Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or Adaptive Leadership Challenge
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Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or Adaptive Leadership Challenge
- 1. Reablement and Wellness for Regional Assessment Services in Australia – A Technical Problem or an Adaptive Leadership Challenge? Community Options Australia Regional Assessment Services Subcontractor Forum Carrie Hayter, Managing Director Carrie Hayter Consulting 29 July 2015, Sydney, Australia 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter Consulting 1
- 2. Outline • Why reablement and wellness? – Research – Research evidence and gaps • Reablement and Wellness as a leadership challenge – Technical problem and an adaptive leadership challenge (Heifetz & Linksy, 2002) • All stakeholders & actors • Adaptive leadership Framework – Starting conversations with you as leaders 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter Consulting 2
- 3. 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter Consulting 3 Wellness Reablement Restorative • Building on the strengths • Outcomes for people – outcome or goal focused • Right balance between ‘doing with’ rather than ‘doing for’ • Looks at appropriateness of services • Identifies what a person can do and wants to do in the future • Time – limited targeted interventions to regain function, confidence or capacity to resume activities • Evidence-based interventions led by allied health workers that allow a person to make a functional gain or improvement after a setback, or in order to avoid a preventable injury. Defining Wellness, Reablement and Restorative Approaches Source: Australian Government Department of Social Services (2015) Living Well at Home: CHSP Good Practice Guide, pg 11-13
- 4. Why reablement and wellness? • Research - UK, Australia and New Zealand – Improved health and welling for older people (Lewin at al, 2013, Parsons et al, 2013, Parsons et al, 2014) – Reduces people’s dependence on paid supports (King & Parsons, et al 2012, Lewin & Alfonso 2013, Lewin & De San Miguel, 2013) – Role of assessment is critical (Department of Family and Community Services, Ageing, Disability and Home Care, 2012) • Further research – People with dementia (Alzheimer’s Australia NSW, 2014) – Engaging carers and service users in their reablement and wellness (Wilde & Glendenning, 2012) • Australian changes – Outcomes and benefits 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter Consulting 4
- 5. 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter Consulting 5
- 6. 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter Consulting 6
- 7. Difference between Technical Problems and Adaptive leadership Technical problems are well defined. Their solutions are known and those with adequate expertise and organisational capacity can solve them. (Heifetz & Linksy, 2002) Adaptive leadership challenges are entirely different. The challenge is complex and not so well defined; and the answers are not known in advance Problems that require us to learn new ways (Heifetz & Linksy, 2002) 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter Consulting 7
- 8. Technical Problems or Adaptive Leadership? Technical Problems • Inappropriate referrals • Issues with the portal – Algorithms in the portal and the outcomes it leads to – Monitoring assessors workloads Adaptive Leadership • Receiving enough referrals to make our business model viable – How do we manage this? – How do we look for other revenue streams? • Service providers understanding of reablement – Want long term clients and don’t understand reablement 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter 8
- 9. Seven ways to know if you have an adaptive leadership challenge 1. If the solution requires working in a different way than you do now… 2. If the problem AND the solution require learning… 3. If the solution requires shifting the authority and responsibility to the people who are affected…. 4. If the solution requires some sacrifice of your past ways of working or living.. (eg losses) 5. If the solution requires experimenting before you’re sure of the answer… 6. If the solution will take a long time… 7. If the challenge connects or challenges people’s deeply held values…. (Heifetz & Linksy, 2002, 2009) 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter Consulting 9
- 10. 1028/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter Consulting
- 11. Shifting Policy Landscape – Personalisation Passive Clients Participants or ‘consumers’ Block funding Individualised funding or fee for service Monopoly Providers ‘Market of Care’ 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter Consulting 11
- 12. Shifting Paradigms in Australia Old • Block funded • Dependency model • Services for life • Multiple Assessment Models • Multiple entry points for older people and their allies • People navigated multiple systems to get care outcomes New • Fee for Service • Wellness, restorative Model • Short term focused • National Assessment Framework • One entry point – My Aged Care • Economic rationing of supports 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter Consulting 12
- 13. Get on the Balcony Give the work Back Think Politically Orchestrate the conflict Manage your hungers Anchor Yourself What’s on the line Hold Steady Adaptive Leadership Elements Source: Heifetz & Linsky (2002) 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter Consulting 13
- 14. Picture downloaded from: https://janeaustensworld.wordpress.com/category/regency- etiquette/page/2/ Getting on the Balcony Picture downloaded from: https://www.youtube.com/watch?v=qSvyDLTdlyU What is your team saying about their role? What is their story? What is the ‘song beneath the words’? What is your inner voice saying about the changes? 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter Consulting 14
- 15. Think Politically 1. Find Partners 2. Keep the Opposition Close 3. Accept Responsibility for your piece of the mess 4. Acknowledge their losses and accept casualties 5. Model the behaviour (Heifetz & Linksy, 2002)Picture downloaded from: www.twitter.com What is your responsibility as a team leader? What is Community Options Australia’s responsibility? What might be the losses or casualties? How does your organisation manage the financial and reputation risks of this new model? 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter Consulting 15
- 16. Give the Work Back • Solutions are achieved when “the people with the problem” go through a process together to become “the people with the solution”. • Take the work off your shoulders….place it where it can be addressed by the relevant parties. What are the main issues your team faces as a Regional Assessment Service Sub-Contractor? Who do you need to engage in the solutions? 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter Consulting 16
- 17. Anchor Yourself • Don’t confuse one’s self with one’s professional role • Identify a truly trustworthy confidant who can really tell you what you NEED to hear • Do not use allies as confidants • Find a sanctuary for retreat, rejuvenation and personal reflection 17 Who are your confidants? How can they support you? How do you look after yourself? 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter Consulting
- 18. Summary Regional Assessment Services • Technical problem and adaptive leadership challenge • Time • Engaging people in solutions More Research • Who benefits? 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter 18
- 19. References and Resources Leadership • Heifetz, R., & Linksy, M., (2002) Leadership on the Line: Staying Alive through the Dangers of Leading, Harvard Business Review Press, Boston Massachusetts • Heifetz, R., Grashow, A., & Linksy, M., (2009) The Practice of Adaptive Leadership – Tools and Tactics for Changing your Organisation and the World, Harvard Business Review Press, Boston Massachusetts • Goleman, D. (1998). Working with Emotional Intelligence London Bloomsbury. • Covey, R., (1996) The 7 Habits of Highly Effective People, Simon and Shuster, New York – https://www.stephencovey.com/7habits/7habits.php • Cambridge Leadership Associates – http://cambridge-leadership.com/ 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter 19
- 20. References and Resources Reablement and Wellness Alzheimer's Australia NSW. (2014) The Benefits of Physical Activity for People living with Dementia, Sydney , Alzheimer's Australia NSW downloaded from https://nsw.fightdementia.org.au/nsw/news/the-benefits-of-physical-activity-and-exercise-for-people- living-with-dementia Australian Government Department of Social Services (2015) Living Well at Home: CHSP Good Practice Guide, pg 11-13, downloaded from https://www.dss.gov.au/our-responsibilities/ageing-and-aged-care/aged-care-reform/commonwealth-home- support-programme/living-well-at-home-chsp-good-practice-guide Glendinning, C. (2012). Home care in England: markets in the context of under-funding. Health & Social Care in the Community, 20(3), 292-299. doi: 10.1111/j.1365-2524.2012.01059.x King, A., M. Parsons, et al. (2012). "Assessing the impact of a restorative home care service in New Zealand: A cluster randomised controlled trial." Health and Social Care in the Community 20(4): 365-374. Lewin, G., & Vandermeulen, S. (2010). A non-randomised controlled trial of the Home Independence Program (HIP): an Australian restorative programme for older home-care clients. Health & Social Care in the Community, 18(1), 91-99. doi: 10.1111/j.1365- 2524.2009.00878.x Lewin, G. F., H. S. Alfonso, et al. (2013). "Evidence for the long term cost effectiveness of home care reablement programs." Clinical interventions in Aging 8: 1273-1281. Lewin, G., K. De San Miguel, et al. (2013). "A randomised controlled trial of the Home Independence Program, an Australian restorative home-care programme for older adults." Health & Social Care in the Community 21(1): 69-78. 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter 20
- 21. Reablement and Wellness (Cont) Parsons, J. G. M., N. Sheridan, et al. (2013). "A Randomized Controlled Trial to Determine the Effect of a Model of Restorative Home Care on Physical Function and Social Support Among Older People." Archives of Physical Medicine and Rehabilitation 94(6): 1015-1022. Ryburn, B., Wells, Y., & Foreman, P., (2009) Enabling Independence: Restorative Approaches to Home Care Provision for Frail Older Adults, Health and Social Care in the Community, Volume 17 (3), pp 225- 234, see pg 22 Senior, H. E. J., M. Parsons, et al. (2014). "Promoting independence in frail older people: A randomised controlled trial of a restorative care service in New Zealand." Age and Ageing 43(3): 418-424. Wilde, A., & Glendinning, C. (2012). ‘If they’re helping me then how can I be independent?’ The perceptions and experience of users of home-care re-ablement services. Health & Social Care in the Community, no-no. doi: 10.1111/j.1365-2524.2012.01072.x References and Resources 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter 21
- 22. More Information Carrie Hayter Email: Carriehayter@gmail.com Twitter@carriehayter Slideshare: Carrie Hayter www.carriehayter.com Linked in http://au.linkedin.com/pub/carrie- hayter/34/536/517/ 28/07/2015 Reablement and Wellness for Regional Assessment Services in Australia - A Technical Problem or an Adaptive Leadership Challenge? © Carrie Hayter 22
Editor's Notes
- I would like to acknowledge the Gadigal people of the Euroa nation and pay my respects to Elders past and present. I have been asked to start a conversation today about reablement and wellness and what that means for Regional Assessment Services. As I am talking to an audience of leaders and managers I thought I would use a leadership lense to explore with you the challenges you face in your work.
- Today I am going to start a conversation with you about why I think the changes in assessment practices as well as the explicit focus on reablement and wellness has elements of both technical problems ( for example, portal issues, or not being able to send referrals to service providers) and an adaptive leadership issue. It is not only an adaptive leadership issue for all of you as sub contractors but all the other stakeholders or actors in the sector. We are in the process of significant reform that requires the dismantling of elements of Australia’s aged care system. This takes time, changes in attitude and significant changes in practices and ways of working and why I think it is an adaptive leadership challenge I am hoping to introduce an adaptive leadership framework and have some conversations with you about some of these changes. I will pose some questions from a leadership lense to get you to get on the balcony and look down at the last 3 months and see where things are heading for you and your team
- Within your role as assessors and managing assessors it is expected that your staff are able to understand and articulate the difference between these areas. I think there is some blurred line between restorative and re-ablement given that allied health workers are often involved in re-ablement and wellness.
- Talk about gaps in the research Identify the potential gaps in the research Research paper by Caroline Glendinning ‘If they’re helping me then how can I be independent?’ The perceptions and experience of users of home-care re-ablement services identified how carers and some users of home care are not aware of these concepts of re-ablement. I would like to see some research on the experience of regional assessment services and how they approach wellness and reablement, what stops them? Is the system supporting them to implement this approach? How does reablement work for people with cognitive impairment? What does it mean for people from different cultural backgrounds or for Aboriginal and Torres Strait Islander people.
- My father passed away 8 months ago of a rare aggressive form of Parkinson’s disease called Multiple System Atrophy. It is aggressive and effects the brain stem and is a bit like motor neurone disease. His journey and our families journey through this disease was a story of wellness and re-ablement because we made the system work him and for us as his supporters and allies. My father’s journey through the aged care system was a story of wellness and at times reablement. He had access to a level 4 home care package, we had palliative care, carer respite support all of it and made the system work for him to support our family, friends and him through his journey. He had an wellness approach to life and did not want to let the disease stop him and kept fighting to the end. He had a home based exercise program which staff did with him twice a day as well as with family and friends encouraging him. We had hoists, wheelchairs, an accessible bathroom and a hospital bed and he did as much for himself as possible. This picture was on his 72nd birthday and all he wanted to do was to go surfing. If only I had a wheelchair that you could use in the sand he would have gone surfing. Despite all of this we could not honour his wish of wanting to die at home because in the last four months of his life his support needs were too great for us to manage at home and he spent the last four months of his life in a nursing home.
- More Stories This is Bob. He had contacted his local neighbourhood centre in the last couple of weeks because he heard about a lunch that one of his mates attended run by the local neighbourhood centre. He wanted to attend. They referred him to My Aged Care and he was sent to the RAS for an assessment. Bob said it took me 40 minutes waiting on the phone to get to speak to someone at the contact centre. Then a couple of weeks after this “this lady came out with a computer and saw me today” – she asked me all these questions and “I am going to have some one come and clean my house” and “I am going to be able to drive again so I can get back to what I used to do”. I said to him I thought you told me that you wanted to go to the lunch group or the men’s shed or no the lady told me that I did not need that…. Story two A neighbourhood centre who had been trying to get an Auskey to interact with the My Aged Care. They were told the organisation already had an Auskey. The manager thought that maybe it was someone from the board. She checked the board records for the last 3 years and yes it was a board member. However, the board member had died and they then had to prove to the government agency that the person had died and that the auskey needed to be changed to the manager. What appeared to be a technical problem became an adaptive leadership problem because of the systems and processes of government.
- So how do we know if something is a technical problem or an adaptive leadership challenge? Technical problems have solutions that are known.
- Heifetz and Linksy talk about the ways in which you know if you have an adaptive leadership challenge. If the solution requires working in a different way than you do now… If the problem AND the solution require learning… If the solution requires shifting the authority and responsibility to the people who are affected…. If the solution requires some sacrifice of your past ways of working or living.. (eg losses) If the solution requires experimenting before you’re sure of the answer… If the solution will take a long time… If the challenge connects or challenges people’s deeply held values….
- One of the challenges of personalisation is to appreciate and understand the historical forces or structures that have created the different service systems in this country. If you look at history we have come a long way, however, we are in the process of dismantling a whole service infrastructure and moving from a block funded to individualised funding system with different stages occurring for older people, people with disabilities and their carers. This picture shows some of the drivers of personalisation for older people in Australia. It contends that for older people they were largely invisible and the system was created in the interests of professionals, providers and with older people institutionalised. However, with the economic costs of ageing combined with the changing expectations and the emergence of the concept of active ageing we are seeing changing models. However, moving from the Old to New system takes time is a complex process of dismantling and transitioning not only funding but the practices, values of people in your organisations. It also requires people to lead organisations through significant changes – It is an adaptive leadership challenge.
- There are significant changes happening in the policy landscape in age care and disability policy in Australia as part of the agenda of personalisation. The assumptions that underpin these shifts include the changing role of people who use public services shifting from being ‘passive’ clients to ‘active consumers’. It is assumed that people who use disability services or aged care services will become active ‘consumers’. Rather than being passive clients relying on professionals for support and advice people are assumed to be active engaged ‘consumers’ who will make informed choices about their care. Flowing from this assumption is the need for changes in the how agencies are funded from block funded to individually funded. It is assumed that individualised funding will provide more mechanisms for service users to get their needs met. We are seeing this funding system emerging as part of the launch sites of the NDIS as well as the emergence of the concept of ‘consumer directed care’ in packaged care in aged care in Australia. As part of this changing landscape there are significant challenges for small, medium to large organisations in being able to thrive and survive in this changing landscape? As well as considering the structures that are in place to enable the participation and engagement of service users in your service. Underpinning these changes are competing tensions between human rights of people on the one hand and economic positioning and arguments about the costs of ageing.
- Thanks and