180DC Final Report for CHC

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Co-‐operative Home Care

Final Report

Completion Date: 24 October 2014

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This report has been prepared for CHC in response to the project brief and

ongoing consultations.

It is the result of work conducted by the following student consultants from 180

Degrees Consulting in Semester 2 (August-‐November) 2014:

Charles De Souza

Zoe Hawkins

Andrew Maytom

Jacqueline Dunlop

Thilan Tudor

If you have any questions, please do not hesitate to contact Vidushee Deora

(consulting director) at [email protected]

About 180 Degrees Consulting

180 Degrees is an international student consultancy that works with growing

non-‐profits, helping them achieve a greater social impact. The organization

currently has a global footprint with branches in over 20 universities, covering 5

continents.

180 Degrees bridges the gap between an unmet demand by not-‐for profit

organisations for socially innovative and cost-‐effective professional services, and

a supply of tertiary students who are passionate about and desire to make a

social difference through the application of their education and skills. In doing

so, 180 Degrees enables these organisations to create a significant and tangible

social impact. Not-‐for-‐profit organisations are empowered through the provision

of custom solutions to systemic problems. Simultaneously, students are given the

opportunity to contribute meaningfully to their communities, apply their

university studies in a practical environment and develop valuable life skills.

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TABLE OF CONTENTS 1.0: Executive Summary 4-‐5 1.1 Overview of Co-‐operative Home Care 4 1.2 The Project Brief 4 1.3 Overview of Insights & Recommendations 5 2.0: The Hub Location 6-‐8 2.1 Recommendations 7 3.0: Hub Clientele 9-‐14 3.1 Recommendations 9 4.0: Existing Competition 15-‐29 4.1 Home Care Services 16 4.2 Residential Villages 19 4.3 Day Activities 24 4.4 Relevant Case Study 27 4.5 Overview of Comparisons 28 5.0: Marketing the Hub 30-‐36 5.1 Recommendations 30 6.0: Hub Financials 37-‐52 6.1 Recommendations 37 6.2 Overview of Scenarios Modeled 38 6.3 Scenario 1 Analysis Summary – Base 39 6.4 Scenario 2 Analysis Summary – Adjusted Funding 41 6.5 Scenario 3 Analysis Summary – Increased Users 43 6.6 Scenario 4 Analysis Summary – Increase fees 45 6.7 Scenario 5 Analysis Summary – Adjusting Staff Ratio 47 6.8 Scenario 6 Analysis Summary – Combined 1 49 6.9 Scenario 7 Analysis Summary – Combined 2 51 7.0: Appendices 53-‐82 7.1 Recipients of Care by Select Characteristics 53 7.2 Ryde and Hunters Hill Demographics 55 7.3 Aged Care Growth Areas in Ryde 58 7.4 Community Facilities 58 7.5 Rental Prices 60 7.6 Contact Information 62 7.7 Staffing Breakdown (Ratio 2:1) 64 7.8 Staffing Breakdown (Ratio 3:1) 68 7.9 One-‐time Costs 72 7.10 Staffing Breakdown (18 Users) 76 7.11 Ongoing Costs (18 Users) 80 7.12 Reference List 81

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1.0: EXECUTIVE SUMMARY 1.1: Overview of Co-‐operative Home Care

Co-‐operative Home Care is a not-‐for-‐profit, social co-‐operative homecare agency that operates throughout Sydney. It provides high quality aged, disability and respite care for families and support workers. CHC has a vision of supporting and enabling vulnerable people to lead fuller and more active lives. It aims to achieve this by providing reliable, local and consistent home support services with eleven foci

Disability Care Aged Care

Dementia and Alzheimer’s Care Assisted Living

Dedicated Support Service Respite Care

Relocation Services Housing and Tenancy Support

Information and Advocacy Individual and Personal Budgets

Wellness and Resilience Service

1.2: The Project Brief

CHC has approached 180 Degrees Consulting in order to receive assistance with designing a ‘Healthy Ageing and Wellness Hub’. This aims to address the fact that modern communities are increasingly operating in a manner that leads to the gradual exclusion and alienation of aged and disabled persons living independently. The Hub(s) will be non-‐clinical, daytime destinations where seniors can spend time together whilst improving their health and general quality of life. CHC, having completed much of the conceptual groundwork already, requires assistance with developing core elements of a business plan for the Hub. Specifically, the 180 Degrees Consulting team was tasked with examining the following aspects

• Market feasibility (including location, target market and competition) • Staffing & organisational structure • Marketing fundamentals • Financial feasibility

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1.3: Overview of Insights & Recommendations

Focus on the Ryde Municipality for Hub development

Develop partnership with Hunters Hill Ryde Community Services

Avoid building a relationship with the Department of Housing at this stage

Prioritise linguistic and cultural competency of Hub staff

Consider outreach to local educational and religious institutions

Develop database summarising venue accessibility and staff capacity

Study ACAS evaluation process to develop Hub-‐speci\ic client consultation

Recognise the diversity of organisations and institutions with which the Hub would compete

Maximise differentiation by positioning the Hub based on 6 key attributes

Focus on community-‐based marketing

Avoid neglecting digital marketing

Develop partnerships with 'competing' service providers

Consider decreasing staf\ing levels to a ratio of 3:1 (user to staff).

Consider decreasing user fees.

Introduce additional revenue streams.

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2.0: HUB LOCATION

CHC has expressed interest and intention to establish their first Hub either within the Ryde Council area, or the Hunters Hill Council area (encompassing Gladesville). The success of establishing such a hub depends on the identification of a suitable and well-‐rounded location, with accessible services and availability of council partnerships. Both council areas provide sound amenities for aged care initiatives, but certain demographic information and statistics make Ryde council area more suitable than Hunters Hill. Furthermore, rental prices also make Ryde Council more attractive in terms of setting up an economically sustainable venture.

Focus on the Ryde Municipality for Hub development

Develop partnership with Hunters Hill Ryde Community Services

Avoid building a relationship with the Department of Housing at this stage

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2.1 Recommendations

1. Focus on Hub development in Ryde Municipality (rather than Hunters Hill Municipality

Figure 1: Benefits of the Ryde Municipality as a pilot location

Figure 1 outlines the benefits that make Ryde Council a more appealing location than the Hunters Hill Council area. The details of each benefit are elaborated upon within the appendix. After a demographic assessment, it was determined that Ryde Municipality was the most suitable choice of location in fulfilling the CHC brief. “Knowledge of how the age structure of the population is changing is essential for planning age-‐based facilities and services, such as child care, recreation and aged care” (Forecast ID, 2014) and as such, the demographic assessment material will be of use when choosing a location. Comprehensive statistics are presented in Appendix 7.2.

Ryde Municipality: Benefits for pilot CHC Hub

Avaliability of symbiotic

relationships with pre existing aged facilities (HHRCS) (See Apendix 2.6)

Changing demographics and expected elderly population

increases (See Appendx 2.1)

Areas of signi\igant growth of aged populations:

Macquaire Park, East Ryde and Putney (See Appendix 2.5)

Wide variety of community facilities for

proposed areas (See Appendix 2.2)

Signi\icantly cheaper rental prices than Hunters Hill Council (See Appendix 2.3)

Potential for community project lease within a Ryde Council building (See Appedix 2.4)

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1. Develop partnership with HHRCS (Hunters Hill Ryde Community Services)

HHRCS is an exsting non-‐for-‐profit organisation that operates within the Ryde Council precidinct. It is a purpose-‐built organisation that provides activites, transport, meals, carers respite programs, social support programs, volunteering visiting services, seniors day centres and local neighbourhood centres for the aged population within the Ryde area. Being an established enterprise within the area, it provides an excellent opportunity for CHC to create a partnership with an organisation with similar values and goals. This report recommends developing upon such a relationships and shows great potential for an interdependent and cooperative relationships to form. The details of HHRCS can be found within the Appendices.

2. Avoid relationship with Department of Housing Our research concluded that a relationship with the Department of Housing for the means of a location would be unviable and have limited benefit to CHC. The Department of Housing, both state and national, is tending to a deficit in appropriate housing options for Australia’s most vulnerable. There is a housing shortage with a wait time up to 2 years for permanent housing. Due to reasons of instability, and lack of confirmation, this assessment deems the Department of Housing as an unadvisable route to finding a location for a wellness hub. However there are localized options within the proposed council area. Ryde Council recognizes that community buildings play a pivotal role in improving the quality of life in the community. They are identified by both the community and the service sector as being vital to the delivery of affordable services that meet the community’s needs (City of Ryde Council, 2014). As such, Ryde Council currently supports 29 community services in subsidized accommodation, including childcare centers, baby healthcare centers, family support services, arts groups, heritage groups, community service organizations, and disability support services (including aged care). Multiple community hubs currently exist in Ryde Council public buildings (City of Ryde Council, 2014). They are seen as a way of meeting community needs and aspirations. They provide a multitude of services that are working together to provide responsive, holistic care and support for the community. If CHC chooses the initiative as an option, they can be placed on a register and notified when a building becomes vacant. Appendix 7.6 contains the relevant contact and process details.

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3.0: HUB CLIENTELE

The characterisation of prospective clients for the Healthy Ageing and Wellness Hub is based on the existing demographic profile for Ryde LGA. The following key data from The Australian Bureau of Statistics indicate relevant demographic trends that should be noted:

• The largest growing age groups are the 85+ group, with a 53.6% increase from 1996-‐2006, and the 55-‐64 years old age group who have grown by 24.8% over the same period

• In Ryde, predictions indicate that the 60+ age group is estimated to increase by 5,883 persons between 2011-‐2031, which represents a 28.6% increase

It has been noted that the majority of the 65+ age group and individuals who are enrolled in the Commonwealth Home Care Programme (CHCP) have their lifestyles and daily routines deeply embedded within the community. As a result, this expanding 65+ age group will demand greater independence in their non-‐residential daytime activities, such that their full personal needs are taken into account, not just their healthcare requirements. 3.1 Recommendations

1. Prioritise linguistic and cultural competency of Hub staff members

Based on the diverse nature of the 65+ age group in Ryde LGA, it is recommended that select prospective staff at the Hub are linguistically proficient in the target languages that prospective clients of CALD communities are most comfortable with. Cultural and linguistic competence promotes diversity and inclusion within the Hub’s clientele, encourages the successful integration of clients within the Hub’s community, and facilitates the quality provision of healthcare and services to clients of diverse backgrounds. Social exclusion,

Prioritise linguistic and cultural competency of Hub staff

Consider outreach to local educational and religious institutions

Develop database summarising venue accessibility and staff capacity

Study ACAS evaluation process to develop Hub-‐speci\ic client consultation

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loneliness, and sub-‐standard care delivery may be the product of inadequate linguistic and cultural competency on the part of staff members. Culturally and Linguistically Diverse (CALD) communities comprise a large proportion of Ryde’s ageing population. In Ryde LGA, the percentage of residents not born in Australia is 37.6% as of 2006. With regard to the 65+ age group, the ABS indicates that 13% of the cohort does not speak English well or not at all, and this proportion is projected to increase. The highest CALD speaking languages for Ryde are as follows:

• Cantonese -‐ 8.6% of the population • Mandarin -‐ 7.1% of the population • Korean -‐ 3.9% of the population • Italian -‐ 2.8% of the population

In Ryde LGA, the population sub-‐groups that require substantial assistance with special needs are consistent with demographic trends indicating an ageing population. Relevant special needs and accessibility data for prospective Hub clientele are summarised below:

• In the Ryde and Hunters Hill area, 47.5% of the 85+ age group and 17.5% of the 75-‐84 age group had a severe disability and required assistance

• In New South Wales, the proportion of the population is predicted to increase from 1.0% in 2001 to 2.7% in 2050

• Estimates suggest a threefold increase proportion of residents in Northern Sydney and the Central Coast Area with dementia from 13,000 to 42,000 by 2050

As a growing number of seniors in Ryde LGA will be affected by dementia, it is critical for the Hub’s success that health and social professionals are able to identify the special needs of clients with dementia. In order to break the cycle of wicked problems, which includes loneliness, anxiety, and depression, staff at the Hub should be prepared to actively engage clients with special considerations such as dementia in social engagement projects that promote inclusion. Alzheimer’s Australia notes that the creation of team-‐based projects and initiatives amongst community members living with dementia can help break the wicked cycle of social exclusion and create a sense of belonging and purpose for clients. Within Ryde, 4.4% of the population reported the need for assistance with essential activities in 2011. For age groups that reported a need for assistance, the comparative data for Ryde municipality and Greater Sydney are as follows:

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• A larger percentage of the 85+ age group in Ryde (51% vs. 48.4%)

reported the need for assistance • A smaller percentage of the 80-‐84 age group in Ryde (25.5% vs. 27.7%)

reported the need for assistance • A smaller percentage of the 75-‐78 age group in Ryde (16.9% vs. 18.1%)

reported the need for assistance

2. Consider outreach to local educational and religious institutions Local educational and denominational outreach groups have established channels and programs that encourage social inclusion of seniors. The existing framework of community integration events that exists between aged care providers and educational and religious institutions suggests that CHC should consider outreach to these local institutions in order to develop programming that promotes stronger inter-‐generational and inter-‐cultural connections between clients and the community. CHC should seek to develop regular and consistent programming on a weekly/fortnightly/monthly basis with these institutions such that clients experience the benefits of longitudinal contact with community out-‐groups. The Hub promotes community integration not only through the development of a strong community amongst prospective clients, but also inter-‐generational activities within the local community. Figure 2 below summarises findings that local day-‐based care providers for seniors in New South Wales have adopted a holistic approach to activity planning for clients, with different categories of activities that develop strong relationships between clients and with the community at large.

Activity Category Function Event Examples

Physical Activity Events • Develop mobility and physical capacities of clients

• Promote healthy active lifestyle through manageable physical activities for all clients

• Bush walks, Golf, Indoor Sports, Tai Chi, Racquet sports, Yoga

Community Excursion Events

• Immerse clients into the community at large through integrative events with other community members in public

• Community centre events, Library readings, Trips to local parks and attractions, coach trips

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locations Social Events • Develop strong

social intra-‐community bonds between clients in order to promote social inclusion and belonging

• Cinema screenings, Shopping trips, Social mixers

Figure 2: Prospective activity categories

Furthermore, activities are often scheduled on a weekly, fortnightly, or monthly basis depending on client interest for a given activity and their respective categories. The Hub has proposed inter-‐generational events to combat wicked problems such as loneliness, ageism, and loss of socialisation opportunities. Therefore, it has been proposed that CHC implements inter-‐generational events with local youth, adolescent and adult groups in Ryde to realise the benefits of social integration through intergroup contact on a regular basis. The following institutions have been identified as having a strong history of conducting programming and events with aged care facilities:

• Local public schools • Local TAFE institutions • Religiously-‐affiliated community outreach groups (e.g. Church-‐based

volunteer associations)

3. Develop database that summarises venue accessibility and staff capacity

As a result, the development a database of prospective local activity venues that meet clients’ mobility and special needs requirements is proposed. Information for support staff and volunteers from the Hub should also be included in order to determine staffing capacity at given activities and community excursions. Health, safety and operational accidents may occur when planning off-‐premises events and activities, especially when with a population cohort with extremely specific health and social care needs. These risks must be accounted for with sufficient health, safety, and legal preparations in the case of emergencies. Off-‐premises community integration events should be planned in collaboration with venue hosts, and a detailed accident and emergency plan of action should be developed for each given activity venue. The health and well-‐being activities implemented at the Hub should take into account the diverse needs of prospective clients. As a large proportion of clients will require assistance to some degree with physical mobility and continued

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support during activities, local venues and service providers should accommodate the specific needs of clients.

4. Further study ACAS evaluation process to develop Hub-‐specific client consultation structure and function

Based on the Aged Care Assessment Services (ACAS) model in Victoria, the Hub may consider the implementation a similar initial diagnostic consultation process for incoming clients in order to accurately determine which Hub services and activities will best meet their needs and goals. From this initial consultation, interdisciplinary team members will have a measurable baseline from which to measure client progress as they progress through the Hub’s programs. An interdisciplinary team of health professionals aged care support workers will cater to clients’ special needs, dietary considerations, and specific health and social requirements. Figure 3 below illustrates how the various agents in the interdisciplinary team work together to provide holistic care to an individual client and promote knowledge sharing and empowerment between clients.

Figure 3: Relationship between Interdisciplinary Care Team and a given user

The interdisciplinary team should work in a coordinated manner such that patient information flows effectively from one member of the team to the next. Personal care programs and programme diaries should serve as a central

Physiotherapists

Occupational Therapists

Community Nurses

Aged Care Support Workers

Social Workers

Client

Client Client

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reference point that team members can consult to stay updated on the progress of the client. For example, Aged Care Assessment Services (ACAS) are interdisciplinary and independent teams of health professionals, social workers and nurses in Victoria who provide assessments of seniors in order to determine what services will best meet the needs of clients. It has been evident that in the Victorian context, the ACAS model has proven to be effective at including diverse groups of seniors, including CALD and Aboriginal residents, into aged care models. Furthermore, these coordinated groups assess what services and provisions will best meet the needs of aged residents through direct consultation with seniors.

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4.0: EXISTING COMPETITION

The viability of the Hub is naturally dependent to some extent on the competitive climate in which it would operate. The Arc Centre of Excellence in Population Ageing Research (CEPAR)’s ‘Aged Care in Australia’ report illuminates the highly competitive nature of the aged care industry. Not-‐for-‐profit providers have traditionally dominated the aged care sector; however there has been a recent increase in the representation of for-‐profit competitors. Simultaneously, it is reported that aged care service provision has consolidated into increasingly large facilities, exploiting economies of scale. Thus, the influx of private investment and growth of venue size indicates an increasingly competitive market.

Figure 4: Providers by sector

The future clients of CHC’s Wellness Hub are seeking to address a specific need:

Combatting the practical, medical, social and emotional difficulties that come with the aging process.

This need is ubiquitous in the aging population and is already being addressed by the multitude of service providers mentioned above. These competitors come from a variety of funding backgrounds, and approach the issue from a selection of angles: home care services, residential care and day activities.

Recognise the diversity of organisations and institutions with which the Hub would compete

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Understanding the parameters, strengths, weaknesses, and promotion angles of these competing services will provide vital insight for the formation of CHC’s marketing strategy. This section will now review a selection of CHC’s potential competitors in the three principle sectors of:

• Home care • Residential activities • Day activity centers

The philosophies on which these services promote themselves will be noted and used to roughly demarcate the appropriate marketing basics for CHC. A successful case study reflecting many of CHC’s goals will be reviewed for further recommendations before general conclusions are drawn. 4.1: Home care services

Many families fulfill the needs of the elderly through the regular visits of a nurse/social worker to the current residence of the individual. This style of care provides for the physical, medical and practical needs of the client, however can potentially neglect the mental and emotional dynamics of aging. Emphasis is seen on the preserving the comfort and dignity of the individual, but little is done to address issues of social isolation. Four home care service providers are reviewed below: è Kinder Caring Kinder Caring is a national network of home care services that operates in all metropolitan suburbs of Sydney, Brisbane and Melbourne. Contact [email protected] Services Offered

• Domestic assistance: shopping, medical appointments etc. • Companionship: company and entertainment

• Home care services allow individuals to age within their comfort zone • They focus on the maintenance and protection of pre-‐existing relationships • Most do not address the need to generate new social interactions

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• Specialised care: Alzheimer’s, Parkinson’s, dementia and diabetes • Case management

Philosophy Kinder Caring promotes their service as one that enables individuals to stay at home during the aging process. They emphasise the way in which this style of care preserves the dignity of the individual. è Bannister In Home Care Bannister In Home Care identifies itself as ‘non-‐medical’ and personalised alternative to residential aged care. Contact http://www.bannisterinhomecare.com.au/ Services Offered

• Grooming and hygiene support • Domestic assistance: chores and errands • Meal preparation • Companionship

Philosophy Bannister In Home Care advocates a ‘person-‐centered approach’ to aged care, which involves incorporating the needs and preferences of the individual into shaping the nature and delivery of their care. Bannister In Home Care also promotes the importance of ‘healthy outcomes’ as a goal of its services. It argues the home care service has positive outcomes for mental health, as the engaging interaction helps prevent dementia. Despite the emphasis on healthy outcomes, Bannister In Home Care identifies itself as ‘non-‐medical’ care, but a service focused on companionship and partnership. è SummitCare SummitCare offers a full spectrum of aged care options for the Sydney area. One of its service branches is private home care that allows the individual to maintain independent living for as long as possible. Contact www.summitcare.com.au/sydney-‐home-‐care-‐and-‐support-‐summitcare

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Services Offered • Domestic assistance • Medication assistance • Pet care • Companionship and social

interaction

• 24 hour nursing at home • Home maintenance • Hairdressing • Hospital to home rehabilitation

Philosophy SummitCare brings all the necessary aging support to individuals in the familiar and comfortable environment of their own home, in line with the motto of ‘warmth, worth and wellbeing’. The focus on the client’s ‘wellbeing’ is concentrated into five main areas: optimal health, personal relationships, personal preference, meaningful activities and environment. This holistic approach to healthy aging echoes some core concepts of CHC’s Wellness Hub, as shown in the diagram below.

è Just Better Care, Ryde Just Better Care is a franchise of in home aged care service providers, owned and operated locally. Contact www.justbettercare.com

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Services Offered • Meal preparation • Domestic assistance • Personal care • In home nursing

• Travel and transport • Overnight support • Dementia support

Philosophy Just Better Care argues home care allows individuals to maintain their existing personal relationship and social connections. Just Better Care differentiates itself, as a service that tailors the nature and specifics of care to every individual, are rejects categorised treatment plans based on age and ability. Staff are hired and trained locally in order to reflect and involve the surrounding community. Conclusions Thus, home care services prioritise the privacy, comfort and dignity of the client, through emphasis of maintaining the individual’s status quo. This operates on the assumption that a simple continuation of the client’s home situation with the addition of private carer visits will provide for the psychosocial needs of the individual. 4.2: Residential villages

Many families choose to fulfill the need of aged care support by relocating their loved one to a residential nursing home. These facilities provide accommodation, meals and activities for residents. This is a more intensive style of care than the concept of the CHC Wellness Hub, often necessary at lower levels of self-‐sufficiency and comes at a higher price point. Focus is directed to the practical provisions of this service, and neglects the way aged care villages reinforce negative social norms of marginalising the aged community.

• Residential options promote themselves as a one-‐stop shop for aged care needs, including activities

• There is a range in cost: some are prohibitively expensive at $100 per day, with others very accessible at as low as $50 per day

• Perpetuates the concentration and marginalisation of the aged community at the edge of society

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è Calvary Retirement Community Ryde Calvary Retirement Community is a residential solution for aged care, based on Catholic values. This organisation offers a variety of care levels, from an intensive dementia-‐specific ward, to ‘Independent Living Units’. Initially founded in 1891, Calvary offers a more traditional approach to aged care. Contact: 678 Victoria Road, Ryde www.calvaryryde.org.au Philosophy This retirement village identifies itself as a ‘Catholic health, community and aged care provider’. Calvary promotes the values of hospitality, healing, stewardship and respect. Activities Calvary employs ‘recreational activity officers’ who are responsible for organising a program for residents that runs five days a week. These activities, including music therapy, are designed to entertain, rehabilitate and increase self-‐esteem. Other Services The village also provides physiotherapy, pastoral care, chaplaincy and hairdressing. Price point Calvary offers different categories of residential care, at different price points. The Marian building provides a higher level of care and activities than the Marry Potter building, which has communal bathrooms and is more affordable.

Room Type Daily Accommodation Payment Single room with ensuite $100.81

Single/double/four bed room with shared bathroom

$64.15

Strengths

ü Specially equipped to support late stage dementia patients ü Brand value of history – 125 years of caring

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Weaknesses Ö Explicit faith bias potentially narrows target demographic to Christian

clients Ö Care with 5 day activity program is almost prohibitively expensive

è Clermont Aged Care Clermont Aged Care is a family-‐owned residential village that has been in operation since 1960. Contact: 8-‐14 Clermont Ave, Ryde www.clermontagedcare.com.au Philosophy Clermont Aged Care identifies itself as a unique service primarily due to its close relationship with the medical community. It boasts hospital partnerships and an affiliation with university research and training programs. Activities Clermont Aged Care also identifies its ‘lifestyle program’ as an important part of . Residents benefit from: Creative writing groups

• Ladies morning tea • Poetry series • Music therapy program • Pantomime and comedy shows

Additional Services Residents of Clermont are also provided the services of a dentist, podiatrist, physiotherapist and hairdresser.

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Price point Clients of Clermont receive accommodation, medical support, recreational activities and all meals for the following costs:

Room Type Daily Accommodation Payment Single $85.37 Double $79.92 3 Bed $74.47 4 Bed $69.02

Strengths

ü Community integration with local hospitals and universities ü Strong system of professional medical support

Weaknesses

Ö Potential for over-‐medicalisation creating a sterile and un-‐homely environment

è Glades Bay Gardens, Twilight Aged Care Glades Bay Gardens is one of four residential villages operated by Twilight Aged Care. This organisation caters for many different stages of aging, from residential to palliative and respite care. Contact: 116 Punt Road, Gladesville www.twilight.org.au/our-‐homes/glades-‐bay-‐gardens Philosophy Glades Bay Gardens is based on a social model of ‘person-‐centred’ age care, and emphasises the importance of maintaining the autonomy of every individual throughout the aging process. Activities Glades Bay Gardens offers a Recreational Activities Team that organises a range of exercise therapy, social events, bus outings and games for the entertainment of the residents. Whilst encouraging participation in such activities, the organisation also stresses the importance of autonomy and the individual’s freedom to choose how their time is spent.

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Other Services Residents also have access to assistance with medication, rehabilitation support and emergency assistance. Optometry, podiatry, physiotherapy and hair services are available at an extra cost. Price point

Room Type Daily Accommodation Payment Basic Daily Care Fee $45.63 Strengths

ü Affordability ü Attention to autonomy and avoidance of ‘infantisation’

Weaknesses

Ö May be easy for individuals to remain isolated and lonely within this environment

è New Horizons Aged Care New Horizons is a North Ryde residential aged care solution. It offers accommodation and around the clock care for 78 people. Contact 53-‐63 Badajoz Road, North Ryde www.newhorizons.net.au Philosophy New Horizons presents itself as offering state of the art facilities balanced with the ‘comforts and convenience of home’. The concept of ‘overall wellbeing’ is prominent on their home page, echoing the sentiment intended to be adopted by the ‘wellness hub’. Activities Residents are able to take part in recreational activities organised by the facility including bus tours, ladies’ day, mens’ day, exercise classes and craft making.

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Other Services New Horizons is also able to connect residents with a spectrum of services including physiotherapy, dieticians and hairdressers. The facility also provides practical support for residents such as full laundry services. Price Point

Room Type Daily Accommodation Price Single $90.82 Double $81.73

Strengths

ü Promoting a sense of homeliness ü Relieves the burden of practical domestic chores such as laundry ü Garden

Weaknesses

Ö Extra cost for extra services Conclusions Residential services position themselves as providing on all fronts, for the accommodation, nutrition, and activity needs of aged individuals. However these facilities are, by definition, geographically isolated and demographically concentrated. Despite the provision of activity programs, this service does not address the more systemic need to re-‐involve aged individuals with society as a whole. 4.3: Day Activities

This group of service providers resonates most closely with the function and form of the aim of the Hub. These organisations offer daytime engagements for aged individuals for socialisation. However most of these activities are simply that, and do not provide any additional practical support.

• The services provided are more infrequent than those of home care of residential care

• They cater for simply one aspect of aged care needs, neglecting the potential for consistency, infrastructure and reliability offered by the permanent venue of the Hub

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è North Ryde Community & Information Centre The North Ryde Community and Information Centre provides a calendar of social activities such as lunches, morning teas and bus trips. Intended to provide opportunity for companionship and friendship, this is an aid organisation with no direct cost to the aged individual in need. Costs are dispersed through charitable memberships paid by local citizens and corporate sponsorships. Contact: www.nrca.org.au Activities

• Arts and crafts • Women’s groups • Men’s groups • Social mixers

è North Ryde RSL Seniors Club The North Ryde RSL Seniors Club offers seniors a chance to network and socialize with a variety of activities that occur on a set schedule. Contact: www.northrydersl.com.au/intra-‐clubs/seniors Activities: available activities include Bike riding Shopping trips Theatre Bush walks Tai Chi Coach trips Swimming Golf Cost A yearly membership fee of $5 is required, plus the small additional costs of each activity to cover transport, entrance fees etc.

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è Older Women’s Network Contact: www.ownnsw.org.au The Older Women’s Network (OWN) was founded in 1985 and strives to facilitate women ‘growing old with dignity and wellbeing’. Whilst not specifically a recreational activity network, OWN connects groups of older women for advocacy projects. They address issues important to mature females, including homelessness and domestic violence. OWN is the peak body of 19 groups in New South Wales. This organisation gives older women purpose, motivation and increased social exposure. è City of Ryde The City of Ryde also organises activities and services for senior members of the community. A small selection of activities run on a consistent basis, including a monthly morning tea featuring guest speakers, and charity knitting groups. These events are held at libraries in Eastwood, Gladesville and West Ryde each month. Contact: www.ryde.nsw.gov.au Conclusions These activity networks provide seniors with a variety of entertainment options, providing them with social exposure, enabling them to create new friendships and pursue new interests. However, they do not provide a consistent support network on a daily basis. These activity networks fall short of providing well-‐rounded practical and medical assistance to compliment the social experiences.

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4.4: Relevant Case Study Case Study 1: Upstream in the Community, UK Upstream is an ‘innovative’ British aged care initiative that aims at ‘engaging’ the isolated members of the local mature population through networking and social activities. It is an alternative to in home care and residential care, instead integrating the mature population back into society. Contact: www.upstream-‐uk.com Similarities to CHC

ü Recognises aged individuals still capable of self-‐sufficiency have ‘practical, social, mental and personal needs’ that often go unmet

ü Emphasises the importance of reducing marginalisation of aged community, and encouraging social integration

ü The belief that proactive social integration ‘upstream’ can help prevent increased costs ‘downstream’. This echoes CHC’s concept of combating wicked problems, such as depression, unnecessary falls and over medicating

ü Utilises partnerships with existing institutions, organisations and clubs within the community

Differences to CHC

Ö Distinctly separates itself from medical care, as it believes ‘the service would be prejudiced if it became focused on specific health and social care issues’. Conversely CHC plans to include and address medical issues through the Wellness Hub.

Ö Not operated out of a physical venue, but through networks and people’s houses

Ö Operates on a system of referrals and selection through GPs rather than Lessons • Emphasise the benefits of CHC’s physical venue in terms of the sense of

belonging and community that this creates • Present it as something that will ‘enable people to stay in their own homes

longer’ • Advocate the long term cost saving benefits of improving overall wellbeing • Describe as a service beneficial to more than simply their physical and

practical needs, but their social needs as well

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• Promotion through: ‘leaflets, posters, articles in parish newsletters and through regular contact with GP surgeries, health and social care professionals’

4.5: Overview of Comparisons

In light of this market research, several conclusions can be drawn in regards to how CHC should position its services in relation to those of its competitors. Comparison to In Home Care The home care sector emphasises the dignity of the individual through the maintenance of their social status quo. In some cases, this is a missed opportunity for the many who require a change and are suffering depression and social isolation. CHC should differentiate its Wellness Hub from the concept of home care by promoting its ability to improve and increase an individual’s social experience. Offering the venue as a destination should be argued to provide clients with a daily purpose and sense of activity. Comparison to Residential Care The strongest selling point of residential services is their capacity to provide overall care for aging individuals. Their ability to house, feed and clothe the clients provides significant peace of mind for loved ones. However, this village-‐oriented approach systematically excludes the aged community from society as a whole. CHC should promote itself as an initiative that re-‐positions aging individuals in the center of society, both geographically and relationally. By building on relationships with existing organisation and institutions and positioning the Hub in the center of town, rather than the outskirts, CHC can address this social issue.

è Promote the Wellness Hub’s ability to generate new friendships and social networks for those that are already marginalised and isolated

è Emphasise the Wellness Hub’s capacity to reintegrate the aged community into the center of society and foster the creation of institutional and demographic links

è Show the Wellness Hub’s holistic approach, providing positive social interaction whilst offering consistent and reliable practical and medical support.

29

CHC services must also be priced with thoughtful consideration of the price point of some of the more accessible residential services, which provide permanent accommodation as well as activities. Distinguish from Other Activity Centres Many of the activity networks are fragmented and lack the sense of reliability and permanence that the Hub will be able to provide. Instead of a one-‐dimensional provision of entertainment, CHC should promote itself as an integrated and holistic solution to the social, mental, practical and medical obstacles of aged care.

30

5.0: MARKETING THE HUB

The success of the Hub, both as a single institution and as a replicable model, depends not only on appropriate design but also on effective marketing. Although the aged and disabled persons within Australian society are underserviced, the aged and disabled care space is increasingly crowded. Two trends in particular highlight the growing need for a more strategic approach to marketing in this sector: the proliferation of for-‐profit providers and the consolidation into larger facilities. Additionally, the sector as a whole is more than ever before adopting commercial marketing strategies, with larger institutions utilizing professionally-‐produced, multi-‐channeled promotional campaigns aimed not only at users of their services but also their families and friends.

5.1: Recommendations

1. Maximise differentiation by positioning the Hub based on six key attributes

As the analysis presented in section four indicates, the Hub would be competing not only with similar institutions (should they develop) but also to some extent with providers of in-‐home services, residential care, and other day activities. It is therefore recommended that, in order to achieve the maximum differentiation from these existing service providers, CHC build their marketing efforts around six key attributes:

1. Facilitation of community-‐building 2. Compatibility with independent lifestyles 3. Synergistic collaborations with local institutions (e.g. TAFEs, local council,

RSLs etc.) 4. The strengths of a co-‐operative social enterprise 5. Relatively low cost 6. Dual focus of leisure activities and care provision

Maximise differentiation by positioning the Hub based on 6 key attributes

Focus on community-‐based marketing

Avoid neglecting digital marketing

Develop partnerships with 'competing' service providers

31

Figures 5-‐7, found below, demonstrate the relative positioning of the Hub, residential aged care, in-‐home care and irregular activity providers on the above attributes. The key takeaway is that the industry is quite diverse, in that the central attributes of the Hub are not in general shared by the key institutions and organisations with which it will compete.

Figure 5: Perceptual Map comparing the Hub to key competing institutions on select attributes (1)

32



33

However, this is not to say that prospective users of the Hub currently recognise that care providers can be assessed according to these six attributes. This is to say that the core of the CHC’s marketing effort, particularly in the initial stages, should be directly highlighting the relative benefits of the Hub (on these attributes) in comparison with residential villages, in-‐home care and irregular activities. Figure 8 outlines three simple strategies the Hub can use to build its brand identity around its key attributes.

Figure 8: Illustrative examples of initial strategies to build the Hub's brand identity around its six defining attributes

2. Focus on community-‐based marketing

Given the desire of CHC to make the Hub an institution that is at once a part of the local community and also works to strengthen it, community-‐based, local marketing will be key. Although it must be differentiated from other aged and disabled care providers, the Hub will suffer it does not possess the same degree of exposure in terms of advertisements in local papers, posters placed in local clubs and shopping centers and radio advertisements.

One problem afflicting the aged care industry in Australia is the generally low level of customer loyalty. Users of services are increasingly seeking more flexible contracts, even with retirement homes, so as to be able to best take advantage of what is available. CHC hold that this ensures the Hub has a key advantage – users pay only per day if they attend, and are therefore never locked in. However, in order to maximize the benefits of this, CHC must maintain the presence of the Hub in the local community so as to continue attracting users.

Develop a series of print media advertisements and posters, with one 'edition' highlighting one of the six key differentiating attributes of the Hub

Utilise 'case studies' of prospective hub users in which their desire for a particular attribute is expressed idiosyncratically

Have early advertisements, especially print and radio, directly contrast the Hub with other care providers to show its unique nature

34

Figure 9: Making the Hub a community institution

3. Recommendation: Seek to develop partnerships with ‘competing’ service

providers Whilst the Hub would in many ways be competing with in-‐home care, residential villages and irregular activity providers, it is recommended that CHC be open to ‘co-‐opetition’, that is, cooperating with its competitors. Such a strategy should be adopted only once the Hub has proven viable, and only in concert with other initiatives. It is, however, worth it in that it potentially opens the Hub up to additional user (and revenue) streams. There are a number of ways in which this co-‐opetition could occur:

• Having the Hub organize special daytrips to which residents of ‘retirement villages’ are invited

• Seeking to staff the Hub occasionally with employees of various in-‐home care services

• Partnering with local networks and organisations that provide irregular activities for fundraisers and other events

• Offering discounts to residents of ‘retirement villages’ if a sufficient number attend the Hub

• Renting out rooms or Hub facilities to other networks and organisations

Build a presence in what the

community is exposed to

Develop partnerships with

community institutions

Become a part of the community

35

4. Recommendation: Consider simple digital marketing initiatives

Although the level of internet usage among older people (aged 65 and above) is lower than other demographic cohorts, it is increasing. In 2011, approximately 40% of those aged 85 and above had no internet access at home, but this is an improvement on previous years, a trend that is expected to continue. In light of this, aged care providers in Australia and other developed nations are increasingly utilizing online channels as a part of their operations and marketing. Importantly, should CHC discover that its targeted users are unlikely to be online, this does not necessarily mean online should be ignored. Rather, there is still likely to be value in seeking to reach the families of prospective users, and also other related institutions such as doctor’s surgeries and RSL clubs.

Figure 10: Broad applications of online channels to be considered by CHC

It is also worth noting the development of applications designed specifically for the elderly and their networks. One such example is Tapestry (www.tapestry.net), a platform designed to simplify online family interactions and sharing so as to enhance inclusiveness for the elderly and disabled.

The value of online for the Hub

Marketing geared towards

prospective users

Marketing geared towards families of prospective

users

Marketing geared towards

contributors

Operations, including the development of an 'online

hub'

36

Figure 11: The Tapestry application interface

CHC may find it beneficial in the future to perhaps seek to partner with the organisations behind such applications, or simply to use their technologies to create an online network for the Hub. Alternatively, depending on the digital literacy and online access of the Hub’s eventual users, it may also be advisable for CHC to consider developing a simple Hub application, which could include elements such as those below.

Figure 12: Possible features of a Hub application

Hub updates and news

Hub (and potentially fellow user) contact details/messaging system

Bus routes

Activity schedules

Local area map functionality

37

6.0 HUB FINANCIALS

6.1: Recommendations

The recommendations discussed below have been put forward with the aim of trying to reduce the Hub’s reliance on third party funding whilst optimizing the affordability for the Hub’s users.

1. Recommendation: Consider decreasing staffing levels to a ratio of 3:1 (user to staff).

It is recommended that the Hub explores the option of adopting a user to staff ratio of 3:1. The modeling for this outlined scenario has identified significant savings in employee costs totaling $260,000 over the four-‐year period. This will in turn allow the Hub to reduce the requirement for third party funding. In relation to user to staff ratios, no formal national recommendations exist for the aged care sector in Australia (LMHU 2010), however the United States National Adult Day Services Association (NADSA) recommends minimum user to staff ratios of 4:1 in the highest rated level of respite care (NADSA 2014).

2. Recommendation: Consider decreasing user fees.

Whilst providing users with flexibility to use the Hub’s services on a visit-‐by-‐visit basis has its advantages it does however allow users to shop around and use other services. To increase the attractiveness of the Hub’s affordability for its users it is recommended that the option of decreasing user fees is considered. The modeling in scenario 6 was able to achieve a reduction in third party funding

Consider decreasing staf\ing levels to a ratio of 3:1 (user to staff).

Consider decreasing user fees.

Introduce additional revenue streams.

38

of $100,000 over the four year period whilst offering a $30/day decrease in fees. The inputs for the outlined model comprised of full fees at $50/day per user and a user to staff ratio of 3:1.

3. Recommendation: Introduce Additional revenue streams.

Across the seven scenarios modeled the Hub’s income was comprised of 81-‐87% third party funding and the balance coming from user fees. It is therefore recommended that additional revenue streams are introduced to reduce the apparent risk of over reliance on third party funding. The co-‐opetition option previously discussed in the marketing section of the report could be one additional source. A ‘friends of the Hub’ initiative in which users are given an option to donate crafts and other products that they have created during the Hub’s activities to CHC could provide additional income. Items such as cakes, cards, stationery and knitted garments could be sold from a CHC stall during suburban market days. This could also provide an additional marketing and communication channel for CHC into the community. 6.2: Overview of Scenarios Modeled In order to assess the financial feasibility of the Hub this section of the report will analyze six scenarios. Each scenario has been modeled with different mixes of income and expenditure. A number of the scenarios have proven viable subject to availability of funding and timing of funding inflow, refer to Figure 13 below for a summary of each

It should be noted that the current pricing and cost structure of the Hub will not achieve financial sustainability. In all scenarios the percentage of income received from funding accounts for 81-‐87%, with the user fees making up the balance. Other revenue streams will need to be introduced to reduce the apparent risk caused by over reliance on funding.

39

Scenario 1 (Base) As per DSS grant application Not viable

Scenario 2 Adjusted funding timeline Viable*

Scenario 3 Increase number of users Not viable

Scenario 4 Increase fees Viable*

Scenario 5 Adjustment in user to staff ratio (3:1) Viable*

Scenario 6 User to staff ratio 3:1, decrease fees and funding levels Viable*

Scenario 7 User to staff ratio 3:1 and decrease in funding levels Viable*

*Viable: subject to approval and receipt of funding prior to January each year and six full fee paying users & six partial fee paying users for 260 days p.a. adhering strictly to upfront payment terms. Figure 13: Scenario Summary

6.3: Scenario 1 Analysis Summary – Base

Analysis of the base scenario has ascertained that this scenario is not viable. This

model has identified a cash flow deficit in December 2016 and 2017, refer to

figure 16. The result is an inability to pay expenses as they fall due in these

periods. The income statement in figure 15 indicates a cumulative surplus of

$33,000 substantiating that the total amount of funding is sufficient, however to

rectify the cash flow deficits the timing and proportions of the cash inflows from

funding will need to be adjusted as detailed in Scenario 2. For a summary of

Scenario 1 assumptions refer to figure 14 below.

No. of full fee paying users 6 x 260 days p.a. No. of partial fee paying users 6 x 260 days p.a. Client to staff ratio 2:1 Price of full fee users per day $80 Price of partial fee users per day $20 Employee Costs Refer to Appendices, Staff Breakdown Setup Costs Refer to Appendices, One time Costs Rent & Utility Refer to Appendices, Ongoing Costs Miscellaneous Ongoing Costs Refer to Appendices, Ongoing Costs Figure 14: Scenario 1 Assumption Summary

40

Scenario 1 Annual summary

Income 2015 2016 2017 2018

Grant funding

DSS

660,000 144,000 149,000 149,000

HACC

0 384,000 472,000 472,000

Aged Care Workforce Fund

0 60,000 61,920 61,920

Clientele fees

Full fee paying clients

67,200 115,200 115,200 115,200

Subsidised clients

16,800 28,800 28,800 28,800

Total Income

744,000 732,000 826,920 826,920

Expenses

Employee costs

463,162 584,747 584,747 584,747

Rent & Utility costs

83,760 83,760 83,760 83,760

Miscellaneous ongoing costs

67,722 116,843 116,843 116,843

Setup costs

125,900 0 0 0

Total Expenses

740,544 785,350 785,350 785,350

Net Cash

Yearly surplus or deficit

3,456 -‐53,350 41,570 41,570

Cumulative surplus / deficit

3,456 -‐49,893 -‐8,323 33,248

Net surplus / deficit 3,456 -‐49,893 -‐8,323 33,248 **Unless noted otherwise the estimated amounts in the income statement summaries are based on calendar years not financial years. Figure 15: Income Statement Annual Summary Scenario 1

Figure 16: Cashflow Forecast Scenario 1

-‐100,000

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

Jan-‐15

Mar-‐15

May-‐15

Jul-‐15

Sep-‐15

Nov-‐15

Jan-‐16

Mar-‐16

May-‐16

Jul-‐16

Sep-‐16

Nov-‐16

Jan-‐17

Mar-‐17

May-‐17

Jul-‐17

Sep-‐17

Nov-‐17

Jan-‐18

Mar-‐18

May-‐18

Jul-‐18

Sep-‐18

Nov-‐18

Scenario 1 Cashflow

41

6.4: Scenario 2 Analysis Summary – Adjusted funding Timeline

Scenario 2 has kept all assumptions as per the base scenario but adjusted the

proportion and timing of funding inflows. This scenario is considered viable with

a monthly cash flow surplus, refer to figure 19. At the end of the four year period

a cumulative net surplus of $33,000 is achieved as shown in the income

statement figure 18. For a summary of Scenario 2 assumptions please refer to

figure 17 below.

No. of full fee paying users 6 x 260 days p.a. No. of partial fee paying users 6 x 260 days p.a. Client to staff ratio 2:1 Price of full fee users per day $80 Price of partial fee users per day $20 Employee Costs Refer to Appendices, Staff Breakdown Setup Costs Refer to Appendices, One time Costs Rent & Utility Refer to Appendices, Ongoing Costs Miscellaneous Ongoing Costs Refer to Appendices, Ongoing Costs Figure 17: Scenario 2 assumption summary

42

Scenario 2 Annual summary Income 2015 2016 2017 2018

Grant funding

DSS

660,000 158,400 142,000 142,000

HACC

0 422,400 450,000 450,000


0 66,000 61,520 61,520

Clientele fees


67,200 115,200 115,200 115,200

Subsidised clients

16,800 28,800 28,800 28,800

Total Income

744,000 790,800 797,520 797,520

Expenses

Employee costs

463,162 584,747 584,747 584,747


83,760 83,760 83,760 83,760


67,722 116,843 116,843 116,843

Setup costs

125,900 0 0 0

Total Expenses

740,544 785,350 785,350 785,350

Net Cash


3,456 5,450 12,170 12,170


3,456 8,907 21,077 33,248

Net surplus / deficit 3,456 8,907 21,077 33,248 **Unless noted otherwise the estimated amounts in the income statement summaries are based on calendar years not financial years. Figure 18: Income Statement Annual Summary Scenario 2


0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

Jan-‐15

Mar-‐15

May-‐15

Jul-‐15

Sep-‐15

Nov-‐15

Jan-‐16

Mar-‐16

May-‐16

Jul-‐16

Sep-‐16

Nov-‐16

Jan-‐17

Mar-‐17

May-‐17

Jul-‐17

Sep-‐17

Nov-‐17

Jan-‐18

Mar-‐18

May-‐18

Jul-‐18

Sep-‐18

Nov-‐18

Scenario 2 Cashflow

43

6.5: Scenario 3 Analysis Summary -‐ Increase Number of Users

Scenario 3 has maintained a user to staff ratio of 2:1, grant funding levels as per

the base scenario but increased the number of users to 18. This is not a viable

option as indicated by a cumulative net deficit of -‐$217,000 and a number of

cashflow deficits over the four year period. Refer to the income statement and

cash flow at figure 21 & 22. It should be noted that increasing the number of

users to 18 in conjunction with increasing the levels of funding over the four

years by an additional $230,000 would result in cashflow surplus. For a

summary of Scenario 3 assumptions please refer to figure 20 below.


44


Grant funding

DSS

660,000 144,000 149,000 149,000

HACC

0 384,000 472,000 472,000


0 60,000 61,920 61,920

Clientele fees


100,800 172,800 172,800 172,800

Subsidised clients

25,200 43,200 43,200 43,200

Total Income

786,000 804,000 898,920 898,920

Expenses

Employee costs

521,717 695,480 695,480 695,480


83,760 83,760 83,760 83,760


84,554 150,508 150,508 150,508

Setup costs

125,900 0 0 0

Total Expenses

815,931 929,749 929,749 929,749

Net Cash


-‐29,931

-‐125,749 -‐30,829 -‐30,829


-‐29,931

-‐155,680

-‐186,508

-‐217,337

Net surplus / deficit -‐29,931 -‐

155,680 -‐

186,508 -‐

217,337 **Unless noted otherwise the estimated amounts in the income statement summaries are based on calendar years not financial years. Figure 21: Income Statement Annual Summary Scenario 3


-‐300,000

-‐200,000

-‐100,000

0

100,000

200,000

300,000

400,000

500,000

600,000

Jan-‐15

Mar-‐15

May-‐15

Jul-‐15

Sep-‐15

Nov-‐15

Jan-‐16

Mar-‐16

May-‐16

Jul-‐16

Sep-‐16

Nov-‐16

Jan-‐17

Mar-‐17

May-‐17

Jul-‐17

Sep-‐17

Nov-‐17

Jan-‐18

Mar-‐18

May-‐18

Jul-‐18

Sep-‐18

Nov-‐18

Scenario 3 Cashflow

45

6.6: Scenario 4 Analysis Summary -‐ Increase Fees

Scenario 4 has maintained a user to staff ratio of 2:1, grant funding levels and

timing as per Scenario 2 whilst increasing the user fees by $10 per day. This is

considered a viable option substantiated by a cash flow surplus and a cumulative

net surplus of $136,000 over the four-‐year period, refer to figure 24 & 25. For a

summary of Scenario 4 assumptions please refer to figure 23 below.


46

1


Grant funding

DSS

660,000 158,400 142,000 142,000

HACC

0 422,400 450,000 450,000


0 66,000 61,520 61,520

Clientele fees


75,600 129,600 129,600 129,600

Subsidised clients

25,200 43,200 43,200 43,200

Total Income

760,800 819,600 826,320 826,320

Expenses

Employee costs

463,162 584,747 584,747 584,747


83,760 83,760 83,760 83,760


67,722 116,843 116,843 116,843

Setup costs

125,900 0 0 0

Total Expenses

740,544 785,350 785,350 785,350

Net Cash


20,256 34,250 40,970 40,970


20,256 54,507 95,477 136,448



0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

Jan-‐15

Mar-‐15

May-‐15

Jul-‐15

Sep-‐15

Nov-‐15

Jan-‐16

Mar-‐16

May-‐16

Jul-‐16

Sep-‐16

Nov-‐16

Jan-‐17

Mar-‐17

May-‐17

Jul-‐17

Sep-‐17

Nov-‐17

Jan-‐18

Mar-‐18

May-‐18

Jul-‐18

Sep-‐18

Nov-‐18

Scenario 4 Cashflow

47

6.7: Scenario 5 Analysis Summary -‐ Adjustment in User to Staff Ratio

Scenario 5 has maintained grant funding levels and timing as per the base

scenario whilst adjusting the user to staff ratio to 3:1. This is a viable option

given a cumulative net surplus of $293,000 is achieved over the four year period

with significant surplus cash flows, refer to Figures 27 & 28. For a summary of

Scenario 5 assumptions please refer to figure 26 below.


48


Grant funding

DSS

660,000 144,000 149,000 149,000

HACC

0 384,000 472,000 472,000


0 60,000 61,920 61,920

Clientele fees


67,200 115,200 115,200 115,200

Subsidised clients

16,800 28,800 28,800 28,800

Total Income

744,000 732,000 826,920 826,920

Expenses

Employee costs

424,125 510,925 510,925 510,925


83,760 83,760 83,760 83,760


67,722 116,843 116,843 116,843

Setup costs

125,900 0 0 0

Total Expenses

701,507 711,527 711,527 711,527

Net Cash


42,493 20,473 115,393 115,393


42,493 62,966 178,359 293,751



0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

Jan-‐15

Mar-‐15

May-‐15

Jul-‐15

Sep-‐15

Nov-‐15

Jan-‐16

Mar-‐16

May-‐16

Jul-‐16

Sep-‐16

Nov-‐16

Jan-‐17

Mar-‐17

May-‐17

Jul-‐17

Sep-‐17

Nov-‐17

Jan-‐18

Mar-‐18

May-‐18

Jul-‐18

Sep-‐18

Nov-‐18

Scenario 5 Cashflow

49

6.8: Scenario 6 Analysis Summary -‐ Adjustment in User to Staff Ratio,

Reduction in Funding and Fees

Scenario 6 has adjusted the user to staff ratio to 3:1 whilst reducing the full

paying user fees by $30 and grant funding levels by $107,000 over the four

years. This is a viable option demonstrated by surplus cash flows and a

cumulative net surplus of $31,000 over the four-‐year period, refer to figure 30 &

31. This is an attractive scenario as it significantly reduces the amount of grant

funding required and offers affordability to users. For a summary of Scenario 5

assumptions please refer to Figure 29 below.


50

Scenario 6 Annual summary

Income 2015 2016 2017 2018

Grant funding

DSS

660,000 151,000 134,000 134,000

HACC

0 403,000 425,000 425,000


0 63,000 55,500 55,500

Clientele fees


42,000 72,000 72,000 72,000

Subsidised clients

16,800 28,800 28,800 28,800

Total Income

718,800 717,800 715,300 715,300

Expenses

Employee costs

424,125 510,925 510,925 510,925


83,760 83,760 83,760 83,760


67,722 116,843 116,843 116,843

Setup costs

125,900 0 0 0

Total Expenses

701,507 711,527 711,527 711,527

Net Cash


17,293 6,273 3,773 3,773


17,293 23,566 27,339 31,111



0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

Jan-‐15

Mar-‐15

May-‐15

Jul-‐15

Sep-‐15

Nov-‐15

Jan-‐16

Mar-‐16

May-‐16

Jul-‐16

Sep-‐16

Nov-‐16

Jan-‐17

Mar-‐17

May-‐17

Jul-‐17

Sep-‐17

Nov-‐17

Jan-‐18

Mar-‐18

May-‐18

Jul-‐18

Sep-‐18

Nov-‐18

Scenario 6 Cashflow

51

6.9: Scenario 7 Analysis Summary -‐ Adjustment in User to Staff Ratio and Reduction in Funding Levels Scenario 7 has adjusted the user to staff ratio to 3:1 and reduced grant funding

levels by $210,000 over the four year period whilst maintaining user fees in

accordance with the base scenario. This is a viable option validated by surplus

cash flows and a cumulative net surplus of $79,000 over the four-‐year period,

refer to figure 33 & 34. For a summary of Scenario 7 assumptions please refer to

figure 32 below.


52


Grant funding

DSS

660,000 130,000 130,000 130,000

HACC

0 400,000 400,000 400,000


0 50,000 50,000 50,000

Clientele fees


67,200 115,200 115,200 115,200

Subsidised clients

16,800 28,800 28,800 28,800

Total Income

744,000 724,000 724,000 724,000

Expenses

Employee costs

424,125 510,925 510,925 510,925


83,760 83,760 83,760 83,760


67,722 116,843 116,843 116,843

Setup costs

125,900 0 0 0

Total Expenses

701,507 711,527 711,527 711,527

Net Cash


42,493 12,473 12,473 12,473


42,493 54,966 67,439 79,911



0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

Jan-‐15

Mar-‐15

May-‐15

Jul-‐15

Sep-‐15

Nov-‐15

Jan-‐16

Mar-‐16

May-‐16

Jul-‐16

Sep-‐16

Nov-‐16

Jan-‐17

Mar-‐17

May-‐17

Jul-‐17

Sep-‐17

Nov-‐17

Jan-‐18

Mar-‐18

May-‐18

Jul-‐18

Sep-‐18

Nov-‐18

Scenario 7 Cashflow

53

7.0: APPENDICES 7.1: Recipients of Home care Package and Residential Care by Selected Characteristics (source: CEPAR 2013).

55

7.2: Changing Demographics in the Ryde and Hunters Hill Areas Statistical data forecasts that within the Ryde municipality, the number of persons over 60 is expected to increase by 5, 883, which equates to a 28.6% increase (Ryde Community Profile, 2011). They will comprise of 20.4% of the population. Forecasts such as these make Ryde a sound municipality to create an aged care wellness hub. Furthermore, the statistics indicate that in the future years, there will be an increased need for such aged care facilities. City of Ryde -‐ Total persons

2011 2026

2031

Change between 2011 and 2031

Age group (years) Number % Number % Number % Number

0 to 4 6,628 6.1 7,901 6.1 8,170 6.0 +1,542 5 to 9 5,642 5.2 6,949 5.4 7,227 5.3 +1,585 10 to 14 5,285 4.9 6,263 4.8 6,540 4.8 +1,255 15 to 19 5,907 5.5 7,035 5.4 7,324 5.4 +1,417 20 to 24 9,883 9.1 10,465 8.1 10,895 8.0 +1,012 25 to 29 9,553 8.8 11,137 8.6 11,567 8.5 +2,014 30 to 34 8,829 8.1 11,108 8.6 11,563 8.5 +2,734 35 to 39 8,297 7.7 10,521 8.1 10,869 8.0 +2,572 40 to 44 7,509 6.9 9,444 7.3 9,983 7.4 +2,474 45 to 49 7,436 6.9 8,277 6.4 8,945 6.6 +1,509 50 to 54 6,857 6.3 7,429 5.7 7,828 5.8 +971 55 to 59 5,991 5.5 6,569 5.1 6,922 5.1 +931 60 to 64 5,364 4.9 6,083 4.7 6,074 4.5 +710 65 to 69 3,902 3.6 5,405 4.2 5,633 4.2 +1,731 70 to 74 3,330 3.1 4,741 3.7 5,047 3.7 +1,717 75 to 79 2,888 2.7 4,117 3.2 4,296 3.2 +1,408 80 to 84 2,564 2.4 3,083 2.4 3,509 2.6 +945 85 and over 2,508 2.3 3,010 2.3 3,114 2.3 +606 Total persons 108,373 100.0 129,538 100.0 135,508 100.0 +27,135

Figure 13: Forecast age structure, City of Ryde: 5 year age groups (Source: Australian Bureau of Statistics, 2011)

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City of Ryde -‐ Total persons

2011 2026

2031

Change between 2011 and 2031

Age group (years)

Number

% Number

% Number

% Number

Babies and pre-‐schoolers (0 to 4)

6,628 6.1 7,901 6.1 8,170 6.0 +1,542

Primary schoolers (5 to 11)

7,822 7.2 9,498 7.3 9,888 7.3 +2,066

Secondary schoolers (12 to 17)

6,257 5.8 7,550 5.8 7,873 5.8 +1,616

Tertiary education and independence (18 to 24)

12,638 11.7 13,663 10.5 14,225 10.5 +1,587

Young workforce (25 to 34) 18,382 17.0 22,244 17.2 23,130 17.1 +4,748

Parents and homebuilders (35 to 49)

23,242 21.4 28,242 21.8 29,797 22.0 +6,555

Older workers and pre-‐retirees (50 to 59)

12,848 11.9 13,999 10.8 14,751 10.9 +1,903

Empty nesters and retirees (60 to 69)

9,266 8.6 11,488 8.9 11,708 8.6 +2,442

Seniors (70 to 84) 8,782 8.1 11,941 9.2 12,852 9.5 +4,070 Elderly aged (85 and over)

2,508 2.3 3,010 2.3 3,114 2.3 +606

Total persons 108,37

3 100.

0 129,53

8 100.

0 135,50

8 100.

0 +27,135

Figure 14: Forecast age structure; service age groups (Source: Australian Bureau of Statistics, 2011)

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Figure 15: Population and household age forecasts, 2011-‐31 (Population Experts 2012)

Emerging groups (Australian Bureau of Statistics, 2011):

• A larger percentage of persons aged 85 and over (51.4% compared to 48.4%) • A smaller percentage of persons aged 80 to 84 (25.5% compared to 27.7%) • A smaller percentage of persons aged 75 to 79 (16.9% compared to 18.1%)

Emerging (increasing) groups were also identified. They include

• 85 and over (+310 persons) • 60 to 64 (+72 persons) • 75 to 79 (+70 persons) • 65 to 69 (+66 persons)

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7.3: Significant ‘Aged Care’ Growth Areas in the Ryde Municipality

Figure 16: Population age structure map, ages 50-‐85 (ABS)

The above map indicates areas of significant growth of aged populations:

Macquarie Park, North and East Ryde, and Putney. An increasing ageing

population has indicated Ryde Council as a high needs area for increased quality

aged care services. Compared to the Greater Sydney area, Ryde has higher rates

of people’s aged 85 and over with a need for services with core activities.

Analysis of the need for assistance of people in the Ryde municipality has

highlighted certain dominant groups.

7.4: Community Facilities in the Ryde and Hunters Hill Areas

Both Ryde and Hunters Hill Municipal Council offer a variety of social services to

make them ideal councils to establish a co-‐operative aged health care center

within. However, the abundance and accessibility varies due to the disparate size

in municipal areas. Ryde is a significantly larger municipal council area, and thus

has a larger variety of facilities. However, Hunter’s Hill being a smaller council

has a higher concentration of high quality facilities.

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Services Ryde Municipal Council

(City of Ryde Council, 2014)

Hunters Hill Municipal

Council (Municipality of

Hunters Hill, 2014)

Summary of community facilities

Ryde has a commitment to supporting their elderly populations. Much time and money has been invested via the Ryde Council to enhancing the lives, opportunities and ability of older populations to live with fulfilment and independently. Further information regarding contact can be accessed directly through Ryde Council website.

Hunters Hill council has a commitment to supporting older people in the local community. The council arranges and organizes a variety of activities and events for seniors. Contact the aged and disability coordinator: Ph: 9879 9454 Email: [email protected]

Emotional Wellbeing • Volunteering opportunities for older people

• Social clubs • Seniors week (once

a year) Physical Wellbeing • Home and community

care services (pre existing services for frail aged persons with desires to stay in their own home)

• Home modification: assistance to modify, maintain and consumer help service for people living in Ryde area.

• Exercise groups and clubs

• Access to Northern Sydney Commonwealth Respite and Care link Centre (Ph: 1800 059 059)

Leisure Activities • Ryde Library Services for seniors

• Exercise services and classes

• Excursions to

• Home library service

• Exercise classes • Language classes • Day trips to local

clubs, cultural days • Seniors morning

teas Social Services • Computer and tablet • Computer classes

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classes • Tracing your

ancestors programs • Cultural enhancement

tours: e.g. ‘Eastwood: Tea and Tai Chi’

• Assisted services (assisted access to remaining independent in own homes-‐ information on transport, meals, home maintenance and a range of other option is available with information on local accommodation options).

7.5: Rental Prices in the Ryde and Hunters Hill Areas Median rent per suburb (2014) (only indicative of houses 3 br, units 2 br)

Ryde (Domain, 2014)

Ryde: Houses $590; Units $430

ER: Houses $848; Units NA

Putney: Houses $700; Units $803

North Ryde: Houses $610; Units $733

Macquarie Park: Houses NA; Units $460

Marsfield: Houses $650; Units $480

Eastwood: Houses $650; Units $435

Denistone East: Houses $700; Units

$550

Denistone: Houses $663; Units $580

Denistone West: Houses $615; Units NA

West Ryde: Houses $590; Units $423

Meadowbank: Houses $458; Units $425

Tennyson Point: Houses: $735; Units

$585

Hunters Hill Municipal Council

(Domain, 2014)

Gladesville: Houses $725; Units $420

Hunters Hill: Houses $800; Units $420

Woolwich: Houses $1000; Units $420

Huntley’s Cove: Houses NA; Units $850

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LGA One bedroom

dwelling

Two

bedroom

Three Four+

City of Sydney $420 (10.5%) $570 (9.6%) $728 (11.9%) $790 (16.2%)

North Sydney $380 (8.6%) $510 (6.3%) $725 (3.6%) $1000 (-‐

14.9%)

Willoughby $430 (7.5%) $495 (10.0%) $700 (7.7%) $950 (6.1%)

Waverley $400 (9.6%) $530 (14.6%) $800 (14.3%) $1325

(39.8%)

Woollahra $395 (8.2%) $550 (11.1%) $900 (12.5%) $1400 (-‐6.7%)

Mosman $360 (4.3%) $450 (0.0%) $840 (2.4%) $2300

(37.3%)

Hunters Hill -‐ $400 (-‐3.6%) $585 (6.4%) -‐

Lane Cove $325 (12.1%) $410 (15.5%) $590 (19.3%) $978 (16.4%)

Ryde $280 (16.7%) $350 (12.9%) $498 (10.6%) $650 (25.6%)

Inner Ring $393 (12.2%) $500 (11.1%) $680 (13.3%) $950 (20.3%)

Middle Ring $320 (6.7%) $360 (10.8%) $450 (12.5%) $630 (14.5%)

Sydney SD $350 (6.1%) $390 (11.4%) $385 (10.0%) $500 (11.1%)

Figure 17: Median rents for all dwellings 2008 (City of Sydney Housing Market)

According to the Real Estate Institute of NSW (2012), vacancy rates for inner ring

local government areas of Sydney for November 2008 were just 1.3% and for

middle ring were 1.2%. Vacancy rates have been tight across Sydney for some

time, including Hunters Hill and Ryde Council. They have been at or below 1.5% in

the inner and middle ring since at least October 2007. This is a key factor in the

recent significant increase in median rental levels, and have continued to rise to

the current day.

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7.6: Contact Information for Ryde and Hunters Hill Services Ryde Community Project Lease Contact Information Contact: Community Projects (Community Buildings) Coordinator on 9952 8222; http://www.ryde.nsw.gov.au/Community/Community+Hubs

To Apply for a Ryde Community Building: Fill in the Application for Community Space -‐ Licensed or Sessional (PDF link) and email to [email protected]

Hunters Hill Ryde Community Services Information

Established Services: • Meal Services • Neighborhood Centre • Local transport • In-‐home care respite programs • Social support programs • Volunteer visiting services • Seniors Day Centre (which arranges a variety of social activities within area,

including BBQ’s, picnics, cooking, music, club outings) • Needs specific days (Monday for clients whom speak Cantonese, and

Wednesday for people with dementia symptoms) Benefits of creating such a relationship include exposure to potential clientele as well as access to pre-‐existing activities for the elderly. HHRCS also recognizes the ethnic diversity that exists within the Hunters Hill Ryde area. Their clients come from many different cultural backgrounds including Italian, Spanish, Iranian, Chinese, Indian and Afghan. They employ multicultural staff, as well as utilize volunteer services to create inclusive and diverse activities to suit all. We recommend that CHC follow such a model and employ linguistic services, to allow for a more holistic clientele base. The aim of the HHRCS is to support, promote and enhance the independence, quality of life and wellbeing of their clients. They also provide referrals and liaison with other service providers to individual clients. This presents an opportunity for CHC to liaise, and create a relationship with a pre-‐existing, successful aged care organization within the proposed area to create the highest quality aged care.

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Contact information: Hunters Hill Ryde Community Services 42–46 Gladesville Road, Hunters Hill, NSW 2110 Office Hours: 9:00 am – 4:30 pm Phone: 9817 0101 Fax: 9816 5462 Email: [email protected]

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7.7: Staffing Breakdown (Ratio 2:1)

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7.8: Staffing Breakdown (Ratio 3:1)

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7.9: One-‐time Costs 7.10: Ongoing Costs

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7.10: Staffing Breakdown (18 users)

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7.11: Ongoing Costs (18 users)

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7.12: REFERENCE LIST Aged & Community Services Australia. n.d., Innovative Housing Solutions for Older Australians Delphi Technique Summary, accessed 1 October 2014, <http://www.agedcare.org.au/publications/general-‐pdfs-‐images/delphi-‐technique-‐summary-‐q-‐1-‐and-‐2.pdf>k Ageing Disability and Home Care (ADHC). 2011, Respite program guidelines (disability) operated and funded services under the disability services program, Department of Family and Community Services, Sydney, viewed 10 October 2014, <http://www.adhc.nsw.gov.au/__data/assets/file/0005/236786/ADHC_respite_guidelines.pdf> Australian Ageing Agenda. 2014, ‘Big challenge requires bold thinking: Maddocks’, Australian Ageing Agenda, 11 July, accessed 20 August 2014, <http://www.australianageingagenda.com.au/2014/07/11/big-‐challenge-‐requires-‐bold-‐thinking/> Australian Bureau of Statistics. (2003), ‘Main Features -‐ How Australia is ageing’, accessed 18 September 2014, <http://www.abs.gov.au/ausstats/[email protected]/Previousproducts/4914.0.55.001Main%20Features3Sep%202003?opendocument&tabname=Summary&prodno=4914.0.55.001&issue=Sep%202003&num=&view=> Business Council of Co-‐operatives and Mutuals. 2014, White Paper -‐ Public Service Mutuals: A third way for delivering public services in Australia, accessed 20 September 2014, < http://bccm.coop/wp/wp-‐content/uploads/2014/09/PSM_WhitePaper_LQ.pdf> The Centre for Social Impact. 2012, Our Quality of Life The City of Ryde’s Wellbeing Check Up, University of New South Wales, accessed 25 September 2014, <http://www.ryde.nsw.gov.au/_Documents/Community/Indicators_SummaryReport.pdf> CEPAR. 2014, Aged care in Australia: part I – Policy, demand and funding, ARC Centre of Excellence in Population Ageing Research Brief, accessed 1 October 2014, <http://www.cepar.edu.au/media/133377/aged_care_in_australia_-‐_part_i_-‐_resupply__v3_proof.pdf> CEPAR. 2014, Aged care in Australia: part II – Industry and practice, ARC Centre for Excellence in Population Ageing Research Brief, accessed 1 October 2014, <http://www.cepar.edu.au/media/129425/aged_care_in_australia_-‐_part_ii_-‐_web_version_fin_pdf.pdf> City of Sydney Housing Market (2014) ‘Information on City of Sydney Housing Market’, Housing New South Wales, accessed 2 October 2014, <www.housing.nsw.gov.au/InformationonCityofSydneyHousingMarket> Co-‐operatives in New South Wales and ACT. (n.d.), accessed 18 September 2014, <http://www.coopdevelopment.org.au/nswlinks.html#health>

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Grant Thornton. 2012, Living Longer, Living Better, Grant Thornton Aged Care Reform Package Report #1, accessed 10 September 2014, <http://www.grantthornton.com.au/files/2067_gt_aged_care_reform_review.pdf> Grant Thornton. 2013, The Impact of Increased Price Regulation in Aged Care, Grant Thornton Aged Care Reform Package Report #3, accessed 10 September 2014, <http://www.grantthornton.com.au/files/2013_aged_care_report.pdf> JCA. 2011, The emerging environment for aged care providers in Australia and strategies for change, John Coxon & Associates Report, accessed 20 September 2014, <http://www.johncoxon.com.au/documents/agedcare.pdf> LMHU 2010, LHMU submission to the productivity commission inquiry ‘caring for older australians’, LMHU, viewed 18 October 2014, <http://www.pc.gov.au/__data/assets/pdf_file/0005/101795/sub335.pdf> Marketing Mag. 2013, ‘Chris Frame: bringing aged-‐care marketing into the 21st century’, Marketing Mag 21 June, accessed 4 September 2014, <http://www.marketingmag.com.au/interviews/chris-‐frame-‐bringing-‐aged-‐care-‐marketing-‐into-‐the-‐21st-‐century-‐41716/#.VEbPHJOUduA> McCrindle. 2014, ‘Demand vs. supply: Australia’s aged care puzzle’, The McCrindle Blog, 6 May, accessed 10 October 2014, <http://mccrindle.com.au/the-‐mccrindle-‐blog/demand-‐vs-‐supply-‐australias-‐aged-‐care-‐puzzle> National Adult Day Services Association 2014, NADSA, North Carolina, viewed 10 October 2014, <www.nadasa.org> Nielsen, A. 2014, ‘Dementia-‐Friendly Resources’, accessed 11 October 2014 <https://nsw.fightdementia.org.au/about-‐us/dementia-‐awareness-‐month/resources> NSW Department of Ageing, Disability and Home Care. 2008, Metropolitan North Region Ryde/Hunters Hill Local Government Areas Planning Framework, accessed 15 October 2014, <http://www.nsforum.org.au/files/HACC-‐Misc/HACC-‐Planning-‐Framework/Northern%20Sydney%20Planning%20Framework%202008%20S5.pdf> PWC. 2011, Preparing for success in a time of uncertainty and change, PriceWaterhouseCoopers LLC Productivity Commission Inquiry Report Response, accessed 13 September 2014, <http://www.pwc.com.au/industry/healthcare/assets/Aged-‐Care-‐Oct11.pdf> Robinson, A. and Street, A. 2004, ‘Improving networks between acute care nurses and an aged care assessment team’, Journal of Clinical Nursing, 13(4), pp. 486–496, doi:10.1046/j.1365-‐2702.2003.00863.x Victoria, A. (2014, February 27). ‘The Aged Care Assessment Service (ACAS) -‐ Services: Aged Care in Victoria -‐ Victorian Government Health Information, Australia.’ Accessed 18 September 2014, <http://www.health.vic.gov.au/agedcare/services/assess.htm>

180DC Final Report for CHC

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