Aged Care in the Twilight Years

Twilight Aged Care

The movement to establish the first aged care home commenced over a hundred years ago when a group of women wanted to provide accommodations for older women who had limited accommodation options. In 1912, informed by letters of appeal that speak of women who were deserted by their children who were supporting them, as well as women who had spent years in domestic service who then retired and found themselves with no place to go, a committee was established and funds were raised through a series of social events and fundraisers in and around Sydney. Some land was donated and by 1915, in the middle of World War one, these women had built and opened the first aged care home, a facility which would remain in operation until 2010. In 1924 further land was donated and a second home was opened in Beecroft. This property has expanded over the years and is still in operation today.

We recently spoke with Twilight Aged Care CEO John Stuart, who was able to share that, “In 1994 we merged with a company in Mosman that was providing hospital care that had some land and wanted to break into aged care. Twilight had the capital, so we built and opened another aged care facility in 1999. In 2010, we purchased another home in Gladesville which has now replaced the original 1915 home and has really come around and has become a place to come to. We have had a very long history in aged care.”

John himself has been with Twilight Aged Care since 2004, when he was tasked with bringing the company into the future by modernising and developing a sustainable corporate structure. Originally John was a registered nurse and had spent close to 28 years in the New South Wales health system; he was then a Director of Nursing in two hospitals in Western Sydney and then General Manager of two hospitals on the north shore of Sydney. John acquired his Masters Degree in Management in addition to various teaching qualifications and then left the health system and was headhunted for the CEO position at Twilight.

“A good majority of Twilight staff come from a broad geographical range, some as far as Nepal who are in Australia as students working on their degrees,” John explains. “A large referral of potential employees comes in through friends of existing employees. It is easy to understand how Twilight attains and retains its staff, as excellent training programmes are provided and paid study days are offered to staff to complete relevant courses. “I think this speaks well of the company when the staff wants to refer us to their friends. We have in the past supported all of our staff who may not have had a qualification in Aged Care to get one. We were able to access funding from both State and Federal Governments to pay for the tuition for those courses.”

John is understandably proud of this learning environment. “Some employees are able to complete Lifestyle and Leisure courses and all supervisors can acquire Frontline Management training as well,” he explains. “Online learning is available to everyone, so all staff has the opportunity to learn qualifying or advancement programmes over the course of one year. And if they complete 20 hours of education and they work a minimum of 20 hours a week they qualify for a wage increase.”

Luckily staff turnover is quite low, and keeping the staff motivated and the residents engaged is easy, as their schedules are packed with ongoing entertainment. Twilight has an excellent Recreational Activity Team placed in each of the four residential homes to assess the social needs of the residents. An interesting assessment called “Key to Me” helps the Activity Team build an applicable social activity programme for each resident. Volunteers conduct reminiscence sessions with residents receiving dementia care, sharing photos, music and stories; other volunteers facilitate Art Therapy. Students come in on the weekends to perform, and there are regular functions with themed celebrations. John was happy to share that there are three Centenarians living in the home, so residents are able to enjoy some very big birthday celebrations as well.

Twilight Aged Care is continually expanding, and at present is looking at the acquisition of another residence. In-home care is another area the organisation is exploring. “We know for a fact that our clients of course would prefer to stay at home,” says John. “We are looking at community care service and with the latest strategic directions the government has released around aged care, the trend is moving more toward providing care in people’s homes.” Some needs, of course, still benefit greatly from residential care; “Nearly 75 per cent of our residents have Dementia,” John explains. “The other 25 per cent have long term mental illness and need supportive care. I think residential care in Australia is largely going to become centered around Dementia and other types of mental health issues that leave people vulnerable if they were to remain at home.

“A huge problem confronting most of the Western world in Aged Care is Dementia. Governments are struggling with the burden that Dementia will place on the resources that are available. Twilight is looking at what opportunities there are to provide residential care. For Australia, the figures are about 250,000 people with a Dementia diagnosis and that is predicted to rise to approximately 750,000 very quickly,” so Twilight wants to be well positioned to provide effective and appropriate care in this area.

To get the word out to the local community, “Twilight has a fairly comprehensive marketing strategy, and we tend to find that most people are referred through the aged care assessment process which is run by the federal government. Most people are assessed when they end up in hospital and a decision is made as to whether they need community or residential care and then these people are referred by social workers in hospitals. We use websites where people can search for aged care accommodation provided in their local area, we advertise on radio, and we have a television advertising program on a continuous loop with a local station that plays in doctor’s offices and soon to be accessed in hospitals. In all of our local referring hospitals, they have a bedside booklet that explains the hospital services to the patient and we advertise in there. So we do have quite a broad brush including our internet site.” As far as getting involved in social media, John says that is soon to come, as it is a powerful tool that the organisation plans to utilise to good effect.

The company also maintains strong relationships with social workers and assessment teams in each of the hospitals, “as they need to know what we can do and what kind and quality of care we can provide,” John explains. “A good example of this would be the home that we purchased in 2010, Glades Bay Gardens. This home had a reputation with referrers because of the previous history there and we were able to work with them and demonstrate that we are a different company with a different philosophy and they were able to overcome that and are now a very important part of our referring business.”

As a not-for-profit organisation, Twilight has actually remained viable and sustainable over the years. “We have been fortunate in our history to have received donations and bequests in the early days which helped us build a good solid foundation. We have a very tight management process and have maintained a focus that we are a strong company that relies on staying in the black. We pay close attention to the claim process and the Australian government funds that are provided for Aged Care. So we have very sophisticated information systems that assist us, ensuring that we can get every dollar we are entitled to and that we also control our expenditures. The board continues to have a philosophy of wanting to provide a higher level of care than what you might find in a for profit sector so our staffing ratios are a little higher but at the same time we need to balance that with the income we are receiving,” says John.

John is quite proud of each of the Twilight facilities. “Each property has its strengths in the services they provide. Jamieson House has an outstanding reputation with the local providers for caring for people with Dementia and challenging behaviours. Horton House at Gordon is a home for women and has a larger portion of people with mental health problems and behavioural issues and over the last year we have worked to educate the staff on Behavioural Management; because of this we have been able to reduce the number of incidents occurring in the home, and have also been able to reduce the use of psychotropic drugs.”

Keeping ahead of the innovation curve in the industry, Twilight has some renovation projects in the pipeline. The organisation is looking to invest close to a million dollars in a building refurbishment to the Gladesville location, adding a new service wing. John explains, “The dining area is not large enough for all of the residents and there is quite a bit of congestion with walking aids every meal time. We would also like some additional recreation space for the residents and the staff should have appropriate facilities for their needs as well. The local government authority is working with us and we have plans to possibly start this project in January of next year.”

Ultimately, Twilight Aged Care lets its reputation speak for itself. “We are not the type of company that likes to boast,” says John. “If your clients are talking about you in a positive way, that is absolutely the best endorsement you can get.”

Making Sense of Management

Management is the art, or science, of getting things done through people. Sounds fairly straightforward – except for the fact that people are not robots waiting to do our bidding. People have their own minds, motivations, and goals. So how do managers keep operations – and the people behind them – running as planned?

December 19, 2018, 9:24 AM AEDT