On Wednesday 6 March 2024, Neerim Health hosted a Community Meeting at Algie Hall in Neerim South. The Community Meeting was held to outline our current Health Services; Aged Care Services; our Facility Infrastructure and Utility Challenges; the Priority Community Infrastructure Program Grant; and plans for future Health Services. Outlined below, is a summary of the information presented on the evening by Lauren Mucic, Director of Clinical Services and Andrea Linden, Chief Executive Officer. Between Lauren and Andrea, it is their responsibility for all day-to-day operations at Neerim Health.
Neerim Health Services
Presented by Lauren Mucic, Director of Clinical Services
Currently, Neerim Health services include:
Aged Care – Residential, Short Term Restorative Care (in Home) and Respite;
Day Procedures – Ophthalmology, Endoscopy and Dental; and
Hospital Ward – In-patient Care, Transition Care Program, and Palliative Care.
Our Day Procedure theatre was fully updated two years ago, and is fully compliant with current standards. Neerim Health has passed State Government Department of Health Private Hospital Regulatory assessments as well as being Australian Council on Healthcare Standards Accredited – which means we have met the National Safety & Quality Health Service Standards.
Our Residential Aged Care “Tarago Views” home was built when hostel style living was the design of choice for Aged Care[1]. Hostel style living is no longer the accepted model for residential facilities. Our facility is licensed for 25 beds of which six rooms have ensuites. The remaining individual/shared rooms have access to two communal bathrooms. Which means, that up to 18 residents would share two bathrooms. Potential residents and family members often find the shared communal bathrooms as an unacceptable long-term choice.
Over the last two years, of the 25 beds available, only 14 to 17 beds have been occupied on average.
Admission Limitations
There are limitations on the type of patient or resident we can admit to Neerim Health. This is due to our remote/rural location; on-site medical care; and distance to emergency care.
When considering who we can safely care for, we need to take into consideration what would occur in the event of a medical emergency. Noting, we have:
No Doctor Onsite 24/7 – Any initial response to a medical emergency is provided by Neerim Health nurses. If further escalation of care is required, then patient/resident transfer to another health service is often needed.
No Emergency Department (ED) Onsite – Our closest ED is 20 minutes away, and the closest hospital does not currently have an Intensive Care Unit (ICU). The closest ICU is at Casey or Traralgon, and then, a vacancy is required before the patient/resident can be transported by ambulance.
No Dementia Specific (Memory Support) Unit Onsite. This means that all our residents are cared for in the same communal spaces.
We need to thoroughly assess someone’s behaviours and symptoms before deciding if they would be a “good fit” to live full time with current residents, and if we are able to provide adequate levels of care.
We have limited access to geriatricians and even less access to Aged Persons Mental Health. Many of those consults are undertaken virtually which is inefficient for identifying and assessing behaviours of concern.
If a potential resident’s medical needs are not appropriately taken into consideration, there is the potential to increase ED visits if behaviours are a risk to themselves or others. ED visits should always be a last resort care option due to the impact on the resident.
Admissions Capability Framework
It is only as recently as 2020 that Neerim Health began to formally assess patients and residents prior to admission to ensure that NH did not admit a patient or resident whom, given our admission limitations, we could not adequately care for. The 2020 Admissions Capability Framework has grown into our updated admission capability framework; pre-operative assessment; and appointment of a pre-admission nurse to limit risk in the peri-operative suite and hospital ward beds. All residents to Tarago Views and patients for day procedures and admission to our hospital ward must adhere to the same admission capability framework.
Tarago View Aged Care
Do we meet standards?
Tarago Views has passed accreditation as well as additional monitoring since the notification in December 2023 to the department of our transition. The Aged Care Quality & Safety Commission is a federal level Commission that oversees the compliance of all Aged Care Providers across the country.
All Aged Care Providers are aware, and have been aware for years now, that there is increased transparency and access of information to the public so those accessing services can make informed decisions. Since the Royal Commission handed down its findings in 2019 all providers have known that an organisation’s information, including compliance, feedback, quality measures and financial information is accessible and transparent.
Tarago View Aged Care performance in relation to Compliance, Quality Measures, Residents’ Experience, and Staff can be found at myagedcare.gov.au/find-a-provider/
As at 26 February 2024, Tarago Views received an overall star rating of four out of five stars “Good”.
Compliance
Three stars “Acceptable” which means Tarago Views Aged Care has no compliance issues, was last updated 9 October 2023. The Aged Care Quality Standards are a subset of the compliance requirements designed to provide an easy way to see how each home is performing. For example:
Quality Measures
Four stars “Good” which considers if Tarago Views Aged Care is delivering good clinical care. This rating was most recently updated 26 February 2024.
These Quality Measures target aspects of health and wellbeing that are more likely to affect older people but can be minimised when good quality care is provided, such clinical areas as pressure injuries, restrictive practices (previously known as restraint – physical, chemical and environmental), unplanned weight loss, falls and major injury, and medication management. In all cases, a lower percentage is a better result.
Residents’ Experience
Four stars “Good” rating shows what current residents think of Tarago Views Aged Care. This rating was most recently updated 20 December 2023.
The results are from an independent survey of residents which are used to calculate the Residents’ Experience Rating.
Staffing
Five stars “Excellent” considers the amount of care provided by Registered Nurses, Enrolled Nurses, and Personal Care Workers at Tarago Views (TV). This is reported quarterly and the target is provided by the Australian Government. This rating was most recently updated on 26 February 2024.
The rating shows if we meet our quarterly targets:
| Government Target | TV Average Result | |
| Direct Care Per resident per day |
206 minutes | 288 minutes |
| Care from a Registered Nurse per day | 43 minutes | 98 minutes |
| Registered Nurse Onsite 24/7 | 24 hours 00 mins | 24 Hours 00 mins* |
* The national average was 23 hours 32 minutes of the 24/7 RN target.
After mandatory onsite 24/7 Registered Nurses came into effect in 2023 many facilities moved to reduce the number of hours enrolled nurses were onsite in order to offset the increased wage cost.[2] Neerim Health has for over a decade had a registered nurse onsite 24/7 as well as an enrolled nurse in the morning and afternoon shift.
The Staff rating does not take into account our dedicated Lifestyle care team, who are also experienced Personal Care Workers. As well as our Environmental Services and Kitchen team who work collaboratively with our care team to ensure the residents are in a safe, clean environment and provided with meal choices that suit their needs and preferences.
We are proud of the care and support provided by our dedicated and loyal staff.
Finance & Operations
Not a rating as such but an important element of an aged care home to understand. The finance & operations helps one to know how a provider is being run and funded. This section provides an overview of the expenses and income streams, as well as important business details.
Expenses
Expenses incurred in the financial year ended 30 June 2023:
| Sector Average | Tarago Views | |
| How much did this provider spend on care and services? Per resident per day. |
$344.07 | $467.71 |
| Comprised as follows:** | ||
| · Care & nursing | $191.68 | $311.81 |
| · Administration | $44.59 | $55.07 |
| · Cleaning and laundry | $29.53 | $26.72 |
| · Accommodation and maintenance | $36.74 | $15.07 |
| · Food and catering | $36.89 | $59.04 |
** We are aware the Sector Average figures don’t add up to $344.07. The Sector Average figures are as reported on the MyAgedCare website. Any queries as to the discrepancy should be directed via the MyAgedCare website.
Notes:
Care & nursing – Tarago Views spending is 63% above sector average.
Administration – 24 % above sector average – due to increased demands of reporting, accreditation and meeting standards and addition of Quality, Learning and Development position required in all facilities.
Cleaning & laundry – 10% below the sector average. This includes the cost of cleaning and laundry staff, supplies, and equipment they use. We reported no additional spending in the period on COVID and infection control.
Accommodation & maintenance – 59% below the sector average. This cost includes supplies, maintenance staff, equipment and real estate costs. Neerim Health is well under the sector average as it has owned its property since the 1960s and has no major property loans, compared with other sector providers.
Food & Catering – 60% above the sector average.
Many other factors, including the costs of allied health (in great demand in the West Gippsland area and therefore the pricing has increased) have caused a significant increase in the cost to provide adequate care to residents.
As outlined above, no matter our financial position we do not and have not compromised on the funds required to care for those that live or stay in our facility.
Income Streams
Income received in the financial year ended 30 June 2023:
| Sector Average | Tarago Views | |
| Where does this provider get its income from? Per resident per day. |
$332.81 | $341.15 |
| Comprised as follows:*** | ||
| · Residents’ contribution | $79.71 | $81.93 |
| · Government funding | $241.49 | $250.68 |
| · Other income | $2.20 | $8.53 |
*** We are aware the Sector Average figures don’t add up to $332.81. The Sector Average figures are as reported on the MyAgedCare website. Any queries as to the discrepancy should be directed via the MyAgedCare website.
Budget Surplus or Deficit
The financial performance for the last financial year provides an insight into how Aged Care providers operate financially – showing how much their spent above or below their income.
The budget surplus or deficit for the financial year ended 30 June 2023:
| Sector Average | Tarago Views | |
| Budget Surplus/Deficit Per resident per day. |
-$10.91 Deficit | -$126.56 Deficit |
The difficulty we have faced in the past and now is akin to asking, “Where would one suggest we cut spending to reduce the deficit?”
Less care and nursing staff?
Less food and catering?
Previously, Aged Care has been subsidised by the income generated by our other services. Unfortunately, the increased cost of running all our healthcare services, compounded by our low bed numbers and admission limitations has meant that the income generated within Aged Care and across our other services no longer fully supports Tarago Views Aged Care. This means that year after year we are running at a loss and not able to afford the facility improvements required without assistance from the government and other available grants.
Tarago Views Aged Care
Presented by Andrea Linden, Chief Executive Officer
Whilst Lauren has outlined our admission limitations, touched on the financial losses, per day, per resident, there have been many efforts made in the past to improve the facility. Tarago Views Aged Care is a homely, welcoming and comfortable place for our residents to live and our staff to work. And, we have great views! In the last ten years, efforts have been made by previous and current boards and staff to improve the facility, such as:
| Year | Funding | Area |
| 2004 | $$$ Grant | Banksia Ensuite Rooms |
| 2018 | $200k Grant | Day Room Upgrade |
| 2023 | $150k Grant – Refunded* | Two new ensuites |
| 2023 | $16k Part Grant & NH Funding | Improvements to Wifi Capability |
| 2023 | $23k NH Funding | New Air Conditioning Units |
Notes:
Whilst Tarago Views has been and continues (for the short term) to be a homely and comfortable place to live, our biggest hurdle is with our ageing infrastructure and failing utilities. Our challenges are under the floor, in the walls and in the ceiling.
Infrastructure & Utility Challenges
Most of the works over the last ten years has been cosmetic. Our core infrastructure and utility issues have not been addressed, either due to lack of resources or simply that to address the issues, the walls, floors and ceiling need to be pulled apart.
The facility is new 57 years old. The challenges of the facility are as follows:
Lastly, our Aged Care facility does not meet the National Aged Care Design Principles and Guidelines. We are far from meeting what is the acceptable current minimum standards of accommodation.
Our infrastructure issues have been going on for ten years, if not longer. The only way to fix the issues is to pull the place apart, get into the walls, floors, ceiling, and renew the facility.
When the whole facility is losing money, we do not have the resources (without going into significant debt) to purchase new equipment, upgrade or renovate the facility. It is too much to ask the community to fund.
Grants are the best way for us to renovate the facility – allowing us to continue providing a range of healthcare services and providing the opportunity to expand the range of services to the community.
PCIP Grant
As we announced recently, Neerim Health has been successful in being approved for a $5 million Priority Community Infrastructure Program (PCIP) Grant, which will allow us to redevelop the site creating a Community Health Hub. We are appreciative of the funding from the Department of Infrastructure, Transport, Regional Development and Local Government.
The Minister, The Honourable Catherine King, MP, approval for the Grant was given on 16 November 2023 last year. The Minister wrote in her approval letter: I am pleased to advise you that I have approved funding of up to $5,000,000 (GST exclusive) under the Priority Community Infrastructure Program (PCIP) to Neerim Health for the Neerim Health Community Health Hub project. This approval delivers on a 2022 election commitment.
Until the Grant Agreement was signed on 12 February this year, Neerim Health was bound by confidentiality.
We gratefully received our first instalment on 16 February 2024 which is being used to fund the cost of the design, services, engineering surveys, etc, and next steps with the project.
As an aside – Grant Agreements include milestones and clear deliverables. Every dollar spent is accounted for to the department; and any money unused is returned to the department.
Neerim Health undergoes an independent financial audit every year as part of being an Aged Care provider, a Not for Profit and Charity organisation.
The PCIP Grant is providing the resources to renovate our facility and provide modern facilities designed to complement our existing services and provide for new community health services in the future.
Renovations
The renovation timeline is July 2023 to December 2025, pending council approvals etc. The renovations include major demolition of internal brick walls, renewing aged services/utilities; attending to roof and stormwater issues; addressing uneven floors, etc before restoring the facility. Plans are available to view, during business hours, in our Learning Centre at Neerim Health.
In the South Section new group rooms will be fitted out for day respite, lifestyle activities, dining/lounge, etc. A new rehabilitation gym will be built to compliment physiotherapy services to our existing patients and can be extended to day respite and others. New toilets and shower facilities will be built. Our current commercial kitchen will be refurbished to continue onsite catering to our patients and consumers.
In the Mid-Section, new specialist and allied health consulting suites will be created with the potential to provide local access to occupational therapy, physiotherapy, diabetes management, etc. A new procedure room will also be built which could be used in the future for Urgent Care and/or Nurse Practitioner Lead clinics. We will also have a room devoted to Telehealth services, improving access to specialised consultations locally.
As the newest part of Tarago Views, the Banksia Wing will become the new hospital ward with a new after-hours access. Very little will be required to bring these areas up to standard. We will also introduce a patient/visitor lounge.
General upgrades will include new rear access – new compliant and covered stairway, and a new lift and rear access to reception from the rear carpark. The front entrance will include a new canopy for ambulances setting down/picking up patients. Our reception and waiting areas will undergo a refresh to improve customer service, confidentiality and the patient journey. Currently, in each area, our staff share one toilet with visitors/patients. To address the congestion issue, we will build new accessible toilets for staff and visitors.
We are proud of our long history as a bush nursing hospital to Neerim District Soldiers Memorial Hospital to today as Neerim Health Inc encompassing the Memorial Hospital and community healthcare services. We have may signs, artwork and plaques that will be removed during renovations, stored appropriately and reinstated when the facility is renovated. We are also attached to our front gardens and significant trees and will take steps to protect them as much as practicable – changing plans if needed.
The PCIP Grant will enable us to deliver existing services and build capacity for new services, in collaboration with local GPs, Monash Rural Health, West Gippsland Healthcare Group, LaTrobe Regional Health and others. It also provides an opportunity for community healthcare services and community collaboration.
Neerim Health has no plans to build a new operating theatre in the next 10-12 years. We also have no plans to become a drug rehabilitation facility. And, we have not given up on Residential Aged Care. We intend on taking full advantage of a new Aged Care Capital Grant which was announced at the end of 2023.
Aged Care Capital Assistance Program Thin Markets
https://www.health.gov.au/our-work/aged-care-capital-assistance-program
The Aged Care Capital Assistance Program (ACCAP) provides grants to build, extend, or upgrade aged care services or to build staff accommodation where older Australians have limited or no access.
Round one opened in November 2023, and closed on 12 January 2024. There is a total of $95 million available for staff accommodation and upgrades, expansions and new builds. The grant process is competitive.
Neerim Health will submit a $30 million grant application in Round Two, which is scheduled for the first half of 2024.
We are currently working on the application, to ensure our grant application has the best chance of success. Should we be successful, it will take at least four to five years to build the new facility, behind our existing facility. Our scope of works includes:
There is no guarantee we will be successful, but we will do our best. We have a very strong case for reintroducing aged care in a new build.
This grant is our only real option for reintroducing residential aged care in the near future. If we are unsuccessful, and we will give it the very best chance possible, we will keep trying as new opportunities present themselves.
Neerim Health Services in the next 18 Months
In the next 18 months whilst we renovate the facility, our healthcare services will not change significantly.
We will continue to focus on what we are good at and focus on services for which we have accreditation.
Aged Care – Short Term Restorative Care (in Home), Respite and Home Care Packages;
Day Procedures – Ophthalmology, Endoscopy and Dental; and
Hospital Ward – In-patient Care, Transition Care Program, and Palliative Care.
The main change will be with Aged Care where we will transition our residential services to home care packages. We are also investigating with the Federal Department of Health and Aged Care to continue offering Respite in our Victorian Department of Health accredited hospital ward. A similar arrangement is in place at Orbost Regional Health.
Future Opportunities
Once the facility is renovated, our Community Health Hub will be able to offer:
We will also look to expand our services to nursing in the home and palliative care in the home.
Community Involvement
Neerim Health is committed to providing health care services to the community, that meet their changing healthcare needs. We encourage the community to get involved through becoming:
We encourage locals to provide feedback as to what health services they would like provided at Neerim Health, or they may be a healthcare/allied health care provider and wish to offer services at Neerim Health.
Finally, local providers may wish to partner with us in providing Home Care Packages. We will be looking for partners providing maintenance, gardening, cleaning services, etc. Please note: As per Aged Care Requirements, partners are required to have appropriate insurances, licences, WWC, Police checks and vaccinations are mandatory.
Please send expressions of interest to be a Consumer Representative, Health Service Suggestions and/or Partnering Opportunity to info@neerimhealth.org.au
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12 December 2023
After much consideration, Neerim Health confirms our intention to cease offering residential aged care at our Tarago Views Aged Care facility from 1 July 2024.
We intend transitioning aged care residential services to home based and day respite services as we begin building the Neerim Health community health hub and adding further healthcare services – thereby retaining our dedicated workforce and expanding our services to the community. Commencing in July 2024, our facilities will undergo a significant upgrade, with thanks to a $5 million Federal Government Priority Community Infrastructure Program Grant. Please note that this grant is to upgrade community facilities and is not related to Residential Aged Care or Hospital Acute services.
In the last financial year, changes to aged care funding and substantially higher operating costs that exceeded our subsidies, resulted in a significant financial deficit. As a community-owned health service, our funding is neither stable nor fully underpinned by government.
In October 2022, the Federal Government increased compliance requirements for residential aged care. The current scale for an aged care facility to be viable is a minimum 100 residents. We only have 25 beds (only six of which have ensuites) but are required to put in the same level of resources as a larger facility. Maintaining residential aged care has been a challenge for Neerim Health for many years. Now, it is simply no longer viable.
Whilst we understand that this news is distressing, we believe that providing over six months’ notice will provide ample time for residents and their families to assess their options, view alternate facilities and make an informed decision about their relocation.
Neerim Health is committed to supporting residents and families in making their relocation as smooth as possible. We are also committed to providing quality care for all residents to 30 June 2024. Whilst we will not be accepting any further permanent residents, we will continue to welcome respite residents.
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