Care in the Community

Mecwacare

The organisation has long since outgrown the name because it cares for a much wider geographical catchment area, but declined to abandon it altogether because of the remarkably positive reputation it denotes. “Care” was added more recently and stands for Caring, Accountability, Respect, and Ethical behaviour, something that very much drives the organisation’s services, according to Chief Executive Michele Lewis.

Mecwacare has seen much change in the provision of services for senior citizens over the past five decades. And, as Michele told us, change is accelerating hugely. An increasing—and increasingly aged—population, coupled with ever-growing demands in terms of service provision and quality of care, has not hampered this not-for-profit organisation, which, she explains, is in growth mode.

“The way we address growth,” says Michele, “is by providing excellent services, which creates demand for them. We certainly apply at every opportunity for any government funding in order to expand those services, and we also offer significant private services for care in the home.” Much of mecwacare’s funding comes from relatively small contributions made by the families of the elderly in care—two dollars per contribution which, according to Michele, “goes into our coffers and accumulates. That, together with the interest we receive on bonds, is what gives us the money to enhance services, purchase land and make investments.”

The entire aged care industry is being repositioned to provide a greater proportion of care in the homes of the elderly, first for cost reasons and second because it is considered more desirable for the aged to remain in their familiar environment as long as possible before moving into residential care. “Care is moving toward the home as part of a strong government initiative,” explains Michele. “Residential care is more expensive, and the government is keen to see people being looked after in their own communities and homes. It is the people who are more chronically unwell who use our more supportive services and facilities.”

The length of stay in a mecwacare residential facility used to be an average of seven years, but now it is down to two: the last two years of a life, when more intensive care is necessary because of people’s increased frailty, rather than a more considerable slice of a person’s life when he or she remains fit enough to live independently in their home —with a little supported assistance, of course. “The people who arrive in our service are much more aged and declined in health than they would have been ten or twenty years ago,” says Michele. “The people we are looking after are in a much more palliative phase of their life and require more intensive nursing by our staff to provide some quality of life in their latter years as they head toward the end.”

Mecwacare is looking to grow both the home-based and residential sides of its business; the waiting lists for its facilities are testimony not only to the national shortage of care places for the aged, but to the reputation the company has for quality and excellence of care. The organisation wants to buy more social housing, according to Michele, “so those that are disadvantaged can live in a safe home environment and receive support as they grow older—the homeless or people on low incomes who are unable to have their own homes, who can obtain better health outcomes if they are in a safe, quality home with ongoing security of tenure. We are expanding this area to provide care in these homes. We are expanding our home nursing care business into broader areas of the [Melbourne] metropolitan region, and we are looking for other residential services. We believe we have a really good product to offer the community.”

Michele says mecwacare constantly receives positive feedback about its quality: “People definitely do want to be with us. But we are not out to buy just any business or property. We are looking to expand in the right ways, looking for staff and services that meet our value base.” Michele runs a tight ship, avoiding the pitfalls of allowing a business to overlook efficiency in favour of doing good: “Fiscal accountability is critical, in my view. It’s no good if we cannot sustain the organisation over time. There is always a tension between management and carers around the need to provide care while maintaining long-term viability so we can continue to offer a valuable product worthy of the values we extol. It is critical that we meet these values at every level and we are a modern business, not a cottage industry, needing strong quality systems and accountability.”

Michele is clearly not satisfied that remuneration for care workers and nurses in this industry is not on par with other jobs. “You can get more money holding up a stop sign on the street than working at the coal face of aged care,” she says. No one works in this industry solely for the money, she agrees, but, “Nevertheless, we have a really good staff retention rate and we are very proud of it—and of them.”

Word of mouth is key and the reputation of mecwacare—53 years young by the standards of some Melbourne establishments such as 155 year old Melbourne City Mission, perhaps, but much longer established than most entrants to the sector—precedes it. “I prefer to say, ‘let’s get our heads down and make sure we provide really good care,’ that we are reliable, safe, and honest, and that we deliver on our promises and that everyone receives the best level of care.”

There is, she says, some value in the government’s new, more consumer-focussed approach to aged care, as portrayed in the Living Longer, Living Better programme outlined early in 2012. This is good for elderly people who have friends and families that can help them join all the dots in a much more complex series of often bureaucratic systems, but according to Michele, “It can be difficult for some people when they age, without such support, to be trying to manage their money and understand the complexity of the industry. But generally speaking, I think the initiatives are good in terms of people being able to advocate and have a more transparent aged care system.”

Michele agrees it is good for people to be cared for in their own home, as long as that care meets their current needs. “I’m not sure how good it is if you suffer from an illness such as dementia, and are being looked after at home, or are alone and without community connections, or if you can’t look after yourself and need 24-hour care rather than someone coming in for a few hours.”

She also agrees with widespread criticism that the ACFI should be more needs-based: “If you are asking me, ‘is aged care well funded?,’ I would have to say no. I don’t believe it adequately compensates organisations for the care that is undertaken. I think it’s a very good idea for consumers to be paying more toward their care, but I would be interested to see if consumers embrace that idea. My experience is that people tend to think it is the government’s responsibility to pay for the aged—that is the society we live in, that believes you work hard all your life, you get a pension, and the government should look after you. But the government is clearly saying you have to look after yourself.”

Governments are less interested, Michele agrees, in provision of aged care in part because of the blow-out caused by baby boomers: “The person that gets squeezed is the provider. The not-for-profit provider is expected not to place dollar values on care provided.” Mecwacare is growing despite such a straitjacket, but its profit margin (for reinvestment) is a much lower proportion of turnover than would be tolerated in other industries, leaving the organisation constantly vulnerable because of the inability to keep a long-term buffer as a hedge against disasters or increases in demand. More revenue would allow the Board to put a little aside for a rainy day, but according to Michele, “We feel very strongly this is community money; it belongs in the community, and we must manage it very wisely.”

In terms of the level of service provided, Michele says, “there is always room for improvement. We are always searching for ways we can do things better.” Mecwacare is closely involved in hands-on nursing care improvement and research to examine best practice, working with bodies including the National Australian Research Institute and Latrobe University on programmes examining how better to deal with things like falls or dementia.

Michele and her team display a passion for quality and a desire to uphold the traditions of the community-based organisation’s roots, not looking over their shoulders at the rest of the industry but preferring to simply work to do things better. It’s less about beating the others than about ensuring that mecwacare strives from within to keep getting better in a pattern of continuous improvement, she says. “If we look at our competitors, we are looking away from where we need to focus, which is how we can do things better ourselves.”

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July 20, 2018, 12:42 PM AEST

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