PAGE 1 | © ARCARE | © Simavita Limited Walking the Tightrope to Ensure Smart Technologies are in Place Today to Deliver Quality Care in the Future

PAGE 2 | © ARCARE | TECHNOLOGY WILL BE KEY TO THE AGED CARE INDUSTRY OF THE FUTURE Productivity Commission’s Caring for Older Australians report highlighted the need "to harness new cost effective assistive and information technologies that offer opportunities for productivity gains and higher quality care“ Due to expected labour shortages in the sector it is expected that productivity gains would need to be in the order of % per annum Key areas identified by the government include tele-health, remote monitoring and sensor networks The inference of the report is clear, government funding will be directly linked to efficiency gains

PAGE 3 | © ARCARE | WHY THE NEED FOR SMART TECHNOLOGIES? In 2010, 13% of the population was over the age of 65 years and by 2050 this is predicted to rise to around 20% Currently 1 to 5 people working will fall to 1 to 2.7 in 2050 Older people with urinary incontinence are more likely to be living in Residential Aged Care than in the community Estimated that $1.54 billion aged care funding could be attributed to bladder and bowel management – this equated to 32% of the total basic subsidy The rising rates of age-related and other chronic illnesses equal more complex care services OLDER AUSTRALIANS WANT TO STAY IN THEIR OWN HOMES

PAGE 4 | © ARCARE | CURRENT CONTINENCE MANAGEMENT PRACTICE? Expected Outcome 2.12 Continence is managed effectively Primary goal is to identify, treat and manage incontinence Establish an individual Care Plan ACCREDITATION STANDARD 2: HEALTH AND PERSONAL CARE Continence Assessment 1-2 hourly checks Visual identification Manual recording Staff motivation effects the outcome of the assessment CONTINENCE D claim in toileting and continence equates to $13,000 / resident / annum which must cover linen, staffing and continence products

PAGE 5 | © ARCARE | WHY THE NEED FOR THIS TYPE OF RESEARCH? Management of incontinence is a challenge for the individual as well as the family Family members are looking towards us for a solution in providing a standard of continence care they can no longer provide at home Continence will be a focus point in Consumer Directive Care and the transition to a consumer empowered environment will be challenging Managing consumers’ expectations on how the aged care industry will deliver continence care services, will further challenge current practice and will require more evidence based practice The residents’ rights to optimum continence FAMILY MEMBERS ARE LOOKING FOR A SOLUTION

PAGE 6 | © ARCARE | UNIVERSITY OF WOLLONGONG RESEARCH STUDY Research Study: An exploration of the effects of introducing a telemonitoring system for continence assessment in a nursing home (Yu et al., 2014) Published in the Journal of Clinical Care Nursing

PAGE 7 | © ARCARE | RESEARCH TEAM Assoc. Prof. Ping Yu Director Health Information Technology Research Centre School of Information Systems and Technology Faculty of Engineering and Information Sciences Dr David Hailey, School of Informatics Associate Professor Victoria Traynor, School of Nursing, Midwifery and Indigenous Health Professor Richard Fleming, Faculty of Science; NSW/ACT Dementia Training Study Centre

PAGE 8 | © ARCARE | WHY THE NEED FOR THIS TYPE OF RESEARCH? A review of client records from aged care assessment teams found that 87% of registered nurses recorded urinary incontinence as a ‘very significant’ or ‘significant’ reason for relocating into residential aged care Incontinence has both physical and psychological consequences, including damage to skin, urinary tract infections, depression, anxiety, increased risk of falls, dehydration, and adverse or aggressive behaviours The quality of life of older people living in residential aged care deteriorated when incontinence was experienced 71% of residents are incontinent which is set to climb with an accelerating ageing population 25% of care staff time is managing incontinence

PAGE 9 | © ARCARE | CURRENT PRACTICE NOTED Lack of person centred approach Poor compliance with care plans among staff – only 43.9% of continence care plans were implemented Staff feel powerless as they believe that they have no more to offer than routine toileting and incontinence pads Current manual continence assessments are intrusive, unreliable, labour intensive and generally unpleasant for the person and care staff Shortages of staff and high turnover also impact practice BASELINE PRACTICE NOTED DURING THE STUDY

PAGE 10 | © ARCARE | MEASURING OUTCOMES OF TELEMONITORING SYSTEM? Melbourne aged care residence 120 x high care places, 78% women, 22% men Older people (n = 31*) years (mean 81 years) & kg (mean 65 kg) All participants were living with dementia Method Assessment using a telemonitoring system (72 hours), followed by implementing recommendations (new continence care plan) Two weeks later a second SIM® assessment completed

PAGE 11 | © ARCARE | SIM® A 21 ST CENTURY TOOL CONNECTING RESIDENTS TO QUALITY CARE SIM® 72 HOUR ASSESSMENT

PAGE 12 | © ARCARE | QUANTITATIVE DATA - URINARY INCONTINENCE (1) Weight of urine voided into the continence pad (2) Number of prescribed toileting events in the care plans (3) Number of actual toileting events (4) Number of successful toileting events, that is the number of voiding events into the toilet (5) % of successful toilet visits (6) Adherence to care plans by staff MEASUREMENT INDICATORS:

PAGE 13 | © ARCARE | QUANTITATIVE DATA - INCONTINENCE PATTERNS SIM® ASSESSMENT (T1) SIM® ASSESSMENT (T2)

PAGE 14 | © ARCARE | SIGNIFICANT FINDINGS PUBLISHED IN THE JOURNAL OF CLINICAL NURSING Positive continence management leads to individuals regaining independence, improving socialisation and overcoming depression associated with incontinence. Effective continence assessment becomes a detective for other clinical problems Using SIM® during this research, caregivers were able to greatly improve continence management within 2 weeks: reduced volume of urine voided into continence pads reduced number of prescribed toileting visits increased number of actual toilet visits increased number of successful toileting events increased adherence to urinary continence care plans by staff

PAGE 15 | © ARCARE | WHAT WERE THE STAFF VIEWS? Before the intervention, staff tended to treat a request by an older person for toileting assistance as merely an attempt to seek social interaction The telemonitoring system raised awareness about the urinary care needs of older people Care staff became more relationship centred and responsive to toileting requests

PAGE 16 | © ARCARE | WHAT WERE THE VIEWS OF THE RESIDENTS AND THEIR FAMILIES? Naomi said: “Jeremy and Isaac did not have one episode of incontinence for a whole 8 hour period. That’s never happened before.” Douglas family stated: “We’re happier because Dad doesn’t feel like he needs to come so early each morning to make sure Mum is helped to go to the toilet. He trusts the electronic system and knows Mum doesn’t need help to go to the toilet so many times in the day.”

PAGE 17 | © ARCARE | CONCLUSION New evidence suggests SIM® could provide more effective urinary continence care Residents experienced fewer episodes of incontinence and associated health problems Family members less distressed and more confident in the care provided Staff motivated about improving continence care through the excitement generated by using a telemonitoring system Shift in focus towards Consumer Directive Care Family members are wanting us to provide a higher standard of continence care CURRENT ASSESSMENT AND MANAGEMENT PRACTICES NEED TO BE IMPROVED

PAGE 18 | © ARCARE | ARCARE’S COMMITMENT TO HIGH QUALITY CONTINENCE CARE One of the biggest providers in Australia of residential care Our brand dictates that we provide high quality services with the relationship in mind We pride ourselves on innovation and promoting positive resident lifestyles Products selected must be financially Rolling out to all Arcare sites Reviewing in light of community care opportunities Integrating the technology with our care planning system Considering other technology to assist in care delivery

PAGE 19 | © ARCARE | REFERENCES Ostaszkiewicz J, Chestney T, Roe B (2010) Habit retraining for the management of urinary incontinence in adults (Review) Oxford: Cochrane Collaboration O'Connell, B.; Ostaszkiewicz, J. & Hawkins, M. (2011) A suite of evidence-based continence assessment tools for residential aged care Australasian Journal on Ageing 30(1); 27–32 Yu, P; Zhang, Z; Hailey, D.; Fleming, R. & Traynor, V. (2011) Urinary continence (UC) assessment and management practices: Mapping improvements for older people living Residential Aged Care Services in Australia Unpublished report; Wollongong: University of Wollongong and Under review for the Journal of Clinical Nursing Yu, P; Zhang, Z; Hailey, D.; Fleming, R. & Traynor, V. (2012) Comparison of continence (UC) assessment and management practices for older people living Residential Aged Care Facilities in Australia : A new telemonitoring system and standard manual techniques Unpublished report; Wollongong: University of Wollongong Pearson et al 2003, Coll-Planas et al. 2008, Dubeau, et al, Australian Institute of Health and Welfare, 2006