Putting the person first in a regulation-heavy sector 

NewDirection Care burst onto the scene in 2017 as what many would call a disruptor to the norm. 

With 17 domestic-style homes that feature shared kitchens and laundries, a retail precinct that looks like any suburban centre and staff who don the mantle of House Companion Support Worker, it’s aged care done differently. 

It’s also a model of care that’s drawn plenty of attention, especially as it was established and developed during a period of incredible regulatory upheaval.

Greg Aleckson Director, NewDirection Care, told Hello Leaders that despite external pressure and challenges, they have always felt confident about the success of their model of care. 

“We’ve established NewDirection Care in an environment that wasn’t necessarily enabling innovation. Natasha [Chadwick, Founder & CEO], myself and Justin [Chadwick, Director] talk about it often; could we do this now? The reality is there is no reason why we wouldn’t,” he said.

“If you can do it in a highly regulated one you can do it in any environment. What’s holding people back is the challenge. You have to be prepared.”

There are challenges all around when you have a staffing model that doesn’t exactly fit in a neat box, for example. 

“When you’re presented with an innovative model and you’re a regulator, the more and more layers of regulation that you put in the less innovation can happen,” he added.

One of the boxes mentioned by Mr Aleckson is Registered Nurse (RN) care minutes. Providers currently have to provide an average of 40 RN care minutes per resident per day with the total increasing to 44 minutes from October 1.

On one hand, Mr Aleckson praised the requirement as an “effort to move the industry forward” but on the other hand, he was critical of the blanket approach thrown onto providers. Many providers are struggling to meet their requirements, while those who are meeting their targets often face financial difficulties due to additional agency expenses. 

“One of the challenges the Government faces is that every decision has an unintended consequence,” he explained.

“The Royal Commission findings were about the whole person, not about a clinical or medical model of care. The unintended consequence is that to pay for RNs to cover that many minutes you have to sacrifice somewhere else. 

“You’re seeing Registered Nurses being employed in other roles because they want more Registered Nurse minutes to meet the compliance requirement. Lifestyle and allied health are important for whole person care but providers are cutting this, those roles are being sacrificed.”

Those cuts are not occurring at NewDirection Care, even with the House Companion model. Allied health is another major focus, and together, they have seen their length of stay grow beyond the industry median of 20 months. 

Including lifestyle staff and allied health in care minute totals would be a step toward promoting whole-person care across the sector, Mr Aleckson added. 

Another step he hopes to see would be the introduction of a funding model promoting reablement. While AN-ACC has admirably resulted in positive change for providers, he said that once again the unintended consequences mean reablement isn’t encouraged. 

Under AN-ACC, more funding is made available for higher-needs residents. Therefore, there’s no financial incentive to improve functional ability. Yet as ability decreases, reassessments are likely because more funding is up for grabs. 

This places financial and resource burdens on the Government and assessment teams. In a reablement model, there would be less reassessment. 

Spearheading innovation

Much like the need to fit providers into a specific box with care minutes, there’s a general need in society to label people as though they belong to a specific box or category. NewDirection Care aims to buck the trend and separate itself from any particular category.

“People still talk about us as being a dementia village and we are just nowhere near a dementia village. We’re beyond that,” Mr Aleckson said.

“The people who live in our houses come as whoever they are. If someone comes to us with dementia, whatever stage they’re at, they have a room in a small house with residents who may have a cognitive illness or not. People with dementia aren’t hived off and put in a locked unit. They live in the same house and have the same freedoms as everybody else.”

This is an approach they’re happy for others to copy, too. There is no hoarding of secrets: the innovation is for everyone to learn from. And the hope is that the Government sees this innovation and gives providers more support and freedom to create unique aged care homes. 

“The more of us who are doing it the easier it becomes. If the regulator looks and sees people doing something different and innovative, they will look at ways to support it. It’s great because the Government’s listening now, they are very open to change. It’s just a matter of how they promote innovation,” he added. 

Then there is the need to overcome internal challenges. Mr Aleckson said he’s seen plenty of organisations begin the process of following in their footsteps, but often because they feel like the need to because of regulation or a fear of being left behind.

He said they’re the exact opposite reasons for changing a model of care. Instead, it’s the focus on the individual and a model of care that promotes ability and normalcy that should drive innovation.

“It’s about enabling by letting them do as much as they possibly can,” he added.