In his latest apostolic exhortation, Gaudete et Exsultate, Pope Francis says: âGrace acts in history; ordinarily it ta
C AT H O L I C H E A LT H A U S T R A L I A
matters issue 86 W INTER 2 018
www.cha.org.au
Q&A with
The Hon.
Ken Wyatt, AM
Minister for Aged Care
Prof Janet Hardy on the place of medicinal cannabis
SVHA
Group CEO
Toby Hall on homelessness
ELDAC:
Giving people the Right Tools for the job
Fr Gerald Arbuckle
on The Loneliness Pandemic
• Challenges arising in the practical implementation of Advance Care Directives • The origins and evolution of nursing practice in Australia • Rethinking Mission moving forward • High Papal distinctions awarded to Dr Bernadette Tobin AO and Terry Tobin QC • Celebrating our heritage: St John of God Subiaco Hospital and Ballarat School of Nursing
From the CEO
L O O K I N G F O R WA R D ,
Looking Back by Suzanne Greenwood Chief Executive Officer Catholic Health Australia
I
n April 1978, the first National Catholic Health Care Conference was held in Melbourne. Historical records about the meeting state that it was “a successful meeting with some 300 delegates attending and many important issues were discussed”. The major resolution which came forward from the Conference was that a working party be established to seek the formation of a National Catholic Health Care Association, and so the idea that would evolve into the entity—Catholic Health Australia—was born. This first working party was established with Fr Paul Duffy S.J., as Convenor, Bishop E.G. Perkins, representing the Australian Episcopal Conference, other representatives from each state, and representatives from the Major Superiors of Religious Orders. The working party became the National Council of the Australian Catholic Health Care Association. Then early in 1982, the National Council, with the support of many— particularly the Major Superiors of Religious Orders— proceeded to the appointment of a full time Secretariat. With the cooperation and generosity of the Mercy Maternity Hospital, an office was made available at 100 Grey Street, East Melbourne. Many changes have occurred over the years, including a relocation of the national office to Canberra and, in 1999, a change of name to Catholic Health Australia. In 2018, we will be celebrating 40 years since the first Conference gathering as we again come together in Melbourne for our National Conference, to be held 27-29 August 2018.
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And my dreams are strange dreams, are day dreams, are grey dreams. And my dreams are wild dreams, and old dreams, and new, They haunt me and daunt me with fears of the morrow – My brothers they doubt me – But my dreams come true. These words resonate with us today as we celebrate our living history, yet look forward to the future of Catholic health and aged care services. Our vision for better health outcomes for all Australians might seem to be ‘day dreams or wild dreams,’ in the face of changing sociological trends, political factors and economic drivers. Yet Catholic services continue to improve, innovate and outreach towards this vision. This edition of Health Matters features some highlights of the speakers and topics you can enjoy at this year’s Conference, Looking Forward, Looking Back. Looking back, we have brought together a panel of past winners of the Sr Maria Cunningham Lifetime Contribution Award to reflect on the past of the Catholic health and aged care sector and to share their vision for the future. “Whatever is has already been, and what will be has been before; and God will call the past to account.” Ecclesiastes 3:15
Slim Dusty was the first music artist in worldwide commercial recording history to release 100 albums. The title track to that album, Looking Forward, Looking Back, is the inspiration for the theme of this year’s CHA Conference.
In this magazine, Fr Gerard A. Arbuckle SM, past winner of this Award who will be presenting in the panel, challenges Catholic health and aged care ministries to respond to the loneliness pandemic.
For this song, Dusty found inspiration in the words of one of Australia’s best known bush poets, Henry Lawson, who in 1902 wrote:
Looking forward, the Conference will also feature a keynote presentation by Uncle Toby’s Ironman turned researcher, Andrew Meikle, who has a unique and in-depth understanding
of what sets high performers apart—born out of over 20 years of research. His presentation will help crystallise our thinking in our quest to inform the next generation of leaders, to build health and aged care services that can successfully innovate to meet the challenges of the future. Andrew will share with us his learnings gained from oneon-one interviews with high achievers such as Everest mountaineer Sir Edmund Hilary, President Nelson Mandela, and Olympic medallist Carl Lewis. Over the past 20 years, his research has evolved into a desire to pinpoint and understand not only individual high performance, but also the dynamics that exist within certain environments that result in the high performance of individuals within those environments. These are termed ‘high performance environments’—those places or events where the very best are stretched to their limits. Last year, at our 2017 National Conference, HESTA generously sponsored a new award to recognise the impact of the Arts in Health. The award aimed to acknowledge projects and programs which enhanced the experience of patients and/ or aged care consumers through the use of art. The number of projects nominated exceeded all expectations. They were featured in a poster display at the Conference, and over many months in our weekly e-newsletter. With a view to fostering continual innovation, this year HESTA is again partnering with CHA to sponsor a new award—the Digital Innovation in Health Award. The $5,000 prize will recognise that project or initiative that best utilises technological innovation or digital solutions to engage the patient/consumer in their recovery and quality of life. These projects or initiatives will enhance the patient/consumer experience, improve the quality of health care or aged care delivered, promote better patient/consumer outcomes through the application of IT, or support the mission and/or values of the health or aged care service provider in patient/ consumer interactions. Another exciting initiative which will feature at the Conference and which was launched in June by the Federal Minister for Aged Care, the Hon. Ken Wyatt AM, MP, is the End of Life Directions in Aged Care (ELDAC) initiative—a governmentfunded collaboration between the Queensland University of Technology, Flinders University, the University of Technology Sydney, Palliative Care Australia, ACSA, LASA, AHHA and Catholic Health Australia. Professor Patsy Yates, ELDAC Chair, will be presenting at our Conference on the achievements of ELDAC and how CHA services can access the ELDAC information, guidance and resources to support palliative care and advance care planning for older people and their families. Alongside the conference highlights featured in this edition of Health Matters, many other unmissable speakers and topics are listed in our full conference program. I look forward to seeing these presentations and more at this year’s CHA National Conference, and to catching up with many CHA members. So, in the words of Slim Dusty, “Looking forward, looking back; We’ve come a long way down the track. Got a long way left to go …”. n
CATHOLIC HEALTH AUSTRALIA
From the CEO
Looking Forward, Looking Back
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Policy & ADVOCACY Highlights from the 2018 Budget for Health
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The origins and evolution of nursing practice in Australia 7 Is it time to bring respite services into the reform equation? 11 Looking ahead to 2030 and beyond
15
Rethinking Mission moving forward
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The Sector SPEAKS Challenges arising in the practical implementation of Advance Care Directives
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Fr Gerald Arbuckle on The Loneliness Pandemic
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Q & A with The Hon Ken Wyatt: Minister for Aged Care 27 The place of medicinal cannabis in palliative care
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SVHA Group CEO Toby Hall on Homelessness 35 End of Life Directions for Aged Care (ELDAC) toolkits
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Around the NETWORK New St John of God Berwick Hospital opens
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High Papal distinctions awarded to Dr Bernadette Tobin AO and Terry Tobin QC
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Championing Catholic sector research
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2018 HESTA Australian Nursing and Midwifery Awards
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Federal Health Minister opens NHMRC Centre for Research Excellence at Cabrini
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Mater research grants supporting women in research
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SJOG Subiaco Hospital celebrates 120 years
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History of St John of God Ballarat 1958
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Adding remote dialysis to the MBS
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REFLECTION Looking Forward, Looking Back
inside back cover
Health Matters is published quarterly by Catholic Health Australia Edited by Suzanne Greenwood • Design - Iroquois Design National Office: Level 2 Favier House, 51 Cooyong Street, Braddon, ACT, 2612. P 02 6203 2777 E
[email protected] www.cha.org.au ACN 167 751 537 • ABN 30 351 500 103 • ISSN 1443-3532 The views expressed in articles written by external contributors are those of the authors and do not necessarily reflect the views of CHA.
We are @chaaustralia on Twitter and on Facebook we’re Catholic Health Australia.
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Policy & ADVOCACY
highlights from the
2018 B udget for H ealth by Annette Panzera Director of Health Policy
T
he 2018 Federal Budget for Health was well received publicly and contained some potentially positive funding allocations needed to address some of the current issues in our health system. Three areas of interest for our sector worth monitoring are described in this article below. Addressing regional health workforce needs The Government has recognised the geographical maldistribution of the Australian health workforce, which results in an over-supply in urban areas and chronic shortages in regional ones. The increasing prevalence of chronic diseases and an ageing population further exacerbate the issue, leading to below average health outcomes for those living in regional Australia. The Government’s Stronger Rural Health Strategy aims to offer more opportunities to the Australian rural doctor workforce through better teaching, training, recruitment and retention strategies. The stated objective is to deliver a further 3000 specialist GPs and 3000 additional nurses in rural general practice over the next 10 years. As a measure to attempt to address the workforce shortages, a new rural health medical training network will be established, called the Murray-Darling Medical Schools Network. This network will prioritise enrolments from medical students from the bush and offer them long-term training opportunities. This will feed into the work being undertaken by the National Rural Health Commissioner to develop the National Rural Generalist Pathway. A pool of medical Commonwealth Supported Places (CSPs) will be established (drawn from existing allocations), prioritising rural and regional areas of need that enables students to undertake end-to-end medical training in regional
locations. This initiative will include the establishment of a new medical school in Orange, NSW. Rural hospitals will benefit from increased staffing which should improve medical workforce sustainability. Further along the training pipeline, the More Doctors for Rural Australia program will provide incentives for nonvocationally recognised doctors to become Fellows and work outside major cities. These doctors will be able to receive a Medicare provider number to directly bill Medicare in Modified Monash 2-7 areas. Newly supported training pathways provided through specialist GP colleges (the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine) will develop this workforce with a five-year grandfathering period. Funding of 100 additional places for medical practitioners to become rural generalist doctors will be allocated from 2021. Training subsidies will be available to support them to attain Fellowship. Two new junior doctor training program streams have also been announced. The Rural Primary Care Stream will provide funding to support junior doctors while working in rural primary care settings (Postgraduate years one to five), while the Private Hospital Stream will provide salary support for junior doctors who work in private hospitals. Finally, a single, integrated health workforce and services database called the Health Demand and Supply Utilisation Patterns Planning (HeaDS UPP) Tool will use newly defined geographical catchments to better inform workforce and analysis planning. The tool will be made available to organisations such as rural health workforce agencies, Primary Health Networks (PHNs) and medical colleges, as well as local health districts and services. continued next page
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Policy & ADVOCACY
Additional Health and Medical Research Funding for our researchers As at 31 March 2018, the Medical Research Future Fund (MRFF) had $6.7 billion in capital. The 2018 budget confirmed that the MRFF should reach the target of $20 billion in capital by 2020–21, with a forecast balance of $20.2 billion at 30 June 2021. An amount of $2.3 billion is estimated to be added to the capital in the next financial year. This represents a significant investment in health and medical research, which the sector applauds, however questions remain about the transparency of the MRFF application process. It should also be noted that research funding available through the National Health and Medical Research Council has stagnated in real terms. The main funding area announced was a large allocation of $125 million over 10 years for a Million Minds Mental Health Research Mission in order to support priorities under the Fifth National Mental Health and Suicide Prevention Plan. Making research into mental health a top priority should be a huge benefit to Australians, as approximately up to one in four suffer from some form of mental illness each year. A further $75 million over four years was also announced to extend the Rapid Applied Research Translation program that supports Advanced Health Research Translation Centres and Centres for Innovation in Regional Health. Research translation is a welcomed focus of the MRFF as Australian universities have historically lagged behind their international counterparts due to few incentives for university researchers to translate research into practice. Other priorities included a smaller allocation of $18.1 million over four years for a Keeping Australians Out of Hospital program to support preventive health and behavioural economics, and reduce avoidable presentations to hospital. Behavioural economics strategies have been used with great success internationally to decrease avoidable hospital preventions, so this will be an interesting research area to see develop. Another allocation of $39.8 million will be spread over four years for a Targeted Health System and Community Organisation Research program with a focus on comparative effectiveness studies and consumer-driven research. Lastly, $17.5 million is set aside over four years for research into Women’s Health, Maternal Health, and First 2,000 Days. This aims to address the underlying social determinants of health that impact on a child’s early days of life. Also announced was the new National Health and Medical Industry Growth Plan, with the stated aims of improving healthcare outcomes and developing Australia as a global destination for medical sector jobs, research and clinical trials. This plan will provide $1.3 billion over 10 years, and would be supported through investments in medical innovation to enhance the sustainability of the health system, deliver
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long–term health benefits and strengthen partnerships between researchers, healthcare professionals, biomedtech firms, government and the community. These investments (using proceeds from the MRFF) will include $500 million over 10 years committed to the Genomics Health Futures Mission. Additional funding will be distributed to the Australian Institute of Health and Welfare to improve accessibility to health information and statistics, including better data sharing capabilities and ICT upgrades. Preventive health measures There were several investments announced in the Budget aimed at addressing mental health-related illnesses, including additional resources to the National Mental Health Commission to improve delivery and design of mental health support services and policies. Aftercare following suicide attempts was also prioritised, as well as delivering a targeted suicide awareness scheme Better off With You through the PHNs. Three PHNs in Western Victoria, North Queensland, and Sydney North have been chosen to pilot the scheme. Infant health was also included as a priority area for preventive health, along with financial support for strategies to improve vaccination rates for childhood immunisation; educating women about the risks of gestational diabetes; a new National Injury Prevention Strategy to reduce accidental deaths and hospitalisations for children; free insulin pumps to disadvantaged families; development of a digital baby book; and a campaign to increase awareness and understanding of endometriosis among GPs and health professionals. Finally, Australian sports were a recipient with the Government pledging support for the goal of building a more active Australia, including $41.7 million to expand the Sporting Schools Program to a total of 5,200 primary schools and 500 secondary schools—a program providing free sporting activities for students. Local community sporting infrastructure development grants were also announced, as well as further funding to assist national sporting organisations. To conclude, the three areas outlined above (regional health workforce, health and medical research, and preventive health measures) are just some of the highlights of the 2018 Health Budget, and the significant announcements made around initiatives to improve aged care service delivery are not included. This article also does not examine areas where Budget funding was notably absent, for example dental health and primary health (outside Medicare funding measures). The Budget this year definitely contains some welcome developments for the healthcare sector, but noticeable gaps remain where healthcare reform and innovation is still desperately needed. n
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Advocacy, research, policy, protection and creation of safe environments are all components of nursing, but what truly defines a nurse is their incredible capacity to show compassion and provide care to those who are most in need.
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Policy & ADVOCACY
the origins and evolution of
NURSING PRACTICE in Australia by Emma Hoban Health Policy Officer
N
urses comprise 56.9 per cent of all health practitioners registered in Australia. At some point in our lives—often at the most vulnerable moments— we will encounter a nurse providing care. Australia has over 380,000 Registered Nurses who work individually and collectively to provide care for the sick, reduce suffering, and improve the health of many.1
Nursing is defined by the International Council of Nurses (ICN) as a profession that: “…encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people”.2 Yet nursing encompasses so much more. Advocacy, research, policy, protection and creation of safe environments are all components of nursing, but what truly defines a nurse is their incredible capacity to show compassion and provide care to those who are most in need.2 We all have inspiring stories to share about the dedicated nurses that work within our hospitals, aged care facilities and community settings, and the work they do every day
that so often goes unrecognised. Therefore, in the spirit of recognising and understanding the great work of Catholic Health Australia (CHA) nurses, this article seeks to explore how nursing in Australia came to be the mighty profession it is today. While the principles and practices associated with nursing certainly predate the 19th century, many credit Florence Nightingale to be the founder of the modern profession of nursing. Nightingale, the well-educated daughter of wealthy British parents, defied social convention to make a career of nursing. She rose to prominence during the Crimean War where she introduced the world to holistic nursing using scientific principles and education, and saved thousands of lives. Leading a small group of nurses, Nightingale travelled to a military hospital at Scutari (now known as Üsküdar, a municipality of Istanbul, Turkey) and reorganised the delivery of care. In accordance with 19th century science, sanitation principles were implemented; ventilation created; nourishing, healthy food provided; and efficient regulation, recording and administration of medications and treatments applied. As a result, death rates plummeted as infectious disease was controlled and reduced.3
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Policy & ADVOCACY
Nightingale’s philosophy soon spread worldwide, and in 1866 Sir Henry Parkes—then Member of NSW Parliament who would later become Premier—wrote to Nightingale to request that Nightingale-trained nurses be sent to the colony. Sydney Institute, now Sydney Hospital, was in squalid condition. Patients were being treated in wards that were ‘crumbling, foul-smelling and vermin infested’.4
medical sphere. These challenges can be traced as far back as Lucy Osburn’s time, who received an abundance of public criticism for the changes she implemented at the Sydney Institute. These disputes continue today, when comparing funding distributions for nursing research and programs, and pay disparities between nurses and other medical professionals.10
Prior to his request of Nightingale in 1866, Parkes had visited a patient at the institution and was appalled at the condition in which his friend was being treated. When this patient died the next day, scandal ensued.5 With the support of the Infirmary doctors who had been petitioning for change since 1857, and with government backing, Parkes corresponded with Nightingale.
Interestingly, nowhere was the battle for legitimisation more notable than in the fight to have nursing education moved into the tertiary sphere. It took 28 years for Australian governments and medical bodies to recognise the need for nursing education to move from apprenticeship-style training in hospitals to more academically-based programs within tertiary institutions.
Nightingale agreed to send a delegation of Nightingaletrained nurses to Australia to work in the Sydney Infirmary, and to set up a training school to develop the Australian nursing profession. This agreement was conditional and absolute. Nightingale insisted that nursing be independent of medicine and that a matron manage the nursing staff, a highly unpopular decision with medical professionals.6 Thus, Lucy Osburn arrived in Sydney with five Nightingaletrained nurses in March 1868, and the formal profession of nursing was born in Australia.
The push began in 1962 when the Royal Nursing Federation and the College of Nursing Australia presented an initial proposal to upgrade nursing education standards to a tertiary setting as part of a submission provided to the Australian Universities Commission on the Future of Tertiary Education in Australia.11 Various reports followed over the years promoting the same agenda, but the proposal faced continual opposition. Much of the opposition came from medical administrators and was underpinned by a fear— not unfounded—that moving nursing education into tertiary
It took 28 years for Australian governments and medical bodies to recognise the need for nursing education to move from apprenticeship-style training in hospitals to more academically-based programs within tertiary institutions. It is important to note that prior to the arrival of Nightingaletrained nurses to Australia, nuns from religious orders had been providing nursing care. The Sisters of Charity had been providing care at St Vincent’s Hospital since 1857.7 However, these women were unpaid and under the direct control of medical staff. While their efforts were by no means insignificant, the origin of the paid, independent profession of nursing in Australia is seen to commence with the arrival of Nightingale-trained nurses in 1868.8 The nursing profession, in Australia and abroad, has faced many challenges as it has developed and progressed since then. One of the biggest challenges has been its struggle for legitimisation, with a tendency for the profession to be viewed as ‘women’s work’ or ‘dirty work’, and as such, undervalued and treated as lesser than other medical professions.9 This resulted in numerous turf wars as the profession attempted to progress and gain respect in the
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institutions would remove a large cheap labour force from medical institutions as student nurses would need to be replaced by a more costly form of labour. In 1978, the federal Report of the Committee of Inquiry in Nurse Education and Training to the Tertiary Education Commission was tabled. The report agreed that there was no reason that nursing education should be undertaken in settings different from other health personnel, but cautioned against the logistical and financial consequences of a large-scale transfer. The report resulted in the creation of more college nursing education places. However, financial pressures meant that many nurses were reluctant to trade their paid training programs for unpaid degrees. The situation came to a head in November 1983, when the Health Minister of New South Wales made the announcement that as of January 1985, all basic nurse education would
occur at a tertiary level. From January 1982, Diplomas of Applied Science (Nursing) were offered at 14 colleges of advanced science, with a commitment from the Federal Government that by 1990, all nursing education across Australia would be transferred to a tertiary setting.12
Queensland, Katherine Jackman, sums up the incredible impact of the nursing profession in the following statement: “In this constantly changing world we are compelled to continuously seek further knowledge and skills and explore if our practice is achieving the very best of outcomes. Nurses are in a challenging yet privileged position, and we strive to always keep the patient, their family and the health and wellbeing of our community as the centre of our focus.
Today, nurses comprise the single largest health profession in Australia.13 The industry has grown monumentally over the last 150 years to become one of the most vital components of the Australian health system. Registered Nurse and Director of Learning and Development at Mater
“Whilst we continuously strive to provide holistic and ethical care, built on a foundation of critical thinking and advocacy, we must recognise the power of one. One word, one act, one moment, multiplied by over 380,000 nurses is a force to be reckoned with. The future is bright, with our next generation being shaped by our current cohort of intelligent, compassionate health professionals”. n
1
Nursing and Midwifery Board of Australia (2018), Annual report reveals how the Nursing and Midwifery Board of Australia worked to protect the public in 2016/17, Retrieved from http://www.nursingmidwiferyboard.gov.au/News/2017-11-15media-release.aspx 2 International Council of Nursing (2017), Definition of Nursing, Retrieved from http://www.icn.ch/who-we-are/icn-definitionof-nursing/ 3 D’ Antonio, P., Buhler-Wilkerson, K. (2018). Nursing: Medical Profession, Encyclopaedia Britannica Retrieved from https:// www.britannica.com/science/nursing 4 Steep, I. (2008). Lucy Osburn: a Lady Displaced. Nursing Australia, 9(2), 20-21. Retrieved from https://search-informitcom-au.ezproxy.lib.monash.edu.au/documentSummary;dn=2 61023015379155;res=IELHEA 5 Ibid. 6 Willetts, G (2015). From Nightingale nurses to Modern Profession: nursing in Australia, Nurse Uncut, Retrieved https://www.nurseuncut.com.au/from-nightingale-nurses-tomodern-profession-nursing-in-australia/ 7 Steep, I. (2008)., op.cit. 8 Willetts, G (2015)., op.cit. 9 Ibid. 10 Ibid. 11 Duffield, C. M. (1986). Nursing in Australia comes of age!. International Journal of Nursing Studies, 23(4), 281-284. Health Workforce Australia (2014), Australia’s Future Health Workforce – Nurses Detailed, Canberra Australia. 12 Ibid. 13 Health Workforce Australia (2014), Australia’s Future Health Workforce – Nurses Detailed, Canberra Australia. Florence Nightingale stained glass window, St Peter’s Church, Derby, England
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Policy & ADVOCACY
is it time to bring RESPITE SERVICES into the
REFORM EQUATION? by Nick Mersiades Director of Aged Care
T
he Australian Government’s original objective in subsidising older Australians’ access to respite services was to delay or avoid the need for more costly permanent residential aged care by giving family carers a break from caring—including in case of emergencies— and giving consumers more opportunity for socialisation and variety in caring arrangements. More recently, the objective of respite services is being expressed increasingly as supporting consumer choice to remain living in the community for as long as possible. In the Roadmap1 context, access to respite services assumes greater significance as an essential service for supporting and enabling consumer choice to remain living in the community, rather than permanently in residential care. However, respite care arrangements have been largely untouched by the reforms initiated since the Living Longer Living Better reform package.2 A question that arises is whether the current respite care arrangements are consistent with–and support recent reforms directed at–creating a more consumer-driven, market-based aged care system where consumers have greater choice of services and where to live. Current arrangements Respite services are currently available under one or another of the major aged care programs, namely residential care, home care packages and the Commonwealth Home Support Program (CHSP). As a result, substantially different arrangements apply for respite services including with regard to funding, eligibility and assessment arrangements
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and consumer contributions, depending under which program they are accessed; notwithstanding that similar policy objectives apply across all types of respite services. A key distinction is which populations are being targeted. Residential respite and respite accessed under a home care package are targeting consumers with Aged Care Assessment Team (ACAT)-assessed higher care needs, whereas CHSP respite is targeting Regional Assessment Service (RAS)-assessed consumers with basic care and support needs. A feature of home care packages is that the package holder may use their individual budget to choose how much community-based respite to use, the type of respite, and which provider delivers the service within the overall limit of each person’s individual budget and the local availability of respite services. The only condition is that individual budgets may not be used to pay for fees or charges that apply for CHSP-funded respite services. In contrast, home care package holders may not use their individual budget to purchase residential respite. The package is in fact suspended for the duration of a package holder’s stay in residential respite. The absence of individual budgets and ‘funding following the consumer’ in the CHSP means that CHSP consumers do not have the same flexibility in choosing respite services and providers. Instead, CHSP respite services are rationed through block-funded contracted providers. In theory, there is flexibility to increase the availability of residential respite services to the extent that providers
can apply to the Department of Health for approval to use allocated places for respite services. In practice, however, this greater capacity to respond to respite demand is balanced against competing demand from permanent residents and the economics of respite care compared with permanent residents, which favours the latter. Choice of provider is also constrained because ‘funding following the consumer’ does not extend to residential care.
at a cost to the Commonwealth of $287 million. At 30 June 2016, respite residents represented 2.8 per cent of total residents.
There is no published data on what proportion of allocated residential beds are approved for respite care; how the proportion may have changed over the years; or the extent to which providers have been seeking approval to increase the number of allocated places that they can use for respite.
The Aged Care Financing Authority (ACFA) has reported3 that there has been a steady increase in the use of residential respite over the years, with sustained higher growth since July 2014. Residential respite care use (measured in bed days) increased by 10 per cent and 7.2 per cent in 2014–15 and 2015– 16 respectively, compared with an annual average increase of 4.5 per cent previously.
Trends in the use of respite care services The following section discusses respite usage based on available trend data. •
In 2016–17, 40,720 consumers accessed CHSP respite services at a cost to the Commonwealth of $248 million, involving about 4 per cent of CHSP consumers.
Trend data on respite care use under the CHSP is not readily available. However, given the capped block funding arrangements that apply under the CHSP and limited growth funds in recent years, it can be assumed that the number of consumers using respite care services funded under the CHSP has remained relatively stable over recent years.
•
It is not known how many home care package holders access community-based respite care, either directly through their home care provider or from a CHSP respite provider. It is also not known how many home care package consumers used residential respite.
•
In 2016–17, 59,228 accessed residential respite care
It is generally accepted that there has been a long-standing practice for residential respite to be used on a ‘try before you buy’ basis by consumers contemplating permanent residential care, as well as to provide respite for family carers. However, it is unlikely that ‘try before you buy’ would account for the increase in residential respite care use that has occurred since July 2014. On the other hand, there is some evidence and anecdotal reports that the new combined income and assets test for all permanent residents introduced in July 2014 has contributed to consumers and providers choosing respite care pending the completion of means testing processes, and pending financial affairs being settled. For one, the continued next page
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increase coincided with the introduction of the new means testing arrangements. Second, the significant increase in the number of permanent residents admitted within seven days of a respite episode4 also supports this conclusion. This explanation for the increased use of residential respite seems consistent with the recent Carers Australia survey5, which showed that, notwithstanding the increased use of respite, Commonwealth Carer Respite Centres (CCRCs) are reporting difficulty in finding sufficient residential respite vacancies to meet demand, though it is uncertain to what extent such difficulties were present previously. On balance, it seems that means testing timelines, together with ‘try before you buy’, are combining to reduce the proportion of residential respite places that are being used to support older people living at home. It is not suggested that respite use in these circumstances is inappropriate, but rather a factor that should be taken into account. Other reported characteristics of current respite service use Anecdotal evidence also points to the following as being characteristic of respite services: • The work associated with admitting a respite consumer in residential care is as high as for a permanent resident, hence the majority of aged care homes will not consider anyone for respite unless the respite duration is for at least one week. • As well, many providers consider that the funding they receive does not cover the additional costs incurred by short-term respite arising from the fact that a respite consumer is in a strange environment, surrounded by strangers and away from familiar supports and generally unsettled. As a result, the support and behaviour management required is much higher. Overall, providing respite services for high needs residents is high risk, resulting in many providers limiting numbers in order to limit the risk. • The disparity between costs and revenues for low care ACAT-assessed respite residents in particular reduces the availability of low care respite places. Many providers are more likely to consider high care assessed respite residents. • Due to priority given to occupancy management, many aged care homes have a decreased ability to provide respite that some carers may wish to book well in advance. Most providers instead manage respite in the context of overall occupancy. • There is no consistency in fees paid by home care package consumers and CHSP consumers for community-based respite services, and consumers of residential respite are not required to contribute towards their care costs, even though home care packages (suspended while a package holder is
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in residential respite) are income tested. The only consumer contribution for residential respite is the equivalent of 85 per cent of the single pension for everyday living expenses (the same as a permanent resident pays for everyday living expenses). • There is an incentive for non-supported consumers to extend their respite status prior to becoming a permanent resident because consumer costs are lower. • Overall, current funding arrangements can be a barrier to accessing residential respite for the following categories of consumers: low care respite consumers; consumers seeking short-term respite, emergency respite or planned respite well in advance of need; and consumers with high care needs associated with a dementia diagnosis. CHSP respite services are either generally not readily available for these groups of consumers or are not suitable for their needs. • There are reports that the supply of CHSP respite services for lower needs consumers, especially cottage respite and emergency respite, does not meet demand. Possible reforms to improve access to residential respite The available evidence suggests that ‘try before you buy’, means testing timelines and current funding arrangements are impacting the availability of residential respite for supporting consumers wishing to live at home for as long as possible. An anomalous feature of residential respite is that, unlike for permanent residents, aged care homes do not receive an explicit accommodation payment, either by way of government payment on behalf of consumers, or consumer contribution. Recognising that this situation—along with the ‘churn’ costs of managing short-term respite stays was a disincentive for residential providers to provide respite care—the Australian Government some time ago introduced incentives and supplements to encourage aged care homes to make more respite bed days available, especially for consumers with higher care needs. The value of the supplement and incentive varies depending on whether the consumer has a low or high respite ACAT assessment and the percentage of allocated respite places that are occupied. Under these arrangements, the maximum possible daily payment for a low and high respite resident is $84 and $220 respectively, compared with $270 for a permanent supported resident with the highest ACFI assessment. How these incentives and supplements were formulated is not clear. However, there is a general view amongst residential providers that the supplements and incentives do not transparently or sufficiently address the costs incurred in providing residential respite care. There is anecdotal evidence that providers are limiting the availability of respite places because of the additional costs of short-term stays and lower returns compared with permanent residents.
Policy & ADVOCACY
• Removal of the current requirement to seek Departmental approval for residential respite places. Instead, uncap the number of days that may be used for respite and introduce ‘funding following the residential respite consumer’ (noting that packages are suspended while a person is using residential respite applies). With more consumers expected to remain at home longer, residential providers (and cottage respite providers) should be given flexibility to develop business and service models that cater for this demand. Equally, home care package consumers should have choice of residential respite provider.
The demand for residential respite is likely to increase significantly, as more consumers choose home care packages (current policy is to double the number of packages by 2021–22 to 151,000 packages). There is therefore a case for improving access to residential respite in order to position residential respite for the more consumer-driven future envisaged by the recent reforms and the Roadmap. To this end, matters that should be addressed include: • The economics of permanent and respite care in aged care homes to ensure a more ‘even playing field’ so that one form is not favoured over the other: – including assessing whether the current low/ high level care payments received by aged care homes (and potentially in the Resource Utilisation and Classification Study (RUCS) context) are sufficiently calibrated to reflect the care needs of respite residents, especially consumers with a dementia diagnosis, and whether accommodation costs are appropriately recognised. • Replacing the current opaque incentive and supplement arrangements with revenue streams that reflect cost structures. This includes: –
extending accommodation supplements paid for permanent residents to residential respite users, and – introducing a one-off admission payment to cover the cost of admitting a consumer into respite care for the first time. The latter explicitly recognises the high proportion of admission-related costs relative to total revenue from a short-term stay.
1
The timing for introducing funding following the respite consumer would need to be coordinated with the removal of the Aged Care Approvals Round (ACAR) for residential places.
Overall, the judgment for the Australian Government is whether the social and economic benefits of supporting more people in their choice to remain at home longer, rather than use residential care, outweighs the cost of subsidising the cost of respite care. Access to community-based respite services Improving access to community-based respite is more difficult.
Respite residents continue to incur accommodation costs in their principal place of residence. There is a case therefore for extending the accommodation supplement to all residential respite consumers, subject to retaining an annual cap over the number of respite days each consumer may use. The appropriateness of the current annual cap on respite days should also be reviewed.
As has been noted in earlier Aged Care Updates when discussing the intention to create a single home-based care and support program, administrative arrangements for the CHSP and the home care package program—and hence the arrangements for funding and accessing respite services under the two programs—bear no similarities or consistency. Improving access to community-based respite services will therefore be a more difficult proposition because change in this area is likely to be coordinated, with intended reforms to achieve greater integration more generally across the two home-based care and support programs. Because of the complexities involved in achieving greater integration, it is also likely that only incremental change will be possible, focused on issues such as assessment, access, consumer contributions and consumer choice and control. n
Means testing for care contributions for respite care may lead to practical and affordability issues for many older people who are income poor. On the other hand, home care packages (which are suspended for the duration of residential respite) are income-tested.
Disclosure statement: The author of this Update, Nick Mersiades, is a member of the Aged Care Financing Authority. The opinions in this Update should not be read as being an expression of the views of the Aged Care Financing Authority.
Aged Care Sector Committee Roadmap for Aged Care Reform March 2016 2 Parliament of Australia Aged Care (Living Longer Living Better) Act 2013, available at http://parlinfo.aph.gov.au/ parlInfo/download/legislation/billsdgs/2429310/upload_ binary/2429310.pdf;fileType=application/pdf
3
Aged Care Financing Authority Fifth Report on the Funding and Financing of the Aged Care Sector July 2017 4 Ibid. 5 Carers Australia Improving Access to Aged Residential Respite Care February 2017
14
Policy & ADVOCACY
loo k i n g a head to
20 3 0
AND BEYOND by Richard Gray, Senior Aged Care Advisor
T
he theme for Catholic Health Australia’s National Conference this year is ‘Looking Forward, Looking Back’. Nine years ago, I wrote the following in an article titled Aged Care in 2030:
growth, the Government will rely increasingly on the marketplace through deregulation of the supply of places and the pricing of them to consumers, resulting in increased co-payments and means testing’.
‘Baby boomers will start turning 85 in 2030 so we know the hump of residents will enter residential aged care in the 2025 to 2035 decade or possibly later, due to further delays in age of entry, with the average age being closer to 90 by then.
Nine years on, these predictions continue to have validity when looking to the future of aged care in 2030 and beyond. How might we further expand on these predictions when examining the conditions which face the aged care sector today? I consider that there will be two distinct care types of residential aged care facility in the future: the long-stay, essentially dementia, continuing care service, and the shortstay, sub-acute hospice style nursing home.
Currently, aged care subsidies are funded by the Australian Government on a pay-as-you-go basis, with working age taxpayers bearing around 70 per cent of the cost of care and user co-payments, the remaining 30 per cent. Demographic growth will create increased demand for aged care services. Increased longevity and the need to ration scarce health and aged care resources will challenge future policy makers. To satisfy unmet need and fund this demand
15
The large congregate facilities will still be around, for the main part being dementia-specific; and units or wings, being hospices. However, there will also be the emergence of the five-bed suburban house size nursing home. This will enable more scope for services to be close to family support and will lower the cost to residents and families. Many of these will be operated as not-for-profit community or family cooperatives.
It will often prove practical for two sets of family friends to join forces to provide an accessible home for the ageing parents of the two couples to enable them to live together with ongoing care—supported by their children. The sector will have a new post Aged Care Funding Instrument (ACFI) funding model that determines the relevant care subsidy with the consumer having the control over where it is spent and which provider receives the payment.
support, residents will be able to get involved in household activities such as cooking, laundry and gardening—just as they would at home.
In some examples, the families will engage a provider to deliver the care and receive the subsidies. Other families may choose to become the approved provider and be responsible for engaging the staff. Some families will choose to have live-in staff, others will have daytime care staff and provide the overnight support themselves.
Another of the predictions I made nine years ago was that there might be insufficient care staff to assist residents and those receiving care in their own home to have their medication administered, assist residents at meal times, or possibly even with bathing, showering and toileting. Family members will be asked to fill the workforce gaps.
The group home in the community model has been in existence in the disability sector for over 30 years. There, it was seen as the key to de-institutionalisation and for people with disabilities to continue to live in a residential home in the community. It also furthered their integration into the community. Older people often wish to remain part of their communities. This post-ACFI funding model will likely enable the funding to be more closely linked to the individual care recipient’s complex clinical care needs, and this will drive the required staffing skills mix levels.
Multiple factors such as the decline in family carers, staff shortages, increasing demand for care by the baby boomer generation and the high capital and operating costs of residential aged care will combine to drive further reform to enable innovation in service types and service delivery. Government and consumers will require that there still be in place a robust quality monitoring and regulatory system, and maintain an approved provider process.
With residential care increasingly becoming sub-acute, hospice types of support and care services, the resourcing differences between the aged care and health sectors will result in aged care being treated as a part of the health system with its public and private characteristics. The government may institute a Medicare levy style compulsory private aged care insurance, copying the National Disability Insurance Scheme (NDIS) example. Community care will be where the explosion in care occurs, with a number of models operating from the full range of services for-profit model to the family cooperative model. There will be support for families that choose to manage the care, funding and accountability themselves, employing the care staff they need. Funding will be more flexible and regulation less onerous for the small services. How many written policies, procedures and trend analyses does a oneperson community package provider or five-bed residential aged care service need? Recently, Mercy Health announced that it had started work on the redevelopment of an existing decade-old aged care facility, transforming it into seven small houses across two stories.1 Designed for up to eight people, each home will have a kitchen and laundry, along with their own lounge room, dining area and outdoor garden to create a home-like environment. Residents will also have access to a café, grocer, hair and beauty salon, and a games and activity room that they can enjoy with their friends and family. With
“Staff will develop ongoing relationships with residents and where possible, do things with them instead of for them”, Mercy Health Chief Executive Aged & Community Care Kevin Mercer said.
The key to driving and delivering the innovation that will be needed to meet the baby boomer bulge in demand, will be the removal of the rationing of services in favour of a robust user-pays contribution funding model. The recent Federal Budget signalled moves in this direction. The most significant measure regarding access and consumer choice was the decision to combine the formerly separate Budget items for home care packages and residential care. To support planning for the transition, the Budget also allocated $0.3 million for an impact analysis of allocating residential care places to people seeking care, including the impact on areas with limited choice and competition, such as rural and remote areas. A key objective of the Aged Care Roadmap,2 prepared by the Minister for Aged Care’s Sector Committee, is to maximise consumer choice and control by uncapping supply, separating care and accommodation subsidies, and removing controls that govern the proportion of residential and home care places. Placing the care subsidy control in the hands of the consumer will allow the consumer to determine which approved provider delivers the care they want, and delivers it where they want it. The Roadmap journey has begun. n
1 Mercy Place Albury redevelopment to introduce innovative aged care model which promotes independence. (2017). Health Matters, (HM84), p.46. 2 Aged Care Sector Committee Roadmap for Aged Care Reform, March 2016
16
Policy & ADVOCACY
Rethinking
MISSION MOVING
forward
by Susan Sullivan Director of Mission Strategy
H
eraclitus is famously reputed to have said: Nothing endures but change. There is nothing permanent except change. All is flux, nothing is still. Our own Christian spiritual tradition holds the central awareness that the path to fulfilment is a path of letting go of expectations and desires through cultivating a disposition of openness to the new.
In the world of health and aged care delivery, the truth of this wisdom is self-evident. Anyone traversing a long career in health and aged care will no doubt look back with a degree of astonishment at ‘the way things once were’. Models of care evolve, financing and funding arrangements are modified, surgical techniques advance, equipment becomes obsolete, best practice treatments are revised. Yesterday’s logic and approach is rarely sacrosanct, subject instead to the scrutiny of new knowledge and understanding as it arises within the many domains of human enquiry and endeavour. The omnipresent reality of change also holds true with respect to the way we understand our rock and reason for existence, our foundational mission with its many expressions. As CHA prepares to observe 40 years of commitment to serve the Catholic health and aged care services across this wide brown land, it is salient to reflect on the changes in the way we think about and respond to our mission, the core of our reason for being. Reflecting on the changes to the way our mission is understood and integrated has been something of a life’s work for luminary Fr Gerald Arbuckle. His many publications offer a rich resource for anchoring our understanding of the
1 76
implications of evolution across Church, culture, technology, government and business. In his CHA publication The Role of the Mission Leader,1 Fr Arbuckle summarises key phases in organisational approaches to mission. Prior to the 1960s, members of religious congregations were the primary staff of Catholic health and aged facilities. Today, most staff are lay, not necessarily Catholic, and the presence of the sisters or brothers in clinical or administrative roles is mostly consigned to memory. In these earlier times, the religious staff embodied the mission, and little reflection was expected or needed on what mission might mean in strategic or practical terms for a hospital or aged care facility. The mission was carried by the culture of the organisation and the primary influence was the symbolic and personal witness of the presence of the religious. However, as the 1980s progressed, the medical and administrative sophistication of health and aged care increased and the business model shifted from care towards cure. So too, the tacitly understood cultural symbols and expressions of Catholic identity faded within the wider society. The increasingly secular world of the 1980s demanded a rethink in the way mission was understood, communicated and expressed. Positions for ‘mission leader’ specifically dedicated to the nurturing of Catholic ethos and identity were created. These mission leaders were tasked with helping to build a sense of community and nurturing a culture committed to the values inspired by the Gospel and articulated in Catholic Social Teaching.
In the world of the early twenty-first century in which we now find ourselves, there are a range of new challenges to Catholic ethos and mission. Funding is largely sourced via insurance providers and government, while patients and clients are drawn from the community at large, bringing diverse needs and notions of self-understanding. In this environment, leaders navigate significant tensions between secular and religious worldviews. While mission leader positions are still vital to Catholic health and aged care services, the nature of the role is necessarily undergoing change. Mission authenticity and integrity is recognised as everybody’s responsibility, grounded in the CEO as primary mission leader, supported by a wellformed executive team.
and other emerging challenges. The meeting identified that a strategic response to the evolving nature of the way we carry our mission vibrantly forward into the future requires: • The need to focus on the ‘why’ of what we do, as much as the ‘who, what and how’. • Striving to be outward focused in our thinking by responding to the challenge of Pope Francis that “Mercy gets its hands dirty”. • Prioritising the poor and vulnerable by identifying the ‘edges’ in health and aged care serviced provision, with a view to providing services no one else wants to offer.
CHA’s support to our members’ search for mission authenticity and integrity has for many years been guided by the work of a number of committees. These committees include the CHA Bioethics Forum, the Mission and Identity Committee, and more recently the Pathways Taskforce, with its particular focus on strengthening formation.
• ‘Accompaniment’ as the foundation of our Catholic ethos. • Responding to the challenge of climate change and environmental sustainability.
Acknowledging the importance of responsiveness to the ever-changing needs of CHA members, a review of the role and function of the CHA Mission and Identity Committee and the CHA Pathways Taskforce has been recently undertaken. The initial impetus for this review arose from the substantial completion of a major body of work driving the agenda of the Pathways Taskforce since its inception in mid– 2013, as well as changes over time to the Pathways Taskforce membership, resulting in significant overlap with membership of the CHA Mission and Identity Committee.
…it serves us well to remember that what remains essentially unchanged is the source of our inspiration, motivation and direction—the call to be a sign of God’s love and a source of flourishing for all we serve. The current review seeks to address the following questions: firstly, what future committee structure might best serve CHA’s ongoing mission work; and secondly, in light of present issues and circumstances, what role and function are now required of the Mission and Identity Committee? At a combined meeting of the Pathways Taskforce and the Mission and Identity Committee in February, participants reflected on the current and emerging context of our work. Discussion focused on the impact of personnel changes, new formation resources, the current service delivery environment, sector reconfiguration/development/growth,
• Effective support to our members in the new Voluntary Assisted Dying environment. • Awareness of emerging workforce and funding challenges for aged care and community services. • The paralysis arising from current perceptions of the Catholic Church.
negative
• The need to identify the value proposition of our Catholic sector and communicate the good we offer to our communities. • Where we are called to be prophetic, where we can enable liberation and freedom. Following review meetings in February and March, a Discussion Paper was prepared for the CHA Board as a basis for their guidance and input to the review process. Future review meetings will respond to Board feedback and develop a set of new Terms of Reference for the CHA Mission and Identity Committee. A clear work plan will be articulated to fulfill the Terms of Reference and achieve the goals of the committee. Progress on the review process will be reported in forthcoming editions of Health Matters. In the meantime, it serves us well to remember that what remains essentially unchanged is the source of our inspiration, motivation and direction—the call to be a sign of God’s love and a source of flourishing for all we serve. n
1
Arbuckle, G. (2015), The Role of the Mission Leader, Catholic Health Australia
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The Sector SPEAKS
challenges arising in the
PRACTICAL
I M P L E M E N TAT I O N of Advance Care Directives by Penelope Eden, Partner, MinterEllison and Virginia Bourke, Lawyer and Consultant, Director of Mercy Health
T
his is the second of two articles on advance care planning in residential aged care. An earlier article (Health Matters, issue 85, Autumn 2018) provided a broad overview of the legal framework for advance care planning and formulation of Advance Care Directives (ACDs). This article considers some of the challenges which arise in the practical implementation of ACDs in residential aged care.
Advance Care Planning and Advance Care Directives (ACDs) As the community becomes increasingly aware of the place of advance care planning in end-of-life care, residential aged care providers, their staff and the health professionals with whom they engage need to ensure they have a clear understanding of advance care planning, the place of instructional directives, the resident’s decision-making capacity and the role of any Substitute Decision Maker (SDM). Advance care planning is a process of planning for future health and personal care, where a resident’s values and preferences are made known so that they can guide decision-making at a future time when the resident cannot make or communicate their decision. An ACD is a type of written advance care plan recognised at common law or under specific legislation which is completed and signed by a competent adult.1 Broadly speaking, an ACD records a resident’s preferences for future health care, their values and beliefs, goals for end-of-life care (eg. wanting to die at home, not in hospital) and instructions consenting to or refusing specific types of treatment (eg. refusing a blood transfusion
19
or CPR). Some ACDs may also be used to appoint a SDM to make decisions about the health care and personal care of a resident. Note that an ACD is distinct from a clinical care plan, a treatment plan or a resuscitation plan, all of which are written by clinicians (not the resident) to guide clinical care of a resident, usually in an acute care setting. Each of these plans should be informed by an ACD or by the advance care planning process which focuses on the directions of the resident, rather than the recommendations of the treating team. Accessibility of ACDs Where a resident in an aged care facility is in an emergency health situation and decisions are time-critical, one of the most common problems facing staff is that there is either no ACD in place or it is not found on the facility’s computer system or manual filing system in time. Unsure or uncertain as to how to act and possibly with little experience in responding to the clinical situation, the default position for carers and often the least ‘risky’ option for registered nurses or doctors (usually on call, not in situ overnight) is to pick up the phone and call an ambulance. In some situations, a transfer to hospital may be an unwanted consequence for both residents and their families. Many residents wish to be cared for in their home (the aged care facility), and find the hospital transfer a traumatic and burdensome experience. The negative impact on aged care residents of frequent transitions between hospital and home
is well established.2 ACDs which clearly provide direction on treatments and hospitalisation and which are understood by staff may reduce such unnecessary hospitalisation. Paramedics called to the bedside of an unresponsive resident in a residential aged care facility also face the frustration of finding no ACD in existence or readily accessible. In a recent article, The Age captured the stark reality for paramedics in this situation: the (usually) futile performance of CPR and defibrillation, intubation and its brutal effects on an extremely frail body. One of the paramedics interviewed stated that if family members “saw what actually happens during a resuscitation” they would not authorise treatment at all costs for their family member, but would put arrangements in place. The same paramedic said: “it was every paramedic’s dream to see an ACD posted on the wall above the bed”.3 It is vital that clinical staff in residential aged care facilities are aware of where ACDs are stored so they are able to quickly alert carers, paramedics and GPs to the existence of the ACD and provide direction as to the ACD’s content. All staff, including after-hours staff, must understand the processes for storing, retrieving, communicating and transferring information on ACDs. Residents should provide a hard copy of their ACDs to their SDM, and other family members. Residents may also consider recording the location and/or add the details of their ACD as part of the Commonwealth Government’s My Health Record. Information flow between healthcare providers Of equal importance to the accessibility and effectiveness of ACDs is the information flow between healthcare providers. This is challenging in the residential aged care setting as GPs are not employed by the facility (their notes may not be readily available) and hospitals may be slow to provide their discharge summaries. A resident discharged back to an aged care facility may deteriorate without staff being fully aware of recent diagnoses or other health issues. In such a vacuum, an opportunity to appropriately rely on an ACD may be lost. Such an outcome highlights the importance of regular communication and ongoing conversations between health providers, staff, residents and their families. Validity There are many challenges in writing, interpreting and applying ACDs. In order to be valid at common law, the ACD must have been made voluntarily by a capable adult, it must be clear and unambiguous, and it must extend to the circumstances at hand.4 Jurisdictions with legislative schemes which provide for ACDs will also have certain requirements for signing of ACDs.5
‘Voluntarily made by a capable adult’ This issue may arise when a resident is admitted with an ACD in place, but is diagnosed soon after admission with dementia. Competence is assumed unless there is evidence to suggest that at the time ACD was made, the person was incompetent. If doubts arise as to the resident’s competence at the time of making the ACD or if there are concerns in relation to undue influence or coercion, enquiries may be made of the resident, family members, witnesses to the ACD if they can be contacted, and the resident’s GP. ‘Clear and unambiguous’ An ACD may contain medical directions that are unclear, uninformed or too non-specific to guide clinical decisionmaking. ‘Extends to the circumstances at hand’ Difficulties arise when the resident making the ACD lacks the information required to make an informed choice, especially where the ACD is made prior to the onset of an illness for which a treatment decision may be made. For example, a resident directs in an ACD that she does not wish to have life-sustaining treatment (eg. CPR) in relation to her diagnosed lymphoma. Some time later, and in remission from lymphoma, the resident suffers a separate unrelated episode (eg. serious infection), for which life-sustaining treatment is recommended and she is unconscious. In that situation the clinician, in consultation with any SDM, may refuse to follow the ACD and may in some circumstances seek the guidance of an appropriate tribunal or court in confirming that decision.
Given increasing acuity in residential aged care, ACDs should be reviewed annually and in consultation with the SDM or whenever a resident’s medical or health situation changes. Similarly, a health practitioner may refuse to comply with the terms of an ACD where the ACD, made at a particular time, may not reflect the person’s wishes at a later date, and may not reflect advances in medical practice. These situations all point to the need for residential aged care providers to ensure a robust system for regular review of ACDs. Given increasing acuity in residential aged care, ACDs should be reviewed annually and in consultation with the SDM continued next page
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The Sector SPEAKS
Penelope Eden, Partner, MinterEllison – Penelope leads MinterEllison’s national Aged Care practice and has worked exclusively in health and ageing for more than 20 years.
or whenever a resident’s medical or health situation changes. Recognition of interstate ACDs Some jurisdictions recognise interstate ACDs and others do not. With a highly mobile population in Australia, it is vital that aged care providers are aware of the legislation which applies in their state or territory.6 Enacting an ACD A loss of capacity in a resident will trigger the operation of an ACD. A valid ACD in relation to a refusal of a health intervention (eg. life-sustaining measures or hospital transfer) will be binding on health practitioners, regardless of whether following the direction leads to the serious deterioration in health or death of the resident. There are various legislative protections for health and aged care professionals in relation to civil and criminal liability if they abide by the terms of an ACD that they believe in good faith, to be valid.7 Conversely, health practitioners cannot be compelled by the terms of an ACD to provide a particular treatment or a futile or nonbeneficial treatment. Withholding and withdrawing life-sustaining measures – emergency treatment A resident may provide instructions in an ACD on withholding life-sustaining measures such as CPR and defibrillation. In this situation, complex statutory provisions apply in Queensland which require a medical assessment prior to relying upon such an instruction as an ACD. Under the Queensland legislation, a direction to withhold or withdraw life-sustaining measures cannot operate unless the resident
21
Virginia Bourke, Lawyer and Consultant – Virginia consults to the national health industry team at MinterEllison and is a Director of Mercy Health and Chair of St John Ambulance Victoria.
has no reasonable prospect of regaining capacity for health matters and at least one of the following apply to the resident: 1. they have a terminal or irreversible condition, 2. they are in a persistent vegetative state, 3. they are in a permanent state of unconsciousness, or 4. they have an illness or injury of such severity that they cannot survive without the continued use of lifesustaining measures. In other jurisdictions, the requirement for medical assessment against these criteria, prior to relying on the ACD in relation to withholding life-sustaining measures, is not required. Use of Automated External Defribillators (AEDs) A challenging situation can arise in residential aged care where a resident may express a wish that she does not wish a recently installed AED to be used on her: “If you use that thing on me, I will sue you”. Notwithstanding the limitations in the Queensland legislation above which requires medical assessment before acting on the instruction, the common law recognises that wishes expressed by a person with capacity constitute an operative advance directive and should be followed. The provision of health care where a resident has validly communicated a common law directive, would amount to assault. Given the complexities of the legal landscape, residential aged care facilities (and retirement villages where this issue is more likely to arise) may wish to approach the use of AEDs on an ‘opt-out’ basis. That is, all residents will be resuscitated unless they provide prior notice
in place that directs they do not wish to be resuscitated.
Disagreements about care
Withholding and withdrawing life-sustaining treatment – artificial nutrition and hydration
ACDs certainly cannot resolve all family conflicts and the situation is particularly difficult where a resident has lost capacity and family members are in dispute with the SDM, or where two SDMs cannot agree on treatment. While a valid ACD will be binding upon a SDM, it is not ideal to have divergence between family members, and there is clearly a role for health and aged care professionals to lead a collaborative path to the alignment of all parties—the health practitioners, the family members and the SDM. If time is available to the healthcare provider, it is preferable that the SDM and family members reach consensus, as this minimises the likelihood of complaints and further action being taken against the healthcare provider in relation to reliance on an ACD.
Decisions to either commence or withdraw artificial nutrition (via a percutaneous endoscopic gastrostomy (PEG) tube) and intravenous hydration in a resident who has lost capacity are sometimes controversial and may precipitate legal intervention. Family members may seek to sustain life at all costs or fear ‘starvation’ or discomfort for their relatives, rather than rely on palliative treatments that include provision of food and drink as required. Inaction by health practitioners can attract criticism from family members and other healthcare professionals. ACDs are increasingly important in this context, particularly where a resident has advanced dementia. Where an ACD is valid and applies to these circumstances, the resident’s wishes will take priority over any contrary wishes by a SDM or family members.
The focus on ACDs in residential aged care will continue to sharpen as Australians age in greater numbers.
The focus on ACDs in residential aged care will continue to sharpen as Australians age in greater numbers. ACDs will play an increasing role in assisting to clarify difficult end-oflife issues as they become more frequently taken up and more familiar to the community and to health practitioners. Aged care staff, residents, family members and SDMs should be encouraged to have ongoing and regular conversations about advance care planning, to understand directions which are given and to respect the ethical issues which underpin decision making.9 Leading the communication and decision making involved in this process will continue to involve considerable skill and resolve on the part of health and aged care professionals as they navigate the complex interplay of appropriate treatment options, ethical principles10 and legal considerations. n
The underlying principle in respecting the autonomy of the resident in this situation and their wishes expressed in an ACD is certainly consistent with the common law position that a competent adult can make decisions to refuse or accept medical treatment, even if the decision they make results in their death. Certainly, for residents with capacity, there is no common law duty on providers of high care residential services to provide sustenance to a resident who refuses it.8 Where artificial nutrition and hydration measure are withdrawn, it is very important for staff to be supported in understanding the importance of the ACD and the basis for the decision.
Editor’s note: CHA has developed resources which can provide guidance during the advance care planning process for patients and residents in Catholic health and aged care services, which are consistent with Catholic ethics. These resources are freely available online at https://www.cha.org.au/publications355446/273advance-care-planning-documents and include an ACP template, and accompanying guidelines for people considering future health care, and for their healthcare professionals.
1 Each state and territory, save for NSW and Tasmania which rely on the common law, has enacted legislation governing ACDs. There is significant variation between each state and territory in relation to the legislative schemes, including different nomenclature for ACDs between different jurisdictions (for example, ACDs are known as Advance Health Directives in Queensland). 2 Abbey, J. (2006). Palliative Care and Dementia. Alzheimer’s Australia Discussion Paper. 3 Young, E. (2018, February 15). They rush in, our hearts break, The Age, page. Retrieved from http://www.theage. com.au/wa-news/they-rush-in-our-hearts-break-the-traumapoisoning-our-final-moments-20180215-h0w5x7.html?btis 4 Hunter and New England Area Health Service v A [2009] NSWSC 761. 5 For example, s. 17 of the Medical Treatment Planning and
Decisions Act 2016 (Vic) requires the signature of two adults, one of whom must be a medical practitioner. A useful guide to the legal requirements for each state and territory is available at: advancecareplanning.org.au Australian Health Ministers Advisory Council. A National Framework for Advance Care Directives. Canberra, MHMAC, 2011. Available at: www.ahmac.gov.au H Ltd v J [2010] SASC 176 at 36. Schedule 1 of the The Guardianship and Administration Act 2000 (Qld) contains general principles and a healthcare principle to guide ethical decision making by a SDM. The Code for Ethical Practice for Advance Care Directives is a useful resource. It gives a set of principles to guide practice in health and aged care settings contained in the National Framework for Advance Care Directives. Available at: www. ahmac.gov.au.
6 7
8 9
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Book cover of Fr Gerald Arbuckle’s book Loneliness: Insights for Healing in a Fragmenting World, due for publication in October 2018. Fr Arbuckle’s other publications include Humanizing Healthcare Reforms (Jessica Kingsley, 2013).
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The Sector SPEAKS
The LONELINESS PANDEMIC: inspired by the Past Respond Creatively by Fr Gerald Arbuckle, S.M., Ph.D
Turn to me and be gracious to me, for I am lonely and afflicted. (Ps 25:16) The hearts of many people are gripped by fear and desperation, even in the so-called rich countries. (Pope Francis)1 Loneliness is an inescapable and painful fact of human experience. St Teresa of Calcutta believed that loneliness, often accompanied by despair and hopelessness, is the virulent affliction in the West.2 The tragedy is that “the frequency and intensity of loneliness are not only underestimated, but the lonely themselves tend to be disparaged”.3 It is not only afflicting adults. It is on the rise even among teenagers. “Whether it is a consequence of phones, intrusive parenting, an obsessive focus on future job prospects or something else entirely, teenagers seem lonelier than in the past”.4 Defining Loneliness Loneliness has two qualities: the feeling of being excluded, abandoned; and a yearning to belong, to be connected. “Loneliness”, writes Jean Vanier, “is a feeling of being unworthy, of not being able to cope in the face of a universe that seeks to work against us”.5 People feel of little importance or value in other people’s lives. Listen to the cry of the psalmist: “You have caused my companions to shun me” (Ps 88:8). At the same time, lonely people yearn for the intimacy of social connection that is denied them. Yet loneliness is more than these emotions. The lonely person is more likely to become physically ill. Current multidisciplinary investigation has concluded that chronic loneliness is “a serious risk factor for illness and early death, right alongside smoking, obesity and lack of exercise”.6 It has been estimated
that living with air pollution increases one’s possibility of dying early by 5 per cent, being obese, 20 per cent; misuse of alcohol, 30 per cent; but the impact of loneliness, 45 per cent.7 Researchers conclude that, “Loneliness not only alters behaviour, but shows up in measurements of stress hormones, immune function, and cardiovascular function. Over time, these changes in physiology are compounded in ways that may be hastening millions of people to an early grave”.8 Peter Shmigel comments on an Australian national survey of loneliness: “Loneliness wears down your resilience to crisis…When you are lonely…your resilience drops… [Then the] risk of suicide increases”.9 Worldwide Pandemic: Multiple Causes Loneliness is not only a Western experience. It is now a worldwide pandemic affecting all age groups and cultures, some more than others. Because of the impact of global economic, social and political turbulent forces, this disease is fast becoming entrenched in all parts of the world. Communities worldwide are fragmenting.10 Once comforting personal and cultural identities are disintegrating as people lose their connectedness with each other and their past.11 Loneliness exists where it did not before. Yet worse than fragmentation are the increasing polarisations in society that further increase loneliness, especially for those who feel powerless to act. Consider “the enormous inequalities in our midst” that widen the gulf between the rich and poor. “We fail to see”, writes Pope Francis, “that some are mired in desperate and degrading poverty, with no way out, while others have not the faintest idea of what to do with their possessions. In practice, we continue to tolerate that some consider themselves more human than others, as if they had been born with greater rights”.12
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The Sector SPEAKS
Loneliness has many particular cultural causes, for example: poverty, rapid changes in technology, ageing, refugee and asylum statuses, neo-capitalist greed, anti-environmental policies. All cause feelings of abandonment, rising anxieties about one’s powerlessness to act. Of neo-capitalism Pope Francis writes: “Today, everything comes under the laws of competition and the survival of the fittest…As a consequence, masses of people find themselves excluded and marginalised; without work, without possibilities, without any means of escape”.13 And the people on the margins of society, the powerless, are those who suffer the most: “The warming caused by huge consumption on the part of the rich countries has repercussions on the poorest areas of the world, especially Africa, where the rise in temperature, together with drought, has proved devastating for farming”.14 Then there is the rise of fundamentalist nationalist movements, a world of “wall-builders, door-slammers and drawbridge-raisers”15 in which individuals and groups are being pushed aside, unwanted in a world, powerless, lonely. Also polarising divisions based on race or the colour of our skin are also increasingly rising to the surface in some nations, including Australia. Growing anxiety of global wars between the polarising great powers is adding to people’s loneliness: “Conflict on a scale and intensity not seen since the Second World War is once again plausible”.16 In summary, increasing fragmentation and polarisation deepen feelings of loneliness in individuals and societies. Yet, not only individuals experience this loneliness. Cultures do also. Entire cultures can feel politically, economically or socially oppressed and marginalised by more powerful groups. Australia does not escape this rising disease of loneliness and its causes. When Hugh Mackay in his recent book speaks of an epidemic of anxieties gripping many Australians, he is describing the symptoms of loneliness.17 In Australia, with a population of 24 million, between two to three and half million people are estimated to have incomes below the poverty line.18 One estimate is that about 23 per cent of households live on less than $400.00 per week; 16 per cent cannot afford to pay their gas and electricity bills on time, 12 per cent can only afford second-hand clothing. Then there is the rise of an anti-migrant/anti-ethnic diversity ideology.19 The sad fact is that “Aboriginal and Torres Strait Islander people, the unemployed, income support recipients, sole parents, large families, aged renters, immigrants and refugees, and people with disabilities are consistently and heavily overrepresented among those deemed to be poor”.20 Responding Dorothy Day, founder of the Catholic Worker Movement and leader for more than a half century in crusades of social justice, is right: “We have all known loneliness, and we have learned that the only solution is love that comes with
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Fr Gerald Arbuckle speaking at CHA’s National Conference in 2016, having just been awarded the Sr Maria Cunningham Lifetime Achievement Award. As part of our 40th anniversary celebrations at this year’s CHA National Conference in August, Fr Arbuckle will be participating alongside other past award recipients in a facilitator-led panel discussion on the past of the Catholic health and aged care sector and a vision for the future.
community”.21 As St Teresa of Calcutta says: “the only cure for loneliness, despair, and hopelessness is love”.22 In fact, “love is a mirror image of loneliness”.23 Day teaches us yet another truth. To give to others in love and justice in order to pull down the walls of loneliness that exclude people demands in us a change of heart: “The greatest challenge of the day is: how to bring about a revolution of the heart, a revolution which has to start with each one of us. When we begin to take the lowest place, to wash the feet of others, to love our brothers with that burning love, that passion, which led to the cross, then we can truly say, ‘Now I have begun’”.24 To change one’s heart ultimately requires that we be in touch with our inner selves in solitude. Pope Francis describes the challenge to connect with others through compassion and justice in this way. In light of the Good Samaritan parable, he calls for “the revolution of tenderness…Tenderness means to use our eyes to see the other, our ears to hear the other, to listen to the children, the poor, those who are afraid of the future. To listen also to the silent cry of our common home, the planet, of our sick and polluted earth. Tenderness means to use our hands and our heart to comfort the other, to take care of those in need…A single individual is enough for hope to exist, and that individual can be you. And then there will be another ‘you’, and another ‘you’, and it turns into an ‘us’….When there is an ‘us’ there begins a revolution [of tenderness]”.25 Challenging Catholic Health and Aged Care Ministries My God…My soul thirsts for you… as in a dry and weary land where there is no water. (Ps 63:1) To belong, to be accepted, to share common values, to participate—these are fundamental needs we all have
as persons and cultures. To be denied these needs as individuals and cultures is to feel abandoned, lonely. When human dignity is overlooked, and hope is in danger of becoming a forgotten word, people and cultures are thrown into loneliness. Such is the experience of many oppressed minority cultural groups today. Little wonder there is so much sadness and loneliness! As we—Catholic Health and Aged Care Ministries—look back at the past, we can be justly proud of the myriad innovative ways in which we have responded to the loneliness of countless peoples and groups in our midst. As the challenges of this pandemic intensify, we will respond in yet more innovative ways, provided we remain faithful to our Gospel roots so well established in the past. We will foster communities of compassion and justice in our facilities and beyond, provided we are ever committed to
1
Pope Francis, Evangelii Gaudium (The Joy of the Gospel) (Strathfield: St Pauls Publications, 2013), par. 52. 2 See Mother Teresa of Calcutta, A Simple Path (London: Edbury Press, 1995), 83; see also Lori C. Bohm, “Introduction,” eds. Brent Willcock, Lori C. Bohm, and Rebeca C. Curtis, Loneliness and Longing: Conscious and Unconscious Aspects (New York: Routledge, 2012),1-9. 3 Robert S. Weiss, Loneliness: The Experience of Emotional and Social Isolation (Boston: MIT Press, 1975), 12. 4 “The youth of today,” The Economist (13 January, 2018), 52. The report further comments: “Some Western countries are beginning to look like Japan and South Korea, which struggle with a more extreme kind of social isolation in which young people become virtual hermits.” 52. 5 Jean Vanier, Becoming Human (New York: Paulist Press, 1998), 33. 6 John T. Cacioppo and William Patrick, Loneliness: Human Nature and the Need for Social Connection (New York: W.W. Norton, 2008), 108. See also Timothy B. Smith and Julianne Holt-Lunstad, Social Relationships and Mortality Risk: A Meta-Analytic Review (2010), https://doi.org/10.1371/journal. pmed.1000316 (Accessed 8/5/17). 7 See J. Holt-Lunstad, M. Baker, T. Harris, D. Stephenson, and T.B. Smith, “Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review,” Perspectives on Psychological Science, vol.10, no. 2 (2015), 227-37, doi:10.1177/1745691614568352 (Accessed 1/11/17); T.B. Smith and J. Holt-Lunstad, Social Relationships and Mortality Risk: A Meta-Analytic Review (2010), www.journals.plos.org/plosmedicine/article?id=10.131/journal. pmed.1000316 (Accessed 8/5/17). 8 Cacioppo and Patrick, Loneliness, op.cit., 108. 9 Wahlquist, C. (2017). Eighty-two per cent of Australians say loneliness is increasing, Lifeline survey finds. [online] the Guardian. Available at: https://www.theguardian.com/ society/2016/sep/27/eighty-two-per-cent-of-australianssay-loneliness-is-increasing-lifeline-survey-finds [Accessed 2 September 2017].
be forming ourselves as followers of the Good Samaritan— Jesus Christ, the Compassionate and Just One. “Go and do likewise” (Luke 10:37). This is an excerpt from Loneliness: Insights for Healing in a Fragmenting World (Orbis Books, October, 2018), a book written by Fr Gerald Arbuckle, reproduced with permission. Fr Arbuckle’s other publications include Humanizing Healthcare Reforms (Jessica Kingsley, 2013). As part of our 40th anniversary celebrations at this year’s CHA National Conference in August, Fr Arbuckle, a previous recipient of the Sr Maria Cunningham Lifetime Achievement Award, will be participating alongside other past award recipients in a facilitator-led panel discussion on the past of the Catholic health and aged care sector and a vision for the future. n
10 See Gerald A. Arbuckle, Fundamentalism at Home and Abroad: Analysis and Pastoral Responses (Collegeville, MN: Liturgical Press, 2017), 1-29. 11 See eds. Thomas H. Eriksen and Elizabeth Schober, Identity Destabilised: Living in an Overheating World (London: Pluto Press, 2016), 1-19. 12 Pope Francis, Laudato Si’ (On Care for Our Common Home) (London: St Pauls Publications, 2015), par 90. 13 Pope Francis, Evangelii Gaudium (The Joy of the Gospel) (Strathfield: St Pauls Publications, 2013), par 53. 14 Pope Francis, Laudato Si’, op.cit., par. 51. Robinson Meyer notes that according to recent studies global warming will intensify regional inequalities in the United States, particularly in the southern states. “The American South will Bear the Worst of Climate Change’s Costs” The Atlantic (29 June, 2017) (PDF) (Accessed 2/7/17). 15 “Liberty Moves North,” The Economist (29 October, 2016), 11. 16 “The next war: Shifts in geopolitics and technology are renewing the threat of great-power conflict,” The Economist (27 February, 2018), 9. 17 See Hugh Mackay, Australia Reimagined: Towards a More Compassionate, Less Anxious Society (Sydney: Macmillan, 2018). 18 See discussion by Daphne Habibis and Maggie Walter, Social Inequality in Australia: Discourses, Realities and Futures (South Melbourne: Oxford University Press, 2015), 73-74. 19 Ibid. 20 Ibid. 21 Dorothy Day, The Long Loneliness: The Autobiography of the Legendary Catholic Social Activist (New York: HarperOne, 1980), 286. 22 Mother Teresa of Calcutta, A Simple Path, op.cit., 83. 23 Bohm, “Introduction,” eds. Willcock, Bohm, and Curtis, Loneliness and Longing, op.cit., 8. 24 Dorothy Day Quotations (PDF) (Accessed 30/8/17). 25 Pope Francis, Address to TED (Technology, Entertainment and Design) (PDF) (20 April, 2017) (Accessed 6/5/17).
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The Sector SPEAKS
QA &
with
The Hon Ken Wyatt AM, MP Minister for Aged Care
K
en Wyatt AM is a proud Noongar, Yamatji and Wongi man, and was elected in 2010 as the Federal Member for Hasluck, the first Aboriginal Member of the House of Representatives. In 2015, Ken became the inaugural First Nations member of the Federal Executive after being sworn in as Assistant Minister for Health, and in January 2017, he again made history as the first Aboriginal Minister to serve in a Federal Government, after being appointed Minister for Aged Care and Minister for Indigenous Health. His portfolio responsibilities also include Australian Hearing Services and organ and tissue donation, through the Organ and Tissue Authority.
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Education District, and Director of Aboriginal Health in New South Wales and Western Australia. Not only has Ken had an extensive career in health and education, he has also made an enormous contribution to the wider community, particularly in training and mentoring young people. This was recognised in 1996, when he was awarded the Order of Australia in the Queen’s Birthday Honours list. Later, in 2000, Ken was awarded a Centenary of Federation Medal for ‘his efforts and contribution to improving the quality of life for Aboriginal and Torres Strait Islander people and mainstream Australian society in education and health’.
Before entering politics he worked in the fields of health and education including as District Director for the Swan
The Hon Ken Wyatt AM, MP, Minister for Aged Care, was interviewed for Health Matters by Nick Mersiades, Director of Aged Care at CHA.
What is your vision for aged care services ten years from now?
We are charting a roadmap for a decade and beyond, that focuses on the needs of ageing Australians.
My aged care vision for 2028 is founded in the landmark 2018 Budget, which will deliver an additional $5 billion investment, designed to strengthen the sector and make funding sustainable and flexible, while being more responsive to the needs of older Australians.
My vision is for active ageing; through better health, lifelong learning, continuous participation in society, and the provision of security and certainty—a future where ageing Australians are connected to the community, their wisdom sought and their value appreciated, as teachers and students of life.
I want people to realise the benefits of preparing early and aiming to live well to 100 or more.
To achieve this, we must continue building a strong and viable aged care sector, in tandem with an equally strong
Top: Ken with 100 year old John Foley at Southern Cross Care’s Jeremiah Donovan House in Forrestfield, WA. Bottom: Ken with 103 year old Sydney choreographer and dancer Eileen Kramer.
and qualified workforce. Exciting new technologies will continue complementing care in ways we may not even be able to imagine now. While I see an increasing growth in home services, I believe the age of people requiring aged care will rise, thanks to better personal planning for their health needs, careers, finances and leisure. At the same time, I envision the continuing development of strong, sophisticated and integrated ‘living communities’ of residential care, to assist those with high-level needs. What would you describe as the Government’s key aged care achievements? The Turnbull Government’s aged care achievements came to the fore in February 2017, with the Increasing Choice In Home Care reforms giving older Australians more options to live independently and receive care when and where they need it. This means funding now follows the individual; providing them with greater choice and control over their care needs. Ageing Australians can choose and change providers, with more market-driven care already greatly increasing competition and putting downward pressure on fees and charges. They can now move anywhere in Australia and take their home care package with them. This new national home care queue system provides transparency, allowing the Government and the care sector to better respond to people’s needs.
Building on this, the 2018 Budget funds an additional 14,000 high-level packages—on top of 6,000 released late last year—with the rollout beginning immediately. Reflecting the growing demand for in-home care, the overall number of home care packages will grow from 87,000 to 151,000 during the next four years, while another $5.5 billion will be invested in the Commonwealth Home Support Scheme for two years from July 2018. This year’s Budget is a watershed for reform and funding, including the More Choices For a Longer Life package and a broad response to two major aged care reports, the Tune and Carnell-Paterson reviews. Residential aged care will see record growth, with 13,500 new residential places and 775 restorative care places to be allocated in 2018, plus a $60 million capital investment. Residents and their families can have confidence and certainty in aged care and the protection of their loved ones—the new Aged Care Quality and Safety Commission will create an independent, one-stop shop to ensure older Australians receive the best possible care. My Aged Care will be improved, with an investment of $61.7 million to make it easier to use, along with simplifying the forms required to apply for aged care services. There will be a $7.4 million trial of community information hubs and personal navigators to help people choose the aged care services that suit their needs. continued next page
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The Sector SPEAKS
A new reablement program aims to help people who have had physical or medical challenges—to get back on their feet and live at home for as long as they want, close to family and friends.
The reforms of the past two years, particularly the new Budget initiatives, are all focused on achieving our vision. However, underlying this, the key change I want to see is a mindset shift by Australians towards ageing. Ageing is normal, ageing is about living well. We want to age better than many of us currently do, living life to the full as much as we can.
There is record investment in mental health support for older Australians, including $82.5 million for psychological services in residential aged care and a $20 million community pilot program to prevent social disconnection for people over 75. We’re also investing $46.1 million in a major program to combat loneliness, through the Community Visitors Scheme. Regional, rural and remote aged care will see $145.7 million in significant expansions and upgrades.
We are beginning this process now, by asking younger Australians to consider their lengthening life expectancies, with the Budget funding the development of checks for 45 year olds and 65 year olds, to help them chart their future health, employment and finance and leisure needs. People over 65 will be encouraged to get active, with significant grants going to local sporting groups to deliver new programs for older Australians.
Choice will also be made easier through a new, user-friendly online aged care provider comparison system.
…the key change I want to see is a mindset shift by Australians towards ageing. Ageing is normal, ageing is about living well. We want to age better than many of us currently do, living life to the full as much as we can. Maintaining quality care depends on a strong workforce, so a key achievement this year will be the delivery of Australia’s first Aged Care Workforce Strategy, due to the Government by the end of June. Professor John Pollaers and the Taskforce have been busy reaching out to those working within the aged care sector and senior Australians, to get their views. Crucial to this is building capacity within the workforce, and a strong focus on staff retention and career paths. The Taskforce has already achieved much, with the formation of an Industry Reference Committee to guide training and career development, and an Industry Accord for the remote aged care workforce underway. Parallel to these reforms, the Government’s 2015 $200 million, five-year dementia research commitment promises significant improvements in the management and treatment of this condition. What are the key areas that will need to be addressed if the vision is to be achieved? What are the strategies for addressing these key areas?
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This will be complemented by a national awareness campaign, encouraging people to seek out information and develop strategies for a longer life. It began just a week after the Budget, centred on the new information website: http:// longliveyou.gov.au. Advancing reform is based on codesign between the aged care sector and Government, but I want to see much greater involvement of the broader community in this process, to reflect the development of living communities of the future. Do you think the provision of quality aged care services is sustainable under current funding arrangements, given the 2015 Intergenerational Report estimated that total Commonwealth aged care expenditure will almost double to 1.7 per cent of GDP by 2055? The 2018 Budget provides record aged care investment, strengthening the foundation for a sustainable aged care sector and further reform. There is an additional $5 billion over the next four years, with total funding growing from $81.6 billion to $86.6 billion. The Turnbull Government understands that viable aged care providers, dedicated and qualified staff and strong regulation, are the cornerstones of quality care. For the first time, we have ensured that all Commonwealth funding allocated each year for aged care is invested in aged care. Previously, this unused funding could be returned to Consolidated Revenue each year. No more. We are committed to investing every cent back into aged care, including increasing both residential places and home care packages. This is fundamental to our commitment to guaranteeing the essential services on which ageing Australians rely. n
Recruiting for Mission Fit:
Strengthening our Culture in Catholic Health and Aged Care Mission is what makes our Catholic organisations distinctive and unless we are recruiting people who “get the mission thing,” we will lose that distinctiveness. EFFECTIVE GOVERNANCE AND LEADERSHIP FOR MISSION
CATHOLIC HEALTH AUSTRALIA
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O r d e r yo u r c o p y n ow
A major strength of our study is that it will target symptom burden as a whole, rather than just individual symptoms, in an attempt to capture the improvement in general wellbeing as reported anecdotally by many who have used cannabis.
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The Sector SPEAKS
what is the place of
medicinal cannabis in palliative care?
by Professor Janet Hardy, Medical Director Cancer Services, Mater Health Services, Brisbane; and Associate Professor Phillip Good, Director of Palliative and Supportive Care, St Vincent’s Private Hospital, Brisbane
Q
uality of life in a patient with advanced disease is dependent on multiple factors including control of symptoms (both disease- and treatment-related), physical functioning, ability to undertake activities of daily living as well as psychological, social and spiritual well-being. Despite advances in medical care, patients with advanced disease still experience substantial symptom distress.1 In a large study of patients with cancer in which symptoms were assessed, the overall symptom distress score was significant (approximately 30 out of a maximum score of 90). The individual symptoms that most commonly required interventions included pain, fatigue, anxiety, drowsiness, appetite, wellbeing and poor sleep.2 Palliative care aims to take a skilled, holistic approach to individualised medical care to improve patients’ symptoms and quality of life. This is achieved through a multidisciplinary team approach, addressing patients’ physical, psychological, social and spiritual needs. While medication provides a core component of improving symptom distress, there remains a need for more effective options to improve symptom control. There is currently a wide range of analgesic medication and supportive therapies available for pain management, but the control of many other symptoms (such as fatigue, anorexia, and weight loss) remains a challenge.3 Furthermore,
psychological and spiritual distress is not easily targeted by current management practices. Therefore, the increasing interest in the use of medicinal cannabinoids in health care over recent years4—particularly for the relief of symptom distress in palliative care patients— is not particularly surprising. Recent legislative change in several Australian states, including Queensland,5 provided pathways for the use of medicinal cannabinoids for a range of indications including chemotherapy-induced nausea and vomiting, resistant epilepsy, pain and spasticity in multiple sclerosis and symptoms associated with terminal illness. Despite centuries of cannabis use, the importance of the endocannabinoid system (thought to have a widespread physiological role on the immune, autonomic nervous, gastrointestinal, endocrine and cardiovascular system) has only recently been discovered.6 Cannabis contains almost 500 bioactive compounds, including over 70 different cannabinoids.7 The predominant cannabinoids include delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the main psychoactive component of cannabinoids. Potential benefits of this compound include analgesia, anti-nausea, and muscle relaxation. There are also a wide variety of potential side effects including intoxication, psychosis, anxiety and sedation. In contrast, CBD is not continued next page
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The Sector SPEAKS
intoxicating, and has a range of anxiolytic, antipsychotic, anti-inflammatory, anti-oxidative, anti-convulsant and neuroprotective effects.8 There is emerging evidence for the use of medicinal cannabinoids in health care, but little high-quality evidence to date. There is some evidence of benefit for chronic noncancer pain, spasticity, chemotherapy-induced nausea and vomiting, sleep problems, HIV-related anorexia, Tourette syndrome, anxiety, and Parkinson’s disease symptoms.9 The evidence of benefit is not always very strong however, and all reviews are consistent in their conclusion that more research is needed to determine the best formulation of cannabis, and the best THC/CBD ratio for different conditions. There is also considerable interest in the use of cannabinoids in palliative care, but again little high-quality evidence to guide clinical practice.10 A recent survey of palliative care patients in Australia indicated that the main symptoms for which participants had used cannabis were pain, appetiteloss, mood, insomnia and nausea.11 However, there are many unknowns when it comes to prescribing medicinal cannabis for palliative care patients. In particular, the optimal formulation is unclear as is the ideal ratio of THC/CBD, and dose. Whilst THC appears important for analgesia, mood, sleep, and appetite, the role of CBD remains less clear. A very important consideration in the medical use of cannabinoids is the assessment of their safety. The most common adverse effects are disorientation, confusion, dizziness, euphoria, drowsiness, psychiatric disorders and
1
Singer AE, Meeker D, Teno JM, Lynn J, Lunney JR, Lorenz KA. Symptom trends in the last year of life from 1998 to 2010: a cohort study. Ann Intern Med. 2015;162(3):175-83 2 Hui D, Shamieh O, Paiva CE, Perez-Cruz PE, Kwon JH, Muckaden MA, et al. Minimal clinically important differences in the Edmonton Symptom Assessment Scale in cancer patients: A prospective, multicenter study. Cancer. 2015;121(17):3027-35 3 Yates P. Symptom Management and Palliative Care for Patients with Cancer. Nurs Clin North Am. 2017;52(1):179-91 4 Whiting PF, Wolff RF, et al. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA. 2015;313(24):2456-73.Qld Government. Public Health (Medicinal Cannabis) Act 2016;accessed 27/09/17 Available from: https://www.legislation.qld.gov.au/view/html/asmade/ act-2016-053 5 Qld Government. Public Health (Medicinal Cannabis) Act 2016;accessed 27/09/17 Available from: https://www. legislation.qld.gov.au/view/html/asmade/act-2016-053 6 Matsuda LA, Lolait SJ, Brownstein MJ, Young AC, Bonner TI. Structure of a cannabinoid receptor and functional expression of the cloned cDNA. Nature. 1990;346(6284):561-4 7 Elsohly MA, Slade D. Chemical constituents of marijuana: the complex mixture of natural cannabinoids. Life Sci. 2005;78(5):539-48
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dry mouth.12 These side effects may not be acceptable to patients in palliative care. Ongoing concerns remain around the uncertainty over the optimal formulation, ratio of THC/ CBD, toxicity and potential for abuse. There is a need for palliative care physicians to familiarise themselves with the potential problems associated with cannabis use (such as abuse or dependence), and to encourage their patients to allow themselves to be closely monitored. While the evidence is emerging that cannabinoids may have a role in health care, their use is not without potential for substantial harms, and more research is needed to define their role not only in palliative care, but in many fields of medical practice. To address this gap, we are undertaking further research investigating the role of medicinal cannabis in palliative care. A major strength of our study is that it will target symptom burden as a whole, rather than just individual symptoms, in an attempt to capture the improvement in general wellbeing as reported anecdotally by many who have used cannabis.14,15 To this end, we will use a symptom assessment scale to assess total symptom burden.16 Symptom burden will be represented not only by the physical scores (sum of pain, fatigue, nausea, drowsiness, appetite and dyspnoea) but also emotional (depression and anxiety), and wellbeing scores. Information from this study to rigorously evaluate the efficacy, safety and acceptability of medicinal cannabinoids for symptom relief in advanced cancer patients is urgently required to inform future prescribing practices, research and health policy. n
8 Zuardi AW. Cannabidiol: from an inactive cannabinoid to a drug with wide spectrum of action. Rev Bras Psiquiatr. 2008;30(3):271-80 9 Barnes M, Barnes J. Cannabis: The Evidence for Medical Use, 2016 [Available from: http://www.drugsandalcohol. ie/26086/1/Cannabis_medical_use_evidence.pdf 10 Strouse TB. Cannabinoids in Palliative Medicine. Journal of Palliative Medicine. 2017 11 Luckett T, Phillips J, Lintzeris N, Allsop D, Lee J, Solowij N, et al. Clinical trials of medicinal cannabis for appetite-related symptoms from advanced cancer: a survey of preferences, attitudes and beliefs among patients willing to consider participation. Intern Med J. 2016;46(11):1269-75 12 Qld Government. Public Health (Medicinal Cannabis) Act 2016, op.cit. 13 Strouse, op.cit. 14 Luckett, op.cit. 15 Swift W, Gates P, Dillon P. Survey of Australians using cannabis for medical purposes. Harm Reduction Journal. 2005;2:18 16 Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care. 1991;7(2):6-9
“
On a daily basis I like the fact that words such as love, joy, formation, sacred and hope are always welcome at the table right there alongside quality reports, budget negotiations and patient care. – Tony Doherty,
”
So You’re Working For The Catholic Church
For further information, or to order your copy, please contact CHA at
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The Sector SPEAKS
AUSTRALIAN GOVERNMENTS
are asleep at the wheel on homelessness
IT’S TIME TO SHAKE THEM
awake by Toby Hall Group Chief Executive Officer St Vincent’s Health Australia
L
ast month, in an impassioned video posted on her Facebook page, New Zealand’s Prime Minister Jacinda Ardern committed her government to spending an extra $100 million on emergency housing so that no citizen need sleep rough over winter. While recognising the housing was transitional, Ardern said: “We couldn’t stand by and see people in cars or completely unsuitable housing in the meantime”. As Catholic providers we should be proud of the Kiwi approach. Jesus and his family had lived experience of rough sleeping and homelessness. Perhaps this was highlighted because we should care about this more than we do as a nation? Across the ditch, compare Ardern’s leadership with the Australian Government which, a week after the New Zealand Prime Minister’s broadcast, was announcing its 2018–19 Federal Budget. One might expect that, beset by an affordable housing problem that even the most charitable voices describe as a crisis and with homeless numbers having grown 14 per cent in recent years—20 per cent among people sleeping rough on the streets—the Government would use the Budget as
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an opportunity to take action. But Budget night came and went with barely a whisper of either subject. Housing and homelessness service providers were irate. The Salvation Army said: “With 116,000 homeless people in our country today, those people are no better off in what’s delivered in this Budget. 200,000 people on social housing waiting lists are no better off in this Budget. It is housing that is the thing that drives more people than anything else to the doors of the Salvation Army”. Mission Australia said the Budget had ignored people experiencing homelessness. “The Government has missed another opportunity…to address rising homelessness and provide a national plan to meet the critical shortage of affordable housing for those on the lowest incomes. “The absence of a plan is short-sighted and will only lead to greater social and economic dislocation down the track”. National Shelter called it a “tragedy” and a “real lost opportunity”. While it is bitterly disappointing for those of us who have worked in and around homelessness for many years, continued next page
Australia’s homelessness situation is deteriorating and yet our leaders seem either content to ignore the problem or engage in windowdressing masquerading as action, rather than the real thing.
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The Sector SPEAKS
Group Chief Executive Officer of St Vincent’s Health Australia, Toby Hall
it conjures up a familiar sense of déjà vu. Australia’s homelessness situation is deteriorating and yet our leaders seem either content to ignore the problem or engage in window-dressing masquerading as action, rather than the real thing. Take the recent release of the Australian Bureau of Statistics’ 2016 Census count of homeless people. The results were damning. In almost every category, homelessness had grown worse since 2011. Providers of homeless services, including St Vincent’s Health, reacted with great disappointment and anger— as we always do—that the situation had been allowed to deteriorate so badly. Governments then released ‘glass half full’ statements in response, claiming activity and purpose in addressing the problem. And then the caravan rolled on. It’s all so familiar. And depressingly, unless something dramatic happens, I can’t see anything changing in the future. Most people unfamiliar with homelessness tend to shrug their shoulders and say it’s “just one of those things”, that it’s “just part of modern life”. But it’s not true. We absolutely know how to end this problem. There are truckloads of evidence—gathered both here and overseas—about what solves homelessness. We only need to find the political will. Finland has ended homelessness. The US state of Utah has virtually ended homelessness. By following the same basic steps, tailored to the Australian context, we can too.
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It will be of no surprise to say the first thing we need is more social and affordable housing. The Everybody’s Home1 campaign estimates that Australia needs around 300,000 new social homes and 200,000 affordable rentals to take the pressure off people in insecure housing and to provide enough stock for already homeless people to get back into accommodation. No one expects governments to make this happen alone, but we do need their leadership. There are countless innovative ways governments can partner with the not-profit-sector and investors can put a rocket under social and affordable housing, including social impact investing and championing ‘inclusionary zoning’, which requires a percentage of any new housing projects to be affordable. The second thing we need is to gear our approach to homelessness towards what is commonly called ‘housing first’. Housing first simply means providing already homeless individuals with immediate long-term accommodation and then building around them a range of services—particularly health care—to help them maintain their tenancy. It’s exactly the approach Finland and Utah took in eliminating their homeless problem. Getting a homeless person into accommodation is not enough. You need to make sure they have supports—such as mental health care—so that the issues that caused their homelessness aren’t repeated. Over the past 15 years Australia has seen many successful ‘housing first’ initiatives, underpinned by extensive research, but not on the scale required. Cost benefit analyses of ‘housing first’ programs also give us overwhelming evidence
that they deliver savings to governments and health and community organisations, while helping hundreds of people out of homelessness. This is a fact: allowing people to remain homeless costs taxpayers far more—in terms of health, justice and welfare— than it costs to give them the help they need. St Vincent’s Hospital Sydney’s research shows 15 rough sleepers were responsible for emergency department presentations, totaling a cost of $1.3 million in just one year! Providers of health services can also have an impact in reducing homelessness. Australia has a particular problem with vulnerable people exiting state-provided care— including hospitals—into homelessness. In 2016–17, around 7,100 clients or two per cent of all specialist homelessness service clients were identified as having left care. Over half were leaving either a psychiatric hospital (20 per cent), rehabilitation (19 per cent) or a hospital (15 per cent). Recent evaluations of the homeless health services at St Vincent’s Hospitals in Sydney and Melbourne confirmed what we already knew anecdotally, that ‘step up and step down’ services—places where homeless people can recuperate for short-to-medium periods after leaving hospital and receive help with housing and other problems—deliver outcomes. We should be attaching more of these types of services to public hospitals which serve large, homeless populations. Expanding assertive outreach health care, including mental health, is another area where we can have an impact. People in tenuous housing—including public housing—or those
who are already homeless, need healthcare at their point of need so their illnesses and injuries can be treated and managed in order for them to maintain a long-term tenancy. Health organisations also need to look at our own systems and processes and address the barriers that get in the way of us helping homeless people more effectively. For example, gathering accurate and timely data around patients who are homeless or in tenuous housing, and using it in an effective way, isn’t one of our sector’s strengths. With Australian governments not running over themselves to place housing and homelessness at the top of their agendas, the onus is on organisations with close experience caring for people who are homeless or in housing stress, to increase our advocacy. Driven by our Mission, Catholic healthcare organisations are ideally placed to take a lead role in this debate. We also see the distressing impact of homelessness in our facilities. Working with our peer organisations—through bodies such as the Australian Catholic Housing Alliance and the recently established taskforce of Catholic organisations committed to eliminating rough sleeping—we have a responsibility to share our knowledge and insights with politicians until we see from them the commitments needed to adequately address this problem. Other campaigns, such as Everybody’s Home, also deserve our support. Australian governments are asleep at the wheel when it comes to homelessness. We need to shake them awake. Surely, this is the call of our Mission. n
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See more at: http://everybodyshome.com.au/
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The Sector SPEAKS
by Deb Parker, Professor of Nursing Aged Care (Dementia), Faculty of Health University of Technology Sydney
END OF LIFE DIRECTIONS for Aged Care (ELDAC) Toolkits:
Giving People the
R IGH T T OOL S F O R T H E J O B
T
he number of Australians over the age of 65 is rising and, during the next three decades, the proportion of the population aged over 85 will more than double.
information, resources and services. ELDAC initiatives include a navigation and phone advisory service, technology solutions, partnership projects and policy initiative.
This demographic change is driving significant growth in demand for aged care. The availability of home care packages has significantly expanded in the last decade to allow people to be cared for in their homes, including those that require palliative care.
A major resource is the development of five online toolkits which provide support to aged care staff, specialist palliative care professionals and general practitioners (GPs) to provide a comprehensive evidence-based, person-centred and sustainable approach to palliative care and advance care planning. These toolkits build on the previous work of the consortium partners.
A shift in the complexity of people moving into residential aged care has also occurred; people are older, frailer and have more complex care needs. Across the spectrum of aged care services there is a need and an expectation for people to have their end-of-life needs met. The government-funded initiative End of Life Directions for Aged Care (ELDAC) aims to connect people working in aged care and palliative care to advance care planning
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Toolkits can be broadly defined as a collection of information, resources and tools around a particular topic or practice area. They have increased in popularity across healthcare settings. Either in hard copy or online, they can help users to develop a plan and organise their efforts to follow evidence-based recommendations or practices.
The ELDAC toolkits are interactive and have been built and reviewed by experts working in aged care, specialist palliative care and primary care. While the format of each ELDAC toolkit varies, they are online resources, presented in a userfriendly format for ease of use by direct care staff including nurses, care workers, allied health professionals and GPs as well as staff in managerial, quality or educational roles. All five toolkits provide up-to-date clinical evidence, learning opportunities and organisation tools to support palliative care and advance care planning.
As online products, the five toolkits can adapt to changes that occur across the aged care, palliative care and primary care sectors. The Residential Aged Care Toolkit and Home Care Toolkit are built around the ELDAC framework: eight key domains mapped to elements essential to providing quality palliative care and advance care planning for older Australians.
Evidence-based clinical guidance is available in the ‘What I can do’ section, while staff can identify their learning needs and set a learning plan in the ‘What I can learn’ section. The ‘What my organisation can do’ section provides direction in setting up a palliative care and advance care planning working group, and includes organisational and clinical audits linked to a quality improvement framework. The Primary Care Toolkit, tailored for primary care staff including GPs, has a similar structure with clinical information, links to education and mapping of health pathways across Australia. The Legal Toolkit provides factsheets and practical help for seven commonly encountered legal issues in palliative care and advance care planning. The Working Together Toolkit provides evidence-based strategies for connecting the aged care, specialist palliative care and primary care sectors. As online products, the five toolkits can adapt to changes that occur across the aged care, palliative care and primary care sectors. New additions to toolkits taking into account sector changes and user feedback will be incorporated during the project, which will run through to 2020. Visit the ELDAC website to find out more: www.eldac.com.au n
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Around THE NETWORK
New
St John of God
B E R W I C K H O S P I TA L opens to meet demand
T
he new St John of God Berwick Hospital is giving people living in Melbourne’s fast growing southeastern corridor more access to health care close to home.
adds to our existing facilities nearby including St John of God Frankston Rehabilitation Hospital and St John of God Pinelodge Clinic”, he said. “These hospitals will go a long way to meeting the growing needs of Victoria’s eastern corridor”.
The new $120 million hospital, which opened on 18 January 2018, replaced the old facility also run by St John of God Health Care, increasing capacity and services to the region. St John of God Berwick Hospital Chief Executive Officer Lisa Norman said the demand for the new hospital— which featured more patient beds and new services—was immediately clear.
Ms Norman said the response to the hospital was particularly rewarding and vindication of the efforts put in to ensure the community was consulted throughout the hospital development.
“Within two weeks of opening, the hospital was already busier than projected and on several occasions we reached the hospital’s overnight bed capacity”, she said. St John of God Health Care Executive Director of Eastern Hospitals Bryan Pyne said the initial patient numbers were higher than predicted, highlighting demand in this growing region. “The community is very familiar with St John of God Health Care and this new hospital is really a response to their calls for more services and beds close to home”, he said. “We are thrilled to be able to continue providing our Missionled services in this world-class hospital, which for the first time offers people living in the local area access to critical care, cardiology, rehabilitation and mental health services”. Mr Pyne said that while this hospital was the newest facility in the region, it was a part of a bigger commitment to providing health care to the community. “The original hospital site will soon be redeveloped into a dedicated rehabilitation and mental health hospital, which
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“Throughout the whole redevelopment project, we talked to the community and our internal stakeholders about how we would deliver care in the new hospital, and we then ensured that the design would enable our model of care”, she said. “Whenever we got to a point when we had to make a decision, it was always what was best for our patients, and the best people to make this decision were the people delivering and receiving the care”. Fast facts about St John of God Berwick Hospital: • $120 million cost of building and opening new hospital. • 200 new jobs created. • 35 new volunteer roles created. • 33 patients welcomed on opening day, including four babies in the special care nursery. • New services include the 10-bed cardiac care unit, cardiovascular catheter laboratory, and rehabilitation unit. • 3,055 procedures have been completed at the hospital in the first three months since opening. • 215 babies were born at the hospital in the first three months since opening. n
High Papal distinctions awarded to Dr Bernadette TOBIN AO and
Terry TOBIN QC
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he Holy Father Pope Francis awarded prominent academic ethicist Dr Bernadette Tobin AO the Honour of Dame Grand Cross of St Gregory the Great on 9 March 2018. She was presented with the Papal Honour by the Archbishop of Sydney, His Grace Anthony Fisher OP, at a formal ceremony at Chapter Hall in Sydney, in recognition of her outstanding service to the Church and to the broader Australian community in her chosen profession of medical ethics, and through her leadership of a range of health and research organisations. Bernadette was Foundation Director, and continues to be the Director, of the Plunkett Centre for Ethics at St Vincent’s Hospital in Sydney, a joint centre of ACU and St Vincent’s Hospital in Sydney. She is Reader in Philosophy in the Faculty of Theology and Philosophy at Australian Catholic University. Over a number of decades, she has made significant contributions to a range of hospital and governmental advisory bodies dealing with research, professional ethics and public healthcare issues, and to boards of professional healthcare and bioethics associations. In the context of proposals all around Australia to allow doctors to provide ‘euthanasia’ or ‘assistance in suicide’, Bernadette has been an advocate for the superiority of the model of care provided by Catholic hospitals. During the same ceremony, her husband Mr Terry Tobin QC was presented with the Papal Honour of Knight Grand Cross of St Gregory the Great, for his outstanding commitment to the Catholic Church and to tertiary education in Catholic Universities in Australia and overseas. Terry, an Adjunct Professor of Law at Australian Catholic University, was awarded the Papal Honour “in recognition of his devotion to faith and his generous commitment to Catholic higher education in Australia and within the Middle East”. Bernadette said she was touched and greatly honoured to receive the Papal Honour. Two things made the occasion especially memorable for her. “My greatest pleasure is that Terry and I are standing here together today. In addition, it is such a pleasure to ‘share the stage’ with my friends and colleagues, three Sisters of Charity, from St Vincent’s Hospital, Srs Sesarina Bau rsc, Jacinta Fong rsc, and Anthea Groves rsc”. The Sisters were each awarded the decoration of honour, the Holy Cross pro Ecclesia e Pontifice. The medal was
Pictured from left: Dr Bernadette Tobin AO, His Grace Archbishop Fisher OP and Terry Tobin QC
established by Leo XIII on July 17, 1888, to commemorate his golden priestly jubilee and was originally bestowed on those men and women who had aided and promoted the jubilee, and by other means assisted in making the jubilee and the Vatican Exposition successful. It is currently conferred for distinguished service to the church by lay people and clergy, and is the highest medal that can be awarded to the laity by the Pope.1 Honours were also awarded to Aboriginal leader, Dr Elsie Heiss, who was made a Dame Commander of the Order of St Gregory the Great, and John Munce, Chairman of Dooleys Lidcombe Catholic Club, was made a Knight of the Order of St Sylvester. n
1 With thanks to the Sisters of Charity of Australia for allowing parts of their story, ‘Three Sisters of Charity Recognised for their Ministries by the Pope, available at http://www.sistersofcharity. org.au/news/three-sisters-of-charity-recognised-for-theirministries-by-the-pope/ , to be used in this article.
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Around THE NETWORK
Championing Catholic Sector Research: cutting-edge innovations
making a difference where it counts
C
HA’s 2018 Research Symposium brought together researchers from across Australia to foster productive collaboration and learning, to celebrate achievements and ongoing initiatives, and importantly—to showcase the world-class innovative research being conducted and translated into practice across the Catholic health and aged care sector. The event was generously hosted by Mater Health Services and held at the beautiful Whitty building at Mater Hospital in Brisbane on 1 June. This year’s Symposium—the third of its kind for CHA—was packed with valuable content, delivered by distinguished researchers and academics and a number of accomplished clinical researchers representing CHA’s members and the wider research community. The focus of the Symposium was ‘Benchtop to Bedside’—how researchers are translating their world-class research across the continuum of the health sector and applying technological innovations in the health space to make a real difference in patient care. With the valued support of our sponsor, the Australian Centre For Health Services Innovation (AusHSI), CHA was able to showcase cutting-edge innovations and research happening across our health services. AusHSI is a research, consultancy and training organisation committed to advancing new ideas with positive impact and championing partnerships between researchers, clinicians and policymakers. Dr Carrie Hillyard, Deputy Chairman of Mater Medical Research Institute, delivered the Symposium’s keynote address for the day, sharing her learnings about translating research while bringing new products to market. She
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Dr Carrie Hillyard, Deputy Chairman of Mater Medical Research Institute
amused audience attendees with her recounting of the serendipitous discovery of ’The Whiskey Test’ to screen for medullary thyroid carcinoma. Dr Hillyard reminded the audience how far the health sector has come in the areas of research and technological advancements, and how much Australia still has to offer in the areas of global research. Over the course of her career, Dr Hillyard has commercialised products from laboratory bench to market and is an inventor of seven patented technologies. In recognition of her contributions to the biotechnology industry, Dr Hillyard has been awarded the Centenary Medal, the Women in Technology Biotechnology Star award, AusBiotech Excellence Award for Outstanding Contribution and recently, Women in Technology’s Entrepreneurial Outstanding and Life Sciences Outstanding awards. With her presentation, the stage was set for a day of inspired sharing of knowledge and important networking for researchers of the Catholic sector. The significant achievements in Catholic sector research by each of CHA’s members were showcased in the well-received first session of the day. Key messages from the sector included discussions on much-needed improvements in the use of digital technologies and big data to improve health services; expanding research into precision medicine in the treatment of cancers and immune conditions; strengthening partnerships both across Catholic services and with external stakeholders; and the need to study the structures and systems that contribute to health inequalities, in order to articulate and address the needs of vulnerable groups. The key roles the Catholic sector can
Presenters from Research in the Catholic sector, pictured from left: Dr Chidozie Anyaegbu (also an invited speaker), Dr Carolyn Lethborg, Ms Anne Spence, Dr Emma Baker, Dr Tu’uhevaha Kaitu’u-Lino, A/Prof Allison Pettit and Ms Linda Brown
play in this area were highlighted, as was the need to work collaboratively as a sector to address social justice issues. Professor Ross Crawford took to the stage in the second session to share his valuable insights into the progress of medical robotics, and how organisations can prepare for the disruptive technologies of the future. Prof Crawford is the Chair of Orthopaedic Research and the Professor of Medical and Health Robotics at QUT. He recommended our organisations look to how we can best utilise and pool resources to encourage investment in new high-cost technologies. Professor Bruce Brew spoke next on how his team is leading the way in technological innovation for patients with epilepsy. Prof Brew is a Professor of Medicine (Neurology) at the University of New South Wales and the University of Notre Dame, and also the Director of the Applied Neurosciences Program and Peter Duncan Neurosciences Unit in St Vincent’s Centre for Applied Medical Research. The centre specialises in neurological complications of immune deficiency. Professor Nick Graves is an internationally renowned health economist and has been the Academic Director of AusHSI since its inception in 2011. His specialist areas of knowledge include health economics; health services research; prevalence of high-value and low-value care and its effects on patients; health behaviour change interventions; and how research funding is allocated. Prof Graves rounded out the second session by sharing with the audience a major focus in his work—showing how health services can be improved by evaluating ‘high-cost low-value’ services, and trimming the fat in excessive health expenditure.
Dr David Abbott, who recently joined the Commonwealth Department of Health as the Principal Research Scientist for the Medical Research future Fund (MRFF), shared some key insights in the third session of the day on the Australian Genomics Health Futures Mission, being financed by the MRFF. CHA members look forward to further consultations with research experts and the Commonwealth to build direct action for the Health and Medical Industry Growth Plan. Professor Janet Hardy is the Director of Palliative and Supportive Care at Mater Health Services, Medical Director of Mater Cancer Services and Cancer Program Leader in the Mater Research Institute. Her presentation focused on how to define the role of medicinal cannabis in palliative care. The key, she concluded, is viewing symptom burden as a whole rather than as individual symptoms. Prof Hardy’s research into the role of medicinal cannabis in patients receiving palliative care is also featured in this edition of Health Matters in the section, ‘The Sector Speaks’. Our final speaker of the day was Dr Chidozie Anyaegbu, a postdoctoral research fellow at St John of God Subiaco Hospital in WA, who took the stage to share his expertise in molecular biology and tumour immunology. His research aims to use the multiplex immunofluorescence technique to investigate the prognostic value of the type, function, and spatial distribution of dendritic cells engaging with T cells in colorectal tumour samples. The much-anticipated Shark Tank segment was held to conclude the day, and our expert panellists heard continued next page
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Around THE NETWORK
Shark Tank winners, pictured from left: Dr Liisa Laakso, Prof Leanne Monterosso, Dr Gail Ross-Adjie and Dr Elizabeth Hurrion
outstanding pitches from researchers representing Catholic Health providers from across the country, in the search for ideas at the forefront of innovation. The three winners chosen by our expert panellists—Dr Elizabeth Hurrion, from Mater Health in Brisbane, Dr Liisa Laakso, also from Mater Health in Brisbane, and Dr Gail Ross-Adjie from St John of God Murdoch Hospital—were each awarded $1,000 to put towards their projects to further facilitate their research. The winning teams and their research will be featured in our Health Matters publication over the next three editions.
CHA thanks AusHSI for their participation and support of the sector’s leading researchers, and dedication to improving research and innovation through their sponsorship of the inaugural Shark Tank segment. We would also like to thank all those involved—the sponsors, hosts, chairs, presenters, organisers, speakers, Shark Tank participants and judges, and valued audience members. The common purpose shared by all CHA members can serve to build upon and enhance the innovative, patient-driven research already happening throughout our organisations. n
Invited speakers, pictured from left: Prof Nick Graves, Prof Bruce Brew, Prof Ross Crawford, Prof Janet Hardy and Dr David Abbott
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St Vincent’s Health Midwifery: Team Finalists in the 2018 HESTA
Australian Nursing and Midwifery Awards
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ncreasing numbers of women are finding the transition to motherhood difficult, with many lacking family and community supports they can rely on as new mothers. This can have a significant impact on women during the first few weeks at home after the birth of their babies. Midwives Judelle McFarland and Michelle Cambrey, part of the midwifery team at St Vincent’s Private Hospital Melbourne, recognised that women often feel overwhelmed in the weeks after they’ve given birth. They designed the Parenting Enhancement Program to help mothers after the birth of their babies—by enhancing maternal mental health, contributing to infant and child development, and strengthening family and community bonds. The midwifery team at St Vincent’s Private Hospital in Melbourne have been nationally recognised for the development of this Program, being announced as finalists in the 2018 HESTA Australian Nursing & Midwifery Awards. This year’s finalists were selected for their outstanding initiative in developing innovative services and processes that elevate levels of care, and improve the patient experience. Debby Blakey, Chief Executive Officer, HESTA, said: “Through the Awards, we are proud to be able to recognise this year’s finalists. Their commitment to care and the outstanding work they do has a profound impact on the lives of the individuals they care for and the communities they operate in”. “It was very exciting for our team to be recognised and reach to finalist level for the HESTA Awards”, said Judelle McFarland, Maternity Nurse Unit Manager, St Vincent’s Private Hospital Melbourne. “To have acknowledgement of the success of one of the many projects our team has put in place to ensure all maternity patients have the best support during pregnancy, birth and the early days of parenting, is hugely rewarding”. The Parent Enhancement Program was conceived after the team established during patient follow-up that many women were struggling with the transition to being a parent and full-time carer of an infant. Often the joy experienced in the first few days after birth rapidly vanished once the baby was taken home. Comments from the women indicated many struggled with the ‘loss of life as it used to be’, and felt they had lost control over their lives. They experienced difficulties in reconciling their anticipated ‘perfect’ life with their fragile emotional state, especially when they were not expecting to
Michelle Cambrey, St Vincent’s Health Midwife, with her 2018 HESTA Australian Nursing & Midwifery Award. Pictured from left: Marnie Fletcher, ME Bank, Michelle Cambrey, and Debby Blakey, CEO HESTA
encounter any problems adjusting to motherhood. This gap between expectations and reality added to their state of distress. Difficulties in baby management were also identified as a major precipitating factor for feelings of parenting inadequacy. Mothers who were unable to find a solution to a baby management problem felt that this reflected negatively on their parenting ability, and might lead to them perceiving themselves to be a ‘failure as a parent’. The Parenting Enhancement Program reminds new mothers that no matter the age of your child, there is no better time than now to learn about the most effective parenting styles and apply them to your own life. “Being a parent isn’t easy, but with helpful hints and practical advice from our parenting experts and child psychiatrists, you can become a more confident parent who will raise children who are happy and healthy,” said Michelle Cambrey, St Vincent’s Private midwife. The midwifery team at St Vincent’s Private Hospital Melbourne are celebrating 80 years of delivering babies in 2018. Over that time, more than 100,000 babies have been welcomed to the world and the midwives remain dedicated to providing new parents with the best care and support. The Parenting Enhancement Program is offered to all patients who birth at St Vincent’s Private Hospital. For more information about having your baby with St Vincent’s Private, check the website: svphm.org.au/maternity n
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Around THE NETWORK
Federal Health Minister Opens NHMRC Centre for Research Excellence at Cabrini
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n March 2018, the Federal Minister for Health, the Hon Greg Hunt MP, officially opened the National Health and Medical Research Council (NHMRC) Centre for Research Excellence for the Australia and New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network. The new centre is to be run by Monash University at the Cabrini Institute in Melbourne. The NHMRC Centre for Research Excellence for the ANZMUSC Clinical Trials Network, with hubs in both Sydney and Melbourne, is a collaboration of more than 200 clinician-researchers from 21 universities, 21 hospitals and 10 research institutes. Led by Professor Rachelle Buchbinder, Director of the Monash University Department of Clinical Epidemiology at the Cabrini Institute, the aim of ANZMUSC is to optimise musculoskeletal health by addressing the “paucity of high-quality research that has been focused on arthritis and musculoskeletal conditions, despite these conditions affecting 28 per cent of Australians,” she said. The opening of the centre coincided with a series of groundbreaking papers from Australian and international researchers in The Lancet, published in March 2018, warning that low back pain is a major health burden globally and that the current escalating over-treatment of the condition is useless, unnecessary and harmful. Low back pain is the leading cause of disability globally—with more than 540 million people affected by activity-limiting low back pain at any one time. The burden from low back pain has doubled in the last 25 years, and the prevalence of the condition is expected to continue to increase with an ageing and increasingly obese population. According to Professor Buchbinder, the lead researcher of one of the three Lancet papers, “the burden from low back pain has reached a tipping point where the condition is growing rapidly, is poorly understood and is being mismanaged medically—at cost both to the patient and to the healthcare system. Low- and middle-income countries are already emulating the low-value care that is endemic in high-income countries”. “One of the big problems is that patients aren’t always being given the right advice”, she says. “Rather than evidencebased advice to stay active and exercise, much care for low back pain is of low value and is making the problem worse”. The final paper in the series by Professor Buchbinder is a worldwide urgent global call to action.1 “Across the globe [there is an] inappropriately high use of imaging, rest, opioids, spinal injections and surgery. Doing more of the
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Federal Minister for Health, the Hon Greg Hunt MP, speaking at the opening of the NHMRC Centre for Research Excellence at Cabrini.
same will not reduce low back pain disability, nor its longterm consequences”, she said. The paper also calls for coordinated leadership to address fragmented and outdated models of care; evidence-based responses emphasising the concept of ‘positive health’ (the ability to adapt and self-manage in the face of social, physical and emotional challenges); avoidance of harmful and useless medical treatments; public health campaigns to address misconceptions; and funding to support intensified research efforts on prevention and management of low back pain. The international team behind the series comes from Brazil, Canada, Denmark, Finland, Germany, South Africa, Sweden, Switzerland, The Netherlands, UK and USA. Also outlined in the series are the breadth and impact of low back pain globally; how medical care is exacerbating the problem in both developed and developing countries; and promising solutions that need testing. According to Professor Chris Maher, another of the Australian lead authors, there is room for hope. “There are safe, effective treatments for low back pain; the challenge is ensuring patients get the right care at the right time”, he said. “A better understanding of low back pain, and changes to the way care is delivered and reimbursed, are key to reversing the problems we see now”.2 n
1 2
Buchbinder, R., et al. (2018). “Low back pain: a call for action.” The Lancet. Foster, N. E., et al. (2018). “Prevention and treatment of low back pain: evidence, challenges, and promising directions.” The Lancet.
Mater Research Grants
support women in research CHANGING our WORLD
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wo female researchers in Queensland have been awarded strategic grants as a step forward in closing the research and academic gender gap.
The Mater Research Strategic Grants for Outstanding Women are proudly funded through Mater Foundation’s generous donors and supporters.
The winners of Mater Research Strategic Grants for Outstanding Women were awarded on International Women’s Day to Associate Professor Katharina Ronacher and Professor Josephine Forbes, both Group Leaders at the Mater Research Institute, University of Queensland.
Mater Research is committed to supporting women and was awarded the Employer of Choice—Small Business at the 2017 Women in Technology Awards. n
Chair of the Gender Equity Working Group at Mater Research, Associate Professor Allison Pettit, said the grant scheme provides funding for two awards per year. “Each award provides $45,000 per annum for two years to support the research and career progression of high potential female researchers at Mater”. Dr Pettit said the barriers for women are multifactorial. “Combining motherhood and being the primary carer with being a clinical or biomedical researcher is demanding. Research can be quite unforgiving and the attrition rate is high for women. “The Australian Academy of Science has recognised that women comprise more than half of science PhD graduates and early career researchers, but just 17 per cent of senior academics in Australian universities and research institutes”, said Dr Pettit. “In light of this, this grant has the potential to make a real difference in the career progression of Mater Research female research academics”. Dr Pettit said women in research need to be recognised for their contributions to discovery and research translation. “Women need to be equitably compensated and have confidence in progressing their career even if they choose to be a primary care giver. An important part of this cultural shift will be achieving gender balance in assuming the carer load and consequently avoiding our male colleagues being disproportionately disadvantaged for taking on some of the burden”, said Dr Pettit. Dr Forbes shared advice for early career female researchers: “Stay balanced—make sure you don’t forget about the rest of your life because the person that you are contributes to the type of research that you do and the quality of that research”.
Pictured from left: Associate Professor Katharina Ronacher and Professor Josephine Forbes, both Group Leaders at the Mater Research Institute, University of Queensland.
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Around THE NETWORK
ST JOHN OF GOD
Subiaco Hospital celebrates 120 years
S
t John of God Subiaco Hospital, founded by the Sisters of St John of God on 19 April 1898, celebrated its 120th anniversary in April 2018.
The special milestone was marked with a number of activities recognising the hospital’s heritage, community and significant contribution to medical and surgical advances. St John of God Subiaco Hospital Chief Executive Officer Professor Shirley Bowen said the 120th anniversary was about celebrating the enduring contribution the hospital has made in caring for generations of Western Australians and recognising the many caregivers who have carried on the Sisters’ legacy.
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“St John of God Subiaco Hospital is an iconic landmark in our city. Most people in Perth know someone who was born here, someone who has been cared for here or someone who has worked here”, Professor Bowen said. “The hospital has positively impacted the lives of hundreds of thousands of people over the last 120 years. In 2017 alone, we admitted more than 80,000 patients, supported more than 800 doctors, and employed more than 2,500 caregivers across all areas of the hospital. “Commemorating our 120th anniversary is a time to reflect on our heritage, on the many people who have a connection with the hospital, and on our contribution to medical research It is also a time to feel inspired about our future”.
As a part of the hospital’s anniversary celebrations, they also commissioned its new Clinical Command Centre, further enhancing the patient experience by centralising management of main theatres, improving patient flow through the hospital and increasing communication with doctors. The Clinical Command Centre also offers a one-call service for late bookings which makes it easier for doctors to get patients in who need to be operated on quickly. “[This new Centre] is a great example of integrating technology
Photos from left: Subiaco Hospital 1940, Anaesthetic apparatus 1960, Xray lab at Subiaco Hospital 1930
and innovation to support our mission of delivering excellence in patient care”, Professor Bowen said. “The past leaders of our hospital, in particular the Sisters of St John of God, all drew on innovation to improve patient experience and create clinical excellence”. “Clinical excellence and an exceptional patient experience are our highest priorities and the coming years will see further innovation and development. It is a pivotal and exciting time for St John of God Subiaco Hospital”. n
St John of God photo montage continued next page
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Around THE NETWORK
Photos clockwise from top: Subiaco Hospital 1912, Sister with patient 1965, Nightingale ward 1950 Shared care maternity ward 1940 Subiaco School of Nursing 1970
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History of ST JOHN OF GOD BALLARAT 1958 Opening of the School of Nursing
School of Nursing Class 1 of 1959
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n 1958, the School of Nursing at St John of God Ballarat Hospital opened, in the D Wing on the ground floor, and quickly became not only an education hub for nurses, but also their home as they lived on site throughout their training. Student nurses were first housed in two cottages, Lourdes and Fatima, located within the hospital’s grounds. As numbers increased, a small number of student nurses were given rooms in the convent. At a cost of £90,000, the first two floors of the new School of Nursing, Marian House, were built in the early 1960s. Two additional floors were added, with enhanced facilities including bedrooms, a lecture room, two large classrooms, a simulated hospital ward, a practical science room, library, lounge room, secretary’s office, four lecturers’ offices, a small kitchen, and bathrooms. In total, accommodation was provided for 107 nurses. Student nurses lived by strict rules. It was compulsory to live at the nurses’ home for the duration of the three-year course until the late 1970s when, as numbers increased,
second and third year students were allowed to live in the community. Night-time curfews were strict, unless a late pass was obtained in advance, and visitors to students’ rooms were limited to their mothers or sisters. On threat of expulsion from the hospital, alcohol was not allowed, and student nurse uniforms were also compulsory. The original uniform was a yellow dress with white apron and magenta cape. A blue cape replaced the magenta, and for a short time the dresses were light brown, worn without an apron. Later a light blue dress was introduced, and the blue cape reintroduced. Fran Britt, a student nurse who enrolled at the School of Nursing in 1969, recollected that the nurses worked hard: We began Preliminary Training School the next day and were allocated our uniforms. After the initial few weeks of school we began full-time work in the hospital. The shifts were either straight or broken shifts. A broken shift was 8.00am to 1.00pm and returning at 5.00pm to 9.00pm. During our three-year training all our lectures and tutorials were fitted in with our full-time practical work. n
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Around THE NETWORK
Adding REMOTE DIALYSIS to the MBS a welcome change for remote
communities in CAPE YORK
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punipima Cape York Health Council (Apunipima) welcomes the addition of Remote Dialysis to the Medicare Benefits Schedule (MBS). This move by the Hon Greg Hunt MP, Federal Minister for Health; and the Hon Ken Wyatt AM MP, Federal Minister for Indigenous Health; will directly benefit entire communities in Cape York. The change to Medicare funding that will take effect in November 2018 will make it possible for Aboriginal and/ or Torres Strait Islander people in remote Cape York Communities who require dialysis to receive treatment in their own communities. Treatments can also be delivered by a nurse, an Indigenous practitioner or Indigenous Health Worker.
treatment. “In the long term, this move by the Federal Government will improve the quality of life of our clients; it will reduce the cost of treatment and have a direct impact on career pathways for the Indigenous people of Cape York”, Rochelle said. Apunipima are encouraged that the Federal Government are listening and acting on expert Indigenous patient voices and see this latest announcement as a positive step towards closing the gap. n
Aboriginal and/or Torres Strait Islanders are twice as likely to have indicators of chronic kidney disease and one in 10 will require ongoing dialysis treatment. Access to dialysis services is often not possible in remote Aboriginal and Torres Strait Islander communities; this means lengthy and expensive stays away from home, family and community support. Apunipima Care Coordinator, Kidney Health Australia Ambassador and Butchulla, Kalkadoon, Wirri woman Rochelle Pitt said that this decision will have several positive impacts on remote Aboriginal and Torres Strait Islander communities. “As dialysis patients age, they require increasing levels of care; this means that they must leave community in order to access treatment in major hospitals. Dialysis treatment on country is a big step forward in culturally appropriate, holistic care”. “We know that long-term medical treatment away from home has a negative impact on social and emotional wellbeing, the family unit and the wider community”, Rochelle said. “The addition of Remote Dialysis to the MBS will also provide the opportunity for Apunipima to encourage additional training and career opportunities for Aboriginal Nurses and Health Workers in community”, Rochelle added. The renal health MBS item will cover some of the costs associated with the growing Indigenous kidney disease health crisis. It will improve the life of those in the community that are both directly and indirectly impacted by dialysis
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Rochelle Pitt, Apunipima Care Coordinator, Kidney Health Australia Ambassador and Butchulla, Kalkadoon, Wirri woman, said that this decision will have several positive impacts on remote Aboriginal and Torres Strait Islander communities.
REFLECTION
Looking FORWARD LOOKING Back
by Fr Frank Brennan SJ AO
C
atholic Health Australia is celebrating its 40th anniversary with the theme, ‘Looking Forward, Looking Back’. I write on a beautiful autumn day here in Canberra. It’s 9 May 2018. Last night the Treasurer handed down the annual Budget as is customary at this time of year. Autumn leaves and Budget news go hand in hand in Canberra, year in and year out, for every decade. Some years the Treasurer comes from one side of politics, and some years the other. Both sides get a turn sooner or later. This morning, dignitaries gathered in the forecourt of Parliament House to mark the 30th anniversary of the opening of the building by Queen Elizabeth. Just like 9 May 1988, today was a glorious autumn day with clear sunshine and dappled leaves. Thirty years ago, there were protests for land rights outside Parliament. But there were no Aboriginal representatives inside Parliament, and no Aboriginal person spoke. Today, Aboriginal elders conducted a smoking ceremony of welcome and cleansing. There was a good feel to the willing participation of community leaders in the smoking ceremony, including the Governor-General, the Queen’s representative. And of course, there is now some very fine Aboriginal representation inside Parliament, and on both sides of the aisle. Thankfully, some things do change for the better over the decades. Other things just keep repeating themselves. And yet others change for the worse. Thirty years ago, the Australian Church leaders were asking our elected politicians to agree on how best to recognise Aboriginal and Torres Strait Islander Australians when opening the new Parliament House. Ten days after the opening by the Queen, the Opposition in Parliament announced: “Because of the negative community response to radical Aboriginal protests, the Coalition has decided not to proceed with initiating a parliamentary resolution on Aboriginal matters. We do not believe that it would be positively received in the community and hence would fail to promote reconciliation as we had hoped”. No one would say that in Parliament today. But then again, no one would have had a smoking ceremony at the entrance to Parliament 30 years ago. This was all before Mabo, native title, and the apology to the stolen generations.
We Christians can discern God’s action (or what we might call ‘grace’), in the past – by reflecting on both the human mistakes and the finest achievements. In his latest apostolic exhortation, Gaudete et Exsultate, Pope Francis says: “Grace acts in history; ordinarily it takes hold of us and transforms us progressively. If we reject this historical and progressive reality, we can actually refuse and block grace, even as we extol it by our words.” Recently Pope Francis told his fellow Jesuits: “Politics is one of the highest forms of charity. Great politics. And in that, I think that polarisation does not help. On the contrary, what helps in politics is dialogue”. Catholic Health Australia is committed to respectful dialogue, seeking the progressive reality of the best health policies and the best possible healthcare delivery for all, in harmony with the vision of Jesus. Looking forward and looking back, we seek to avoid polarisation. We are committed to dialogue, providing everyone with representation and respect, inside and outside of Parliament. The hallmarks of our practice and of our vision will always be universal service which includes the poor, and healing ministry which respects the inherent dignity and worth of both the patient and the health professional. Today’s smoking ceremony might have helped heal some of the wounds felt on both sides there in the forecourt of our Parliament 30 years ago. Let’s hope so.
Thirty years on, we are still wondering how to recognise Indigenous Australians in our Constitution. It’s by looking back that we can learn the best way forward. We can learn from the past – both from the mistakes and from the achievements.
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