific services: HR, payroll, financialFor many providers, moving human resource activities and residential bonds on-line has been the first plank in their IT journey. There are many benefits with applications such as online rostering, sign on and off providing greater transparency of staff costs. It also provides better visibility with regards to licensing and advanced scope to roles and practice.

Staff training, engagement and communicationsProviding training and education to staff is not only a requirement for accreditation against many of the sector’s mandatory standards, it is also a key enabler for increasing quality of care. For example, staff are able to access on line MIMS or medication protocols and the web-based Joanna Briggs Institute for emerging trends and innovative care delivery models. Access to these resources assists with staff retention, sector specific research and ultimately, quality of care.

Information managementA flexible information system that integrates tailored care solutions for each resident and staff member, including clinical, rostering, maintenance and financial modules will help remove paperwork as well as provide accurate business management tools that promote productivity, efficiency and improved care outcomes.

TelemedicineTelemedicine is currently being utilised to a small extent across Australia’s regional areas, but with the country’s increasing broadband adoption and IT advancements, this is an expanding area. Typically, residents in remote locations utilise IT infrastructure to seek advice from specialists and other allied health professionals via the internet instead of travelling for a face-to-face visit. This reduces stress on the patient and assists doctors and other specialised medical practitioners (such as wound clinics) to deliver health services to patients in rural areas.

Resident activity entertainment: Skype, internet, stocks and shares, email, collaborationAs increasing numbers of baby-boomers enter aged care, their expectations and changing preferences will require providers to deliver on-line entertainment and access to the internet as a basic requirement. These methods ensure that they can stay in contact with friends and relatives through applications such as email and Skype as well as managing their share portfolios. A small number of resident entertainment systems have already been implemented in facilities across the world, including multi-purpose touch screens enabling a full suite of personal and entertainment activities (e.g. TV, computer and communication services) as well as providing a bedside tool for clinical information input and retrieval.

Compliance and qualityAustralia has one of the most developed accreditation standards for aged care and being able to demonstrate compliance with these standards is increasingly more efficient as a consequence of IT. Incident reporting software has the ability to ensure compliance across the facility and is imperative for managerial staff to keep track of statistical data that may potentially necessitate escalation.



9 KPMG provided a governance role for the partnership

The project, which is supported by funding under the federal government’s Clever Networks program, was launched in December 2008. It involves 11 industry and not-for-profit organisations – including Church Resources and KPMG9 – working together to provide affordable clinical, financial and communication software applications, delivered over high speed broadband to small and regional not-for-profit nursing homes.

The first phase of the project’s implementation was completed in July 2009 and includes a fully managed service comprising such features as business grade broadband, wireless capabilities, video-conferencing and time savers such as asset tagging to allow staff to quickly locate critical equipment, such as lifters for residents who have fallen.

The project is initially rolling out its suite of applications and associated infrastructure across four sites located in regional New South Wales as well as central and south-west Queensland. It is planned that the infrastructure and delivery model is made available to the not-for-profit aged care sector at the end of 2009.

The project is hoping to reduce barriers to broadband and IT implementation by smaller aged care facilities by providing an innovative delivery and support model, including a fully managed IT service as well as integrated financial, clinical and communication solutions.

For more information visit: http://www.churchresources.com.au/

Case study – ConnectCare

How do you value time?

“When I first heard about asset tagging I wouldn’t have leapt at it as an urgent priority. It seems like a nice add on – until you see it in action.

It hadn’t been in use very long when someone had a fall. The exact lifter we needed was found much more quickly. Saving time and alleviating pain.

What you need to understand is it’s not so much that you need a lifter. You need a particular lifter. We’ve got eight or nine lifters, and each has a different purpose.

With asset tagging it was much faster to find the lifter that was needed. That meant the team could give our resident the right care and attention to get them safely back up.”CEO, aged care facility Church Resources ConnectCare pilot site

The ConnectCare project is a ground-breaking collaborative initiative which is helping small and regionally based not-for-profit aged care facilities to improve their level of care and efficiency through broadband and IT.



Case study – UnitingCare Ageing

The core goal of UCA’s Inspire strategy is organising information around each person at the point of care, so “there’s a single version of the truth that we can all access from anywhere” including data from finance, human resources and two care systems. UCA has implemented iCare as a client management system across its 85 residential aged care facilities in NSW & ACT. This is the largest implementation of iCare in Australia.

According to UCA CEO Gillian McFee, IT often ends up being the easy part. “It’s the people management, change management and cultural changes that prove to be far more challenging when you embark on this journey,” said Ms McFee.

Rather than making sweeping changes at once, UCA started with “baby steps”, finding regional areas and individuals within those regional areas who were prepared to pilot new systems.

“It’s important to remember our history is one where many local services run by 52 Local Boards who started with a few desktops and got a local computer person to come and hook them up,” said Greg Russell, Director Information Management & Technology. “We have faced many challenges especially with infrastructure where we have experienced many challenges in providing a stable infrastructure and network support to enable us to operate the new applications we are implementing” After 3 years and with a $6 million dollar investment to date and a further $18m budgeted for 2009/10 UCA has focused on two streams.

• Putting in place “industrial strength” infrastructure as a foundation across the organisation.

• Defining business requirements, selecting, piloting and implementing new software applications for residential care, finance and client billing, HR/rostering/payroll, risk and incident management, and community care.

• Investigating future opportunities such as single access points for the community, mobility solutions for staff and tele-health.

Whilst UCA’s challenges are on a larger scale than many other organisations, they believe they are fairly representative of the situation and challenges faced throughout the broader aged care sector.

To date the most successful sites are those where the facility manager championed and embraced the technology and change processes, with more success achieved in the smaller facilities than the larger ones. Lynn May, Director of Care Services, said this has partly been because the manager was able to have a more hands-on knowledge of how everything is running.

“Our first facility post pilot to ‘go live’ with our new care management system which is iCare was one of our smallest and it meant that the regional director was able to be intimately involved because they had five facilities with 300 beds,”

One of the largest and most interesting IT innovations in aged care in recent years has been in UnitingCare Ageing (UCA). They have embraced and implemented technology and business process redesign as a catalyst for an ambitious and client focused strategy change. This includes substantial change to their organisational structure, re-engineering of clinical and management processes, piloting and implementing new systems across all major business functions and driving a cultural shift to focus their business on client service.



Ms May said. “In the larger regions it has been harder for the regional directors to get involved and be visible at the ground level.”

Ms May also said the expected resistance to technology from older staff and people of non-English speaking background turned out to be a myth.

“Whilst older people are inclined to have a higher level of fear towards IT, it was dispelled very quickly and the same can be said for people with English as a second language. The myth was that this group would be reluctant, but in fact they tended to have a more open view of technology because they use IT and telephony to keep in contact with families. So they were actually less inhibited to write on the computer than they were into notes.”

UCA has found their IT adoption has given them a competitive edge with regard to attracting and keeping staff.

“We’ve got anecdotal evidence of where people have had offers of jobs and they chose us because we ran an electronic system in residential care. We’ve also had people leave and come back because where they went they didn’t have an electronic system and there was no way they wanted to go back to the old system,” Ms May said.

UCA have made a deliberate decision not to formally evaluate the impact of their IT and change process yet, because they believe it is too early to reap valuable results. However, they are consciously measuring core benefits through anecdotal evidence and mid term implementation reviews of some projects. Some observations about benefits from iCare are:

• Locating a client’s file, with associated efficiency gains with real time documentation due to point of care access

• Care plan review – what would have taken 5 hours in the past can now be done in only an hour

• Electronic rostering enables managers to draw people from a wider field of staff and gives the manager visibility about whether it is an efficient way to do rostering – it has also meant that UCA no longer has valuable RN’s doing the roster because the system enables admin staff to handle it.

• There is an increased transparency regarding how facilities and regions are being run, with visibility of how well care plans are being put in place, whether they are reviewed in accordance with policy, the quality of those care plans and whether facilities are using the standardised systems and processes.

A key lesson learned by UCA on their journey so far is that putting an IT system in place has been an enabler for business improvement and cultural change. Those organisations who approach their transformation from just an IT perspective probably won’t succeed because the change and people management issues are what matters most.

“You have to have an embedded mission and values that align with what you’re trying to achieve and also organisations have to be prepared to invest resources and take some calculated risks,” said Ms McFee.

“Unless you build up a change program to support the IT system to be utilised in the way you envisaged you won’t get the benefits. It has to be supported by other aspects of the organisation, including position descriptions, performance management systems and even the physical structure of your building layouts going forward.”

�0 Golden opportunITy


This paper does not propose to have the solution that enables every residential aged care facility to harness the opportunity broadband and technology offers. However, the collective experience of Church Resources and KPMG – both through roles in the ConnectCare project, as well as our substantial experience in aged care IT implementations – have led us to develop a number of options for stakeholders to consider:

Affordable broadband accessThe substantial funding allocated by the federal government to assist the development of the NBN presents an opportunity for relevant stakeholders – including government, service providers and the sector – to collectively consider how to provide appropriate and affordable broadband capability to not-for-profit aged care facilities, including both community and residential care providers.

Collective purchasing and shared resourcesIndividual aged care facilities are high cost/low value customers for vendors as individual entities. But if there is collaboration between independent facilities with regards to network access, technology solutions and training, there is greater potential for broadband and IT to be affordable, enabling more facilities and their residents to reap the benefits of the online world. By working collectively, aged care facilities can have a stronger position with service providers as well as software, hardware, content and integration specialists to deliver clever solutions and applications at a much lower per cost.

Managed IT/managed servicesAged care facilities could benefit greatly by adopting a model of managed IT/managed services, including outsourcing their technology strategy decisions, ongoing management and help-desk services to an expert third party. Key to these activities is giving access to centralised, powerful computing that facilities can share, enabling them to utilise equipment and applications hosted outside their walls This removes the requirement for organisations to manage their own IT, have internal IT expertise and avoids the need to spend large amounts of money upfront for IT equipment. Instead, they can rent the computing power, applications and services they need on a monthly basis.

Collaborative effort from industry, government and the aged care sectorA collaborative effort between the aged care sector, industry and government is required to assist aged care facilities to embrace technology. There is great scope for the sector, industry and government to work together to achieve a deeper understanding of the sector’s specific needs, address the barriers to change and importantly, deliver a more affordable and integrated model of IT design and delivery.

Creative funding/financing modelsGiven the evidence of productivity improvements achievable from broadband and technology adoption, there should be potential for government and industry to develop creative financing and funding options that make this affordable for aged care facilities. This could include interest-free loans, grant allocations and annualised operational expenditure models that would significantly reduce capital investment requirements.

How does Australia move forward?

Golden opportunITy �1


eHealth initiatives in aged careA key element of ensuring the complex medical needs of residents in aged care facilities is met, is the active sharing of patient records across aged care and medical providers. The aged care sector is an obvious segment of the market to embrace eHealth initiatives. The benefits to residents and their families, as well as medical and health professionals, all having appropriate and timely access to resident clinical records, is enormous. The residential aged care sector could be an appropriate pilot segment to implement eHealth in Australia.

Broadband funding: possible initiatives focused on the aged care sectorJust as the Clever Networks program provided a substantial boost to the residential aged care sector through its support of the ConnectCare project, there is scope for further development of broadband and IT innovation in this sector via the recently announced Digital Regions initiative.

Change and project managementOne of the clear barriers to successful IT implementation in aged care is the lack of change management and project management skills within aged care facilities, coupled with a lack of time and budget to schedule appropriate training. There are many invaluable learnings which aged care organisations, vendors and project consultants who have undertaken major IT implementations, understand. There could be great value in facilitating a process of knowledge sharing among stakeholders on this issue. There is great potential to develop of additional resources and support services, which leverage those learnings, to assist aged care organisations to more effectively implement IT change in the future.

A collaborative effort between the aged care sector, industry and government is required to assist aged care facilities to embrace technology.

A collaborative effort between the aged care sector, industry and government is required to assist aged care facilities to embrace technology.

�� Golden opportunITy


The available data about demographic changes in our community and the spiraling costs and pressures on our aged care providers demonstrate a significant and urgent need to do things differently.The opportunities provided through advances in technology and emerging innovative IT service delivery models and in the longer term, the National Broadband Network, are enormous. These elements combined create a catalyst for transformation of the aged care sector, beginning with residential care facilities.

There’s no doubt that the challenges in achieving fully integrated solutions, significant participation and successful IT implementation are real. However, there has never been a better confluence of opportunity in the aged care and IT sectors.

By promoting discussion, encouraging innovation and participation, sharing learnings and importantly, supporting facilities to adopt and showcase broadband and IT solutions, we can collectively improve the quality of life of older Australians.

Conclusion

Golden opportunITy ��


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kpmg.com.au

Contact usMalcolm AlderPartner, Digital BusinessKPMG+61 2 9335 8041

Con KoulourisDirector, ICT and TelecommunicationsChurch Resources+61 2 9439 2622

Linda JustinSenior Manager, Business Performance ServicesKPMG+61 2 9335 7176

ResearchersLani BirchAdviser, Business Performance ServicesKPMG+61 2 9336 7613

Carolyn BettsConnectCare+61 2 9439 2622

© 2009 KPMG, an Australian partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International, a Swiss cooperative. All rights reserved.

KPMG and the KPMG logo are registered trademarks of KPMG International.

Liability limited by a scheme approved under Professional Standards Legislation.

December 2009. VICN04331ICE.

The information contained herein is of a general nature and is not intended to address the circumstances of any particular individual or entity. Although we endeavour to provide accurate and timely information, there can be no guarantee that such information is accurate as of the date it is received or that it will continue to be accurate in the future. No one should act on such information without appropriate professional advice after a thorough examination of the particular situation.

© Copyright – Original Material, Church Resources, 2009

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