Aged care divided cannot score its goals – part 3: exhaustion, loss of MVPs and when risk is the best strategy

For those who have sought to score wins on behalf of seniors and sector, in spite of the headwinds, there has been a need to be made of resilient ‘stuff’. Russell Bricknell of Juniper in WA shares insight into the very real exhaustion facing leaders of aged care, this side of reform that promised great care for seniors, and sustainability for sector. 

As the headwinds persist, the loss of seasoned leaders is a grievous result that sector and progress can ill-afford. Looking to a change in approach, in pursuing hard conversations surrounding dignity of risk and leveraging aged care funding to go further, Bricknell sees a way forward. Onboarding the lessons of nations around the world may yet facilitate sustainability options for Australia and its aged care future. 

Troubling tropes

There is no shortage of white papers calling for more efficient and appropriate spending in aged care. They advocate for smarter regulation that doesn’t drain time and resources from public and private operators, as well as supplementary pricing that reflects the true cost of care. Given all this, it’s only fair to ask Bricknell: what’s in his stamina recipe? 

In good-natured bleak humour, likely to elicit a cathartic guffaw from a leader or two, “apart from banging my head against the wall”, Bricknell goes on to highlight a critical point of private and public narrative that needs fleshing out. Easy mainstream tropes of self-seeking aged care leaders, or for-profit profit mongering, is neither found in reality nor helpful to land the excellence in aged care. Absolutes are not found in seniors, nor in the leaders who seek to care for them.

“It gets back to easy stereotypes, you know, CEOs are big bad people with MBAs that don’t understand or care. Speaking from the leaders I know, a huge part of why we’re all in this sector is we want to make a difference for older people, regardless of whether you’re in a for-profit or not-for-profit. That’s what drives us to show up [in the exhaustion]”. 

“That’s what guides us, that’s our light, that’s where you get your stamina from, you don’t get your stamina from trying to make a lot of money”.

Simply exhausted

In talking to Bricknell, in his open freshness of phrase and feeling, it is worthwhile to sit in the fact that there has been a cost to weathering the headwind of unbelief. As put to him, ‘screaming into the void with truth and not being believed or listened to’ has had a cost.

“Exhaustion”.

“I was talking to the chair of a large aged care organisation the other day. We’re just talking about how exhausting it is in aged care, and how exhausted everybody is, and how absolutely flat out everyone is. The chairman shared that he’s been talking to the CEO of his organisation every fortnight over the last two years. That’s 46 meetings, and every meeting the CEO would say to him, ‘when we get through ‘x’ we should be able to see the light at the end of the tunnel and down all operations”.

“And in this conversation, that’s happened with incredible regularity every fortnight, it’s dawned on both of them, it’s not letting up”.

For Bricknell, “that’s the biggest issue, I was talking to another senior executive from another aged care organisation, and we were also talking about the fatigue that we’re all feeling”.

The build up of years of business and leadership weathering, siphoning off of stamina, perseverance, disappointment from electoral cycles and promises, altered public partnership and waning trust, uncertain policy, incessant anticipation and reaction; exhaustion is and has a cost. Bricknell heard recently from the senior exec, “‘yep, we’ve lost a couple of senior executives over it”.

“We’re losing seasoned and caring middle-level and senior managers over it because everybody’s looking at the workload going, this is not sustainable”.

Dignity of risk

For Bricknell, there is an approach to seek change, to let up the exhaustion, compliance burden and regulation diverting funds away from actual care, dignity of risk.

“The government certainly pales when it comes to the dignity of risk, but there is a need for hard conversations on this to happen, in all areas that touch aged care”.

For Bricknell, re-examining risk appetite means opportunity, “allowing for more dignity of risk, you could make dollars go further, you can increase the ability to deliver services, this is a problem we have to confront as a society, as a government, as a sector”.

“We’re scared of having those conversations, and that needs to change”.

European insight

Traveling to Norway, Bricknell saw stairs and night monitoring being norms in the aged care setting. “I started to ask about what happens if a resident falls down the stairs, knowing that if it happened in our services, there’s a massive regulatory response we’ve got to put in place. Their reply to us was simple, ‘they have falls at home, what is the problem?’”.

“They told us how they, at a distance, monitor people overnight but don’t enter their rooms, to minimise disturbance. I shared how we regularly go in and check on people, we need multiple staff doing this, in case of passing away, we deal with it immediately, and their response was, ‘they pass away in their sleep at home and the response is not immediate, why can’t that be the way in aged care?’”

“We need to be changing the risk appetite that we have on care approaches, so that we all can accept a bit more risk”.

Bricknell shares another European view, “in the Netherlands they talk about balancing the risk of harm to older people against the right of their freedom. This means they can come and go from a facility until the point where there’s a risk of harm to a senior being much higher than their right to freedom”.

This pushed view is an alternative that may prove a hard and vital conversation going forward.

Appetising risk

A way that Bricknell and his team have been courting options, and by that hope, to get out of the exhaustion of current headwinds is to look outside of Australia’s shores.

“Looking at European models, there’s a challenge and opportunity. It’s a greater risk model, a lot of the aged care accommodation funding over there is by people renting rooms in facilities, and it’s possible that’s where we’ll end up”.

Bricknell muses, “over in Europe you see a lot more of a market where large multinationals are investing in accommodation of aged care building because there’s a rental model there that means you can generate a return, and a care model which is funded differently”.

Bricknell, alongside peers, sees a sector pushed by over regulation, needing to make a switch ideally before breaking point, “at the moment we’ve taken a zero risk appetite approach and it’s costing us a hell of a lot”.

“Regulation and how much it’s sucking up funding, away from direct care for seniors, this is costing access for people who can’t afford to access it, at home and in resi care”.