After initially taking a ‘wait-and-see’ approach to interRAI, Bupa has finally committed to a training delivery programme for the assessment tool – but on its own terms. JUDE BARBACK talks to Bupa’s Gina Langlands about her concerns surrounding the roll-out of interRAI, and why Bupa is now happy to join the interRAI party.

Bupa’s decision to get on board with interRAI training took many by surprise. In the early stages of interRAI’s entrance onto

New Zealand’s aged care landscape, Bupa was openly cautious about the assessment tool. Now, in partnership with Selwyn Foundation, the organisation is establishing interRAI development sites and is in the process of rolling out training to all its facilities. What prompted the change?

Initial reservations

Gina Langlands, project sponsor of Bupa’s interRAI training programme, says Bupa’s initial decision to be a slow follower was based on a view that as a company Bupa could see massive implications with the implementation of interRAI. She also says there appeared to be a “complete absence of any national strategic document or overarching framework that explained the whys and the hows”.

“From the start, we were told that implementing interRAI would vastly improve the quality of care for people in residential aged care – but measured against what? Where is the base we are starting from and how will we know it’s achieved the objective?

“In fact, what is the objective? Because without an overarching framework that clearly defines this or clearly articulates quality measures, the general view is that the overarching objective was to have a great database – and no one can deny that objective has been achieved.”

But Langlands’ doubts about interRAI’s introduction in New Zealand go deeper still. She says any evaluation of the interRAI pilot has not been disseminated, nor has any documentation emerging from the interRAI Steering Group.

“InterRAI was sold on the back of ‘successful pilot of interRAI in Canterbury’ but I have never seen an evaluation of the pilot. Why wasn’t this communicated?

“The interRAI Steering Group is invisible to us. I’ve never seen any minutes or strategic document. Bupa asked for a seat on the steering group but this was declined. I thought it would have been sensible for New Zealand’s largest aged care provider to have a seat.”

Why Bupa finally got on board

So what did it take to get Bupa on the interRAI train?

InterRAI training was devolved to DHBs, with the offer of a laptop and $650 to backfill a nurse. Bupa thought they could do it better.

The Ministry of Health was happy enough for Bupa to develop its own training, and a Memorandum of Understanding was signed between the two parties.

“I think they were keen to get Bupa across the line. There was pressure from very high up for Bupa to get on board with interRAI,” says Langlands.

Certainly, there has been a significant push from the Ministry of Health to get interRAI rolled out. At signs of resistance from residential aged care providers in signing the ARC contract variation, some concessions for interRAI were quickly made by the Government.

The concessions included a review of the interRAI roll-out in terms of the impact it will have on providers’ costs and RN hours, training for enrolled nurses, training for allied health use of interRAI, an extension of the training deadline, and agreement on the ongoing provision of training resources and support.

Tailoring interRAI to suit its needs

Bupa will meet the Ministry of Health’s sanctions, albeit via a slightly different approach to most other providers.

Bupa and Selwyn Foundation have partnered in the delivery of in-house training in the use of the interRAI Long Term Care Facilities (LTCF) Assessment Tool. This partnership will see training delivered to 59 Bupa and 11 Selwyn aged residential care facilities (or 331 Bupa RNs and 49 Selwyn RNs) by 30 June 2015.

The two organisations have established interRAI development sites to ‘road test’ the in-house training, making full use of all the interRAI tools, not just the assessment tool. The sites are at Bupa’s Te Puke Home, its Parkwood and Parklands facilities in Christchurch, two Selwyn Foundation care homes in Auckland, and the Counties Manukau District Health Board Franklin Memorial Hospital in South Auckland.

The development sites will help the organisations formulate the training programme required to ensure their RNs can achieve their competency in LTCF assessment.

The development sites will serve another purpose, too – they will be used to work out how Bupa can fully integrate interRAI LTCF tool into their care planning practices and systems.

“The care plan that falls directly out of the interRAI assessment nowhere meets the requirements we have for our care plans,” explains Langlands.

“If we have an electronic assessment tool, we really needed to be looking to build on this and have the assessment data cut straight across into an electronic care plan.

“It was through discussions with Momentum that we saw there was a separate Care Planning Module that we could ‘activate’. We had a view that surely using the Momentum care plan would give us the most perfectly matched pairing between the assessment and the plan.”

Consequently, Bupa is also piloting the use of the Momentum care plan in the two Christchurch development sites.

Why size matters

Langlands admits Bupa’s large scale enables it to deliver its own interRAI training, in a way that smaller providers may not be able to replicate.

“Bupa is in a fortunate position with both size and resource and from the outset we knew we wanted to roll out our own interRAI training, which the MOH has sanctioned. We have partnered with Selwyn, who are also doing their own training internally. We have been able to tailor the training to the needs of our own organisation. We have developed our own training resources.”

While she admits to a few challenges – the ability of care homes to release the RNs, a norovirus outbreak at a training venue, trainer illness – she says it is going very well.

Bupa and Selwyn are keen to learn from the exercise and have jointly commissioned an independent evaluation, which is being undertaken by Chris Howard Brown. The findings will help them improve existing processes. Langlands says they plan to share the report beyond Bupa and Selwyn so that it might benefit other organisations as well.

Despite some scepticism around the way interRAI has been rolled out, Bupa is pleased to be on board with interRAI, especially when they can ensure that tools and training are delivered in a way that suits the specific needs of their organisation.

“We are happy to be on the train,” says Langlands.

“New Zealand will be the only country to have a complete line of sight into every aged care facility.”

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