Panellists included: Adjunct Professor Dr Jim Taggart OAM – GWSRR Chairman, Michael Walls – WSBA publisher and editor, David Hegarty – partner Price Waterhouse Coopers, Associate Professor Amanda Johnson, UWS, John Engeler, Group Manager SummitCare (Australia), John Krisenthal, Director Senior Helpers, Marta Aquino, CEO, Residential Gardens, Elly Beck, Business Manager, Realise Performance, Rod Young, Horsley Services and Damian Hiser, Domain Principal Group. Following is an edited transcript of the session.
Jim Taggart: Welcome everyone to the GRSRR. It’s great to see so many influential people here today and I must say a special thanks to Price Waterhouse Coopers and David Hegarty for their support in sponsoring this event today. As we know the subject is Aged Care and Retirement Living and I am looking forward to some robust discussion. Let’s start with introductions, John.
John Krisenthal: I run an in-home care service called Senior Helpers in the Parramatta, Hills and Western Suburbs. We’ve been around for around about 18 months, two years. It’s a private, non-government funded service and I am enjoying that sort of change out in the space.
David Hegarty: I am a partner with PwC within our Norwest office. This office has nominated aged care and retirement living as an area in which we see significant growth opportunities for our profession. We have sponsored this round table as we are seeking local expert assistance to develop our knowledge as well as that of the community within this industry. This industry will become highly regulated over the coming years with the involvement of government, increased medical requirements, improved facilities, pricing sensitivity and greater competitiveness. Given the impending matter it is very important that our expertise in the area strengthens so that we can address accordingly.
Amanda Johnson: Hi I’m Amanda Johnson, an Associate Professor in the School of Nursing and Midwifery at UWS. And my area of teaching research is in the area of Aged Care and Palliation. I’m also the Editor of a new text released this year called Caring for Older People in Australia. And we work with many of the aged care providers across this region and across other States of Australia. So thank you for the opportunity to come.
John Engler. Hi I’m John Engler the Manager of all the Accommodation Services for the Summit Care Group. We’ve currently got about 850 beds. Most of them are in Western Sydney. And I suppose the thing for today is that we’ve got a Development Application for an over 200 bed or 200 person facility in the Baulkham Hills area which we’re moving ahead on very quickly. And so, that will bring our stock to well over 1,000 beds and make us a definitely a medium, if not medium to large player. Privately owned, so, we’ve been going about 50 years. A lot to contribute around some of the differences and the nuances I think that a private operator has to bring to the table.
Geoff Connolly: Hi I’m Geoff Connolly and I’m here with Western Sydney Business Access, as an observer. I’m working sales for them. As an aside, I have a background originally as a Radiation Therapist, and have worked as that and a Hospital Scientist. So maybe I have something to offer as well.
Michael Walls: I’m Michael Walls, editor of Western Sydney Business Access and one of the people that put this Round Table together. Thanks to David and PWC for sponsoring this event and I am looking forward to a lively and educational and informative exchange between some very knowledgeable and talented people.
Rod Young: I’m Rod Young and, looking around the table, I’m probably the living example of the people that you want to talk about today. But I’ve – in my work background I’m now semi retired. So I’m in that beautiful position of actually being able to really enjoy myself. But thank you for the invitation to be here in that role today. It’s I think an exciting place to be. I’ve spent my whole career working in public hospitals and in aged care, the last 13 years of which I headed up the Aged Care Association National Office in Canberra. So I’ve been closely involved in policy, future directions, planning – across the continuum. And I guess one of the things I’d like to discuss today is: are we talking about aged care or ageing – because they are part of the same menu, but they also have quite different connotations, I guess.
Elly Beck: Hi I’m Elly Beck, the Practice Manager at Realise Performance. We’re a consultancy that’s worked with providers in the industry for about 15 years now. We see a lot of the challenges that are faced by providers in the Not For Profit and For Profit sectors. And I’m hoping that, we’ll be able to contribute from that perspective of having a little bit of an overview from not just one viewpoint.
Damian Hizer. Hi I’m Damian Hizer and I work for a group called Domain Principal Group. Specifically, we’re in residential aged care – so, nursing homes. We have 55 homes nationwide, most of them on the East Coast and 30 of those are in NSW, of which seven are in Sydney. I guess probably the most relevant to this discussion is we’re about to reopen our Quakers Hill Nursing Home facility in March. My role is National Business Development. So it’s effectively sales and marketing. I guess what I contribute today is the marketing aspect around aged care – specifically residential aged care.
Marta Aquino: I’m Marta Aquino, the CEO of Residential Gardens. Residential Gardens is specific for the Spanish in Rooty Hill. We are very unique as it is the only one in Australia so it’s very difficult because we are always filled to capacity due to the restriction on our accommodation we have a number of clients on our waiting list. So to help overcome this issue we planning a new project to expand and develop on the new land we have. It’s a new community venture for the Spanish. In the meantime we commenced providing home care services for the broader community. It’s a pleasure to be here, and thank you for the invitation.
Jim Taggart: Thank you. I’m amazed at the quality of people, you know. It’s amazing the stories that people have. I’m really excited for the next two hours of what we’re going to do. One of the growing areas that concerns me in Aged Care and Ageing is the whole area for people with a disability. OK let’s start. Rod, you mentioned the difference between Aged Care and Ageing. Can you set a platform for that?
Rod Young: OK. We were just talking before we started. If we went back to 1912, then you would be fortunate if you lived to 67 years of age. I’m now 65-year-old, and I’m expecting to live to 87 years of age. In the last century, we’ve actually expanded. And part of the reason why we’ve got a 65-year-old aged pension criteria is because of that very fact that, you know, that was your usual life expectancy was 67 particularly if you were a male and had been working in physical labour. So what we’re looking at, I think, in the 21st century is the product of a significant revolution that’s happened in the demographic space. And that revolution is that, in the 21st century, I like to ascribe it as three phases of life – you know, your 0 to 30 years learning, education, starting a career; 30 to 60, starting a family, getting a household – you know, consolidating a good career. We currently describe the 60 to 90 year, or the third phase of your life, as retirement, which I’m adamantly opposed to because I’m a perfect example of a five years post 60 year old who is semi retired – using the only word we’ve got available to us at the moment – but actively engaged in a whole range of different things, including working in my preferred industry which is ageing and aged care. So one of the things I’m struggling with - and many others are challenging the same - is what is ageing and what is aged care. Aged care tends to be in most of our minds, nursing homes, home based services. But ageing is the majority of people who are out there getting some sort of support and ongoing assistance in one way or another. But they are simply living that third part of their life and living it usually quite healthy, with some minor disabilities, some medical assistance and occasionally some home care support. So that’s the difference. And I think there’s a challenge for us as a community as the broader society and government policy as how do you actually get people to maximise that ageing component, good health and wellbeing, whilst getting people to engage with the changes we’ll need to make around housing and transport and all sorts of other issues, to support people in that third stage of life.
Jim Taggart: Thanks Rod. That’s a really good segway into what I want to ask. Now I want to ask, from an academic point of view: Amanda – how do you view that? Is that something that you’re looking at in terms of research. Are we doing enough for aged care in Western Sydney or in Sydney and so on. But I was really interested with that about the difference between ageing and aged care – because they’re quite distinct.
Amanda Johnson: From my perspective, I would say to you that, yes, there are people living healthily in the community – and certainly, that’s government policy and we would certainly promote that. But if you look at the demographics – and one of my areas is around chronic illness and disability – I’m also the Editor of a text related to that – if you look at that and how the lifestyle is impacting on the generation in the fourth and the fifth decade, that is going to seriously impact when they come into the third sort of phase of life – into that retirement phase, as you describe it, Rod. So because of the lifestyle patterns and behaviours that people will have led in the third, fourth and fifth decade, that is going to increase the complexity of care, because they will have long term conditions. The classic example is diabetes. So we’re going to see older people coming into an aged care provider with diabetes, but plus or minus some other form of disability – poor sight, poor hearing or something associated with a complication as a side effect to diabetes such as renal failure, peripheral neuropathy – those sorts of things. So the type of individual coming into aged care will actually have higher acuity needs. And we’ve never ever seen that before. And they’ll come into the provider in an acute state with complex needs. Their stay – their life within that provider will be shorter than what it has been currently. We won’t see 20-year stays in one facility. And they will die in the facility as a result of these complex conditions. So as a result, the provider now also has to provide palliative care needs as well. And that has been a quantum shift, particularly in the last 10 years. And aged care as an industry does not have the workforce. If you look at the Bradley Report, it does not have a workforce that has that capacity to provide what we call a palliative care approach – so, generalist skills around caring for the dying. So there is change happening.
Jim Taggart: And David, from where you sit - your expertise and giving advice – I was really taken aback by that – this whole area of Palliative Care – that people actually now die in their nursing home or aged care facility.
John Krisenthal: I’m agreeing, that we as on-the-ball aged care providers, both public and private, have to concede that – that the level of acuity is increasing. So the stay will be shorter, at an older age, with more complex needs. And in effect you cannot separate palliation – which seems odd. And I’m relatively recent to the aged care sector. But it seems odd that nursing homes – aged care facilities – aren’t necessarily that well geared towards palliative approaches. So that’s a really big thing. And you would think most – the normal person in the street might find that a bit odd, but it is absolutely right.
Amanda Johnson: And there is that historical reason for that – because palliative services were always of a specialist nature. And in Australia, they became a medical specialty in their nursing in the early 1980s. So the Aged care sector and palliation – they didn’t coexist. It’s only been in recent times where some of us have joined that together because of the need within the population. So for my instance, I’m an aged care researcher. But my niche area is palliation. Once upon a time, we never thought that people died from dementia and needed palliation, whereas I and Professor Chang realised that that was a growing area. So in the last 10 to 12 years, there’s been quite a significant shift. We never talked about a palliative approach and connected that to the older person. We always thought it was cancer orientated. So now we know that people die from other things apart from cancer. And they still need the same level of intervention and care. So that’s the difference.
John Engeler: And I think for us – well what we need to do is – all of us as providers or anyone engaged in aged care generally, and the ageing process – and ultimately the death process and therefore palliation – is acknowledge that ultimately – it’s no great mystery – most people would prefer to die in their own home that includes their aged care facility they’ve been living in. We’ve recently been able to do a couple of innovative things which I think are “bits to take away”, as you would say, where we helped a long term resident who was moving to a stage – an end of life stage – it was clear they only had a little while to live – helped the family – got a product together where the person could move back into the daughter’s home for the last stage of palliation. But even aged care facilities need not be one directional. You can - it took a bit of work but it’s certainly something we’re very proud we were able to do – help somebody move back into a family member’s home, so to die at home after having had a very substantial period within Aged Care. At the moment, we’re not particularly geared up for that I think. There was a bit of work involved to make that happen. But I have a sister who’s a physician in palliative care. All the time she says: Most people would want to die in their own home if they had the choice. Very few people would prefer to die in any sort of a facility or hospital setting. So I think a lot of the work around this has to be around, as Amanda knows, getting the education, the training and the awareness around that thing. And we’re not talking about years. We’re often talking about very short periods of time. And I think that’s a challenge for all of us – how can we make that happen and not be “bureaucratic”, I suppose, in our response to it?
Jim Taggart: Thanks John. Damian, how do you feel when you hear that?
Damian Hiser: Look, I think we often have the discussion around palliation and should we sort of be more specialised in palliation. I’d argue actually that is what a nursing home has traditionally been – somewhere – you know, somewhere to palliate and to die. Do we palliate well? Questionably not, and sometimes it’s about medical dynamics. I’ve spent a fair bit of time running hospital with palliative care wards. And you know, that’s traditionally the cancer base, as you talk about, Amanda. But I think that one of the other aspects that we’ve got to consider is: who’s influential in mum or dad’s decision where they want to die. Absolutely agree with John that, if you ask, most people would want to die in their home. But you’ve got the families. And that palliation – that aspect of care for not just the resident but also of the families, how you bring them into that process – because the elephant in the room in nursing homes is that is where people generally end their lives. You know. They – so we’ve got to address that, I guess, in terms of how we treat palliatively, but also how we treat the family and families as well. Look I think just picking up what John’s point is. I think that the industry – and Amanda’s – we’re not geared towards, probably educationally.It’s something that’s always been there. And I guess, as an industry, we do our best efforts. And I talk specifically from our company’s perspective at best efforts. And I think we do it well enough. But I don't think it’s become a specialty or a focus.
Michael Walls: Is that something – for want of a better term – that is an opportunity?
Amanda Johnson: It’s an opportunity. I have a PhD student who’s researching the AINs that work in aged care facilities and how can we increase the knowledge skills and attitudes around a palliative care approach. She will be working in their sites as part of her research study and in other providers. But, you know, that’s the opportunity. That’s where we’ve got to recognise that that’s the vision, that’s what we need, that’s where we need key people that have that level of leadership that can then promote change across the sector.
Jim Taggart: Marta, how do you feel about that? You expressed to us that you’re involved with aged care, but particularly in the Spanish community. Tell us a little bit about that.
Marta Aquino: In the Spanish community, one of the things you have to look into is the cultural issue, because you cannot approach everything in the same way. For a family when someone is preparing to pass, it’s very difficult. OK? So you have to educate it in a way a relative. You have to give knowledge to the staff. And you have to realise the view of individuals. In the palliative care are very difficult issues than aged care – because we were not prepared for that. Before, we used to have a relationship with the government and they sent special nurses, now we don’t have any more. So our nurses, as you say, have to deal with a new approach and care. It’s terribly difficult because they don’t have the skills to be ready for that. So there are a lot of issues in that. For the Spanish community, in the beginning it was easy because ageing was not a big issue. But suddenly everything happens – so, and you have to deal with that. And it’s a difficult approach. It’s difficult for a service provider like us because we don’t have the sort of money to be able to prepare everything at once. But we’re doing the best we can. And at the end of the day, what we have to make sure of is the family is happy and that the person or resident who’s been living with us for a long time, having an end of life that is peaceful and with respect. There is another issue in that if someone’s coming into a room where a person has died it’s a very difficult issue. No-one mentions that. But culturally, it has to be mentioned.
Jim Taggart: Marta, with you looking after the Spanish population, where are we heading down the track that, because of demographics Western Sydney is so dispersed and we’re having more Indians and Chinese and so forth, does that mean that we have to be looking more and more at having a Retirement Village or Aged Care for a certain group of people? Do you think that that’s where we’re heading?
Marta Aquino: Well it has been discussed so many times. As a service provider for a specific language, I think its value – it’s a great value – because the cultural issue – it’s all happening there. Many providers provide service for another language, but they have terrible difficulties because they have to have staff with the language, they have to know about the cultural issues, and they have to have the appropriate menu for them, music – and you name it, and it’s there. Now – and specific providers can organise everything at once. They like to be in your own roots. You like to be in an environment where everything is as you known, .enables you where you want. For me, it’s very – very specific and it has to continue. I think we have to look at the numbers. And you cannot leave residents on their own in one organisation where the communication is not clear. So you need to acknowledge that. One of your real problems though is where you might have several different people from different ethnic backgrounds. And as they unfortunately go through the dementia phase, they often lose their English as a second language. Sometimes people think one word is enough for a person. OK. If you speak Italian, they say: Hi, Seniora. But that’s no good. You have to understand the culture. And you have to provide that. And it’s not easy for any provider with one or two residents. This is an issue for the future. Ageing is an issue from new communities.
Elly Beck: Can I just add to the conversation? Everyone’s talking about the great things that they want to happen in aged care. Everyone at this table here wants the best for our ageing citizens. But one of the major issues is around workforce. We have – in the sector, an ageing workforce and its hard to attract and retain workers. It’s hard to let them know that we value them, because their wages are abysmal. They’re abysmal.
Amanda Johnson: They’re actually below the Acute Sector. So in terms of a new graduate – just to take the example – they will go to the Acute Sector before they’ll think about going and having a career in Aged Care.
Elly Beck: And the sector, as far as I’ve know, it has always been in change – much more than perhaps other sectors where you just get something, you think, bedded down. And the rules change again. So whether that’s the funding rules, the compliance, what you’re able to employ as far as their education levels, it’s all changing. So you’ve got a workforce that’s not attracted to the sector in the first instance. You’ve got an ageing workforce. So how do you provide all these things that you want to give to older people when you can’t even get the people to staff your facilities.
Amanda Johnson: UWS produces each year between 800 and 900 graduates. Now I’m the Director of Academic Programmes for the Undergraduate Programmes. We ask them: Where do you go when you graduate from us? They go to the Acute Sector. Why? 1 Because of income. 2: Because it’s attractive. 3: Because they’re provided with a new graduate programme. The aged care sector – and I’ve been to several providers now to encourage them to set up new graduate programmes, to link with an acute sector so they get that experience as well because they need that – but there is no uptake. And I don't understand why – because there is a huge marketing opportunity. We profile it in the University. We have aged care embedded within our curriculum. We have researchers in aged care. So they’re exposed to it. I’ve got honours students in aged care going up to PhD. But where do they go? They get lost to the sector because there’s no uptake. That is a huge issue. We’re doing our bit, but there’s something not write on the other side. So I think that’s a challenge for us. And I agree with you, Elly. I think it’s very important.
Jim Taggart: OK. Thank you for that.The discussion is so enlightening. Can I just say this is one of the best that I’ve had. John – how do you feel? What’s going through your mind listening to all these structural issues?
John Krisenthal: When you look at the Productivity Commission report, you looked at an announcement that $6 billion is going into the sector, and everyone gets excited. And I’m thinking: $6 billion. It’s a drop in the bucket. You know. It’s nothing. Alright? So I don't think – I think “oldies” are “invisible” out there. The sector is “invisible”. It’s not high on anyone’s priority list. You get the ageing tsunami. But even at the top end of the funding structure in the last ACAR round, you’re looking at - what - $40,000, $45,000 a year in terms of care for staying at home, which equates to the grand sum of 21 hours a week. That’s sort of fiddling around the edges. We go in and do some support for people with Dementia. And I can guarantee you that none of those families who are dealing with – who are looking after a person with dementia, ever comes home early. They might have 3, 4 hours away of respite. Education is one of the biggest challenges we’ve got – and there’s reviews going into the education side of the sector as well. I’ve been approached by fly-by-nighters who want to put people through their Cert IIIs in a month.
Amanda Johnson: I think we need to understand that, when you go into an aged care provider that it doesn’t matter what level of carer you are – so it goes from a registered nurse down to AIN or an Unlicensed Personal Carer – so that’s somebody with no formal qualification - and some providers employ them as well, or a mix thereof - that intrinsically, they need to have knowledge skills and attitudes that are appropriate to care for older people. It’s actually quite a discrete area of practice. Not everybody can do it. And you do need to up skill and give them that capacity to be able to provide the appropriate level of care. And I think that’s where we’ve made some errors in the past, because we think we can just pull you off the street, stick you next to this person, and you can provide and you can feed. Well there’s actually a technique to how you feed an older person that’s got swallowing difficulties, who’s got Dementia, who might be dying, who’s got Diabetes, those sorts of things. It’s very complex. It’s not simple like put them on the toilet, feed them this meal, and put them into bed. Even getting the people into bed, there’s an art to the way you do it. So that’s the knowledge, skill and attitudes. I think it’s about continuing education too. And I think it’s about lifelong learning. If you look at the pedagogy around education, it is about lifelong learning. So they shouldn’t just do their TAFE course and sit at a Cert III. The sector’s actually developed in that time. Things have changed. New knowledge, new skills, new attitudes are required. So it’s important that we engender within any level of carer, this – the notion of continuing education, lifelong learning. Providers have a responsibility to provide that. The government has a responsibility to put in place a Policy and a framework and funding that supports that. And universities have a responsibility – and we do – to promote lifelong learning in the staff that it educates.
Jim Taggart: I’m going to ask John and Damian, what’s your view? I mean you’re spending millions of dollars – if I can just ask, you’re going forward. I think you’re building another 200.
John Engeler: The main thing that I hear is a couple of things – is that we have an anecdote. We had the joy of celebrating the oldest person in Australia’s birthday recently - 112. She’s a resident of one of our facilities; great event. And I’ve got to say what was really good - I’m a non-clinical background – was that there wasn’t a Band-Aid, a bowl chart or a medication syringe in sight. It was about this woman’s wellness. It was a fantastic thing. Sure, she’s a resident of one of our facilities. But I think sometimes – and I understand all the concerns and challenges we have around making sure that we’re focussed in the right direction around our care, but we do it at the expense that most people most of the time – their experience in a residential setting – we certainly hope it is not about their unwellness. It’s certainly about their wellness and how well they’re doing – not how sick they are. We’ve tried to emulate the hospital model – make it a bit sort of cottagey or look like someone’s home. That’s just not going to work. So we’ve put all our fabrics and finishes back in. They’re designed in a way where you can clean them and not feel like you’re going to have an infestation. We’re moving towards a more hotel model. So that’s not to say they are all fine hotels. But if you have the two book-end continuums – hospital/hotel – we’re trying very much to bring ourselves back towards the hotel type model, because that’s more akin to what we do. Most of the time, food, not medication. It’s about their room – not about whether their bed goes up and down. That’s five minutes of their eight hours that they sleep. So I think for us that’s a big challenge. Getting the balance right between keeping all the care and the clinical and the compliance happening, but also questioning why we do certain things which are left over from the hospital. So recently one of ours is: why do we have blue disabled signs everywhere – or blue signs that differentiate where the toilets are. When you look into it – and we’ve certainly employed an interior designer who’s a specialist in Dementia – as long as you’ve got a 30% variation between say a door and a wall, so a person with Dementia can know that that’s where the bathroom is, the sign can be in two shades of beige. They don’t have to be the blue medical thing; but for a long time, we all thought that was the case. So I think there’s a great, a great amount of work happening – I think it’s probably happening all across Australia – moving away from hospital towards the hotel model within an appropriate setting and maintaining their standards. So I suppose just to finish, one of the ones we’ve done and will continue to do in our new facility at Baulkham Hills, in the same way that a hotel would – not a hospital – we separate all of our utility areas in a corridor that’s parallel to the main corridor in a facility. So there’s no reason for anyone to see a dirty utility or a laundry trolley any more than is absolutely necessary. We keep all of that back of house stuff behind. So I think one of the areas we probably haven’t touched on – we’ve talked about people as a resource – the whole spatial planning aspect of it is a really big area – because when we talk about palliation, I hope that we’re going to be as good as we’d like to be in our new facility, to have accommodation for families to come and stay. But the reality is, if we do, because we’ve put it in – not necessarily because there’s a government funding. That will provide for it. Yet I see that as a big missing link. How many of us know – have personal experience, if not professional ones – of people sitting around someone’s bedside eating, you know, KFC and having an instant coffee, having an awful experience – not being available at all for the person who’s at the end of life, because physically they’re in the way really. We’d prefer they went home and came back. But ultimately if you provide the facilities – so I think a lot of the spatial discussion is yet to happen. I think we could do a lot more in that zone. What could we do as providers better to provide spaces where people can just get on with the nature of the experience – whether it’s wellness for a birthday or having a good palliation experience towards the end of your life.
Jim Taggart: Thanks for that, John. Damian?
Damian Hiser: Yeah, look, I agree with John. I mean in terms of care – obviously absolutely a fundamental. And the thing is, if we look at it from a consumer or a resident perspective, that’s almost a given. Now let’s just assume – make the assumption that we provide that. It’s actually about lifestyle, activities, wellness programs. And that’s where we’re investing as much time and energy – in developing meaningful activity programs for our residents. It fits with the accommodation that we’re building – the new Quakers Hill facility, quite large common areas. If you walk around any of our facilities that leave you with that feeling, that’s a great facility. There’s very few residents in their rooms. They’re out doing activities. They’re out in the common areas. It’s got a buzz to it. Families pick up on that. Residents, you know, get a lot from that. So we’re putting as much effort into developing lifestyle and activities programs that actually make it a meaningful time in the home for those residents.
Jim Taggart: Absolutely. The whole area of home base is really pertinent to me. That’s what my doctorate was on – home based business. And one of the research questions I sought for further recommendations was the whole area around Aged living and so on.
Amanda Johnson: I did actually say that there should be diversity in the sector. And when I said that there should be diversity, there should be a place for the single provider. But I think reality is that we’ll have - majority will be probably larger providers. In terms of diversity, there should always be diversity in the levels of education. But they should receive education, both formal and informal.
Elly Beck: I’m just listening to all the discussion around the table. And I’m thinking: what a wonderful opportunity for Greater Western Sydney to actually come together with people who perhaps wouldn’t come together and to really drive the profile of ageing for the betterment of everybody. We’re all on the right page heading the right way, coming together - and actually continuing something past this day, gives us all opportunities to actually make decisions that aren’t made in crisis e.g. when your partner’s died, to actually have some knowledge about going forward, about the community services, the residential services, the education, the support that’s available out there. That’s where it’s all sort of falling down. This doesn’t happen. And it’s not public and in people’s faces until you’re confronted with it.
David Hegarty: In addition to the discussion around aged care and retirement living people must address a number of issues around estate planning etc. This is an area that is very sensitive and not addressed by a large number of the population. It’s not only your Will that must be addressed and prepared it’s also the nominator of various trusted associates you believe are able and willing to make important decisions such as:
• Who can sign documents on my behalf once I am not of sound mind or incapacitated.
• Who should make the final decision to shut down the life support machine.
Given the importance of these issues we must continue to ask questions and develop the awareness within the community.
Michael Walls: How do you handle it, David, at PwC, in terms of – it has to be talked about – right?
David Hegarty: Well we try to talk about it despite some resistance. I am able to sit here and say that a significant number of my clients have their estate planning done. I saw the need for this area to be addressed and I went out of my way about five years ago and located an estate planning lawyer who specialised in estate planning and I requested that he see all my clients. The way I sold it to my clients was: “when you and your wife hop on the plane and fly away for your month’s holiday and your children remain at home as does your business, what’s one of the biggest issues you have in your life?” “Oh, my management. Oh hang on.” “ But what about your assets, your family and how’s it managed if something was to happen to you?” Now when my clients hop on that plane for a month’s holiday, they say: “I don't have to worry about it anymore. It’s all addressed.” That was how I educated my clients to deal with it.
Michael: Yeah, well that’s a marketing angle you don't hear that much off.
David Hegarty: The lawyer I engaged visits every one of my clients every two years. In addition to the lawyers involvement I keep in my office a ‘disaster list’. So, if something happens to one of my clients and one of them passes away, I know exactly who their lawyer is, I know where their Will is, I know who I should contact – where their bank accounts are etc. It’s just a two sheet piece of paper and I have it in the file of each one of my clients.
Jim Taggart: I’d like to give David an opportunity to wrap up and share with us what his reflections are and so on, because that’s important for you, David, as a take-out and a keen supporter of Access, particularly today for aged care.
David Hegarty: Given I am the accountant here, or they say the numbers person, I must say it’s been most interesting discussing all other matters, not just the numbers. I do however believe we need to gain some understanding around key analytics, with some of the major ones being as follows:
• Government involvement via grants etc.
• Basic income levels from the clientele, both governments supported and private funding.
• Different types of villages that require varying levels of facilities, especially around the medical requirements.
• Varying ages of those attending these facilities.
• Overall cost of the facility, not only the capital cost, but the running cost.
• Available funding with bank support given the amount of investment required.
• Legal issues.
• Controls around those funds introduced by those future clients.
To wrap up the first session I’d like to say thanks to everybody for participating – thanks to Michael and Jim for asking PwC to host today. I think it’s been a great success. I was asked to select a topic PwC would like to support, I could have easily picked from a normal accounting matter like tax, cash flow management, return on capital etc. however given our involvement in Western Sydney for 10 months or so, especially the growth and development within the region, I thought a more relevant topic would be aged care and retirement living. I believe that I have learnt an awful lot from the knowledge around the table, which has been unbelievable. I am concerned that the conversation has just started despite the two hours we have spent together. There have been numerous discussions around education, staffing, levels of compliance and finally we got to the numbers. I believe there are numerous issues that need to be addressed, “where does it start, and where does it finish?” the different family issues, estate planning, affordability, capital requirements, ethnic issues, varying demographic centres and so forth. Again, I would like to thank you all, I found the two hours absolutely brilliant. I have sat here with my mouth open and have taken significant notes. I would like to put to the table that this is hopefully the start of something that we can do together. We are all on the same page, we all discussed the issues with a good understanding of the topics. It is obviously something that is very dear to our hearts, because not only do we have parents who are aging, we are all aging ourselves. So again, on behalf of PwC and Michael and Jim, I thank you all for participating, and it was great.
The Table: Thank you. Thank you. Thank you for having us.
Jim Taggart: This is the best one I’ve been to. I was really impressed with the intellect and the quality of the focus of where people’s heads are. Thank you all for your support here today and believe that we have the makings here of another Round Table on aged care.
