Podcast, Season 2 -

Industry Wide Co-operation Panel

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This week’s episode is a panel discussion on industry wide co-operation.
 
The aged care sector is an incredibly complex environment with lots of different players with very different priorities, and now more than ever finding common ground and ways to work together is crucial. And there’s plenty of organisations around Australia and the world leading co-operation, from peak bodies and trade associations to global ageing networks – and we’re thrilled to have a really diverse cross section in this episode.
 
Joining us on the panel is Stephen Johnston from Aging 2.0, George Margelis from the Aged Care Industry Information Technology Council, Mary Patetsos from the Federation of Ethnic Community Councils of Australia and the provider Aged Care Housing, as well as Katie Smith Sloan from the Global Ageing Network.
 
The conversation covers a wider range of topics from workforce challenges, the growing scope of aged care organisations and common approaches to the pandemic. This episode also features a short musical break in the middle from our host Ash de Neef.
 
If you enjoy this format of episode, be sure to check out our last panel discussion on activity programs in aged care.
Transcript

Ash de Neef: Why don’t we jump straight into it?
We’ll do a quick around the room to intro ourselves. Why don’t we start with Steven Johnson

Stephen Johnston: Great. Hi Ash. Aging 2.0 is a company, it’s a global, uh, ecosystem for innovation, so great to be here. Just two seconds on Aging, 2.0. It’s an organisation that I founded with Katie Fike back, um, nine years ago now, to bring together technology and innovation on the one hand, with ageing, senior care and longevity issues on the other.
And we’ve grown to about 130 volunteer run chapters around the world. Uh, and we operate a corporate program called The Collective, which is working with corporates to help them, uh, address big missions and grand challenges facing society and helping improve the lives of older people.

Ash de Neef: Welcome to the show. Steven. George Margelis can you tell us a bit about yourself?

George Margelis: Yeah. Hi George Margelis, I chair the Aged Care Industry Information Technology Council, which is a mouthful. And that’s, uh, basically the peak body for aged care technology. Co-formed by ACSA and LASA, back in 2007 officially, but it’s been an operation probably since around the year, 2000. When the, the two peak bodies back then was sort of setting up the aged care IT roadshows.
My background, I’m a medical practitioner by training, uh, been working in healthcare now for 40 years. Last 25 years of that specifically in health technology. So started off in acute care, but as I got older, I started merging into aged care because it became more relevant to me. Um, key, key thing here is around, how do we help the industry adopt technology in a reasonably successful way.
I mean, we’ve seen technology adoption in, in acute care that’s been successful, but that’s gone meandering. Hopefully aged care won’t have that same challenge, but a big journey ahead.

Ash de Neef: Absolutely welcome George. Mary Patetsos welcome. Tell us a bit about yourself

Mary Patetsos: Hello all. My name is Mary Patetsos and I am the chairperson of the Federation of Ethic Communities Councils of Australia. So we’re the peak body that represents people of culturally and linguistically diverse backgrounds. We work in all sorts of areas, health and aged being some of our main focuses. I’m also the chair person of a large aged care provider, a large, not for profit called Aged Care Housing.
Um, we are innovative, we think any way, organisation within a very constrained and troubled sector at the moment. So, that’s what we do. Uh, I don’t actually have one real job, so I also spend a lot of time in health, I sit on the SA health board in south Australia and also on a university council.
So I find the connections between all those things. Very interesting all the time.

Ash de Neef: Yeah, absolutely. a wide remit there, welcome Mary. And Katie Smith Sloan, Welcome, and can you tell us a bit about yourself.

Katie Smith Sloan: Thank you, Ash. Um, well I have the privilege of both leading a peak body and leading a network. Um, so the peak body is based in the US it’s an association of not-for-profit providers of services for older adults, of all kinds. Everything from meals on wheels, to hospice care and everything in between. With about 5,500 member organisations across the states.
Um, but I also meet a network called the Global Aging Network, which is similarly a network of primarily providers, but it’s tech companies, it’s researchers. It’s, uh, businesses that are all interested in making the world a better place to grow old. Um, and our goal is really to share, to learn from each other to innovate, uh, to find solutions and to advocate at the United nations.
So glad to be with you.

Ash de Neef: Yeah. Fantastic. And thanks for jumping on the plane and doing the two weeks quarantine to join…ah sorry. No you’re calling in from the states today.

Katie Smith Sloan: Oh, police.

Ash de Neef: If only! An excellent place to start then is the idea of cooperation amongst the industry and amongst different parties. And I’d really like to, maybe Steven, you can lead us off with this, with your international network that you’re leading. How do unite an industry? How do you foster cooperation?
Any ideas to kick us off?

Stephen Johnston: Yeah, no, I think it’s a really important topic right now. And the pandemic has given us I think, some fascinating and powerful, um, reminders that international cooperation is possible. If we are focused on solving a sufficiently clear and precise problem.
So I think my perspective on this is more about, let’s start with the mission. Let’s start with the problem that we’re trying to solve. And I think this applies to all industry and frankly, all society.
In terms of the look at the raft of issues that are facing us as we get up everyday and bombarded by the news and, uh, personal and macro stories, we can’t help, but think, you know, we’ve got challenges and that is the way that I think about the world. Which is, you know, what are the big, interesting problems to solve. And I don’t necessarily want to constrain the collaboration or the cooperation among any particular type of industry sector or player.
Um, but I think it’s super important to then have the credibility and have the depth and have the industry buy-in with people who have the depth and the connections and the network.
So I do think there’s a healthy balance between trying to think about what problem we’re solving. But then actually also have the real depth and real expertise in sector specific organisations. So I think the real, I think the key thing for me is is mission, mission driven, um, innovation.
And I think it’s about thinking it as a system where we work together and it’s an iterative process by understanding the complexity and the dynamic nature of the work that we’re doing.

Katie Smith Sloan: I would just add to that, that I think that with global aging, we’re dealing with something that we have never experienced before in the world. And so, um, there is no roadmap. We’re building the roadmap as we go. And so we need to work together to do that.
Because none of us have a lock on the truth here, but we all have the ability to offer ideas and to innovate and to work together.

Mary Patetsos: No, I think that’s a really important point. And I, And I think we’re doing it in a context that involves multiple changes. So I said the other day somewhere and I think, I think I offended some people – but nevertheless that’s okay.
Um, I said, look, you know, the idea that there’s a mythical person, lost likely the expectation being a woman at home. Ready and willing to care, um, and spend the second half of her life caring for her parents, having spent the first time, um, looking after children is probably something we need to get over.
Um so expecting that, especially with it community, it’s almost the misrepresentation that there’s this huge family and a whole bunch of people hanging around with nothing better to do. Um, you know, except continue a care role is, is an expectation that we need to get over.
And in that light, how how do older people age really well, um, and have extraordinary lives, um, and what’s available to us to do that. And in some ways I said the pandemic, dare I raise it first, um, as a really huge catalyst, um, to, to push us along in terms of use of technology. We’ve seen that in health and we’re seeing it now in aged care and that connectivity.
So I think this is a real opportunity for us to debunk some old stereotypes and also solve old problems or, you know, wicked problems. Or things that we have always needed to deal with, cleverly right now in different ways.

George Margelis: Uh, look, I, I, I agree with Mary there, and I think. But again, it’s a bit of a pendulum in that we’ve gone from the care, the personal carer doing all work to a lot of technology companies telling us technology will do the whole thing as well. So yeah, it really is somewhere in the middle is a solution. And I think that’s one of the challenges we face in this area is that it’s like classic if you make hammers everything looks like a nail.
If you make technology, everything looks like a technology problem that needs to be solved. Um, how do we combine the technology with the carers, with the social infrastructure? I mean yeah, there’s a whole, you’re right the pandemic’s highlighted a whole bunch of social issues that – we’ve all been talking about social determinants of health for many, many years.
But Sydney in the last couple of weeks has just highlighted the fact that when you put the whole city in lockdown, those of us in the Eastern suburbs that drink coffees and watch TV, watch Netflix. And those in the Western suburbs, struggle to put food on their tables.
So there’s a whole bunch of issues and it is really complex, um, to Kate’s point, my good friend, Eric Dishman about 25 years ago was talking about the silver tsunami coming along. And everyone sort of went, “ah, we’ll worry about that when we get there.”
Well, Hey, we’re there.

Ash de Neef: What are some, can we think of forums in which information that is crucial, but let’s take the pandemic. The, the elephant in the room as we record this in 2021, Australia is suffering multiple lockdowns.
How can we foster cooperation and shared information throughout the pandemic for best practices, for example?

Stephen Johnston: I think that’s, that’s an important point. Um, and I guess, um, Katie and I have a sort of by definition around everything we do on a global basis. I think the interplay between the local expertise where we really need to understand from the front lines what’s happening, what’s working. And you know, the referencing in Mary’s point the cultural and relevance of some of the interventions that might not work.
I mean, I’m spending quite a lot of time with Japanese and they love robots, you know, to be a rather simplistic model. And George would probably know as much as anybody, but that doesn’t necessarily translate to, certain places, but frankly, there are some things that a robot does better. You know, I would rather be carried up the stairway, by a stair-lift than a human. If I was sort of thinking about it broadly.
So I think adapting insights that work globally, I think or having a global perspective is important and then adapting them locally, is significant. And we just did a session with Stanford on, on family care-giving and try to understand the challenges that the startups in the US were facing around family care giving
And they gave us some really clear perspectives that they’re just missing an industry voice around things like, how do we have a common view on impact metrics? and what does success look like in family care giving. And how do we better integrate the family care-giving innovators with the health systems, for example. Which are often seeing the family as an entirely separate thing outside, uh, health and, and the more formal care.
And creating more of an on-ramp between the family system as it is, and the health system is one of those sort of loud and clear models. But each location and each locality is going to be different, but that does need to be an ability to tap into global insights and best practices.

George Margelis: And I think one of the key things is obviously making sure that we strongly support evidence-based information and not, and knock back on misinformation. Because that’s one of the big challenges we face. And Mary might’ve made a comment but I see it from, in the ethnic community that I’m involved with, that misinformation drives a lot of the activity. So therefore, yeah, we’ve got a responsibility to make sure we actually drive evidence-based information.

Mary Patetsos: I agree, and I think there’s much we can learn and we are learning now because the pressure’s on. We have to, we can’t wait. Um, I think the other, interesting thing from my perspective wearing my FECCA hat is, and I’m stating the obvious and everyone else has said it, is access to resources, Um, and status, education status, income status is critical.
For culturally and linguistically diverse communities, there are particular characteristics. We all have a cultural, we will have a language. Um, uh, if you are well-educated and have access to resources and money, you can solve problems.
What this pandemic, and what the situation, the silver tsunami is showing is that the struggle is for those that don’t.
Um, you know, if you can solve the problem for those that have, um, access to resource issues, then you can solve it for all of us. And I think that therein lies the challenge.
I mean, what we know now is that in Sydney, the hardest hit population groups are also the poorest, and they’re also the ones that are essential workers. So they’re all, they’re also the ones living in two or three intergenerational households. So in many ways, the challenge is that clearer, and should be clearer.
And the way in which we break down how we solve them, relies on us understanding some really complex things that in the past we might have parked. Um, you know, we think we’re a first world country. Well, we’re not necessarily, so in some suburbs, even poverty has got a postcode. Um, and, and how we apply our thinking to to that I think is really interesting.
So, there’s goes the challenge networkers.

Ash de Neef: Yeah, Katie, I mean, your, your network is quite large. I imagine that there are a vast array of, access to resources and opportunities within the organisations that you represent, how do you get this sort of equality across there?

Katie Smith Sloan: So we make a real effort to reach out our parts of our network that are in less resourced countries and less, less resourced organisations. We have so much to learn from them. Because to Mary’s point, you know, the drive, the need to be innovative, the need to be creative and just use just sort of basic ingenuity to solve problems when you don’t have resources is something we can all learn from. And take and take away from that.
Um, I also think Mary made a really good point about, um, the essential workers. You know, at the end of the day, providing services to older adults as a human process, it involves people. And technology does have a role for sure, as a lever, as an enabler, but at the end of the day, we need people.
And I would say one of the biggest crisis we’ve faced right now around the world, particularly in the developed world is um, human capital. People willing and, and, uh, able and trained and qualified, to provide services to older adults.
And, we’re all, every country is fighting for the same small workforce. So we have, uh, we’ve created a problem for ourselves that we have to solve. Which is to make jobs in our field valued and valuable.
Pay people well, treat them well, develop strong workforce cultures and give them the tools through technology to allow them to do their jobs efficiently and effectively.

George Margelis: Yep. Katie makes a great point there, I mean just last week CEDA released its report about the aged care workforce in Australia. And it talks about a shortage of, well over a 100,000 in the next couple of years. And to be honest, that’s probably underestimating the problem because of the fact that the unmet need that that we have out there.
Um, a lot of the stuff we’ve been looking at within the council is how do you digitally enable a workforce to be able to utilize technology, to augment its capabilities?
Um, it’s all well and good saying we’re going to implement an IT system, but if the workforce isn’t trained about how to use it, doesn’t understand the base of the value around it, the system is poorly implemented.
And we’ve seen that in a lot of system solutions where great solutions are poorly implemented. Um, then you’re just gonna add work to the industry, not, not remove at work. And, we need to make sure we have a workforce, which is set up to do, be able to utilize this technology properly.

Mary Patetsos: I think the other interesting challenges of course decision makers tend to be a bit older, are the least – or sort of technology migrants. Or, you know, so that they’re not the non-natural inhabitants of the technology world. So we’re making decisions and we’re not anywhere near being experts on it. I mean, so there’s a disconnect between, um, knowledge of that at the top. So you see a lot of failed activity, because it’s poorly informed.
Uh, I think the other bit of challenges that, um, at the same time, we’re absolutely terrified because there’s so much investment now in learning about cybersecurity. The number of, um, attacks per day, and it’s real.
Because in the sector, um, the more we use technology, the more likely at some point that we’ll be hit. How do you run a human service that relies on getting the right people to the right places, to have medication, to do a whole bunch of stuff when the tablets all crash?
So it’s it’s, it’s a very real… So we solve some problems and as humans we create others. So there you go.

Stephen Johnston: That makes me kind of thing. And I’m interested in the other panelists perspective. It’s like, how do we then start to go beyond our remit? When we’ve got things like inequality that are impacting outcomes. We’ve got the fact that, you know, green environmental climate change is impacting the quality of life for older people.
That’s like killed knocking two years off the average life expectancy of sort of driven by air pollution, and I mean the cyber security piece.
It’s almost as if we’ve got a, a range of skills and a range of, you know, agenda items that are mushrooming and a sort of broader than any one industry. And I’m kind of interested in how you all go about like connecting with those cybersecurity, climate change, inequality, institutional breakdown topics, which are impacting our daily work, but they’re not necessarily within the industry.

George Margelis: One challenge I’ve seen is that it makes my board meetings last about three hours longer. Because as we cover all those topics in our board meetings, we end up going down a whole bunch of rabbit holes.
And I guess when you look at the standard eight within the aged care governance, boards that are skills base is going to be really essential. So you can actually have those discussions that are at senior level. I mean, we’ve seen a lot of, uh, boards in aged care, which have been volunteer driven with people with all good intentions, but without the lack of skills to, to be able to capture some of this stuff in their, in their discussions.
We need to move to a much more professionalized, um,skills based board, so they can actually have those meaningful discussions at a board level rather than just at operational level

Katie Smith Sloan: I think it’s such a good, interesting point, Stephen. Cause I think I feel like issues like climate change and cybersecurity I’m out of my league, right? I’m on a steep learning curve and we’ve all always thought those are sort of issues that are very tangential to our core work. But the truth is they are part of our core work and we just have to get smarter about it.
And find those intersections and find those ways of addressing them and kind of tying our work together. Uh, we haven’t done it yet. We haven’t done it yet as a sector. Um, and I think a lot of it is because we just aren’t smart enough about it yet.

Stephen Johnston: But, but at that point, it’s incredibly challenging to even get your head around it. I’ve been diving into crypto in the last, few months and the overlaps with things like “care coins” and creating models by which you start to give people coins to share their data about their steps and their health issues.
You can trace it all back, but you quickly end up with just a crazy amount of budget. And nobody’s nobody… I think in the 15th century, somebody could know everything,

Mary Patetsos: You haven’t met enough Greek women!

Stephen Johnston: That’s a fair point! But I would say that the, level of skill, the professionalization. George, your point is people by definition, the professionalization is like, “I know a lot about my thing”. And they sort of they burrow deep and by definition then they sort of become, they have to be siloed because it’s impossible to go deep and broad for everything.
And I I’d love it to be, hey, we’ve got some awesome tech, cloud answer that gives us answers that, you know when we need them.” I think there may be something that we can kind of get some help from tech, but it’s not enough.
There does need to be more people who can have that perspective, but then you get your, the room Is so full of different perspectives.
One way out of this morass, I think to have to be very specific about the problem.
We haven’t gone into problems because this could be a 12 hour conversation talking about all the different challenge. The way that Mariana Mazzucato talks about the sort of mission driven innovation, and I think quite a few people announced I’m taking this model. Which is, “okay we don’t know everything about everything, but what about, falls of people in their homes when they get out of the bath?” Um, what about isolation of people whose family have moved away? What about, you know, dot dot, dot food, nutrition, and how to increase the protein consumption?
That is, to me, that’s interesting. If we can take a slice and then we go deep and then we get very specific and then we identify, okay, who really needs to be at this table with this various visit? And then if it’s too broad, we go even deeper and even deeper.
And I think there may be a way if we can just get quite specific, that we can bring enough people together to have enough perspective. I just worry that if we just go up a bit and like, then it’s basically, we need Wikipedia, you know, at the table. And it’s just sort of too broad.

George Margelis: Peak bodies are, are a challenge in that, you know, in Australia we probably have half a dozen aged care related peak bodies. I mean, LASA and ACSCA are sort of the big ones. And then we’ve had the Guild sort of fold over the last couple of months.
You know, again, we’ve got OPAM we’ve got CODA, we’ve got so many aged care peak bodies. And they each sort of cover different parts of the sectors to some degree.
So I guess the challenge is, is how do we have a unified voice? And I mean, I know there’s been discussions around that unified voice, but it is hard. Because again, small market, lots of peak bodies, uh, big gorilla in the room has government because it pays for 90% of the care type models. And they struggled to interact with, uh, with a lot of pig bodies for various reasons. It’s not an easy problem.

Mary Patetsos: No and I think part of the challenge is the way that pig buddies had been set up. I mean, you’ve got a consumer group and a provider group as if they kind of oppose? They should be one and the same thing, which I shouldn’t. And I feel it a lot because I, um, I wear multiple hats. So I could be on something wearing my, well because, I’m the chairperson of the Federation, but I’m also an employer and provider. And so I feel that schism quite often.
And then I wear a tertiary education hat where we talk about workforce, which is the other big elephant in the room. Because we don’t have enough people who want to work in the in the sector.
So I feel that frustration a lot because I can see the perspective. I don’t have to wear one hat all the time. I don’t have a job that pays me to talk on behalf of consumers constantly which you have, if you’re a CEO of a peak provider.
The interesting challenge was the, the conversation we had, um, 2020 and continued into 2021, which was visiting rights in aged care.
Um, uh, when we have locked downs, we closed residential care down and all the people don’t get family visits. And that, was a massive, massive, um, example of the, tension that happens. So um, yeah, so providers have to hold the fort and say, well, you know, we can’t have 120 or 240 people walking through here everyday.
I can’t have two people walking through my house, but I can have 240 people walking through a facility, you know a residential care home.
And yet they were demonized for making those decisions. And at the end, in fact, when they, when they, had people die, um, because COVID got inside…

George Margelis: They were demonised again.

Mary Patetsos: They were demonised again. And it dawned on me because I actually went for a walk before it all got really nasty. And a 93 year old was sitting there and I said to him, “how you going today?”, “yeah really good”. “I don’t like this”, he goes “I’ve lived through this before, we will survive.” And I, said, “how do you feel about getting visitors?”
And he was just brilliant. He just said, “look, my 53 year old, son’s just separated from his wife. I don’t know who he hangs around, keep him out of here!” He said, “I don’t want him hanging around me!”

Mary Patetsos: And I just thought, great answer. The 53 year old was writing letters to me saying, you know, “I demand to see my father,” you know, and I’m just, I’m just asking father what he wants. And he basically thought, well, actually I’m quite happy. Leave me alone for a little while.

Mary Patetsos: It’s a complex problem. The solution for the individual is already made for them. He wanted to be safe. He didn’t want to have to, you know, risk. He didn’t want to take that risk.
And no matter what the peak consumer groups are thinking, and no matter what the provider groups are thinking, individuals can make some rational choices. And then we need to hear those rational choices, um, somehow and live with the decisions that we make then, based on those.

Stephen Johnston: That reminds me of the [??] point around, um, you know, the being mortal. And he talks about how the younger kids, kids always trying to like control and protect and, and the older people, there’s a way to live their lives. And I think that is my question for us is to kind of always ensure that we are… That the older people of today and tomorrow are different from the older people of yesterday, cause people are evolving and constantly changing.
And one of the things that I’m interested in and I’m finding myself much more spending, much more time looking at the science of longevity. Not that I’m particularly into all these anti-aging drugs of biotech. But there’s some really interesting commonalities with people who are living longer and healthier and therefore are very different to the people who were that age, you know, 10 years or 15, 20 years ago.
And I think our expectations, just the way that human nature has evolved, is based on what used to work are the tools and the expectations and the processes that we apply to tomorrow’s problems. And that sort of linear thinking doesn’t I think work with either the exponential world in which we’re living in. Which things, we just don’t think exponentially.
Or the fact that the type of people who are in aged care, um, uh, buildings or, uh, living independently, uh, different than they were 10 or 15 years ago.

George Margelis: I guess the question then is what responsibility do we have to ensure that, um, the people who are doing things like longevity exercises or treatments, are again, doing it on the evidence. I mean, I’ve seen a lot of longevity solutions coming out there that are Peter Evans type stuff where, yeah flash a blue light and stand on one leg, and you’ll live five years longer type stuff. To you know proper evidence based stuff.
I mean, there’s strong evidence that things like Metformin, if used properly can increase longevity. What role does technology and industry play in ensuring that we focus on the evidence, not on, not on the hype. And, uh, we’ve all seen the hype and we’ve seen the side effects of the hype. So we need to play with take a responsible role there as well.

Mary Patetsos: Yeah. And in the same way that we need to recognize that while we’ve added, the number of years well, humans are living longer. Um, we haven’t added enough fun and capability in those later years. Well not enough of it.
So, um, and, and you’re right. I mean, if I, if I follow the trajectory of my children’s thinking, my teenagers, um, you know, um, I’m losing capability every minute. I know less every day, according to them. So at some point I’m going to know very little. They’ve just decided that I know nothing compared to them.
So, um, changing that that stereotype or that stereotype of who, you know, what It is to be an older person compared to our younger selves, and how we can capture that and own it and make something of it.
We, our generation, people listening and the people here, we’re not going to be happy, doing things that are not fulfilling, we’re just not. So I, I, you know, we have to be responsible for shaping stuff now because we’re not going to want to be hanging around doing boring things.
You know, I don’t want to be playing bingo at 88. Surely not. Um, so how, how do we add meaning to those later years? I guess it’s a bit of a challenge for all of us.

Katie Smith Sloan: The thing I find find interesting about the whole longevity question is really we’re extending the years that we’re on the planet. It’s not just that we’re extending old age and the years that were old.
So, you know, it could be that over time we consider, I don’t know, young adults start at age 30, not at age 21. Because we’re all living longer, middle age goes till 70, and then old age starts. So I think we just have to think rethink the whole trajectory of our lifespan with this idea that we’ve got perhaps 10 more years of our lifespan.
Now I don’t know what that looks like exactly, what the new nomenclature will be. Um, but right now I think we’re very focused on these were we’re old for so many more years, so we need to make the best of it which is true. But we also need to make the best of the rest of our lives.
Stephen Johnston: I think Chip Conley is good on this, and Joe Coughlin talking about another 8,000 days that we’ve got bolted on. And a project we’ve started with, uh, one of our Japanese partners is called Pinkora [??], the Pinkora society. Which is a version of a Japanese phrase meaning to live long and die short.
And there was this expectation that if you can actually think about, take a step back and say, what would a good society look like in that perspective. Then you would have maximizing your health span, so the time that you are actually alive and in good health, as a percentage of your time, total life. The delay of the onset of frailty and chronic morbidity at the end of your life, And then a good and dignified death.
And I think a lot of people perhaps don’t necessarily think about putting them all together. I think there’s a lot of expectations that a colleague of mine was saying that his sort of version of healthy aging that he thinks people talking about is, “I want to stay 40 forever.” And I think what we’re not necessarily thinking about is actually the whole sweep of things and how to have a quality death as well as a quality life.
And I think if we can put that together – I think it changes if you view things about how we run society and what expectations are. And it forces the conversation much earlier. And I think that would be really helpful for the whole industry and the whole society to think about ageing, not just as something that you have to encounter at the end of your life. But something that you really start to work earlier on, maybe 21-30.
To think through making sure that you maximize your health span and that that work needs to happen much, much earlier in people’s lives.

George Margelis: One issue that is rising. My kids are a bit older than Mary’s and they’re sort of now getting them into the workforce. So, how do we ensure that just by increasing our longevity, we just don’t – the boomers, and my kids call me a boomer all the time, don’t bottle up the system?
I mean, yeah, there’s that challenge of how do you get out of the way and do something else? Which it can be productive, can be enjoyable, it can be fulfilling, but, not block career prospects for the younger generation coming through.
I mean, we’ve seen a lot of people who probably should have moved on 10 years ago, who was stuck there and the the backlog of 30 year olds who can’t get into their professions because of that is a challenge as well.

Mary Patetsos: It’s because we, I mean, we haven’t worked out how to create meeting other than employment. So, so people hang on to work, because it’s meaningful. And I think to some degree it is.
But we have to move beyond that and get… And you know, none of this is helping because there’s been a huge delay. I was looking at the data the other day, huge delay of people um, not, not moving on from what would have been their last employment years because of COVID. Um, they basically saying, well, I’ll just keep on working, um, because I can’t travel.
So in the absence, what we substituted work for was travel. Um, And now we’re stuck, so we’re just hanging. And it this goes for five years, that’s gotta be pretty painful.

Stephen Johnston: Such a waste though. You’ve got all these problems to solve in the world and all these older people who have just retired, or about to retire or want to retire, who are just incredibly un-utilized.
And it just feels that, I mean, there’s been a few people who try to build that bridge, but it just does feel like a massive mis-allocation of society resources. And frankly, the older people who’ve just also, you know, got the resources as well.
So we’ve got this big latent asset in society that we’re not putting to use to solve the interesting. It can be community problems or macro problems, but there’s a lot of wasted mismatch happening here.

Katie Smith Sloan: I think that’s true, and I think it’s because we’ve never thought of older people as an asset and, and there’s so much sort of ageism in our societies that we don’t view them as a resource that we can tap and actually can provide wisdom and, and contribution and purpose.

Ash de Neef: Hey, going back to something that, uh, that Katie you and George have both mentioned, and I’ve seen that you talk about this quite a bit online, as well is the workforce issue and attracting more people into the space. And maybe there’s a way here, I’ll throw out a crazy idea.
Katie, you said that we haven’t seen older adults as a resource before. Is there a way to partner the resource of older adults and these extra years with the problem of a diminishing workforce?

Katie Smith Sloan: I absolutely think that there is. And actually during the pandemic, there has been an interesting example of that. Um, so at the height of the pandemic in New York City, there was something like 70,000 doctors and nurses that came out of retirement to help provide support to the hospitals. In this case, it was mostly hospitals, not so much nursing homes, but in the city. And then that sort of spread around the country.
So these are people who have had years of a profession, they had lots of skills under their belt and they had, we needed them. And I think if we can figure out what was the, what was the impetus for those people other than a crisis was and what did they get out of it. I think we could try to figure out how do we make this more normal and not, just focused in a crisis situation.
How do we redesign jobs so that they’re much more flexible part-time, job sharing, whatever it is, and not think of ourselves as the you know, nine to five, everything is nine to five and then you go home. So that we can accommodate people’s lifestyles as they have left the formal workforce in retirement. So I think we’ve got a lot to do there, but I think, I think both Steven and you have suggested it’s just there’s an untapped resource.

George Margelis: Definitely. I mean, and one of the roles there obviously for technology is to remove those demanding drudgery type tasks, to enable the individuals to be able to deliver the care type tasks. Then again, like you said, there’s a whole bunch of people in their sixties and seventies who are much more physically able than what they were 50 years ago, you can be who can play an active role.
But if you look at the, recruitment in aged care, it’s 25 year olds with a, you know, a driver’s license and the ability to, uh, physically lift someone and turn them. And that that’s not the only skill you need. Maybe even the robots will take a role there.

Mary Patetsos: I think the, I think the workforce challenges in aged care is so extreme that while we continue to pay them 20 plus dollars an hour, um, we’re not going to get older people or younger people to work for the sector. It doesn’t I mean, it’s just what we need to fundamentally change. So you can talk to any physio student in a university, they’ll do anything to not have to go into aged care.
They want to do babies. They want to do, you know, they’ll do disabled, they’ll do private practice, but they just don’t want to work in aged care. Um, yeah.

George Margelis: Yeah and even in medicine. I mean, trying to get geriatricians to actually get actively involved. I mean, you know, there are so few of them and so scarcely funded that. Yeah. At the end of the day, you know, money, money has an important role.

Katie Smith Sloan: There’s a program in the US called teach for America. And it, I just think this is an amazing model. So they take kids out of college, make it highly competitive to get in. Make it very prestigious, to get an assignment teaching in an inner city school for two years.
And these students make this commitment and it’s an incredible resume builder. It’s an incredible opportunity for these kids to learn real life skills, because this is hard work. Some of them stay in teaching, some of them don’t, but somehow Teach for America has made this a prestigious step out of college. And I keep thinking what’s the magic there that we can translate into our field and create that kind of prestigious opportunity?
And hope that you know, of the thousands of kids that end up in whatever this thing becomes, half of them will decide to make it a career or a third of them. But, um, I can’t, I haven’t sort of figured out what the magic is, but there is some magic there.

Stephen Johnston: I think a lot of the time, um, advertising companies, um, change systems. I mean, I was reading about how in the past, women in the 1920s, um, didn’t smoke and this was a real problem for the Phillip Morris. And so they created this torches of freedom campaign where women were getting on the streets smoking, and this is liberating.
And guess what? After that time, we have a massive increase of percentage of women smoking. And I think there is an opportunity for propaganda for good, if you like. Where we can get smart, get creative and sort of thinking about how you said Katie, change the perception.
Of, okay, could it be as exciting as going off and doing a year of service abroad to, you know, go help build schools in Nepal? Could we have that same kind of mentality?
But I think that’s a really interesting opportunity for the people outside ageing who are working in Madison avenue to think about using some of their skills or the Google entrepreneurs who were optimising ad word clicks and social media companies who are wanting us to get addicted. Let’s get them to get addicted to the good things.

George Margelis: Yeah. So obviously one key area we’ve been looking at is. Okay, so we have this workforce challenge. How do you improve the productivity of the workforce? How do you make them be able to do more within the limited resources. And, you know, we were looking at what is the role of data.
If you have data transparency, can you enable a workforce to focus on the things that, that have effect rather than focus on the things that don’t have effect? I mean, in healthcare we spoke about 30% of what we spend in healthcare was wasted until you actually have transparency that I know where that waste is. Do we have that same opportunity in aged care?
Do we sort of start looking at what parts of what’s being delivered by an aged care provider at $40 an hour, whatever it is can be replaced. And I think Katie touched on it and Steven touched on it, by community. How do you get community to fill in some of those gaps? So that aged care providers provide high value care, not just low value care.
And we talk about value based health care in, uh, in the acute care sector. We haven’t even started to have that discussion about value based aged care, you know, how do we judge or value the the care we’re providing. And put the resources in where it’s going to have the maximum bang for buck.
That’s a, data is a tool there, but again, having, uh, the people at the ground actively involved because you know Canberra defines what data is, what value Is. And they have different metrics to what an 85 year old living at home with multiple disabilities has.

Ash de Neef: Hey, Mary. I wanted to ask you because your work with FECCA you’re representing ethnic communities. And a lot of the aged care employees that I interact with in my work are from ethnic communities. A lot of them are migrant workers or their families have come over themselves. Is this a sustainable sort of resource of people only engaging in aged care because of the low wage and low bar to entry there for them?
What’s what’s the story?

Mary Patetsos: The story’s pretty complex, of course. Um, so the workforce has, has got a really high number of, um, people from a migrant and refugee backgrounds. A lot of them are visa holders. Um, so they, they’re on a pathway perhaps to permanent residency, but not always. It’s a very, um, it’s a very difficult space to get young kids, our kids to work in.
Um, so we’ve got low uptake at that. Yeah. And we’ve got international borders closed at the moment. So we have it to keep the workforce that we have, and entice them to stay in an environment where they themselves are being underpaid, and job satisfaction is not always great.

Mary Patetsos: So it’s a really, workforce is a really tricky thing for us. Um, on top of that, we’ve got mandatory vaccinations now for people working in residential care. So, um, it’s the first sector that’s got that happening, so they’re having to jump through another hoop.
Um, so we need to focus on this because we’re just not going to have the supply that we had from overseas in, you know, inevitably coming through to us in the short to maybe medium term.
So it’s a massive issue. Um, you know, that is that clever, clever employers are providing, um, really good work conditions and trying to understand how important it is to keep that workforce. And also to sustain a more permanent a relationship with our workers, where we decasualise. And we’d take them off for that kind of, “we’re in control, and we’ll give you the hours we want to”. To that, “you tell us what you want and which way you want to work so that we can create a more permanent and, um, enjoyable place for you to work. Where you can connect to individuals and your work has meaning as well as just, you know, paying, paying the bills.”
So look, I think it’s a very complex question. I mean, I, I don’t know how many people in first world countries raise children in the hope that they work in aged care. Um, you know, how many of us are telling our kids that, you know, “your best bet is to go and become a carer, um, in an aged care facility or in fact in someone’s home.” Um, so. It’s it’s a real challenge. So I don’t have any…
I mean, we’ve got, we’ve got a workforce and we’re not losing our turnover is low. Um, so on the positive, obviously people that choose to work in that space, stay, if you give them a reason to. And they enjoy their work. So, you know, we don’t, uh, once you start working in aged care, I think you start to enjoy it.
But there are some challenges.

George Margelis: Well, yeah. And then a level four home care patient 20 years ago would have been in an acute care hospital. And now they’re providing level that sort of level of care in the home. And it’s not easy. I mean, I’ve yeah, it’s quite a, quite a risky challenge to, to manage that.

Mary Patetsos: Well, one of the one of the big things we’ve pushed for wearing multiple hats, Um, is that the Commonwealth government consider converting a whole bunch of visa holders into, giving them permanent residency during the pandemic, because I couldn’t go home. And and you know, keeping them and saying, “you can be eligible for permanent residency, stay here. And, the only obligation we have on you, is of course toyou know, be an upright citizen, and to continue working in the sector that you’re currently working in.” So, um, I think that would have been a win-win. But it’s so, so in between everything else, you know, we’re all so caught up in immigration and, you know, um, border challenges, which, um, that always makes for logical policy decisions…

Ash de Neef: Then we’re into politics, right?

Mary Patetsos:
So, well that’s exactly right. And and it’s, it’s, it is gonna be really interesting what immigration policies look like post COVID.

Mary Patetsos: I think even for groups like us, um, but the dialogue or conversation is going to be have to be different. Because we, people are frightened of others now in a way that we made even more extreme than before.
So it’s going to be really hard to have, you know, let’s, let’s do a global economy, a global population movement, approach to problem-solving. That conversation belonged way from, um, our thinking in any logical sense. It would, I don’t think anyone would be brave enough to have it right now.

George Margelis: Yeah. I mean, it’s classic. I mean, we, we have done that pendulum thing. We’ve gone from strong institutionalized care with large residential aged care facilities. And then now we’ve moved over instead of saying, okay, well care has to be in the home. And like you said, Mary, I mean, yes, somewhere in the middle there’s a middle ground that makes sense that we need to that middle. Yeah.

Mary Patetsos: I think the royal commission pointed to some of those challenges and hopefully the move to HIPA, the independent hospital pricing authority, looking at values in the way that it doesn’t hospital and, and acute care may, may help.
I think the other challenge is this move to home care, and what that means. Because what we’ve found is that, home care – staying at home, I mean who doesn’t want to live in their own home, whatever that looks like. But it’s been a very, very tricky thing to do because it’s not always ideal.

Katie Smith Sloan: Well, I think part of that is to look at what are the intergenerational opportunities and stuff, segregating older people in their own separate environments. I mean, it’s just not natural, right?

Mary Patetsos: And we idolize it. I mean we again, we over correct. So yes, institutions are poor and not places that we need to send… Why don’t we improve congregate living or joint up living or situation? Cause I, mean, what we’re finding as people are living longer, is social isolation of older people in their own homes.
So I mean, there’s no joy big and be around home bricks and mortar, when you see nobody, um, except for the carer. Um, so, so at least in I mean, why can’t we design places, that bring people together and aren’t institutions? Rather than the solution being to lock them in their home and say, well, you should be happy here. “Someone will rock off between the eight and eight o’clock and nine o’clock, and the rest of the day have fun” – when they really frail and with dementia.
So we need to be clever. And that sort of dichotomy, you know, this or that has got to stop. And we’ve got to think, well, how do you actually do, um, middle ground stuff a bit better. Which takes the best of based and the best of that and puts it together into something that looks like fun?

Stephen Johnston: And a lot of that is that, that I think good work is already taking place, with age friendly cities with the world health organisation program. And I think there is opportunities to say, what does that next version look like?
If we design our villages and towns and cities that are genuinely intergenerational, genuinely inclusive. And the ability for older people to be, to be seen and be central in the life of a local village in a local town may require some retooling.
It may require not having a car centric approach to building towns. Like most US cities are still. And it might have a new approach to security and safety and that sort of urban planning and urban design and social infrastructure becomes part of the conversation.

Ash de Neef: It’s really interesting mentioning those intergenerational communities. I’m edging towards the point of buying my first home. And I keep seeing like, “oh, retirement village for say, oh wait, no, they wouldn’t let me in.” But the idea of like, of being able to live in a community of people who are up for socially engaging who want extra support, who want to provide value to me as a younger person is, is really exciting.
And it’s kind of disappointing that there’s nothing there immediately for me to jump at. I think there are some models in the US maybe Katie or Steven, you know of some that are kind of edging in that direction

Katie Smith Sloan: There are some.

Mary Patetsos: There are in Greece. Sorry I was just going to say that the villages in Greece do it really well.

George Margelis: I was going to say that my parents’ old village in Greece would be a perfect environment for that. I just can’t get over there at the moment.

Ash de Neef: Yeah. Give me the plane ticket and I’ll go.

Mary Patetsos: And they happen organically.

George Margelis: Yeah.

Ash de Neef: Yeah.

Mary Patetsos: Sorry Katie.

Katie Smith Sloan: No, I was just going to say there are some, some examples. I think they’re more and more people who are, uh, providers that are looking to create those examples. There are some of them that are sort of natural that have just organically, um, evolved.
I mean, I live in a neighbourhood in Washington, DC, close to the Capitol, so Capitol hill. And there is a village, a virtual village in my neighbourhood of older adults who have come together and said, we want to stay in this neighbourhood for as long as we can.
So we’re going to come together, we’re going to create our own organisation. We’re going to run it ourselves. We’re going to provide companionship to each other. we’re going to help each other out. We’re going to provide activities. So for the group of guys that love history and they meet for lunch every Tuesday and, talk about history. And there’s another group that does Yoga. I joined when I moved to this community, because I was so curious about what was going on.
I can’t, you know, I’m busy. I don’t do anything with them, except read their newsletter and know what they’re doing. But I, love it because it’s completely organic. It’s completely self-driven and it’s older people saying, “this is how we want to live the rest of our lives. Or as long as we possibly can, to live our best lives. And we know we meet each other, so we’re going to lean on each other and learn from each other.”
And there are these all over the country.

George Margelis: And it, this is an opportunity for technology to play a role in facilitating that. Because again, you know, the chances of, of walking down the street and bumping into a half a dozen people with that same mindset is limited. But finding a half a dozen people online with that. same mindset within 10 kilometers is probably a much more positive use of Facebook than watching anti-vaxxers online. So

Katie Smith Sloan: I think you’re right.

George Margelis: But there’s opportunities there.

Stephen Johnston: I love how a lot of these conversations end up with localism being a common thread. Which is, you know, at the end of the day, it kind of goes back to how we’ve lived, most of society in small groups of 150 people, intergenerational, very organic. And I think a lot of what Europe has got to add to the conversation around innovation is to re-imagine what success looks like.
Whereas I think a lot of the time we think that innovation is all defined in terms of tech, startups and, um, big corporations. But I think a lot of the more organic village vibe, is native to Europe. And I think there’s parts of America that, uh, that are doing this as well.
But I think the mentality and in still American cities is, is not like this. And I think that’s where we, going back to the very beginning of the conversation, learning from Japan. Learning from parts of Asia, learning from parts of Australia. And learning from wherever they are in the world that are doing interesting things.
The bluesette [??] I think has done a fantastic job of just sort of highlighting what works in a very Organic, uh, but also analytically helpful way. To sort of, pull it apart of model and bring those components. So that to me just sort of shows that we sometimes have to go back, uh, to go forward.

Ash de Neef: Yeah. Hey guys, we’ve covered a, a lot of different stuff here. Lots of different opinions and ideas shared on a really huge range of topics. Before I start wrapping up, do you guys have any questions for each other or anything you wanted to bring up while we’ve got this space and time?

Stephen Johnston: Well, you mentioned George about the efficiency, I think it’s very interesting. I didn’t know if there’s a resources you can share about like how, what are you doing in terms of helping people be more efficient in terms of the processes and the procedures? Is that something, a study that you’ve done?

George Margelis: So we did a study last year, looking at sort of the current level of use of technology in aged care. And found it to be a hugely heterogeneous. We have some organisations that had, you know, great systems, bulk of organisations that had a few systems in place, but were not well integrated. And many organisations that had nothing.
So we’ve been looking at that whole model of digital maturity. How do you build on your digital maturity to improve your organisation? Um, and the reality is, you know your core infrastructure doesn’t work, then just dropping in a solution into a organisation without core infrastructure…
I often talk about this concept of vanity projects. People do these great now technology demonstration projects, which look really good, but don’t actually have any value. Because they just solved very small part of the problem.
So building on digital maturity is really important. That then reflects back on digital workforce. And how do you enable the workforce, and how do you provide resources for the workforce to be, to take better use of technology.
But then co-design comes into it. How do you then work with the industry to say, what are the solutions we need? Because yeah, I mean, I worked in vendor land for many years for a large American multinational, and producing a solution is easy producing or producing a technology solution is easy. Implementing it in an effective way in an organisation and doing the change management associated with it is the hard part.
And it’s going to be an ongoing journey, but again, highlighting successes and sharing failures, I think is a really important part of the journey forward, so that we, uh, learn from each other and, and, and build upon it.

Stephen Johnston: Yeah. Maybe a good follow up, we’re doing a project right now where one of the objectives is how do we shift from one person able to take care of two people to one person take care of four, so like doubling the efficiency in the workforce. But I think that’s part of that is also what’s the quality of the experience as you get.
And you don’t just want to reduce numbers. You want to reduce numbers they’ve got, and improve the quality. And I think that sort of technology as a component, but the overall…

George Margelis: This is where co-design is really important, including the consumer. Making sure that we actually have that consumer reported experience and outcome as part of the measures. Not just, yeah, we were now we can now provide care at $3 per person versus $6 a person. That’s not the metric you want.
But realistically, if we’re only going to get X amount of dollars, we have to work out how do we utilize that X amount of dollars most effectively? So it’s a double-edged sword, but um, yeah, the experience is critical as well.

Ash de Neef: Well, George Margelis, Mary Patetsos, Katie Smith Sloan and Steven Johnson, thank you so much for your time today. It’s been really enjoyable. I feel like, um, I’ve been scrambling to keep up and stay on top of everything we’ve been talking about. So it’s been really informative and interesting for me as well. Thank you so much for your time.

Mary Patetsos: Thanks

George Margelis: Thanks a lot Ash

Stephen Johnston: Thanks Ash.

Katie Smith Sloan: Thank you.

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