Home' Australian Ageing Agenda : AAA Jul-Aug 2013 Contents ON AGED CARE REFORM
"At the moment there is a lot of moaning and negativity
but the clock won't go back. We will move to a
deregulated marketplace without a doubt. In five years,
when we have a bit of a flavour for CDC, people will
be demanding it. The system has been so blocked and
inflexible and hasn't worked for so many people. Why
would we go back?"
"One thing I learnt [in psychiatric nursing] at the time
of the Richmond Report, was that people coming out of
[psychiatric institution] Gladesville and living at home
for the first time, when you took them shopping, all
they would want for the first couple of weeks was chips
and Coke. But they soon got sick of that and then got
interested in planning and shopping for meals.
"It's no different for an older person. The CDC pilots
found that once people became more confident with the
system they started using it differently and trying new
things. The choices they make are important to people.
We need to empower them and assist them to step up
rather than down or backwards."
Growing up in Newcastle before moving to Sydney at age 17,
Noakes says she was strongly influenced by her father.
"My father was a state manager with Woolworths and he would
sit down and talk about business a lot and he had a sort of 'Harris
Farm'* idea that he thought was a real opportunity that hadn't
been picked up.
"Unfortunately he died young, but it stirred up my sense of
wanting to be in business," says Noakes.
"I did nursing and then psych nursing. But I got frustrated
with the system; with going to meetings and putting forward
ideas and then seeing nothing happen. No change. That was the
driver for me to start my own business," she says.
That business -- Noakes Nursing Service -- began in 1995
as an agency providing staff to private hospitals, aged care
facilities and other residential care settings. Noakes says it
evolved more or less organically into community care nursing
because people often wanted to retain a level of nursing care
when they went back home.
The business was purchased by Wesley Mission in 2002,
becoming Wesley Noakes Nursing Service, but was subsequently
sold again to another private community nursing agency, KinCare
in 2008. In the meantime, Noakes established a new business for
herself, Just Better Care, in early 2005.
KEEPING IT LOCAL
For Trish Noakes, the franchise business model was the one that
made the most sense for community based care.
"You need size," says Noakes, "to be able to put efficient
systems in place. You need volume, or you don't survive.
"But the problem with volume is that you can get too distant
from your customer and what they really want. So how can you get
volume without being distanced from your customer?" she asks.
"That's when I got interested in the franchise model, which
seemed to be the best option around."
Noakes firmly believes that a centralised model can't deliver
a real understanding of the subtleties of local customers and
be truly relevant to the local market, especially in a consumer
directed care (CDC) environment. By contrast, she believes
the franchise model can deliver the volume while retaining the
"You can centralise the systems with IT, branding, marketing
etc; but the face-to-face service delivery across Sutherland,
Bankstown, the eastern suburbs, Hawkesbury, Chatswood... it
will all be really different.
"And you actually need to be in those local areas to
understand them. How else do you get to know how that
community works, unless you become a part of it?" she asks.
"People will be looking to their local communities for
connections and engagement and involvement and you need to
know what is around and who is around. Which hairdressers will
do home visits? What volunteer group can take you to the club,
etcetera? Which pharmacies and supermarkets will do home
deliveries? You can't pick it all up from websites."
THE RIGHT MODEL
In the CDC environment, it just makes sense, says Noakes.
"At the moment, all the service provider organisations have
the power and control.
"But with a more customer-focused, market-orientated
system, the power and control will shift from the organisation to
the person receiving the care themselves, and their family."
"I think our model is very suitable for the future of community
care provision, where people will shop around and say, 'I have
this entitlement of care' and they will want the provider to show
how they can best meet their needs with good, quality services
that are flexible and individual."
Noakes says there has been a prevailing view that community
care and other human services operate on different fundamental
principles to other businesses and sectors but she disagrees.
"Customers want to have their needs met. That is no different
in community care," Noakes says.
"And like all franchise operations, the owner wants to succeed
and they make sure they do a good job meeting customer needs."
A PEOPLE BUSINESS
Central to this faith in the model, franchisees retain a great deal
of flexibility in the way they structure and deliver their services.
Noakes says theirs is a model that empowers franchise owners
and also staff, rather than being prescriptive.
The franchisee needs to set the culture of the organisation but
the staff, she says, are 'the eyes and ears' of the business.
Part of the culture of Just Better Care is to 'offer' work
to staff, rather than simply roster people on. "It's about what
you can bring to the service and some people will be good
at personal care work while others might prefer working
with someone who needs more emotional or social support,"
While Noakes is the first to acknowledge that things aren't
perfect ("we need to invert the organisation and bring the
knowledge from staff back into the organisation so we can learn
from them"), their staff turnover rate is 11 per cent, considerably
better than the 25 per cent average across the industry.
"Your staff are integral because they are the ones out there
in the community every day but they might not know about
'services' and 'models'. So we need to engage them and ensure
they understand and that they can communicate that message to
families and to the older people themselves, using the right kind
"The language has to change too, from a language of loss and
passivity. We need to work with people around their wellness and
working toward what they CAN do. And when they achieve it,
what they can do next."
A natural collaborator with a palpable passion for innovation and
a can-do approach, Trish Noakes seems to have hit her perfect
stride with Just Better Care.
Her enthusiasm about community networking is infectious
and she has a very hands-on approach to bringing about change,
which seems to come, at least in part, from a personal investment
in wanting a better society to grow old in.
"We have a mindset about old age that you need someone to
manage your affairs and look after you. I want to be the decision-
maker in my own life. Me, in my fifties, I am thinking about what
I need to do to have a good outcome in the future. And so many
things need to change in the next 10 to 20 years." n
* Harris Farm is a successful family owned 'farmer to market' produce
business in NSW.
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