Please note: The transcript below is automated by speech recognition software and may contain minor inaccuracies.

Jeff Howell (00:07): 

Hi everyone. And welcome again to home health, 360, where we speak with leaders in home health from across the globe. First, we have Rosie lawn today. The CEO of Aviva in Perth, Australia Avivo supports over 3000 customers through disability, aged care and mental health funding. This year was the last year of a transition to the N D I S from previous funders. A massive change that required effort from all of their dedicated 1200 employees. Avivo has been doing some great around breaking work. They now have over 100 neighborhood teams and the amount of work that these teams do in their location increase to an average of 62% of total hours during the last year. This is an adaptation of the Bertz org model out of Netherlands. More on that a little bit later, Avivo has also held their fur health conference with close to 300 employees coming together to develop skills and knowledge in the mental health field, all in a year of a global pandemic. Rosie. Did I get all of that? Right. And welcome to the show. 

Rosie Lawn (01:16): 

Yes. Thanks very much, Jeff. Yeah, you took that from my pitch with the end of last financial year and very interesting. Isn't it? You look, when you look each year about what's been achieved and also, and there is times when the, the world is very strange with a pandemic, but yeah, you, you, you got the heart of it. Anyway, Jeff, thank you. Okay. 

Jeff Howell (01:35): 

Okay. Good. And we have Annette hilly for over two decades. Annette has helped deliver quality to elderly and PE people with disabilities that have boosted their independence and wellbeing. Now she has the opportunity to work and connect with people tech with technology so that they can focus on what really matters, delivering better care, creating great places to work and optimizing org operations for home health agencies and net has spent nine years with Baptist care, a leading, not for profit organization with more than 3,500 staff and a thousand volunteers in new south Wales leaving as chief offer operating officer in 2020 and has spent almost the last two years as general manager for Australia and New Zealand at all, Eli care, a leading home health software company. Annette, nice to see you. And thanks for calling in from Sydney Australia. 

Rosie Lawn (02:27): 

That's great to be here, Jess. 

Jeff Howell (02:31): 

So Rosie, let's go over to you. Give us a little bit more background on where your career has taken you and let us know a little bit more about Avivo where did Avivo come from? What's core to the organization and what direction are you going in? 

Rosie Lawn (02:46): 

Yeah. wow, where do I start? Hell <laugh> look I've, I've always used, it worked in community and human services. I actually started out as an occupational therapist many years ago in New Zealand. And soon when, after my graduating, after working there, I moved to Western Australia. I, I initially started out in the health of the hospital system, but actually really soon realized that my passion lay in how we support people to live life and community. And I started working within the disability sector very early in my career, working with families supporting families with supporting them to their development in relation to their children then moving into adults and so on. So I, I really feel very committed to how we support people and families to live life in community and taken on lots of roles, you know, through, from working in government. 

Rosie Lawn (03:47): 

Then I went into not for profit and I had, was involved in starting up a number of new organizations and that town supported people with employment with disabilities. So that was pretty fighting period and got a lot of work in quality, how to support organizations to really go beyond expectations rather than just what the standards stay. And yeah, and then my journey came around about actually out 16, 17 years ago to Avivo when I working there and, and the executive team, or here there, or here, I'm still here and it's the, the roles evolve. So I became the CEO of Avivo about seven years ago, just as the N D I S was beginning to be established in Australia. So it's been an interesting seven years 

Jeff Howell (04:40): 

And were the listeners who have never heard of N D I S can you give us some background on that? Yeah, 

Rosie Lawn (04:46): 

It's the abbreviation for the national disability insurance scheme and it is internationally groundbreaking because it is a scheme that looks at all people who meet eligibility criteria area, having an access to funding, to support them with their goals meet their needs and to support them with their goals. Very big commitment by the Australian government and all the state governments to ensure that every person that's eligible with the disability can, you know, get access to these resources and have much more choice and control in their own lives and what the supports they use. So that's, that's probably a fair, I think that's helpful, helpful to getting a brief description of it. Do you think so, Annette? 

Annette Hilli (05:37): 

Yeah, absolutely. Oh yeah. I think, I think probably too particularly one thing that the N as brought forward was it was actually putting the person with the disability and control of their care and you know, being very much about an individualized and personal model. So other so right, the historical model was very much, this is what we can give you, and this is how it's going to be delivered. This has really turned it on its head. And you know, as it should be, they're in control in regards to the quality of life, that's really going to make a difference for them. 

Jeff Howell (06:09): 

Now, are, are you both aware for our north American listeners that national disability insurance scheme, the meaning of, of the word scheme might be a little bit different than Australia? <Laugh>, mm-hmm, <affirmative>, 

Annette Hilli (06:20): 

There's a few words we have that are a little bit different between that's right. Australia and north America. Jeff <laugh>. Yeah. I, before we started this call, Rosie, I did say to Jeff, please don't use the word patient when you're talking about Australian aged and community care. It's a little bit of the pet hate down here and, you know, is one of the things that I think I kind of struggled with quite a bit because you know, patient does kind of put you into that medical sort of diagnosis mode, which I think is something that we definitely would never want for our elderly or our, our just disabled citizens. It's very much about seeing them as, you know, members of our community, just like Rosie said, and you know, making sure that it's much more holistic in our approach to the current services that they provide. 

Rosie Lawn (07:12): 

Yeah, exactly. And it's it's interesting. Cause I think that that's been one of the things that's all really driven the development of Avivo as an organization. So it was, I was curious cuz I don't see myself as a health provider. Health is one of the outcomes I'm we very much see ourselves as being an organization that supports people's many aspects of their lives. Health is important. It's almost, it's a fundamental thing, but it's not it's it. And then so many other things are important. We would probably, we do see ourselves very much as a, a community support organization that assists people to live their lives and working within many systems, which can be challenging, but but necessary when you look at a whole person and you know, they need, they've got their health, their, their social networks, their education employment all those things make up a whole life so that yeah. Is really important to us and the language is important. So thanks for that image. 

Jeff Howell (08:14): 

Right. And you're more in the business of life care than just healthcare <laugh>. Yeah, 

Rosie Lawn (08:18): 

Yeah. Which yeah, so you were asking me too Jeff, about the origins of Avivo and so as you intro said in the introduction we're we are actually a west Australian organization, so okay. People who know Australia, we're only on the far west coast, 

Jeff Howell (08:37): 

That was gonna be my next question is where do you have a presence? 

Rosie Lawn (08:41): 

Yeah, Western Australia. We started here at the moment we feel there's enough work to work in Western Australia. Mm-Hmm <affirmative> and we've got no plans at the stage to become a worldwide organization. We are very committed to the local roots of people here. We're a state. I don't know if people have looked on the map, but we're a massive geographical size. Very, very large and with a big city Perth on down the bottom Southwest corner and the more temporary areas and, you know, then large a few regional towns and then large areas that where there's country, many indigenous, more indigenous people, first nation people. And yeah, so it's very low population in those areas, but very important populations too. So we work our interest. We probably started out mainly working around Perth and now we work in parts of regional Western Australia, but not all parts. So we work in the Midwest and also the wheat belt. But anyway, it's, that's a that's, that's where we are. Like we are based at the moment. That's where we, we focus our attention. Mm. 

Jeff Howell (09:55): 

And Annette, tell us a little bit more about you and your time at Baptist care. I'm curious where Baptist care is located in Australia. And, and how did you transition into the home health technology side of the business? 

Annette Hilli (10:07): 

So Baptist care in new south Wales and a CT is where we are based. So the opposite end for, for Rosie and SIM, we did a mixture of both the age care and disability services. I was actually there for 23 years, not nine <laugh> which, you know, still is amazing to me because it was, it was sort of a, an industry I fell into to be perfectly honest. I'd, you know, finished university, I wasn't a hundred percent sure where I was going. There was an opportunity in the local paper and started this role at Baptist care. And then, you know, the next 23 years just took me through so many different roles across both aged and disability care at both the corporate as well as an operational level. And it was just one of those things you fall into and you absolutely just love. 

Annette Hilli (10:57): 

And I think, you know, what really was a driver for me is that you were getting to actually make a difference to the lives of so many people and then being inspired by all the people working in the industry. Because while it's definitely been a tough couple of years for, for the space, with everything that's been going on down here, down in here in Australia with some Royal commissions, a pandemic thrown in, because we didn't really have enough. But I think that, you know, there's just this amazing amount of commitment and drive by so many people and it, you know, it just kept me focused on you know, getting things done. And when it, the, when the going gets tough, I think it's a lot easier when you know, that the work that you're doing is so important to the community. So after 23 years I'm, I'm again, I think it, this opportunity for a iCare came my way and while I was a little bit hesitant at first I thought, well, it's probably a good chance to do something a bit more broad across the space because technology was definitely one of the areas we had challenges with. 

Annette Hilli (12:07): 

So, you know, I thought, eh, great, great chance here. I can go and work with a lie care use the knowledge that I have in what it's like to actually be an end user and see where, you know, where we can actually make a difference. And it's, you know, been an amazing year and a half and the bit I've actually enjoyed well, most is actually getting to interact with a lot more providers and seeing the different things come to, which I think is a really good opportunity to ask Rosie about the model at Avivo, because I know as soon as I heard about it, it really excited me and I loved that. They'd taken something that, you know, can be a little overwhelming, to be honest, from an Australian perspective because of the land size that we have here and make it work. So, you know, I'd love to hear from Rosie about their model and, and the difference it's made for her clients. Mm-Hmm 

Rosie Lawn (13:02): 

<Affirmative>. Yeah. so I suppose the, the pur the, our organization has always been really committed to being alongside people and providing that really practical support. So, you know, as you said, you know we are made up of about 1200 employees, which the great majority of those are people that work with people in the community. We use the term support workers, caregivers that are assisting people in many different ways where they're ranging from personal care, you know, home help helping to get out into the community, those really practical things, but also the role to also supporting people with the recovery, whether that's coming out of hospital due to a health condition or a mental health condition. So recovery and independence in a, in a practical way, and, and also supporting people it's interesting through to <affirmative> maintaining or reestablishing connections and contributions to community. 

Rosie Lawn (14:20): 

So the role of support workers is often really think, oh, it's just a support work when you, when you really think about that whole realm of things that people are doing and being with, with with customers that that's the word I'll use. It's a really diverse and incredibly important role. It's, it's a role that makes things, makes it possible for many people to be able to live their lives. And I think it's very hidden in our community and, and undervalued. So for us, our thing we've been on this, it's like, we've, I can't say there's been, when did we ma we decide to move to neighborhood teams. It's actually been like an ongoing quest, you know, there's been, so over all the years, you would've experienced this a net continually looking about how can we do this better? 

Rosie Lawn (15:13): 

And like all older organizations, I mean, Avivo is 50 years old. But we know we've been through the phases of what's happened with management and all that sort of thing. And we'd actually kind of created as a fairly, a fairly medium to large organization, lots of hierarchy, lots of things that are based on controlling support workers work and making decisions away from the customers. You know, the things about all well intended, but policies, procedures delegations that have kind of really inhibited some of the ability for customers and, and the people that are working with them every day to make really sensible decisions about what matters. And so this, and we've also as an organization I mean, I, you did mention it. So we, we work across aged, supporting elderly people in the community, people with disabilities in the community and people with mental health issues in the community. 

Rosie Lawn (16:10): 

We're lucky we don't have any facilities. Actually. That's one of the things that I really am so pleased as a CEO, we didn't have a lot of transition issues. Infrastructure is a whole lot of amazing people who work in the community. So for us, we were sort of seeing this problem that we built an organization with all these kind of well intended hierarchies, delegation, issues of control, but wasn't, wasn't actually happening. It wasn't, it was actually hindering the quality of the service relationship, right. It can hinder, I won't go, it can be too extreme by saying that there was some good things in it, but there's things that actually, you know, a lot of things can be worked out much more sensibly between support workers and customers. And and then just, you know, letting the letting Avivo know. So this quest and and a real commitment to seeing each person as a unique person and helping them live their lives has been ongoing. 

Rosie Lawn (17:10): 

And it was really interesting. So we, this is at probably seven, eight years ago. We, we, we started hearing about some of the things that were being done internationally. So I was introduced and heard about bet talk, which you mentioned and had the great privilege of going to, to Holland and actually saw a number of organizations over there who had, who had shifted operating model to much more getting the around teams and teams having a greater level of autonomy or self-management, and working really closely at a local level for people to live their lives. And that really but I, I have to say it, wasn't only bet, so that inspired me a lot of, and my colleagues, a lot of, we really looked out into the world to see this kind of trend about what was happening around much more innovative organizations and bringing choice and control and responsibility right down to the ground level. So that's what inspired us and sort of ongoing passion about how can we do this better. So I love the idea of local teams. So Bezo has, is a whole network of neighborhood teams throughout mm-hmm <affirmative> the Netherlands.  

Jeff Howell (18:20): 

And, and if someone's wondering right now it's B U U R T Z O R G. Yeah, that's right. So that's the, let me ask you this, then you guys have sort of tweaked it for the Australian market. If I'm a new customer, bring me through, what, how would my how would my team be formed and what would it look like? 

Rosie Lawn (18:43): 

Hmm. So I'm gonna say we didn't tweak it. We actually, we created, we created our own design and that's something I'd say to other organizations, so you can work with Bezo and they ma you know, establish an agreement and, you know, work with them. And they, they are supporting organizations with their, to, to take their model into home and community services. So I just wanna say that we, we learn from Bezo and they were very generous with sharing their experience and other organizations did too. What we did is developed our own model. So an approach and we'll continue to do that. So I think, and actually that was the advice we got when we went to Holland to actually, don't just take what we've got. You're a different culture. You've got different history, they were a startup. So they started up that really fresh just a block, who's the founder of bet SOG. 

Rosie Lawn (19:36): 

It was a clean start. He'd moved out of other traditional organizations and, and, and started from the very beginning, creating a neighborhood team where people had responsibility for the whole service to the people who lived in that community. Avivo is 50 years old. We had a lot of, I would say in some ways it's much more difficult because you're trying to transition. And and anyway, so I just wanted to make that point that, so going back to your question, though, Jeff is you were asking weren't you about what would be the experi there's two ways. So I, the way we've gone about it is actually we've had to transition to creating neighborhood teams. So this has take, we thought it would be really easy. It wasn't, <laugh> it's taken us four years to get to having over just over a hundred teams. 

Rosie Lawn (20:29): 

We learned a lot about along the, how we had to support our col we needed to be, do it in partnership with our colleagues and our customers. And you can't do, it's a real wish of project managing and doing two colleagues. We really had to get them. We have, we learned a lot about people getting the will and the desire and having control to do this themselves. And so it was a lot of consultation and involvement. Some people didn't get, we needed to really be clear about why and the why is that we wanted people to be able to make more decisions to the customers. We wanted to improve the quality of the service that people were getting. And that it'd be, they'd know the people that they were visiting them. You know, they were that they, we wanted to then be able to work much more closely within the actual communities so that why was needed to be really clear for people. 

Rosie Lawn (21:24): 

So going back again though, so what we we've had all process, cause what was, was previously happening is people were working across a whole region. If you, if you think about it, they'd travel through many communities based on a roster to provide support to the to customers, they had their regular customers, but you would look at an area and, and you'd see people driving all over the place. Okay. So, and they weren't, they were real, there was no sense of team. So, you know, if you look at a particular region, there would be a hundred support workers working right across the particular region. And they might know some people, but otherwise they were pretty much reliant on their relationships through the office. So what we have done is, is created within each region, a number of teams, you wouldn't say they are loosely based around us team size between anything between three and 15 the larger the team, the more difficult it gets. 

Rosie Lawn (22:20): 

And sometimes then when teams grow, we look at their men splitting. So they, they, they kind of divide like ameba into being focused more on a smaller geographical area. So you have to have a team size that's viable and actually can between the group of people provide the supports and services that people need within that community. So that's been the big transition for all the teams that, so every support worker within Avivo now works within a nav hood team. And I'm gonna just add another thing. We ended up creating, cause we were going completely for neighborhood teams. And then we realized that some customers have such high levels of support. They just need their own team. So we S Avivo supports people right through from having a few hours of support a week who, you know, that might be home help or a bit of getting out or a check in through to people that actually need 24 hour support. 

Rosie Lawn (23:17): 

Right. so we've actually realized with some people, the neighbor, it almost like some of those high need CU high support need customers. We really have seen that it's good to have a relat of the neighborhood team, but you actually have a team that sits alongside that. So we've got a man who has 24 hour support, who is quadriplegic and dependent on technology for his breathing. He has his team, which includes about 12 support workers and they sit in a particular locality. Mm-Hmm, <affirmative> a suburb Perth. Some of those support workers might do that a little bit of work in that locality with the neighborhood team. But the great majority of work is done with this man who he has you know, awake over and might support really active support whenever he does anything in the community because of his physical needs. Does that give you a bit of idea with the, it's a very 

Jeff Howell (24:13): 

Comforting idea that you know, it takes a village and, and everyone, you know, from the carer side you're also not frantically accepting shifts and driving to all kinds of different fee for service visits that, you know, you've got big gaps in your day. If you, I would imagine the logistics to set it up might be a challenge up front. Yeah, it is. But that it ends up being a win-win once the teams are in place. 

Rosie Lawn (24:42): 

Yeah. And I'm, I think, I mean, we still got a way to go. We've got all our teams in place, but they never remain the same. Cuz you get you, you lose some customers, people pass away, move on. Some people actually decide they don't like what we do. And then also you get a lot of, you know, you get what you get growth. So there's there's so it's always move it. It's never, you know, like, oh, we've got a hundred teams, oh next week it changes a little bit with how that right. That's going, but so we've got a long way to go. We've now actually you mentioned the beginning, we are actually now around about 70, 75% of the work is now done with somebody's local team, whether that's a customer team or a neighbor team neighborhood team. So that's a big shift we've seen from what you mentioned. 

Rosie Lawn (25:26): 

We were in the 60% now we're way, way, you know, over 75% of their work is done within their, within their team. And it does decrease the driving. But one of the real benefits that the, our colleagues have said is they actually have a sense of team. So there's actually, they're not alone. Now. There's a much, that's a good point. Yeah, yeah. Much more sense of colleagueship and actually somebody else has got my back and what naturally starts occurring and we need, we are wanting to get them now they're all in places, really focusing much more on the community and the community's needs rather than yeah, it, it, now, if you're located in a, a suburb or a, a small country town, you know, that real connection with who's who and what the customers are and potential customers and who you need to speak to who the GPS are, you know, all that sort of thing is where we can see the real potential developing over the next next year. 

Rosie Lawn (26:27): 

So, so they really talk about the sense of team and we started out and then Bezo is, is amazing. And when you look at it, I mean, their team started out with the sense they were, they were primarily healthcare team, so there's a bit of a difference. And they were also primarily their nurse made up of nursing, nursing staff but their nurse, there's a bit of misconception there amongst that nursing team. It ranges through from registered nurses equivalent to registered nurses, to people who are more like our certificate qualified, let's say, so they're not all, they don't all have the same level of qualifications. So they started out right from the very beginning like that. And the level of autonomy that the teen had is really amazing and really good and it's high. So they make a lot of decision. 

Rosie Lawn (27:24): 

We've got much more variety with the level of skills and qualifications that our team members have and the level of autonomy is developing. So one of the things I would say to people looking at this don't think self management's, black and white, it's a journey. You have to develop the capacity of the team to self man manage, not actually say, okay, off you go you're self-managing and it will all work out. Cause you're called chaos. <Laugh> you have to do the groundwork. There's a lot of work to be able to effectively self-manage that you have to do on people taking personal responsibility for their development. So I think one of the things we made as a mistake as early on, we thought it was gonna be easy for people to self-manage in teams. It does it isn't easy. You have to definitely do the work on developing the team and individual development to be able to really effectively work together as a team. 

Annette Hilli (28:19): 

This is kind of a full flip though on the historical, isn't it Rosie? I mean like when you think of aged and disability, disability care of the past before consumer directed care really started to take off here in Australia, it was more systems processes, bureau, bureaucratic. This is what you can do. This is what you can't do. Don't move out of these tasks. Here's the care plan you can only do what's there. It was quite restrictive. And I dunno that we ever really empowered our staff, particularly at the, at the support worker level. There was probably a lot more don't than there was dues. And, you know, the, this whole model is turning that on its head and you are wanting to empower all team members, whatever, or whatever skill they bring in to genuinely engage with their, their customer and coming up with a solution that's actually gonna meet the needs as opposed to it being dictated sort of from the top down, which I think historically, and I think Jeff, that's why the idea of the word patient <laugh> doesn't really fit in nicely with this model because it isn't just about, you know, we are here to diagnose a particular problem and go through a series of steps, 

Jeff Howell (29:37): 

Patients, a very reactive kind of term as well. Right. Something's gone wrong and now you're a patient 

Rosie Lawn (29:43): 

<Laugh> that's right. And you're ill. And it's like, there was another word. I don't remember. Remember the government used to call people an age care, care recipients. Yes. So how and active is that? And it still 

Annette Hilli (29:55): 

You're a care and you still do it. They still do it. It's one of those words that can great on you a little bit because you don't, I think it's also not helpful to, to your team and your staff, because I think for me, if you are wanting to empower them and you are wanting them to see the person that they're working with as another person, you know, they're not, they're not a patient who has a problem that you're trying to heal, particularly cuz of the, the, that whole medical idea. It's wanting to see them as someone who just like you and I <laugh> are, are living their life and what is it that we need to do to ensure that it's a high quality of life, despite the fact that they may have some, some health issues that they're working with, you know, you want to ensure their quality of life is optimized, but you can't do that without engaging them in that discussion and, you know, giving them the ability to make that choice. 

Annette Hilli (30:50): 

Cause we sort of touched on N D I S a little earlier on we, we haven't yet talked about the introduction of CDC and the age care space. So when consumer directed came in and you know, really wanted to, to flip age care on its head and it started in, in home care first, before, you know, now it's sort of starting to, to really get pushed a little bit more in residential as well. But home home care was the, the, the sector that got to, you know, play around with that to, to begin with. And, and it was, it was completely different to how it had ever been before, because the funding no longer just goes to the provider and the provider made the decisions. All of a sudden the funding actually sits with the individual. So, you know, they're told here's your, your package of, of money. 

Annette Hilli (31:41): 

You get to choose with vital of your choice, how you're going to spend that money and how you're going to utilize it to ensure that you have a quality of life. So everything had to turn on its head, cuz historically the case managers sadly, would just look at the assessment and almost make up the mind about what was going to be needed for that person before they even had a conversation with them was just off that first assessment, because you could read an assessment and go, yeah. Okay. I can see that they've got this, this, this, and this. That's quite different to sitting down and saying, okay, Jeff, tell me a little bit about you. What matters to you? And what's gonna genuinely bring you quality of life. And sure. We might tend to a wound that you have, which is, you know, important, but that's not necessarily gonna give you quality of life. And there's some, well it's phenomenal go Rosie. Sorry. I was 

Rosie Lawn (32:31): 

Gonna say, I think it's been one. No, I, I, I really, I was gonna, cause I think one of the things, isn't it, when you only focus on the person's needs or the wound care there, doesn't the reason for, that's not, it's important to people, but actually what will bring joy to their life is the, the sort of how they're gonna get out and visit friends or how they're going to be able to get a job or, or go back to work. So it's, it's, it's one of the things, isn't it? Cause I think a lot of needs based work is about, we decide what's important for people where the, the, the question that goes alongside that is actually what's, what's important to you. What matters to you, which it, it is. It's about, you know, when you ask them, sit down and as you say, and talk to people about what matters it, it's not a, yeah, they wanna be, well, they wanna be safe, but actually what, what brings joy in life is, is unique to every person. 

Rosie Lawn (33:27): 

And that will be what gives them the will to do new things or, you know, to get well. So very we actually, one of the things I think we learned a lot of, we had the real privilege in of working with a number of people who were very early on self-managing their funding and seeing how they as leaders, this is the, the customer or the patient, if you wanna, or the participant what they created for themselves around their lives and how they worked with their support team gave real inspiration for thinking how this is. So it's a bit like the challenge. Well, how do we create this for everyone? You know what's the sort of infrastructure as an organization that you, it's, not those people that not just for those people that are very resourceful, who can set this up, but how do we develop a system and a, and be an organization that supports everybody to have this live of choice and control in their lives. 

Jeff Howell (34:23): 

So I have to jump in with the outsiders obvious question. So I get it. So the government just gives me a check. There you go. I can go by whatever care I, I want. How, how do you generally think it's working out with respect to people making the, the choices they should make for their own health? 

Annette Hilli (34:49): 

So I think probably starting by, it's not so much the, the funding is still overseen by someone. So just to ensure that obviously there, because the government obviously puts in some limitations about what you can spend the money on and what you can't, but it's very, very broad. And the role of the, you know, whether it's a, a case manager, support worker, there's many different titles that you can use, but the, the people that are helping to guide the, the, the decisions and that are kind of looking around, you know, the, the goal, it's very much goal based goal plan, goal planning around, well, what is it that you're wanting to achieve? But I think the what's really great about it is that when you talk quality of life, I mean, obviously they're going to include basic things. Like, you know, I might need assistance with showering or I, you know, I might need someone to help me do my shopping, but you can actually take it this whole other level around, what's going to genuinely going to bring them, you know, true quality of life. 

Annette Hilli (35:56): 

So sometimes I think it's easy with these to think of it from a case study perspective. So the person who, you know, really loves music, but because of their disability or because of you know, what's happened as they've got gotten older, they no longer can necessarily engage directly with it themselves, but what could you do to bring some of that, you know, that passion and that joy back into their life. And, you know, often the, the, the, the, the customer, the client themselves can, can really lead down that path. But sometimes the amazing people they work with are the ones that come up with a potential solution to consider that might, you know, bring some of that passion back. And I mean, there's so many amazing stor stories out there where the people that have working, working with them, you know, they might not be able to give them the ability to play the piano again, if they've got really bad arthritis, but, you know, there's so many new, I mean, particularly from a technology perspective, now there's so many great things out there that you, you can utilize other, other methods to bring some of that passion back. 

Annette Hilli (37:01): 

So I think that's the big difference that you know, this model is encouraging, it's encouraging innovation, it's encouraging, you know, enablement and, and looking more broadly than just those basic ADLs that we are all need done on our sort of day to day Rosie. 

Rosie Lawn (37:22): 

Yeah, yeah, no, I, so I think it's, I, I was it's a complicated answer. So, and it's described very well, the real potential with the model of self-directed supports especially if there's a system put in place allows that creativity. So, you know, sometimes it's, you don't need a support worker to reconnect with music, but you might need a guitar <laugh> and some technology. And so you've gotta, you want, you want the system to be adaptable enough to know to be, but unfortunately I will say this is unfortunately with the rollout. I probably, with the N D I S there's a lot of commitment, but the implementation is quite restrictive. So I honestly actually feel there's a lot to be learned for every country to look what's happened in Australia. The good and the bad cause what look, there is a real tendency to the government wants to keep control. 

Rosie Lawn (38:22): 

So every now and again, they talk about individual examples. A few people who've spent money on things they think are bad. Like one of the examples was, which was really inappropriately. The minister talked about people buying a yacht. Actually, I don't think anybody ended up saying actually nobody could find the person that bought a yacht <laugh>, but, you know, it was one of those things to say, look, what people are doing. You know, it's like go, I would have to say, actually in the past, there was some real misuse of funds. If you look at all the, that were block funded, so, you know, how come executives can get, you know, expensive cards and all that sort of thing, but actually anyway, I'm I know. So I think it's interesting. So, but so there are safeguards, but actually I think the danger of it sometimes is that what the, particularly with the Commonwealth, they've probably got to being a bit too controlling out what people can have in their plans. 

Rosie Lawn (39:17): 

Mm-Hmm <affirmative> and yeah, we're seeing some interesting things happening at the moment that actually is decreasing choice in innovation. And I find that actually I used to work with a state government with, with disability funding and I used to find we had individualized funding and there was much more flexibility than what we currently experiencing with some of the stuff with the Commonwealth national disability insurance scheme. They've also developed a system that's very fragmented. I mean, we have planners in the N D I, we have, you know, they've got another separate organization, which is supposed to be support partners, locally, local coordination. We've got, they, they, they also are support coordinators who have to be in another organization. Some people with disabilities are getting services and supports by multiple organizations and it's not getting good outcomes, but actually the systems created this. So with choice and control, there's also, and a fragmented service system. 

Rosie Lawn (40:13): 

I think there's some things that are leading to some pretty poor act comes for some people, but I'm just paying, I wanna there, so yeah, there's lots to be learned. There's lots of good things. You're seeing that what the N D I S has given is much more equity and a lot more people are getting support than what they're used to, and there's been a real commitment to every person with the disability having away, but they've also kind of fragmented system. So yeah. Interesting. So I'm a much more of an advocate, of course, as you can probably hear the more, you've gotta keep it really flexible, keep government out of making too many of the decisions, but with some good safeguards to make sure that the money is appropriately spent 

Jeff Howell (40:56): 

And for self-directed care what are the eligi eligibility requirements? My understanding is that not everyone is in the program, right? 

Rosie Lawn (41:05): 

So with N D I S people do need to meet eligibility criteria and they provide evidence in relation to the scheme. So they, you know, their, their sign, they have a disability that requires the support. So they have to go through a whole process of screening to get eligibility through and, and through to be eligible for the funding. So there's many people with disabilities that don't get access to the scheme because they haven't been able to demonstrate that they need this level of support with age care as well, isn't it that people have to go through an assessment process. And there's a assessment teams that they have to establish their, they need for access to community support. And yeah, and along with that's right through from very low levels of support. So there is a pathway to be able to start with levels of support that might be only one or two hours of support to help with very practical tasks. 

Rosie Lawn (42:09): 

They start with Commonwealth home support program and they can, they can get, get, they ultimately can get assessment into home care packages. The only problem is we've got enormous waiting lists, so they can be assessed as eligible, but they can't actually get a package that's at the appropriate level. So, you know, we end up people which have really significant needs to be able to stay at home. And they've only got a few hour hours of support every week and UN inadvertently end up in residential care when, if only the system was much more flexible, they would've been able to stay at home with their family and support from the community a lot longer. So there's a lot of need for improving flexibility and access for in the aged care system. Whereas I think, think 

Annette Hilli (42:55): 

Our government's definitely working through that right now. They're very aware that you know, there's waiting lists and the balance of the funding. I mean, cuz in the end, you know, there's a pool of money that they've got access to, but there is a lot of pressure down here in Australia. And, and I imagine it's probably similar, you know, in north to America as well. I mean COVID has not helped the, the issue around you know, the need to be keeping home people home longer because obviously residential didn't fare so well throughout the, the, the pandemic. So the government's definitely sort of flipping its its viewpoint and looking at how it can continue to reduce that wait list. I mean, I think at one point for home care, it was well over 120,000 people on the wait list waiting to access these self-funded packages. 

Annette Hilli (43:43): 

So they, the, a lot of them still were getting some lower level support through other funding, more block funding. But there was, there was a number still waiting and they're slowly making their way through that with the goal to, you know, get to a point where anyone that needs care can access care. But it's a journey like as Rosie said, I think there's, there's good parts about it. There's there's bits that definitely, if other countries were looking at this type of a model, you could learn from some of the mistakes that have occurred here in a Australia. But I think overall the notion that the person should be in control of, you know, the, the supports that they get is absolutely the way that it should be. And you know, I think that the, the community model that Rosie was talking about tries to remove some of those barriers that exist because there's no doubt that if there's too much bureaucracy and there's too many layers, you do stifle innovation. And it makes it much harder to be innovative, but a lot of providers are proving that there's, you know, where there's a, will, you can at least do your best with what's there. 

Jeff Howell (44:54): 

Hmm. Well, with the Uberization of everything and the amount of choices we have and control we have over everything, I definitely think this is gonna be something that will continue to trend in other countries. We're almost up against our time ladies. Why don't I get you both outta here on this, Annette, I'll start with you. And then Rosie, same question. Give us a reason to be optimistic about the future of care in the home. 

Annette Hilli (45:19): 

Oh, look, I think the, like the, the reality is people want to stay at home. I mean, that's, you know, that's just, you can ask anybody, if you say where, you know, where do you want to, you know, where do you wanna age? Where do you wanna live your, your, your last days everyone will say at home? So I think the fact that that is where, you know, the majority of us want to be is, is fantastic. And I think it's something that we've gotta hold onto. And I think it's something that as whether it's our government that are looking at it, whether it's providers we've, we all should be doing what we can to, to make that a possibility. And despite all of the barriers you know, there's some amazing work being done there. There's some amazing people wanting to do work in this space and look, we are all going to get there one day. So I think that we should all want it to be the best that it can be, and we've gotta remain optimistic no matter what, there's always more we can, you know, we can do and we can find new ways and we can find better ways. 

Rosie Lawn (46:23): 

Mm-Hmm <affirmative>. Yeah. And I agree, Annette, I think actually people wanna live at home. They wanna be part of communities. And you know, I don't have an aspiration to a, I'm gonna end up in residential care. No, no most people wanna die at home and live life fully till the end of through all those phases. And I think the other part of it, which I think I think we have got big challenges with it, but there's a real wish for community. So I think the hopefulness and actually COVID has helped with some of this is people realizing there's actually enormous potential within communities for coming up with ways of caring for each other. And yeah. So I think that's the hopefulness for the, so I think ho the place actually, the real contribution that elderly people people's disabilities home community support can provide is actually somehow hard. Is that really interweave and support the development of whole communities to care for each other. Mm-Hmm <affirmative> yeah, I think that's pretty exciting when we think like that. 

Jeff Howell (47:27): 

Well, I'm definitely doing some mental gymnastics right now. Mm-Hmm <affirmative> the exciting things are you know, when you have this community based care, it's also so much more comforting for the, the customer and the customers you know, children that are usually the ones sort of figuring out how to order the services and how would it be to know that the care team is all geographically together. And they work as a team for, for their community members and the sense of safety and security in that. And then from their vantage point, they you know, caregiver, loneliness is an issue that is something that the be org model helps address. And it helps those caregivers feel more like a, a, a valued member of the team. And they have colleagues that they work with together to provide the best outcomes to to all the clients. Well, super ladies, this was this was amazing and I am so happy that we spent some time together here. Rosie, how can people find Avivo online? Mm-Hmm, 

Rosie Lawn (48:38): 

<Affirmative> just need to search for Avivo live life <laugh> okay. Dot org.au. And you'll find us there and have a look at our website see some good stories around in your people. Some of the case studies as, as a network brewing, it's always good to always focus on the people and seeing how they live their lives. It's a wealth experience there. 

Jeff Howell (49:00): 

Good. And Annette, the sponsor of this episode is alayacare. So we can you can just go to alayacare.com <laugh> mm-hmm <affirmative> and when the borders,uopen back up,uI'm hoping to do a road trip in Australia. So I've got someone on the east coast and someone on the west coast I can stop. 

Rosie Lawn (49:17): 

That's great. Yeah, you sure can do we'd love to have happy one though. Yeah. 

Jeff Howell (49:22): 

Yeah. Let's all right. Rosie, Annette. Nice to see you both take care for now.