February 12, 2025 • 34 mins
When you place a loved one in aged care, you want to be assured that they are getting the best care possible.
For many reasons—lots of them valid—the aged care sector in Australia has come under scrutiny in recent years. In this episode of Law Matters, we delve into why problems exist in aged care and what solutions might work.
Catherine Henry hosts this episode and speaks to CEO of Maroba Caring Communities, Viv Allanson OAM.
In this episode, Catherine and Viv discuss:
- How devastating the Royal Commission into Aged Care was for the sector
- Why some aged care facilities are broken
- How education and conversations can pave a positive way forward
Disclaimer
While this podcast is aimed to be informative, it is not intended to be a substitute for legal advice. You should see a solicitor for complete advice that relates directly to your situation.
For more information, please visit:
Learn more about Aged Care Negligence and Elder Law, or download our free eBook, Growing Older.
If you’re concerned about a loved one’s treatment in aged care, you can find out more at Catherine Henry Lawyers, or call the team on 1800 874 949.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:02):
Hi, I'm Catherine Henry from Catherine Henry Lawyers.
At my firm, we do a lot of work in the aged care space and I wanted to focus in on some ofthe issues from an aged care provider's perspective because I know from the work that I do
and from the advocacy that I've done, working in aged care is extremely tough.
(00:23):
So rather than just focusing on some of the things that we hear about, know, the horrorstories, if you like,
I want to focus today on some of the solutions that have been articulated and some of thechallenges that Viv Allanson, OAM and CEO of Maroba Caring Communities will have
experienced.
(00:43):
And that's why I'm so fortunate that Viv has accepted the invitation today.
Viv is, she's a champion of our age community and doing things the right way.
So Viv, welcome to Law Matters.
Thank you.
What a welcome.
Just...
Tell us a little bit about Maroba first.
I've visited clients who are in the residential care area, but also in the retirementindependent living sector.
(01:09):
Just tell us about how you think Maroba fits within the spectrum of aged care andretirement living services in Newcastle and the Hunter.
Well, Maroba has been operating for 70 years.
So we've had
many years of experience in adapting and being nimble to what is around us and what theneeds are.
(01:32):
So we've primarily focused on aged care, as in residential aged care, and in 1999 we wentinto retirement living with just a very small village.
And of course now those people have all very well advanced in age and are aging in place.
(01:54):
and some may even come into our care as they have done over many years.
But it's one big family.
We consider ourselves as a family and I think that's what makes a difference from a robot.
By focusing on family, we can focus on real people's needs, not just system needs orchanges in regulation and compliance whilst that's important.
(02:19):
I very happily told a conference a month or so ago, I do not live and breathe the agedcare standards.
Well, of course it was a seminar, a conference on the standards and quality systems.
But I do live and breathe quality, quality care for older people.
I do live and breathe the fact that I want all of the people in our care and in our widercommunity to enjoy a great life in their latter years.
(02:48):
no matter where they happen to live.
So that's what drives Maroba.
And I've been there for 30 of those 70 years.
And I started as the Director of Nursing.
So I got to do things differently because I hadn't been a Director of Nursing before and Ihadn't been a Director of Nursing in a nursing home before.
(03:09):
I'd been a deputy, but not the decision maker.
You came from the Royal Newcastle Royal Newcastle Hospital and I had a short
time at Green Hills Nursing Home as a deputy where I learnt so much about aged care inthat time and learnt how I would like to do it as the leader.
And I was very fortunate because they gave me my head.
(03:34):
They let me run.
And I had a great deputy who said, Viv, you you can change the world from here, which Ilaughed at.
But she pushed me out the door and she said, I'll run the ship while you go and change theworld.
And I couldn't have asked for a more supportive deputy and I was able to appoint her asdirector of nursing before I left because she got it and she was a great director of
(03:59):
nursing once I stepped into the CEO role in 2000.
So being the decision maker on site for Maroba has made a huge difference because you'llnote that
Most of the providers are very big and growing and they have a head office somewhere andthe CEOs and the leaders rarely would get to go into the services.
(04:24):
I've met many staff across the sector who haven't even seen their CEO, let alone shakentheir hand or greeted them or understood from them what the culture of the organisation
ought to be.
But you have a real presence at Marova.
And everyone knows who you are.
(04:44):
I'm a sucker for old people.
I think that's, you say, well, how did you find yourself in this position?
I really am a sucker for older people and I'm a sucker for humanity.
And I love being around people.
I often say I'm the most hugged CEO in Australia because I can't walk through our buildingwithout arms going out to me.
(05:05):
And of course they're letting go of their walking frames to do that.
Stop, stop.
And such a big contrast to the, you know, those big providers that you were mentioningwho, you know, they're massive.
And often the cases that we read about, unfortunately, do come from that sort ofenvironment.
(05:30):
I just wanted to get back to your comment about your mantra at Maroba being to live andbreathe quality.
How difficult is that given the funding issues that you must have that it's all very wellto talk about the quality and the standards that you aspire to as changing the world, as
(05:51):
you put it, doing the best that you can.
But at the end of the day, you can only deliver the service that you're capable ofdelivering with the funds that you've got.
I think it's really important to talk about that.
chronically underfunded aged care sector.
you talked about 1999 was when retirement living was introduced to Maroba.
(06:15):
1997 was a pretty important year when the then Howard government introduced bigderegulation, if you like.
Tell us how it's been managing to live and breathe quality in that environment.
If you live and breathe quality,
then the funds are sort of to the side.
(06:37):
And I guess, you know, when I was asked to be CEO, I told the chairman and the deputychairman of the board, I think you should find someone that can add up.
And they said, well, no, we love what you do.
So that gave me permission not to have my eyes on the bottom line.
And I think that really helped because whilst I'm very aware of our bottom line and I'mvery aware of a very limited envelope of funding,
(07:04):
As a nurse, I feel I've been able to bring a lot of practicality to how we utilise thosefunds to get the best for everyone in the building and for our staff as well.
Because I love to invest in our people because if our people are well equipped and welleducated, then they have a greater chance of delivering on that dream of giving people
(07:28):
their best life and living and breathing quality.
And it's been...
exciting because we're always on the knife's edge of the budget and we're always lagging.
We're age care price takers.
We don't get to be price setters and the government's constantly changing the rules,changing what we have to do and some years ago we added to our values creativity and for
(07:55):
us that means determining our preferred future.
So we're not waiting for permission.
around compliance and around standards and around rules and new regulations.
We're determining what is it that our people want and let's deliver that.
Now if it happens to land on what the government requires, well that's great, but somehowor other we'll make it work.
(08:21):
But we will not try and fit their glove, we are trying to fit the residents glove.
And that's working for Maroba.
We're offering programs that so many people haven't even thought of and that's benefitingthe residents every day in so many ways.
It's amazing.
So in order to work out what the residents want, you're obviously heavily involved indialogue with the residents, but also a dialogue with the families.
(08:49):
How is it when you have to take those phone calls where families are unhappy or...
something unavoidable has happened.
My heart sinks and I think, gosh.
But then my heart opens up to, wow, this is great because the family is ringing me, whichmeans they're willing to have a conversation.
They're willing to give me an opportunity to make this right, turn it around, investigateand all of that.
(09:15):
So yes, it's never good getting those.
I got something at quarter past 10 the other night saying you've breached the privacypolicy and it's not good enough.
You know, I run a business, Mara Rober is a business.
You have standards that you aspire to and that you communicate to your staff and you hopethat they will comply with those standards and if phone calls weren't being received, I
(09:41):
mean...
I'd be very worried if I wasn't getting those calls and I say to families when I meet themin the hallways and they say how thrilled they are to have their mother or father with us,
I tell them I will make them a solemn promise.
that we will let them down.
And they go, did I hear that right?
I said, yeah, you did hear it right.
I've heard you say that.
Yeah, and I mean it.
(10:02):
So they're hearing it from the CEO.
But then I asked for them to make me a promise.
And that is, promise, you will let me know the minute you smell a rat, the minute youthink things aren't quite right, the minute you think your mother's saying things, but
you're just not sure if it's true or not, you come and speak to me or to one of my seniorpeople.
(10:22):
And they do.
which is great.
And that's the key to aged care, so that it's open, it's transparent.
That's how it seems to me.
It seems that you're living and breathing accountability because you're accessible.
Yes.
And you're hearing, you're listening to what they're saying and you're having thedialogue.
You're not humming that off.
(10:43):
We have focus groups.
So we have food focus groups.
We have the residents meetings.
We have the feedback channels and avenues.
We have just in-your-face feedback.
Like I got a complaint the other afternoon, a couple of Fridays ago, I went to see one ofour ladies and she said, Viv, I've got a complaint as she's sitting in bed with a two is
(11:04):
new.
And I said, well, what is it?
I said, how can I help you?
And she said, I prefer 4X.
And I said, well, I said, I can look into that for you.
And I looked into it and what I found was,
every Monday she has a slab of Forex delivered to her room and when that's finished shehas to have the two is new once that slab's finished.
(11:31):
So I thought isn't that a great complaint?
I was sharing this.
It is a good one.
Yes, but again I don't care how trivial it seems.
I'm interested for the residents sake to follow up every quirky thing they want to raiseas is the many teams on many levels.
that get to meet with families and residents to get their feedback and encourage them tocontribute.
(11:57):
So I've left Maroba today and there was a meeting going on with family members and seniorstaff to just keep them up to date, take on any issues they might suggest for us so we can
keep moving forward around knowing, seriously knowing what the residents wants and needsare.
Well I think that's very commendable and from what I hear and what I see I think you
(12:21):
run a fabulous ship at Maroba.
I am interested though, moving away from Maroba, what would you say about the aged carereform process in the last three years?
I think the process has been pretty horrendous because there hasn't seemed to have been aspace for speaking of and raising up those that are doing a great job.
(12:44):
It's been all about pulling down.
that we lost a lot of people you asked me about workforce.
We lost so many people from the time of COVID and it coincided with the announcement ofthe recommendations of the Royal Commission, which as you know was called neglect.
And where was that neglect?
It was at the bedside.
Where has most of the reform money gone to?
(13:06):
Not to the bedside.
Interesting, isn't it?
More compliance.
And of course, you would know in your business, Catherine, that
Compliance costs money.
So we're adding and adding.
think if you look back over Stuart and Brown, who do our benchmarking, what theadministrative costs were 10 years ago versus what they are now would cause your hair to
(13:30):
stand on end, given that where does that money come from?
Where does it come from?
And someone's got to pay for that.
And I think the community continues to bay for blood.
around aged care and fortunately we're not going to be relatives are involved you mean?
Yeah and some people not even, they don't even have anyone in care.
(13:50):
They join that bandwagon of how terrible it is.
Now yes there's some terrible things happen and I can't abide it when those terriblethings happen.
But not everyone.
We've got to be so careful that when we put everyone in that same boat that's where wewill not have a future workforce.
Because who wants to be putting their hand up
(14:11):
and saying, I work for that crowd and they cringe and everyone says, want, it's a barbecuestopper.
When you say it used to be when you said you were a banker, people had run the other way.
Do you think that's right?
feel that aged care nursing or working in aged care is seen as a really poor career pathat the moment.
(14:32):
absolutely.
Aged care advocates talk about the quality of the workforce and there's lots of strategiesthat have been put forward.
in your experiences would think even talking about it.
So my staff take great heart that they know I'm out there supporting them as a workforce.
But we must raise them up.
(14:54):
We must acknowledge the good work that so many do.
So many get up every day.
Yes, there are some bad providers out there, but their workforce aren't the provider.
No.
And we seem to keep talking about them in the same breath, but they're a different group.
And yes, we've seen some horrendous things by an individual, you know, where they'vecreated trauma for an older person in the privacy of the bedroom or the bathroom, and that
(15:20):
is just intolerable.
And the provider might be a very good provider, and that still can happen.
That's every provider's worst nightmare, that something like that will happen.
But then you've got the situation where you have providers who may be more focused onprofit because they have shareholders thanks to...
John Howard, yes, bless him.
And Doug Moran.
(15:40):
Yes.
We've seen that, yes, profits are important for those organisations.
That's the mantra.
They have to make money for the shareholders.
Whereas the not-profit sector, all the resources that become surplus get ploughed backinto the organisation in one way or another, which is a great news story, I think.
(16:02):
For us that has really worked and helped.
But I think we, even having these conversations about workforce and small groups and smallpockets of people and individuals speaking about it can challenge the myths that aged care
workers aren't good people because of what happened with the Royal Commission.
(16:23):
Because I find I've just been a relative in my own service with my auntie passing awayjust a week or so ago.
It was such a special experience for me to be that relative, to go through the palliationand the care that the staff gave to our family and to my auntie was just so special and I
(16:44):
felt very proud about that and very blessed to have staff that care enough.
And one of them said, Viv, you know we don't do it just for you.
I said, absolutely hand on heart know that.
because that's the message I get from so many families of what that end of life experienceis for them.
What would you like lawyers like myself, who work on aged care cases, generally againstthe big providers, to know about your industry?
(17:14):
Well, I think if they understand the funding and the challenges and even talk to a varietyof providers in exploring the...
how they might approach that case.
They might talk to provider that by word of mouth is a very good provider.
They might talk to them and say, well, what are you doing differently?
(17:35):
And then they might find in comparing that, well, they're not actually doing anythingdifferently.
So what's the key?
What's cause?
What's the root cause?
Is it one or two wicked people or one wicked provider that is just keeping all the profitsto themselves and not
putting them back in the business.
(17:56):
But I think that the legal fraternity can do a lot to work with aged care.
I love how you and John and Julie and I have formed the Hunter Aging Alliance because...
Talk about that because I think it's such a great group.
It's so exciting.
mean, the runs on the board that we've achieved is spectacular, but it's also bringingforward the conversation as colleagues in a public space.
(18:22):
It says, well, lawyers can talk to you.
aged care providers and they can learn from them and aged care providers can learn fromthe lawyers and we can all learn from the geriatrician and the epidemiologist and then all
the other people that have joined our committee for Hunter Aging Alliance I think isinspiring because we must be doing something that people want to see changed.
(18:43):
Yes and we want to get together to talk about issues.
The Hunter Aging Alliance held a symposium dealing with some of those issues.
capacity, what voluntary assisted dying means to those who are at the end of their livesand not necessarily senior.
happens at any stage of life.
also some of the really thorny issues.
(19:05):
think restraint in the aged care sector is a little bit like electroconvulsive therapy ina mental health institution.
People don't really understand what is meant by restraint.
And I wonder
if we could talk about what restraint is in the aged care context and why it may be thatit's demonised because you do have, there's a spectrum of views and some lawyers will take
(19:36):
a very hard line human rights perspective on the administration or use of restraints.
But I think at the coalface you have a different perspective and I'd just like to.
I read something, I was reading a paper from the United Nations and I highlighted aparagraph that was saying that aged care providers are using restraints for financial
(20:01):
gain.
Well, you know, if there was somebody around me who I would have leapt up and, you know,let fly with a speech because I just found that so offensive that there is no financial
gain to be had by
having the need to restrain someone.
In fact, it's a great cost if you get to the point of somebody needing restraint.
(20:24):
It may be that somebody's been injured from that person.
It may be that there's now a workers' compensation cost because a staff member has beeninjured or another resident's been injured or I had one gentleman completely wreck my
memory support unit.
has pulled down every artwork and smashed them and terrorised, tipped over the whole mealservice, wrecked the place.
(20:50):
But we didn't have any approval for any restraint.
He'd only been there for 12 hours.
Tell us about the approval process because it's difficult in the context of the enduringguardianship regime that is in place.
But I think it's important to drill down to
detail of the process.
Previous to the regulatory bulletin that came out, I think a couple of years ago, theEnduring Guardian had the capacity to make decisions about any type of restraint and I
(21:21):
felt that was an appropriate process even though, the facilities may need more education,the medical people might need more education, staff and families.
But again, it was appropriate because
I believe if you're needing some sort of restraint, it's as a result of some medicalissue.
(21:44):
if we try and say that...
The drug regime may not be appropriate.
That's right.
But it may be that someone needs a bed rail because they're thrashing around, they'regoing to fall out of bed or it may be...
And even now, if we imported all these low, beds and now the commission says, no, that's arestraint because it's hard to get out of it.
So you bring in a low, bed so you don't have to have a bed rail, but now it's a restraintbecause they can't get out of it.
(22:08):
And yet, we find that the process now is that you have to have someone specified to beable to give permission and give consent for restricted practices.
Now of course everybody's already got their enduring guardianships embedded and they'venow passed the point of being able to revisit those in terms of their cognition.
(22:31):
So we have this whole cohort of people in aged care, thousands of people, that may need arestrictive practice applied randomly or regularly that no one can give permission for.
the And what's the solution?
You've got to to NCAT.
is that something that happens regularly?
(22:52):
People are ignoring it, families are saying, well, I don't want to, I don't want to dothat, I shouldn't have to do that.
don't want to provide, I don't want to go down the path of going to NCAT.
yes, it's not that they're having a problem approving a medication.
NCAT being the New South Wales Civil and Administrative Tribunal.
yes.
(23:13):
Now when we ring NCAT, they generally don't know much about it, lawyers generally don'tknow anything about this that you can have.
added to the enduring guardian this piece about decision making on restrictive practice.
As we're sending new people that come to us and we say, look, you will need to get yourguardianship papers revisited.
(23:36):
They're going to lawyers and they're saying, we don't know anything about that.
That's not necessary.
So the lawyers will say, yep, yep.
They don't know about it.
So if you ask how the law, legal people can help is have a better understanding.
There's a lot of education required.
I think that people just don't understand, they don't have an understanding of what'smeant by restraint.
(23:58):
It could be chemical, could be environmental.
A bed rail is a restraint.
Absolutely.
what disturbs me, Catherine, is that you can go up to our local hospital, any one of ourlocal hospitals, and you don't need these consents.
They can have five burly security
(24:18):
people jumping on a 35 kilo frail old lady who happens to be having a delirium, put up bedrails up in the bed so the head's so low and the feet are in the air and so therefore they
can't get out, they're completely disorientated.
All this can take place in hospital.
But you cross the road and come down to Maroba and it can't.
(24:39):
So when people talk about human rights, I think sometimes they're very shallow.
because it's okay if it's happening in the hospital, but it's not okay if it's happeningin a nursing home where we have even less resources.
None of us want to restrain people.
We now have an on-site pharmacist three days a week, and that is making a huge difference.
So she's helping us with our nurse practitioner and with our GPs to keep looking at how wecan lower the chemical restraints that we have in place.
(25:08):
But remembering, most people came to our service already on them.
What do you think the answer is in regard to education?
Well, I think that, I mean, I can't tell the legal services how to suck eggs, but in termsof aged care, what I have to do to provide education is very determined and deliberate and
(25:30):
programmed and consistent.
you know, we do online learning, we do classroom learning, we do bedside learning.
We're now creating a clinical lab.
on site at Maroba for the many students that we bring in and I think well why can't thelegal people take some personal responsibility for those small firms that you know where
(25:54):
the mums and dads go for their wills and their enduring guardianship so small firms.
they need that they need to understand when taking instructions about an enduring power ofattorney or an enduring guardian document.
to dismiss it and say well that's you don't need that.
It's just thinking about
possibilities in the future, a bit like an advanced care directive.
(26:16):
You know, have to sort of think through what are the possible scenarios.
And I think a good example is a delirium, where someone is in a full on delirium, beingviolent, aggressive, someone needs to do something.
But yet there's a sense and people are too terrified to apply any form of restraint.
(26:39):
you think...
It's very hard because remember the majority of people in aged care, so we've got our verystrong cohort of registered nurses in Maroba for instance, but then the people under them,
if they're not an enrolled nurse, then they're assert three.
And here we've got complex care needs and then you've got a delirium on top of it.
(27:04):
So what do we do to not break the law because it's drummed into them?
Do not
apply restraint, not, you know, because we'll be in trouble.
And it's the, there's a lot of fear in aged care.
People are fearing the legislator and the commission who doesn't hesitate to lauded overpeople with this fear factor.
(27:26):
And I think that is appalling.
We have to remember we are offering human services.
So if we start, if we keep treating, not start, this has been going on for some time, ifwe keep treating,
the people that are delivering those human services as the enemy, what are we gonna get?
We are not gonna get great human services.
(27:48):
We're going to get technically correct, compliant services, which I think is the lowestcommon denominator of quality.
So for instance, I'm reviewing all our clinical policies at the moment, and the openingline says our source of obligation.
Standard three, blah, blah, blah, blah, blah.
(28:08):
cross that out.
That is not my obligation.
My obligation is our commitment to quality care to every person in our service.
That is our first obligation.
I will not be told my obligation is because of standard three or any other standard.
Yes, that might be a supplementary source of obligation.
(28:28):
But at the crux of it is that overarching quality you don't have the heart to bedelivering quality care and if you are just focusing on so many people
are left, all they can do is just focus on standards.
Well, I just say, don't expect a better aged care system.
You'll keep getting more of the same and it will keep getting worse because the workforceis shrinking, not growing.
(28:53):
And everyone is so constrained in what they can do because of fear.
How can we address the shrinking aged care workforce?
We've got to make it more appealing.
We have a lot of students come through Maroba.
We've now, next year we're looking at dental, dental hygienists and even pharmacystudents.
We have allied health, we have the speech pathology unit, we have nursing students.
(29:18):
I've made it my mission for every student that comes through our front doors to give thema wow experience so that if they never came back to Maroba that they would contemplate
doing something with older people.
Or even if they were in the ED or a
intensive care unit or whatever specialty they're in, as soon as they come across an olderperson, they will have learnt from a roba how to treat that person with dignity and to
(29:47):
genuinely care for them.
So if we can spread that one person at a time back out into the wider health and aged caresystem by giving them a first up positive, fantastic experience, then we will change the
world.
If we can touch the lives of the students, our future,
for this nation, then we can create a better fit workforce with a more robust andinterested team of people to do that work.
(30:16):
It seems pretty self-evident that that's the way to go about it, but it's also a financialissue, recognition by the regulators and the government that there needs to be a
commitment to ensuring there's appropriate remuneration.
It has to be attractive It has to be attractive because people ...
They've still got the same mortgage and rent as everybody else and now we're seeingthere's some catch up now in their wages which is long overdue, completely long overdue
(30:43):
and I appreciate the government is addressing that and there's still more to come.
There's still work to be done.
but people need to feel safe and secure in their workplace and you know our people I thinkfeel
that is really a family.
And if we can create the cultures like that in aged care, then who's going to benefitmost?
(31:04):
Not just the staff, the residents.
Well, I think that you are a model of excellence in aged care.
Newcastle is very fortunate to have you, Viv.
If I could just say this, my dream from day one at Maroba was to create a teaching nursinghome because I worked at the Royal as a student nurse.
I grew up in that environment, multidisciplinary.
(31:24):
I put that, I made a submission to the Royal Commission and of course no word back,ignored, no one recognises this, no government funding for us to offer that teaching
nursing home.
I call it the goodwill economy that makes it work and I tell you it changes theatmosphere, it causes us all to reach for the gold standard, the best practice because
(31:49):
we've always got students that have got the freshest and latest.
information and study and learning to bring into our nursing home is gold, but nobody elseseems to want to take it up.
How common is it for aged care to be a plank of education in schools of nursing around thecountry?
(32:09):
I think most will take students, but it's a transaction.
Can they specialise in aged care nursing?
They can.
So we've started involved in a program with our primary health network.
to take third year students.
406 week, they're with the one person for the whole time, the one RN, and they're reallymentoring them for an aged care placement.
(32:33):
In terms of the teaching bit, it's not just about nurses, because our health system andaged care system is made up of so many other specialties and more expertise is needed, not
just nursing.
So yeah, that's our primary plank, but it's all the other specialties that are just making
at an amazing, really multidisciplinary team approach to the wellbeing of older people andwe've never received a cent for it, but the goodwill economy works if people are prepared
(33:04):
to step out on the ice and open their doors.
But you can't be complacent about that.
It's not something that most facilities would, they wouldn't make the commitment that youdo, I suspect.
It's a driver for me because I value that so much and I know it makes a difference.
All right Viv, well thank you so much for everything you do and thank you for your timetoday.
(33:25):
Thank you very much, it's been great to be here.
Thanks for joining me on this episode of Law Matters.
I'm Catherine Henry of Catherine Henry Lawyers, where we advocate for better.
And if you need help navigating any aspect of aged care, whether it's accommodationagreements, enduring powers of attorney and guardianship complaints, please contact my
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team at Catherine Henry Lawyers.
We also have lots of resources on aged care issues on our website, including an e-book.
Thank you again to my guest Viv Allanson for her time and all that she gives to the agedcare industry.
Thank you to Pod and Pen Productions for producing this podcast.
Hi, I'm Catherine Henry from Catherine Henry Lawyers.
At my firm, we do a lot of work in the aged care space and I wanted to focus in on some ofthe issues from an aged care provider's perspective because I know from the work that I do
and from the advocacy that I've done, working in aged care is extremely tough.
(00:23):
So rather than just focusing on some of the things that we hear about, know, the horrorstories, if you like,
I want to focus today on some of the solutions that have been articulated and some of thechallenges that Viv Allanson, OAM and CEO of Maroba Caring Communities will have
experienced.
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And that's why I'm so fortunate that Viv has accepted the invitation today.
Viv is, she's a champion of our age community and doing things the right way.
So Viv, welcome to Law Matters.
Thank you.
What a welcome.
Just...
Tell us a little bit about Maroba first.
I've visited clients who are in the residential care area, but also in the retirementindependent living sector.
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Just tell us about how you think Maroba fits within the spectrum of aged care andretirement living services in Newcastle and the Hunter.
Well, Maroba has been operating for 70 years.
So we've had
many years of experience in adapting and being nimble to what is around us and what theneeds are.
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So we've primarily focused on aged care, as in residential aged care, and in 1999 we wentinto retirement living with just a very small village.
And of course now those people have all very well advanced in age and are aging in place.
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and some may even come into our care as they have done over many years.
But it's one big family.
We consider ourselves as a family and I think that's what makes a difference from a robot.
By focusing on family, we can focus on real people's needs, not just system needs orchanges in regulation and compliance whilst that's important.
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I very happily told a conference a month or so ago, I do not live and breathe the agedcare standards.
Well, of course it was a seminar, a conference on the standards and quality systems.
But I do live and breathe quality, quality care for older people.
I do live and breathe the fact that I want all of the people in our care and in our widercommunity to enjoy a great life in their latter years.
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no matter where they happen to live.
So that's what drives Maroba.
And I've been there for 30 of those 70 years.
And I started as the Director of Nursing.
So I got to do things differently because I hadn't been a Director of Nursing before and Ihadn't been a Director of Nursing in a nursing home before.
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I'd been a deputy, but not the decision maker.
You came from the Royal Newcastle Royal Newcastle Hospital and I had a short
time at Green Hills Nursing Home as a deputy where I learnt so much about aged care inthat time and learnt how I would like to do it as the leader.
And I was very fortunate because they gave me my head.
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They let me run.
And I had a great deputy who said, Viv, you you can change the world from here, which Ilaughed at.
But she pushed me out the door and she said, I'll run the ship while you go and change theworld.
And I couldn't have asked for a more supportive deputy and I was able to appoint her asdirector of nursing before I left because she got it and she was a great director of
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nursing once I stepped into the CEO role in 2000.
So being the decision maker on site for Maroba has made a huge difference because you'llnote that
Most of the providers are very big and growing and they have a head office somewhere andthe CEOs and the leaders rarely would get to go into the services.
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I've met many staff across the sector who haven't even seen their CEO, let alone shakentheir hand or greeted them or understood from them what the culture of the organisation
ought to be.
But you have a real presence at Marova.
And everyone knows who you are.
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I'm a sucker for old people.
I think that's, you say, well, how did you find yourself in this position?
I really am a sucker for older people and I'm a sucker for humanity.
And I love being around people.
I often say I'm the most hugged CEO in Australia because I can't walk through our buildingwithout arms going out to me.
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And of course they're letting go of their walking frames to do that.
Stop, stop.
And such a big contrast to the, you know, those big providers that you were mentioningwho, you know, they're massive.
And often the cases that we read about, unfortunately, do come from that sort ofenvironment.
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I just wanted to get back to your comment about your mantra at Maroba being to live andbreathe quality.
How difficult is that given the funding issues that you must have that it's all very wellto talk about the quality and the standards that you aspire to as changing the world, as
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you put it, doing the best that you can.
But at the end of the day, you can only deliver the service that you're capable ofdelivering with the funds that you've got.
I think it's really important to talk about that.
chronically underfunded aged care sector.
you talked about 1999 was when retirement living was introduced to Maroba.
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1997 was a pretty important year when the then Howard government introduced bigderegulation, if you like.
Tell us how it's been managing to live and breathe quality in that environment.
If you live and breathe quality,
then the funds are sort of to the side.
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And I guess, you know, when I was asked to be CEO, I told the chairman and the deputychairman of the board, I think you should find someone that can add up.
And they said, well, no, we love what you do.
So that gave me permission not to have my eyes on the bottom line.
And I think that really helped because whilst I'm very aware of our bottom line and I'mvery aware of a very limited envelope of funding,
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As a nurse, I feel I've been able to bring a lot of practicality to how we utilise thosefunds to get the best for everyone in the building and for our staff as well.
Because I love to invest in our people because if our people are well equipped and welleducated, then they have a greater chance of delivering on that dream of giving people
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their best life and living and breathing quality.
And it's been...
exciting because we're always on the knife's edge of the budget and we're always lagging.
We're age care price takers.
We don't get to be price setters and the government's constantly changing the rules,changing what we have to do and some years ago we added to our values creativity and for
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us that means determining our preferred future.
So we're not waiting for permission.
around compliance and around standards and around rules and new regulations.
We're determining what is it that our people want and let's deliver that.
Now if it happens to land on what the government requires, well that's great, but somehowor other we'll make it work.
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But we will not try and fit their glove, we are trying to fit the residents glove.
And that's working for Maroba.
We're offering programs that so many people haven't even thought of and that's benefitingthe residents every day in so many ways.
It's amazing.
So in order to work out what the residents want, you're obviously heavily involved indialogue with the residents, but also a dialogue with the families.
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How is it when you have to take those phone calls where families are unhappy or...
something unavoidable has happened.
My heart sinks and I think, gosh.
But then my heart opens up to, wow, this is great because the family is ringing me, whichmeans they're willing to have a conversation.
They're willing to give me an opportunity to make this right, turn it around, investigateand all of that.
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So yes, it's never good getting those.
I got something at quarter past 10 the other night saying you've breached the privacypolicy and it's not good enough.
You know, I run a business, Mara Rober is a business.
You have standards that you aspire to and that you communicate to your staff and you hopethat they will comply with those standards and if phone calls weren't being received, I
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mean...
I'd be very worried if I wasn't getting those calls and I say to families when I meet themin the hallways and they say how thrilled they are to have their mother or father with us,
I tell them I will make them a solemn promise.
that we will let them down.
And they go, did I hear that right?
I said, yeah, you did hear it right.
I've heard you say that.
Yeah, and I mean it.
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So they're hearing it from the CEO.
But then I asked for them to make me a promise.
And that is, promise, you will let me know the minute you smell a rat, the minute youthink things aren't quite right, the minute you think your mother's saying things, but
you're just not sure if it's true or not, you come and speak to me or to one of my seniorpeople.
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And they do.
which is great.
And that's the key to aged care, so that it's open, it's transparent.
That's how it seems to me.
It seems that you're living and breathing accountability because you're accessible.
Yes.
And you're hearing, you're listening to what they're saying and you're having thedialogue.
You're not humming that off.
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We have focus groups.
So we have food focus groups.
We have the residents meetings.
We have the feedback channels and avenues.
We have just in-your-face feedback.
Like I got a complaint the other afternoon, a couple of Fridays ago, I went to see one ofour ladies and she said, Viv, I've got a complaint as she's sitting in bed with a two is
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new.
And I said, well, what is it?
I said, how can I help you?
And she said, I prefer 4X.
And I said, well, I said, I can look into that for you.
And I looked into it and what I found was,
every Monday she has a slab of Forex delivered to her room and when that's finished shehas to have the two is new once that slab's finished.
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So I thought isn't that a great complaint?
I was sharing this.
It is a good one.
Yes, but again I don't care how trivial it seems.
I'm interested for the residents sake to follow up every quirky thing they want to raiseas is the many teams on many levels.
that get to meet with families and residents to get their feedback and encourage them tocontribute.
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So I've left Maroba today and there was a meeting going on with family members and seniorstaff to just keep them up to date, take on any issues they might suggest for us so we can
keep moving forward around knowing, seriously knowing what the residents wants and needsare.
Well I think that's very commendable and from what I hear and what I see I think you
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run a fabulous ship at Maroba.
I am interested though, moving away from Maroba, what would you say about the aged carereform process in the last three years?
I think the process has been pretty horrendous because there hasn't seemed to have been aspace for speaking of and raising up those that are doing a great job.
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It's been all about pulling down.
that we lost a lot of people you asked me about workforce.
We lost so many people from the time of COVID and it coincided with the announcement ofthe recommendations of the Royal Commission, which as you know was called neglect.
And where was that neglect?
It was at the bedside.
Where has most of the reform money gone to?
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Not to the bedside.
Interesting, isn't it?
More compliance.
And of course, you would know in your business, Catherine, that
Compliance costs money.
So we're adding and adding.
think if you look back over Stuart and Brown, who do our benchmarking, what theadministrative costs were 10 years ago versus what they are now would cause your hair to
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stand on end, given that where does that money come from?
Where does it come from?
And someone's got to pay for that.
And I think the community continues to bay for blood.
around aged care and fortunately we're not going to be relatives are involved you mean?
Yeah and some people not even, they don't even have anyone in care.
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They join that bandwagon of how terrible it is.
Now yes there's some terrible things happen and I can't abide it when those terriblethings happen.
But not everyone.
We've got to be so careful that when we put everyone in that same boat that's where wewill not have a future workforce.
Because who wants to be putting their hand up
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and saying, I work for that crowd and they cringe and everyone says, want, it's a barbecuestopper.
When you say it used to be when you said you were a banker, people had run the other way.
Do you think that's right?
feel that aged care nursing or working in aged care is seen as a really poor career pathat the moment.
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absolutely.
Aged care advocates talk about the quality of the workforce and there's lots of strategiesthat have been put forward.
in your experiences would think even talking about it.
So my staff take great heart that they know I'm out there supporting them as a workforce.
But we must raise them up.
(14:54):
We must acknowledge the good work that so many do.
So many get up every day.
Yes, there are some bad providers out there, but their workforce aren't the provider.
No.
And we seem to keep talking about them in the same breath, but they're a different group.
And yes, we've seen some horrendous things by an individual, you know, where they'vecreated trauma for an older person in the privacy of the bedroom or the bathroom, and that
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is just intolerable.
And the provider might be a very good provider, and that still can happen.
That's every provider's worst nightmare, that something like that will happen.
But then you've got the situation where you have providers who may be more focused onprofit because they have shareholders thanks to...
John Howard, yes, bless him.
And Doug Moran.
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Yes.
We've seen that, yes, profits are important for those organisations.
That's the mantra.
They have to make money for the shareholders.
Whereas the not-profit sector, all the resources that become surplus get ploughed backinto the organisation in one way or another, which is a great news story, I think.
(16:02):
For us that has really worked and helped.
But I think we, even having these conversations about workforce and small groups and smallpockets of people and individuals speaking about it can challenge the myths that aged care
workers aren't good people because of what happened with the Royal Commission.
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Because I find I've just been a relative in my own service with my auntie passing awayjust a week or so ago.
It was such a special experience for me to be that relative, to go through the palliationand the care that the staff gave to our family and to my auntie was just so special and I
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felt very proud about that and very blessed to have staff that care enough.
And one of them said, Viv, you know we don't do it just for you.
I said, absolutely hand on heart know that.
because that's the message I get from so many families of what that end of life experienceis for them.
What would you like lawyers like myself, who work on aged care cases, generally againstthe big providers, to know about your industry?
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Well, I think if they understand the funding and the challenges and even talk to a varietyof providers in exploring the...
how they might approach that case.
They might talk to provider that by word of mouth is a very good provider.
They might talk to them and say, well, what are you doing differently?
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And then they might find in comparing that, well, they're not actually doing anythingdifferently.
So what's the key?
What's cause?
What's the root cause?
Is it one or two wicked people or one wicked provider that is just keeping all the profitsto themselves and not
putting them back in the business.
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But I think that the legal fraternity can do a lot to work with aged care.
I love how you and John and Julie and I have formed the Hunter Aging Alliance because...
Talk about that because I think it's such a great group.
It's so exciting.
mean, the runs on the board that we've achieved is spectacular, but it's also bringingforward the conversation as colleagues in a public space.
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It says, well, lawyers can talk to you.
aged care providers and they can learn from them and aged care providers can learn fromthe lawyers and we can all learn from the geriatrician and the epidemiologist and then all
the other people that have joined our committee for Hunter Aging Alliance I think isinspiring because we must be doing something that people want to see changed.
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Yes and we want to get together to talk about issues.
The Hunter Aging Alliance held a symposium dealing with some of those issues.
capacity, what voluntary assisted dying means to those who are at the end of their livesand not necessarily senior.
happens at any stage of life.
also some of the really thorny issues.
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think restraint in the aged care sector is a little bit like electroconvulsive therapy ina mental health institution.
People don't really understand what is meant by restraint.
And I wonder
if we could talk about what restraint is in the aged care context and why it may be thatit's demonised because you do have, there's a spectrum of views and some lawyers will take
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a very hard line human rights perspective on the administration or use of restraints.
But I think at the coalface you have a different perspective and I'd just like to.
I read something, I was reading a paper from the United Nations and I highlighted aparagraph that was saying that aged care providers are using restraints for financial
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gain.
Well, you know, if there was somebody around me who I would have leapt up and, you know,let fly with a speech because I just found that so offensive that there is no financial
gain to be had by
having the need to restrain someone.
In fact, it's a great cost if you get to the point of somebody needing restraint.
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It may be that somebody's been injured from that person.
It may be that there's now a workers' compensation cost because a staff member has beeninjured or another resident's been injured or I had one gentleman completely wreck my
memory support unit.
has pulled down every artwork and smashed them and terrorised, tipped over the whole mealservice, wrecked the place.
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But we didn't have any approval for any restraint.
He'd only been there for 12 hours.
Tell us about the approval process because it's difficult in the context of the enduringguardianship regime that is in place.
But I think it's important to drill down to
detail of the process.
Previous to the regulatory bulletin that came out, I think a couple of years ago, theEnduring Guardian had the capacity to make decisions about any type of restraint and I
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felt that was an appropriate process even though, the facilities may need more education,the medical people might need more education, staff and families.
But again, it was appropriate because
I believe if you're needing some sort of restraint, it's as a result of some medicalissue.
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if we try and say that...
The drug regime may not be appropriate.
That's right.
But it may be that someone needs a bed rail because they're thrashing around, they'regoing to fall out of bed or it may be...
And even now, if we imported all these low, beds and now the commission says, no, that's arestraint because it's hard to get out of it.
So you bring in a low, bed so you don't have to have a bed rail, but now it's a restraintbecause they can't get out of it.
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And yet, we find that the process now is that you have to have someone specified to beable to give permission and give consent for restricted practices.
Now of course everybody's already got their enduring guardianships embedded and they'venow passed the point of being able to revisit those in terms of their cognition.
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So we have this whole cohort of people in aged care, thousands of people, that may need arestrictive practice applied randomly or regularly that no one can give permission for.
the And what's the solution?
You've got to to NCAT.
is that something that happens regularly?
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People are ignoring it, families are saying, well, I don't want to, I don't want to dothat, I shouldn't have to do that.
don't want to provide, I don't want to go down the path of going to NCAT.
yes, it's not that they're having a problem approving a medication.
NCAT being the New South Wales Civil and Administrative Tribunal.
yes.
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Now when we ring NCAT, they generally don't know much about it, lawyers generally don'tknow anything about this that you can have.
added to the enduring guardian this piece about decision making on restrictive practice.
As we're sending new people that come to us and we say, look, you will need to get yourguardianship papers revisited.
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They're going to lawyers and they're saying, we don't know anything about that.
That's not necessary.
So the lawyers will say, yep, yep.
They don't know about it.
So if you ask how the law, legal people can help is have a better understanding.
There's a lot of education required.
I think that people just don't understand, they don't have an understanding of what'smeant by restraint.
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It could be chemical, could be environmental.
A bed rail is a restraint.
Absolutely.
what disturbs me, Catherine, is that you can go up to our local hospital, any one of ourlocal hospitals, and you don't need these consents.
They can have five burly security
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people jumping on a 35 kilo frail old lady who happens to be having a delirium, put up bedrails up in the bed so the head's so low and the feet are in the air and so therefore they
can't get out, they're completely disorientated.
All this can take place in hospital.
But you cross the road and come down to Maroba and it can't.
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So when people talk about human rights, I think sometimes they're very shallow.
because it's okay if it's happening in the hospital, but it's not okay if it's happeningin a nursing home where we have even less resources.
None of us want to restrain people.
We now have an on-site pharmacist three days a week, and that is making a huge difference.
So she's helping us with our nurse practitioner and with our GPs to keep looking at how wecan lower the chemical restraints that we have in place.
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But remembering, most people came to our service already on them.
What do you think the answer is in regard to education?
Well, I think that, I mean, I can't tell the legal services how to suck eggs, but in termsof aged care, what I have to do to provide education is very determined and deliberate and
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programmed and consistent.
you know, we do online learning, we do classroom learning, we do bedside learning.
We're now creating a clinical lab.
on site at Maroba for the many students that we bring in and I think well why can't thelegal people take some personal responsibility for those small firms that you know where
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the mums and dads go for their wills and their enduring guardianship so small firms.
they need that they need to understand when taking instructions about an enduring power ofattorney or an enduring guardian document.
to dismiss it and say well that's you don't need that.
It's just thinking about
possibilities in the future, a bit like an advanced care directive.
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You know, have to sort of think through what are the possible scenarios.
And I think a good example is a delirium, where someone is in a full on delirium, beingviolent, aggressive, someone needs to do something.
But yet there's a sense and people are too terrified to apply any form of restraint.
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you think...
It's very hard because remember the majority of people in aged care, so we've got our verystrong cohort of registered nurses in Maroba for instance, but then the people under them,
if they're not an enrolled nurse, then they're assert three.
And here we've got complex care needs and then you've got a delirium on top of it.
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So what do we do to not break the law because it's drummed into them?
Do not
apply restraint, not, you know, because we'll be in trouble.
And it's the, there's a lot of fear in aged care.
People are fearing the legislator and the commission who doesn't hesitate to lauded overpeople with this fear factor.
(27:26):
And I think that is appalling.
We have to remember we are offering human services.
So if we start, if we keep treating, not start, this has been going on for some time, ifwe keep treating,
the people that are delivering those human services as the enemy, what are we gonna get?
We are not gonna get great human services.
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We're going to get technically correct, compliant services, which I think is the lowestcommon denominator of quality.
So for instance, I'm reviewing all our clinical policies at the moment, and the openingline says our source of obligation.
Standard three, blah, blah, blah, blah, blah.
(28:08):
cross that out.
That is not my obligation.
My obligation is our commitment to quality care to every person in our service.
That is our first obligation.
I will not be told my obligation is because of standard three or any other standard.
Yes, that might be a supplementary source of obligation.
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But at the crux of it is that overarching quality you don't have the heart to bedelivering quality care and if you are just focusing on so many people
are left, all they can do is just focus on standards.
Well, I just say, don't expect a better aged care system.
You'll keep getting more of the same and it will keep getting worse because the workforceis shrinking, not growing.
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And everyone is so constrained in what they can do because of fear.
How can we address the shrinking aged care workforce?
We've got to make it more appealing.
We have a lot of students come through Maroba.
We've now, next year we're looking at dental, dental hygienists and even pharmacystudents.
We have allied health, we have the speech pathology unit, we have nursing students.
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I've made it my mission for every student that comes through our front doors to give thema wow experience so that if they never came back to Maroba that they would contemplate
doing something with older people.
Or even if they were in the ED or a
intensive care unit or whatever specialty they're in, as soon as they come across an olderperson, they will have learnt from a roba how to treat that person with dignity and to
(29:47):
genuinely care for them.
So if we can spread that one person at a time back out into the wider health and aged caresystem by giving them a first up positive, fantastic experience, then we will change the
world.
If we can touch the lives of the students, our future,
for this nation, then we can create a better fit workforce with a more robust andinterested team of people to do that work.
(30:16):
It seems pretty self-evident that that's the way to go about it, but it's also a financialissue, recognition by the regulators and the government that there needs to be a
commitment to ensuring there's appropriate remuneration.
It has to be attractive It has to be attractive because people ...
They've still got the same mortgage and rent as everybody else and now we're seeingthere's some catch up now in their wages which is long overdue, completely long overdue
(30:43):
and I appreciate the government is addressing that and there's still more to come.
There's still work to be done.
but people need to feel safe and secure in their workplace and you know our people I thinkfeel
that is really a family.
And if we can create the cultures like that in aged care, then who's going to benefitmost?
(31:04):
Not just the staff, the residents.
Well, I think that you are a model of excellence in aged care.
Newcastle is very fortunate to have you, Viv.
If I could just say this, my dream from day one at Maroba was to create a teaching nursinghome because I worked at the Royal as a student nurse.
I grew up in that environment, multidisciplinary.
(31:24):
I put that, I made a submission to the Royal Commission and of course no word back,ignored, no one recognises this, no government funding for us to offer that teaching
nursing home.
I call it the goodwill economy that makes it work and I tell you it changes theatmosphere, it causes us all to reach for the gold standard, the best practice because
(31:49):
we've always got students that have got the freshest and latest.
information and study and learning to bring into our nursing home is gold, but nobody elseseems to want to take it up.
How common is it for aged care to be a plank of education in schools of nursing around thecountry?
(32:09):
I think most will take students, but it's a transaction.
Can they specialise in aged care nursing?
They can.
So we've started involved in a program with our primary health network.
to take third year students.
406 week, they're with the one person for the whole time, the one RN, and they're reallymentoring them for an aged care placement.
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In terms of the teaching bit, it's not just about nurses, because our health system andaged care system is made up of so many other specialties and more expertise is needed, not
just nursing.
So yeah, that's our primary plank, but it's all the other specialties that are just making
at an amazing, really multidisciplinary team approach to the wellbeing of older people andwe've never received a cent for it, but the goodwill economy works if people are prepared
(33:04):
to step out on the ice and open their doors.
But you can't be complacent about that.
It's not something that most facilities would, they wouldn't make the commitment that youdo, I suspect.
It's a driver for me because I value that so much and I know it makes a difference.
All right Viv, well thank you so much for everything you do and thank you for your timetoday.
(33:25):
Thank you very much, it's been great to be here.
Thanks for joining me on this episode of Law Matters.
I'm Catherine Henry of Catherine Henry Lawyers, where we advocate for better.
And if you need help navigating any aspect of aged care, whether it's accommodationagreements, enduring powers of attorney and guardianship complaints, please contact my
(33:47):
team at Catherine Henry Lawyers.
We also have lots of resources on aged care issues on our website, including an e-book.
Thank you again to my guest Viv Allanson for her time and all that she gives to the agedcare industry.
Thank you to Pod and Pen Productions for producing this podcast.
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Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!