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THE 20 FASTEST GROWING JOBS IN THE NEXT DECADE

The 20 Fastest Growing Jobs in the Next Decade

On 13 September 2021, visualcapitalist.com published ‘The 20 Fastest Growing Jobs in the Next Decade’ written by Jenna Ross:

“How is the Job Market Shifting Over the Next Decade?

The employment landscape is constantly shifting. While agricultural jobs played a big role in the 19th century, a large portion of U.S. jobs today are in administration, sales, or transportation. So how can job seekers identify the fastest growing jobs of the future?

The U.S. Bureau of Labor Statistics (BLS) projects there will be 11.9 million new jobs created from 2020 to 2030, an overall growth rate of 7.7%. However, some jobs have a growth rate that far exceeds this level. In this graphic, we use BLS data to show the fastest growing jobs.

We used the dataset that excludes occupations with above average cyclical recovery from the COVID-19 pandemic. For example, jobs such as motion picture projectionists, ticket takers, and restaurant cooks were removed. Once these exclusions were made, the resulting list reflects long-term structural growth.

Here are the fastest growing jobs from 2020 to 2030, along with the number of jobs that will be created and the median pay for the position.

Occupation Percent employment change, 2020–2030P Numeric employment change, 2020-2030P Median annual wage, 2020
Wind turbine service technicians 68.2% 4,700 $56,230
Nurse practitioners 52.2% 114,900 $111,680
Solar photovoltaic installers 52.1% 6,100 $46,470
Statisticians 35.4% 14,900 $92,270
Physical therapist assistants 35.4% 33,200 $59,770
Information security analysts 33.3% 47,100 $103,590
Home health and personal care aides 32.6% 1,129,900 $27,080
Medical and health services managers 32.5% 139,600 $104,280
Data scientists and mathematical science occupations, all other 31.4% 19,800 $98,230
Physician assistants 31.0% 40,100 $115,390

Nine of the top 20 fastest growing jobs are in healthcare or related fields, as the baby boomer population ages and chronic conditions are on the rise. Home health and personal care aides, who assist with routine healthcare tasks such as bathing and feeding, will account for over one million new jobs in the next decade. This will be almost 10% of all new jobs created between 2020 and 2030. Unfortunately, these workers are the lowest paid on the list.”

We ask ourselves, how does this picture unfold in South Africa, and the answer is similar to the article written by Jenna Ross.

According to logicpublishers.com : Jobs That Will Be In Demand In The Next 5-10 Years In South Africa (4May 2021)

“Since technology and the rest of the world are advancing rapidly, it can be hard to know how the labour market will look like in the next five to ten years. Fortunately, according to the current progress, specific jobs with growth potential have become supreme contenders.

  1. Software Developer

A software developer is one of the fastest-growing jobs with best outlook. Unless you have been lying under a rock for the last 20 years, you already know the vast roles these professionals play in everyday life.

  1. Medical And Health Service Manager

A medical and health service manager role is one of the most-demanding jobs in the next 5-10 years. The healthcare industry is extensive and complicated and providing care for patients is only part of the job. A medical service manager’s role is to collect payments, schedule appointments, keep medical records and coordinate with other care providers.

  1. Post-secondary Teacher

A post-secondary teacher is one of the best careers for the future as people seek advanced education from every part of the world. College professors provide the final transitional resources between young adults and the real world. Students attend college to earn practical skills in their profession hence the importance of a post-secondary teacher. One of the most amazing things about this career choice is that it is something that one is passionate about. It is flexible and pays well.

  1. Nurse Practitioner

A nursing practitioner is a registered nurse with advanced training in primary care services. This way, they can perform certain functions ordinarily done by doctors, such as ordering medication, lab test and x-rays. Considering the importance of health, a nurse practitioner is one of the most-demanded professions, which will likely grow.

  1. Financial Manager

If you are looking for a career that will give you excellent financial stability, then one as a financial manager is one of the best. Remember that every firm, regardless of its size, requires someone to handle the money. And big business procures the services of a financial manager that is among the best-paying high-demand jobs in the next 5-10 years. Financial managers create reports and assist in directing the organization’s long-term financial goals.

  1. Solar Photovoltaic Installers

As the world is going green, people are looking for renewable and sustainable energy solutions, and solar panels are one of the most popular. This has resulted in great demand for solar photovoltaic installers that promises a good salary. These professionals install solar panel systems according to the client’s needs and specifications.

  1. Wind Turbine Technicians

With a post-secondary non-degree award and sufficient on-the-job training, you can become a professional wind turbine technician. The profession is amongst the best career for the next ten years as people are going for renewable energy. Wind turbine installers install and maintain renewable energy systems.

  1. Personal Care Aides

Personal care aides are one of the most influential people in the health care profession. They serve the population requiring extra assistance with their daily living requirements. However, people in this profession concentrate more on non-medical services. Regular duties include meal planning, preparation, dressing, bathing, housekeeping duties and many more.

  1. Statisticians

A statistician is one of the fastest growing jobs with a bachelor’s degree. What does a statistician do? They analyze and apply data in a wide array of fields. Since they hold advanced knowledge in statistical interpretation, they are an integral piece of government research institutions and other firms.

  1. Physical Therapist Assistants

A physical therapist’s aide role is to assist the physical therapist with the patient’s appointment and set up equipment for upcoming meetings, among numerous other functions. The responsibilities also vary by the area of practice. One can secure a job in residential care facilities, private physical therapy offices or via government services.

  1. Bicycle Repairers

In recent years, people have discovered the importance of bicycle riding to their health and are adopting the culture. The prevalence of the practice has contributed to the rising demand for bicycle repairers. Ordinarily, bicycle repair technicians assess and solve maintenance issues of bicycles regardless of their complexity. Such professionals find employment in bike shops, sporting goods stores, non-profit organizations and other areas.

  1. Occupational Therapy Assistants

Have you ever thought of a career in occupational therapy? It is one of the best careers for the next ten years, considering the growing demand for occupational therapy. As the name suggests, an occupational therapy assistant aids the therapist with specific duties like stretching, rehabilitative exercises and many more.

  1. Informational Security Analyst

An informational security analyst is one of the most promising careers to pursue, considering the direction the world is taking. The development of technology and its adoption in various aspects of people’s lives has created a significant risk that information system analysts must review. A big part of this job is protecting computer networks and systems from cybercrime. Therefore, these professionals will install antivirus software and other safeguards to protect information.

  1. Accountants And Auditors

Whatever business you are in, you require your financial records to be in good order. One needs to learn if their business is making a profit or loss. That is where accountants come in – they help manage a business’s accounts, including taxes.

  1. Management Analysts (a.k.a. Consultants)

Managers always seek solutions to problems, and it is the analyst’s role, popularly known as the consultant, to make this happen. It is one of the best jobs with growth potential and with an excellent annual income. A management analyst is required to provide revenue increasing and cost-cutting solutions to make a firm more profitable. The profession pays pretty well, but it requires frequent travelling.

  1. Construction Managers

Construction managers are responsible for erecting new structures that are cropping up everywhere in a business-oriented environment. A construction manager is in charge of a construction project and ought to make all the operational decisions.

  1. Dental Hygienist

Dentists are integral in oral healthcare, and it is one of the most demanding jobs in the next 10 years. Everyone requires dental services at some point in their lives, so it is a demanding job.

  1. Civil Engineers

Civil engineers are vital to a country’s growth and citizen’s well-being. They are responsible for ascertaining that people have access to clean water in numerous circumstances like after a hurricane.

  1. Computer System Analyst

As the name suggests, a computer system analyst is responsible for all the computer-related activities in a firm. Firms usually have more than one computer systems analyst with different roles and a manager overseeing their operation. This is one of the most promising careers since all significant firms have computer systems.”

Shire is proud to be part of Project Scaffold.

Project Scaffold has been developed as a voluntary pilot programme that will gather and test results from ten participating frail care facilities to pave the way towards a new dispensation. The main objective is to develop a home-like environment that is person-centred and more affordable. We, like many countries abroad, believe that hospital-like care needs to make way for person-focused care. Project Scaffold, although not a crisis management tool, hopes to facilitate the sharing of best practices within the sector throughout the duration of the project.

A Care Transformation Toolkit (CTT) has been compiled for the use of those care centres selected to participate in Project Scaffold.

Support is available on request from the following participants:

1. Syd Eckley (Consult Age), a gerontologist and social worker who will mainly be responsible for assessing compliance in terms of Act 13/06.
2. Rob Jones (Shire), an experienced consultant on retirement living and associated services, including care.
3. Magda Pienaar & Yolandé Brand (true2you), specialising in facilitating the creation and/or implementation of person-directed care and organisational cultures.

To read more about Project Scaffold, click here.

EMPOWERED DIRECT CARE STAFF: LESSONS FROM THE GREEN HOUSE STAFFING MODEL

Empowered Direct Care Staff: Lessons from the Green House Staffing Model

Susan C. Reinhard, Edem Hado, Barbara Bowers, Susan Ryan & Marla DeVries, wrote on 19 January 2022, for AARP: LTSS Choices: Empowered Direct Care Worker: Lessons from the Green House Staffing Model

“Green House homes, an alternative to traditional nursing homes, are best known for being smaller structures with just 10 to 12 residents that have the look and feel of a “real home.” But they also fundamentally differ in their workforce model, which is designed to improve the quality of work life for all staff, but particularly for the Shahbazim—the Green House home’s direct care team of certified nursing assistants.

The staffing model is unique and fundamental to Green House’s philosophy and results in positive outcomes for residents and workers alike. A national evaluation of the Green House model demonstrated that Green House homes consistently perform in the top tier of nursing homes on clinical/health outcomes of residents. (They have also fared much better than traditional nursing homes during the pandemic, with fewer COVID-19 cases and deaths.)

This report highlights those unique features, particularly the extra training and responsibilities that the direct care workers/Shahbazim receive. The coaching, supervision, and collaborative roles among the Shahbazim, Green House Guides, and nurses are starkly different from those found in traditional nursing homes and result in, among other benefits, significantly lower staff turnover rates.

Empowered Direct Care Staff: Shahbazim

The Green House model empowers the Shahbazim (singular Shahbaz, which also means “universal worker”) by focusing on key staff development areas such as enhanced training, consistent staffing, engagement and collaboration, and shared decision making.

  • Enhanced training. Unlike traditional direct care workers, Shahbazim have an additional 128 hours of specialized training in such areas as emergency preparedness, dementia care, and culinary skills including food safety and handling as well as “soft skills” such as communication.
  • Universal workers. Shahbazim work as a self-managed team of universal workers to respond to residents’ needs. They are trained to provide a full range of services and supports, including personal care, laundry, housekeeping, and meal preparation (which allows residents to enjoy favorite foods, rather than just what’s on the menu.).
  • Consistent staffing. The Green House staffing structure is designed to operate like a family, where workers are consistent and are intimately involved in residents’ lives. This leads to strong bonds between Shahbazim and both residents and their families and is fundamental to achieving a better quality of life for residents and staff.
  • The Guide. As the formal supervisor of the Shahbazim, the Guide is responsible for ensuring Shahbazim meet federal requirements for nursing homes, adhere to the organization’s values and procedures, and honor the Green House model. The Guide ensures high-level collaboration between Shahbazim, nurses, and other clinical support team members.
  • Engagement and collaboration between Shahbazim and nurses. The Green House staffing model operates through an ongoing collaborative/team relationship between Shahbazim and nurses, with the role of the Green House Guide serving to supervise the self-managed work team of Shahbazim. This frees nurses to be mentors and teachers, and to focus on clinical care.
  • Shared decision making. Shahbazim are equipped with problem-solving and decision-making skills and tools as part of their training. Leadership staff work with them to ensure decisions are value based, align with current regulations, reinforce quality care standards, and honor the resident voice.
  • A unique model of leadership. Green House Guides, nurses, other department managers, and additional leaders practice a coaching approach to supporting the Shahbazim with five elements: creates a valued relationship; presents an issue (for the Shahbazim to work through); gathers information to understand the nature of the issue; engages in problem solving with the Shahbazim; develops a plan of action and evaluation measures with the Shahbazim.
  • Shahbazim feedback in assessing the organizational practices. Each year, Shahbazim and other team members participate in an online assessment to evaluate the application of the Green House model in day-to-day practices.

Conclusion

It is also important to note that fairly compensating front-line caregivers is vital— regardless of whether they work in a Green House community. Historically low wages and thin benefits have forced many CNAs and other nursing home staff members to accept multiple jobs to make ends meet.

Finally, even if nursing home operators do not intend to alter their housing structures, they must examine their staffing model. Given the current workforce crisis, it is time to rethink traditional staffing models. Lessons learned from the Green House model can guide new thinking. Nursing homes can avail themselves of support from the Green House Project in order to apply the Green House principles.”

To read the full article, click here.

Founded in 2010 by Rob Jones  in response to a clear need in the South African retirement industry for specialist independent consultants, Shire Retirement Properties is focused exclusively on the retirement industry. To contact us, click here.

Project Scaffold: Revising the approach to Care Services within the older population of South Africa

 We are excited to share with you Project Scaffold. Work commenced last year to address the need to urgently explore a new approach to care services in South Africa. The development of Project Scaffold was a huge effort, involving several specialists.

What became clear is that especially frail care services require urgent restructuring. Never in our history has this sector been so close to total collapse, with reports of over 50% of available beds open and many facilities closing.

The sector must take the initiative to explore a lasting solution and cannot wait on Government for assistance. We believe that serving your own clients the best way possible, rests largely with you.

Project Scaffold has been developed as a voluntary pilot programme that will gather and test results from ten participating frail care facilities to pave the way towards a new dispensation. The main objective is to develop a home-like environment that is person-centred and more affordable. We, like many countries abroad, believe that hospital-like care needs to make way for person-focused care. Project Scaffold, although not a crisis management tool, hopes to facilitate the sharing of best practices within the sector throughout the duration of the project.

A Care Transformation Toolkit (CTT) has been compiled for the use of those care centres selected to participate in Project Scaffold.

Support is available on request from the following participants:

1. Syd Eckley (Consult Age), a gerontologist and social worker who will mainly be responsible for assessing compliance in terms of Act 13/06.
2. Rob Jones (Shire), an experienced consultant on retirement living and associated services, including care.
3. Magda Pienaar & Yolandé Brand (true2you), specialising in facilitating the creation and/or implementation of person-directed care and organisational cultures.

Please note that all participants in Project Scaffold undertake to share findings with the team leaders and other participating organisations. This is very important because the information gathered will ultimately be used to lobby the Department of Social Development for amendment of existing norms and standards.

It is our belief that true transformation of the care sector must come from ground level upwards. Operation Scaffold will seek to simultaneously promote and enhance self-regulation and also to help open new forms of care service, ensuring quality and affordable care for as many people as possible.

Once you have embraced and adopted the programme, you and your team take full ownership and are able to drive it forward either independently (in terms of completing the various steps and maintaining your own identity and intellectual property), and/or to make use of the Project Scaffold team’s services – at your own discretion.

Should you have any questions feel free to contact any of the team members. See full contact details below.

Hope to see you soon as part of the Project Scaffold adventure!

Greetings

Project Scaffold Team

  • Project Scaffold Admin: Anneke Liebenberg – projectscaffold2021@gmail.com / (072) 349 8395
  • Consult Age: Syd Eckley – sydlynne@telkomsa.net
  • Shire Retirement Properties (Pty) Ltd.: Rob Jones – rob@shireprop.com / (082) 658-1402
  • true2you (Pty) Ltd.: Yolandé Brand – yolande@true2you.co.za / (084) 940-8777
  • Magda Pienaar- magda@true2you.co.za / (062) 863-649

Click here for the Project Scaffold Guide

Click here for the Application Form

 

 

Now that’s rock ‘n’ roll!

Now that’s rock ‘n’ roll!

Brigit Grant From Jewish News, wrote on July 12, 2020, 6:32 pm:

“Now that’s rock ‘n’ roll! Care home residents recreate iconic album covers

Sydmar Lodge residents in Edgware pay homage to classic albums by artists including Madonna, Adele, David Bowie and Bruce Springsteen.

When activities co-ordinator Robert Speker, decided to recreate album covers with the residents at Sydmar Lodge in Mill Hill, he had no idea his photographs would go viral in hours and create a media frenzy.

Robert, 41, who has worked at the care home for five years was at work on Sunday when TV and radio stations started calling to ask him about the project which features the home’s Jewish residents replicating the cover poses of artists such as Madonna, Adele, Bruce Springsteen and Rag ‘n Bone man.

Robert, who previously worked at Kisharon was featured in Jewish News when he took resident Shelia Solomons to see Rag ‘n Bone Man and Shelia, who appears in the album collection as Rag ‘n Bone Man complete with tattoos painted on by Robert and as bassist Paul Simonon in The Clash’s album London Calling.

Born and raised in Newcastle, Robert who has been working through lock-down, almost missed the birth of his third daughter, Olivia on June 25 when his wife Aya went into labour while he was at the care home taking the final shot of Hilda for the Blink 182 cover. “My wife is very, very understanding,” says Robert who is always coming up with new ways to entertain the residents.

“I have taken them to the Ritz for tea and I am thinking of ways to get them an outing to a casino. A few weeks ago I hosted a 100th birthday for a resident with her family on Zoom. It was wonderful but sad because she should have had the party she deserved.” With plans to come up with more ways to make the residents happy, Robert set up a go fund me page.

“I did the project to make them happy and I think the models’ families have enjoyed it, with even grandchildren posting about their grandparents, but the risks of Covid means they could be in lock-down for a long time and I want to make it a good time.”

Since posting the covers on Facebook, Robert has been contacted by news agencies across the globe and will appear on BBC News in the morning, CNN and Channel 5 tomorrow. “Then it’s back to Sydmar Lodge to think of ways to keep the residents uplifted.”

To view the album collection, click here.

Shire is proud to provide a range of quality,  independent, personalised services to the retirement market – We look forward to being of service to you. To contact us, click here.

Search dogs being trained to hunt down dementia patients who go missing

Search dogs being trained to hunt down dementia patients who go missing

The Daily Mirror‘s Danny Buckland wrote on 2 March 2020:

Lowland Rescue in Swindon, Wiltshire, is training dogs as part of the Search Dog Heroes initiative, which will help the relatives of dementia patients.

Roo, pictured with handler Jo Armstrong, recently became the first dog in the UK to be trained (Image: North Downs Picture Agency)

Search dogs are being trained to track down dementia patients who go missing as part of a £1million scheme.

Around 100 are involved in the Search Dog Heroes initiative to help police, relatives and care workers bring vulnerable people back to safety.

The dogs are schooled for a year to 18 months and work with their owners, who are skilled handlers.

The first active search dog, Roo the labrador-springer spaniel, has already found a dementia patient who went missing from a care home in Berkshire.

The five-year-old and her owner Jo Armstrong, a volunteer with the Lowland Rescue service that is training the dogs, responded to the missing person’s scent that had been previously collected as a precaution.

Jane Brown of the Missing People charity said: “The dogs will be a great resource. Loved ones can be found quickly and returned home safely. The dog can be any breed. The important thing is their natural ability and enthusiasm.”

The scheme, funded by People’s Postcode Lottery’s Dream Fund, supplies kits for relatives and care staff to take scent samples from the hands on a sterile gauze that can be stored in a jar for up to a year.

Ms Brown added: “It’s a simple, non-invasive process. For the vast majority of people, it will never be used but it can be vital in emergencies and can also provide peace of mind for relatives.”

Missing People chief Jo Youle said: “These dogs will help save lives.”

Around 850,000 people in the UK are living with dementia and the numbers are projected to increase to 1.6 million by 2040, according to the Alzheimer’s Society.

Two dogs have been trained so far  but up to 100 will be deployed nationally over the year in a free service.

To continue reading the article, click here.

Shire Retirement Properties (Pty) Ltd (Shire) is based in the Western Cape Province of South Africa and specialises in the provision of a range of services focused exclusively on the retirement industry. To read more about our services, click here.

Elderly mom died and left her money & assets to a friend that cared for her

Elderly mom died and left her money & assets to a friend that cared for her

“I can’t believe mum left all her cash to a friend who cared for her.”

Daily Mirror’s Coleen Nolan helped this struggling single woman who is ‘hurt and confused’ after her mum left her no money in her will but instead gave it all to her friend.

Daughter:

“Sadly, my elderly mum died a few weeks ago, but I was shocked and upset to find out she’d left what money and assets she had to a friend who had cared for her over the last couple of years of her life.

Of course I would have expected my mum to leave this friend something because she was so good to her, but not everything.

I’m a single woman and work hard to pay the bills, and my mum must have known that money would have helped me.

Also, it’s not just about the financial stuff – it’s the fact that she thought more of this woman than she thought of me. Well, that’s what it feels like.

Am I a bad person to feel this way when my mum died? It’s consuming my thoughts every day and I’m ­struggling to believe she actually did it.

I don’t want it to all be about money, but I feel hurt and confused.”

Coleen Nolan replied:

I don’t think you’re bad to feel this way and I understand you being shocked and disappointed, but I don’t think it’s going to help to dwell on it.

It was her money to do with as she pleased – she could have left it to charity but she chose this friend.

Perhaps she felt she wanted to give something back to this woman who had spent a lot of time caring for her.

I don’t think it means she didn’t love you and it certainly doesn’t mean she valued this friend above you.

In fact, she left you the things that really meant something to her – her wedding and engagement rings and other jewellery that was precious, and the family photographs.

Maybe there’s a message in that to you – this is what’s important in life: things that have special memories attached to them and to remind you of those important family relationships.

I think it’s hard for you at the moment because your grief is still raw, but hopefully, in time, you’ll be able to appreciate that she had her reasons for making these decisions.

I think bereavement counselling would also help you to come to terms with things.

To continue reading the rest of the article, click here.

To find out more about the difference between medical care and frail care, click here.

Shire offers assistance to Service Providers – Continuous personal development of staff servicing retirement villages, such as:

  • Carers
  • Managers
  • Trustees

To contact us, click here.

Residents choose the best candidate for the role as Deputy Care Manager

Residents choose the best candidate for the role as Deputy Care Manager

Residents choose the best candidate for the role as Deputy Care Manager

An architect and author who has lost his sight, a retired school teacher, and a former member of an Examination Board are on the hunt for a new deputy manager at the care home in which they live.

The panel of elderly residents who live at Renaissance Care’s Glencairn Care Home in Edinburgh, have teamed up with the home manager, to interview candidates for the role.

A former architect – Ian (94), is using his recruitment experience to help with candidate meetings. He will also offer a different perspective to each interview, using his loss of sight to deliver an unbiased approach that will allow him to pick up on aspects such as tone and hesitation as he listens intently.

Ian said: “It’s important that the future deputy manager is someone who is a supporter of the current manager and uses their initiative but takes no offence when any ideas are knocked back.”

The vision for the home has been decided by a committee of residents who will now make decisions on things such as recruitment, staff appraisals, décor, dining experiences and menus.

The staff at the care home live by the ethos that they are working in the residents’ home rather than the residents live in their place of work, and have committed to involving them in all future decision making.

Healthcare Business’ Viv Shepherd writes about: “Senior citizens take a break from retirement as they interview for their own deputy care home manager.” To read more, click here.

Shire offers continuous personal development of staff and others serving retirement villages such as Carers, Managers & Trustees. To contact us, click here.

 

Global Ageing Network members serving the aged

Global Ageing Network members serving the aged

A few Global Ageing Network members share their thoughts on challenges and successes in serving the aged in their own countries.

Care for older adults does not occur in a geographic vacuum, so although the issues that providers in one country face may not be exactly the same as those in other countries, there is still much to be learned from colleagues around the globe.

The Global Ageing Network connects providers and researchers from around the world in order to share information and collaborate with one another. In this spirit of teamwork, LeadingAge magazine interviewed a few aged-care leaders abroad—most of them Global Ageing Network board members—to get an idea of the services they provide and what the aging care landscape looks like in their countries.

Our very own Femada Shamam, CEO at The Association For The Aged (TAFTA) in South Africa & Margaret Van Zyl Chapman, director of strategic partnerships for the South African Care Forum were interviewed.

To read the rest of the article by LeadingAge, click here.

Shire Retirement Properties (Pty) Ltd (Shire) is based in the Western Cape Province of South Africa and specialises in the provision of a range of services focused exclusively on the retirement industry. To read more about our services, click here.

Frail Care: What you should know

Frail Care: What you should know

This article was first published in the first-quarter 2015 edition of Personal Finance magazine. 

Laura du Preez writes:

“Healthcare issues loom large in later years when illnesses linger and can result in loss of control over daily living. At these times, residents of retirement villages or homes and their children often take comfort in the fact that the village or home has healthcare or frail-care facilities.

But you may be in for some unpleasant surprises if you are not acquainted with exactly what is on offer in a particular village or home, what additional costs you will incur and what you can claim from your medical scheme. The specifics of an illness and the requirements of your care may also determine whether or not you can be assisted in your community or need to go beyond it.

It is important to know that there is a difference between medical care and frail care, and while your medical scheme will pay for your medical care, it will usually not pay for the care you need when you are unable to manage the normal activities of daily living without assistance.

There are some exceptions, mostly among the restricted medical schemes. Open schemes, which must accept anyone who applies to join at any stage of their lives, cannot afford to contribute to the costs of the long-term care you need when you are frail.

What exactly is frail care?

Frail care is the care you need when you are unable to perform activities of daily living, such as eating, personal hygiene and moving about without assistance.

When you are no longer able to look after yourself because of frailty or mental incapability, you are unlikely to return to independent living.

Frail care is the care you need when you are no longer able to look after yourself because of physical frailty or mental incapacity.

Peter Jordan, the principal officer of Fedhealth, a large open medical scheme, says that while medical care falls within the ambit of medical scheme cover, frail care, or any kind of assisted living, is considered a social welfare responsibility.

Alain Peddle, the head of research and development at Discovery Health, says there may be times when you are recuperating from a health event, such as a stroke or an accident, and when you need short-term assistance with daily living before returning to your former independent state. Such short-term help could be covered by your scheme, but cover for the cost of your longer-term accommodation in a frail-care facility is rare.

Bankmed, a restricted scheme, contributes to the costs of frail care on some options. Dr Niri Naidoo, the clinical and operations executive at Bankmed, says that members of the scheme’s top three options, Traditional, Comprehensive and Plus, are entitled to a benefit of 50 percent of the cost of frail care to a maximum of R355 per beneficiary per day. You have to motivate for the benefit, and the claim is assessed by a medical adviser, Naidoo says.

Contributions on the least costly of the three options, the Traditional option, start at R1 917 for a single member earning less than R5 000 a month, to R2 326 for a member earning more than R10 000 a month. These options also pay 100 percent of the cost of home nursing, to a maximum of R270 per beneficiary per day.

Another restricted scheme, Anglo Medical Scheme, has a benefit of R54 355 per beneficiary per year on its top option, which costs R3 170 a month including contributions towards a medical savings account. But the benefit is only for “medically related frail-care services”, which means you will receive it only if you are recovering from an illness, injury or surgery.

Principal officer Fiona Robertson says the aim of the benefit is to keep high-risk members out of hospital, because one expensive hospital event may cost the equivalent of several years of frail care. Once members require constant nursing or assistance, usually when their condition is medically irreversible, they may be classified as at high risk of fractures or repetitive infections, or may be mentally incapable of taking the correct medication, she says.

The scheme will not pay for frail care when the needs are not medical, but the line between social and medical needs is not always clear, Robertson says. Alzheimer’s disease and dementia, for example, are common reasons for granting frail-care benefits.

Jordan says that while your scheme may not cover accommodation and care in a frail-care centre, any chronic medication you require when you are frail, visits to or by a general practitioner (GP) or specialist, as well as the cost of various appliances you might need while in the frail-care facility, may still be paid by the scheme in line with your benefits.

Levels of care

A frail-care facility should be staffed by carers under the supervision of a nursing sister. Carers may be trained to take care of older people, but are normally not medically trained.

Frail-care facilities need to be registered with the Department of Social Development under the Older Persons Act. The Act sets standards for these facilities and requires annual inspections.

The department is also working on introducing training for carers in these facilities.

While “frail care” sounds straightforward, confusion arises when a retirement village offers both frail care and what is known as a sub-acute care facility. To understand what a sub-acute care facility is, it is useful to know what is regarded as an acute care facility.

The Board of Healthcare Funders (BHF), which represents medical schemes and their administrators, issues the practice code numbers that are used by schemes to identify registered healthcare providers. The BHF explains the difference between an acute care facility and a sub-acute care facility as follows:

* Care in an acute care facility: this is typically care in a facility registered and licensed as a hospital by the provincial department of health in terms of the Health Care Act. An acute care hospital has operating theatres and intensive and/or high care units.

A day clinic, which has an operating theatre but is not equipped for overnight stays, is also regarded as an acute care facility, the BHF says.

A third type of acute care facility is a mental health hospital that treats patients with acute mental health problems, according to the BHF.

These hospitals should have practice code numbers, which you need to claim for admission, in line with your medical scheme benefits.

* Care in a sub-acute care facility: these hospitals treat you when your condition is less serious, or after your release from an acute care hospital, the BHF says.

A sub-acute care facility is equipped like a hospital, has appropriately qualified and registered nursing personnel and must be licensed by the provincial department of health under the Health Care Act. However, Peddle says a sub-acute care facility lacks operating theatres, high-care or intensive care units, and pathology and radiology services.

In a sub-acute care facility, you will receive high-quality nursing care, but should have no need for the high-tech care you would receive in high care, intensive care or in a theatre unit, the BHF says. Your condition must, therefore, be stable.

Some sub-acute care facilities will treat you only after surgery or if you have a non-psychiatric medical condition, depending on the discipline code allocated to the facility, the BHF says.

Some facilities focus on psychiatric conditions and others offer physical rehabilitation. Some are post-natal units and some offer all sub-acute services.

Sometimes the term step-down facility is used to describe a sub-acute facility. However, the BHF says step-down care is less intensive than sub-acute care and is typically for short stays. It is a substitute for an extended hospital stay, and you may be referred to a facility offering step-down care if you still need significant medical involvement and skilled nursing care of more than three hours, on average, a day, as well as pharmacy and laboratory support.

Sub-acute care facilities also need a practice code number, and if you are admitted to such an establishment, you can claim for your stay there, in line with your benefits, from your medical scheme.

If a sub-acute facility is focused on rehabilitating you to normal or near-normal functioning after a disease or injury, you are likely to have access to practitioners across medical disciplines. The care they provide will be goal-orientated, and once their goals are reached, you are likely to be sent home. For example, you may be sent to a sub-acute care facility after a stroke. A neuro-physiotherapist could assist you to walk, a speech therapist could help with your speech and swallowing, and an occupational therapist could help with your movement, vision and concentration.

Peddle says therapies might be supplemented by consultations with a social worker, dietician, psychiatrist or medical doctor.

This treatment can occur in acute care settings, acute care rehabilitation units and sub-acute care units that are licensed to provide rehabilitation.

Asked if Discovery Health Medical Scheme would require a member to use a particular facility, Peddle says this would depend to a large extent on the range of healthcare services you need, compared with what the facility is able to offer. In all instances, he says, Discovery Health will fund services only from registered healthcare professionals and facilities that have practice code numbers issued by the BHF. This means that if a retirement village has a healthcare facility, it must be registered and have a practice code number before any scheme will consider funding the services it provides within what the scheme regards as clinically appropriate.

Peddle says members of Discovery Health who require extensive medical services – for example, after an accident or stroke – will be referred to the scheme’s care co-ordination programme. The facilitators of this programme have a list of accredited facilities that have agreed to meet the scheme’s requirements.

Jordan says that if you have a stroke and need rehabilitation, it is possible that a retirement village frail-care facility may not be suitable, and you will instead be referred to a rehabilitation centre for the best possible prospect of recovery.

If, for example, you fall and break your hip, you are likely to be discharged from hospital before you are able to walk unaided, Jordan says. Fedhealth would offer you care in an accredited sub-acute facility, where you could get both physiotherapy and nursing care, but this may or may not be the facility at your retirement village, depending on what your village offers.

Many sub-acute facilities are situated at retirement villages and some are open to the public, but there are also some independent ones, such as MCare and Intercare.

You may also be referred to a sub-acute facility if you need convalescent care to recover from an operation or health event. Jordan says the length of your stay in a rehabilitation centre will depend on the treatment plan formulated by a multi-disciplinary team working on your rehabilitation and the clinical appropriateness of the treatment within the care you are entitled to in terms of the prescribed minimum benefits (PMBs). PMBs are benefits that medical schemes are obliged to provide to all members, and they cover all emergencies, common chronic conditions, and conditions that, if not treated, would seriously affect your life.

Similarly, the length of your stay at a sub-acute facility would depend on your circumstances, and in this respect you would be assessed by trained specialist case managers employed by your scheme in line with the level of care provided in the PMBs and your progress. If you are discharged and still need physiotherapy, for example, you may need to access your scheme’s day-to-day benefits, unless your treatment is still covered under the PMBs.

Jordan says Fedhealth has a special benefit for physiotherapy, which is paid from the in-hospital benefit for 30 days after discharge, leaving your day-to-day benefits intact. The scheme also has an appliance benefit should you require a walking aid or crutches, he says.

Lizzie Brill, manager of the Oasis Care Centre, situated within the Oasis Retirement Resort in Century City, Cape Town, says large schemes, such as Discovery Health and the Government Employees Medical Scheme, have care co-ordinators who oversee treatment and care for patients who have, for example, suffered a stroke. Typically, these schemes pay a global fee to a rehabilitation facility that covers most of the treatment and care required from a multi-disciplinary team.

Some schemes, however, have separate annual benefit limits of, for example, R35 000 for physiotherapy. The limit will not apply if the condition is a PMB, such as a stroke, and the service is required as part of its treatment.

Dementia

In two other situations there may be confusion about whether your condition and care is covered by your medical scheme. The first is when you have a form of dementia, such as Alzheimer’s disease.

Despite the fact that Alzheimer’s is a progressive and terminal illness, you are unlikely to receive much help from your scheme.

The disease generally affects people when they are over the age of 65, and in the advanced stages requires full-time care, which is usually not covered by your medical scheme. Alzheimer’s is not a PMB, and most schemes cover the chronic medication you require from your day-to-day benefits, which are usually inadequate.

Jill Robson, the regional director of Alzheimer’s South Africa, says Alzheimer’s medication is expensive – in the region of R800 a month – and other medications may be required for other symptoms, such as anxiety or depression. Alzheimer’s patients may also need brain scans, which cost thousands of rands, she says. Some schemes pay for scans only if they are done in hospital and others impose co-payments.

The treatment of other illnesses in patients with Alzheimer’s is also often more expensive as a result of the disease, Brill says.

She says her experience has been that certain restricted schemes offer some benefits for Alzheimer’s, but most open schemes do not, because such long-term care is not regarded as medical care, but as care you require as a result of ageing.

According to Robson, some 750 000 people in South Africa have Alzheimer’s. A group, Alzheimer’s in Action, has launched an online petition to collect signatures from friends and relatives of Alzheimer’s patients who object to the lack of medical scheme cover for the illness.

When you need full-time care, despite the fact that you live in a retirement village with a frail-care centre, you may find that the frail-care centre will not admit residents with dementia.

Some facilities have a separate wing for dementia and Alzheimer’s patients, however. The Oasis Care Centre, for example, has a sub-acute care facility with a licence to provide sub-acute and physical rehabilitative care, a frail-care section for people who are physically frail but still mentally competent, and an entirely separate dementia and Alzheimer’s wing.

Brill says the Department of Health encourages the registration by frail-care centres of separate dementia wings, because dementia have such different needs and they may have behavioural problems. This results in mentally strong but physically frail patients not wanting to be housed together with those who have dementia.

Although not everyone shares the view that dementia patients should be housed separately, Robson believes that it is best. Dementia patients can wander into mentally competent residents’ rooms and upset those residents with their behaviour, she says. They need to be in facilities where they are protected from wandering off and are not at risk of being allowed to leave the facility by someone who is not aware of their condition.

Brill says dementia patients need to be cared for by staff that are not only passionate about providing special care for these residents, but also have been trained to provide appropriate care for them.

The Oasis Care Centre facility for dementia and Alzheimer’s patients is like the frail-care centre, but has its own qualified nursing sister on duty and staff nurses and carers who have been trained by Dementia SA, she says. Continuous in-house training is also required to ensure the best care, Brill says.

To make matters worse for retirement village dwellers who develop Alzheimer’s disease or any other form of dementia, if their village’s frail-care centre is unable to accommodate them, they may be asked to leave the village if they are regarded as being a nuisance to other villagers. In this case, family members will have to find alternative accommodation and care.

When it’s near the end

The other situation that gives rise to confusion about what is covered is imminent death. Medical schemes are obliged to pay for what is known as palliative or terminal care intended to improve quality of life when there is no prospect of prolonging life. Typically, care focuses on pain relief.

The PMBs state that when death is imminent, your scheme must pay for comfort care, pain relief and hydration. These can be done in a sub-acute care unit or hospice environment that may be provided by a retirement village frail-care facility.

Peddle says Discovery Health determines the appropriateness of the facility for your condition and the treatment required. If the nurse or GP who provides the palliative care has a practice number and can bill your medical scheme, the scheme should pay for these services, according to your benefits.

Jordan says Fedhealth will approve treatment in an accredited hospice or nursing facility for palliative care. He says while palliative care is a PMB, the scheme also has a specific benefit for the terminally ill of R25 000.

Peddle says Discovery Health’s Compassionate Care Benefit offers benefits for the terminally ill beyond the PMBs. This benefit provides:

* Access to psychosocial support for the member and his or her family, aimed at easing the resumption of normal life and preventing the consequences of traumatic situations.

* Access to any medication the member requires to be comfortable, and this is not limited to pain medication. This medication is also not restricted to a formulary (or list of approved medications), which normally applies to PMBs.

* A choice of caregiver – a nurse, GP or hospice. In the case of PMBs, these services are usually provided by nurses.

* Pathology services where this is required as part of the member’s medical management.

Peddle says that medical management delivered by a registered healthcare professional – that is a nurse, GP or social worker – will be covered by the scheme as far as it relates to palliative care. The scheme will not, however, cover any bills from a frail-care facility that is not registered with BHF and does not have a practice number.

Discovery Health has introduced a new service this year offering home-based palliative care, as well as home care for other needs, such as wound care and intravenous infusions. These services from nurses and caregivers contracted by Discovery Health are covered by the scheme in line with your benefits.

You can also get respite care – temporary relief for the caregiver to an elderly person – but this will not be covered by the scheme.

HEALTHCARE FACILITIES ON OFFER

There are about as many different healthcare facility arrangements as there are retirement homes and villages, Paul Rosenbrock, a director of the South African Association of Retired Persons, says.

Some villages have no healthcare facilities, some offer home-based care, some have only a frail-care centre and possibly an on-duty nurse, and others offer a full range of services, from assisted living to sub-acute care and rehabilitation to frail care, as well as separate facilities for people with dementia.

Assisted living is also known as midcare or supported living. In most cases, a person will live in his or her own unit, but enjoy support from cleaning services, a carer assisting with personal hygiene and the administration of medicine, a nurse on 24-hour call and meals. Often, these units are available to rent or are sold on a life rights basis – you buy the right to live in the unit for the rest of your life or until you are too frail to live alone. If you buy a life right, when the last-surviving partner dies, the right ceases. Some value may be returned to your estate, but not the full resale value of the unit – for example, your estate may be reimbursed your original purchase price, or the purchase price plus a percentage of the profit on the sale.

Marelize van Rooyen, an estate agent and market research consultant to retirement village developers in Cape Town, says some developers of villages with frail-care or sub-acute care facilities provide the equipment and the building for a healthcare facility and then bring in a company with the necessary expertise to run it. In other cases, the facility is owned by the body corporate of the retirement village.

Val Heighway, a former nursing services manager at the Cape Peninsula Organisation for the Aged (CPOA), says most CPOA-associated homes and villages offer frail care. Many now also offer home-based care, which delays the need for frail care, because frail care, with staff on duty for 24 hours a day, is expensive. Once you need 24-hour care, however, frail care is cheaper than home-based care, she says.

CPOA employs professional nurses on all shifts and provides occupational therapy groups daily. Palliative care is provided, and assistance is obtained from a hospice.

Some newer villages have purposely chosen not to provide healthcare centres, preferring instead to promote home-based care and the concept of “ageing in place” – or ageing in your home and community.

Rayne Stroebel, the managing director of Gerontological Research, Training, Education and Care (Geratec), which offers catering, caring, housekeeping, management consulting and training to retirement villages and facilities involved in the long-term care of older people, says that around the world there is a move to ageing in place.

He says the health and mental state of residents in frail-care facilities decline much more quickly than those of people who remain in their communities. In addition, healthcare facilities tend to become bottomless financial pits, and when they are a drain on a village, a facility will start cutting corners, leading to potential problems.

Keeping people in their communities means that they buy from a care provider only the services they need. Rosenbrock says the advantage of this is that if a healthy spouse is not strong enough to provide for all his or her ill partner’s needs, the couple can enlist home-based services, to help with bathing, for example, and the healthy spouse can continue to do whatever he or she is still capable of doing, such as cooking.

Van Rooyen says a common problem with healthcare facilities is that retirement villages start with relatively young residents, between the ages of 60 and 65, but 10 to 15 years later, the residents are older and have greater medical needs, so the costs of running the healthcare facility rise.

Henry Spencer, the former chief executive of the Association for the Aged and the manager of a retirement village, says that villages in which the majority of residents have been in the village for some time tend not to attract younger residents, even when vacancies arise.

Stroebel says retirement villages with healthcare centres are booming, but younger generations will not necessarily choose these villages, now that there is a trend towards ageing in place. They are likely to prefer villages that form partnerships with service providers. For example, Geratec is in partnership with, among others, Langverwacht, a retirement apartment block in Stellenbosch. Geratec provides care, catering and cleaning services and has guaranteed the residents of Langverwacht that they will not have to move from their apartments to get the healthcare and other services they need.

Van Rooyen says villages that partner with providers such as Geratec typically have a healthcare centre with consulting rooms, a nurses’ station and emergency stabilisation room, but care, including nursing care, is delivered in your home. She says some newer villages have a frail-care centre nearby for those who need it and/or an independent dementia village.

Evergreen Lifestyles, a division of the Amdec property development group, has four retirement villages in Cape Town and one in Johannesburg where home-based care is promoted. The company believes home-based care is the best option, Arthur Case, the former general manager, says. frail-care facilities are sad places, as people seldom move out of them and only a small percentage of people really need to use them, he says.

Evergreen Lifestyles has trained nurses providing nursing care, and all homes and apartments have emergency buttons with which to summon assistance 24 hours a day. The healthcare functions are outsourced to the CPOA in the Western Cape and 24/7 Care in Johannesburg. Healthcare staff will also check on you to see that you are being cared for properly through home-based care.

Case says home-based care is likely, at its cheapest, to work out to about R16 000 a month, because two live-in workers are required to provide care each week. If the carers do not live in, four a week are needed.

Frail-care facilities cost between about R13 000 and R25 000 a month, depending on the facility and the quality of care, he says, although Robson says she knows of places that charge about R5 000 a month.

Lizzie Brill, the manager of Oasis Care Centre in Century City, Cape Town, says Oasis encourages home-based care for those who would like to use these services, but residents must use carers or nurses from agencies that Oasis has approved.

There will always be a market for frail care, because some people are not comfortable with carers or nurses in their homes up to 24 hours a day, she says.

In addition, Brill says when older people are cared for at home they often become isolated and their interaction with others is limited to their care givers, especially in families where younger members have moved overseas.

Brill denies that the Oasis Care Centre is a sad place, saying all the facility’s residents are encouraged and assisted to live full lives as far as possible. A full-time occupational therapist runs daily programmes, which include events and activities, as well as outings. In addition, Brill says the centre’s facilities are like a five-star hotel, which few residents and patients, even the wealthiest, could themselves provide.

She says while home care has its place, it is the daunting demands of running a fully-fledged care centre that have led some developers and bodies corporate to shy away from running such facilities.

Van Rooyen warns about retirement developments that make promises about developing healthcare facilities but never deliver on these promises.

She says often the villages have not been developed as retirement villages as defined in the Housing Development Schemes for Retired Persons Act, and the “promises” are not included in the deed of sale, which leaves you unable to take action against the developer.

Van Rooyen says some villages are marketed as “retirement lifestyle estates”, but they are not registered under the Act.

She advises you to look for a developer with a proven track record to make sure the village is registered under the Housing Development Schemes for Retired Persons Act, and that the frail-care facility is registered under the Older Persons Act. Then read the agreement of sale and the village’s constitution, she says.

Stroebel says people often move into a retirement village during a crisis and do not do enough research. He suggests talking to as many people as you can at a village about the facilities and how they are run.

Rosenbrock suggests you read the constitution and rules of each village you are considering.

A resident of Noordhoek Manor on the Cape Peninsula told Personal Finance magazine that the brochures about the village stated that it offered sub-acute and frail-care facilities. But after she moved in, the village decided to scale down its healthcare services and offer only frail care.

Villagers who need sub-acute facilities are expected to use facilities at a nearby village, the Noordhoek Manor resident says.

Mike Vietri, the chief executive officer of Faircape, the developers of Noordhoek Manor, says the village’s management rules bind it to offering primary healthcare through nursing staff. He says the village fully complies with these obligations and more. In 2011, Faircape obtained a sub-acute care licence to try to improve the Noordhoek Manor healthcare centre’s occupancy levels. Vietri says there was limited demand for this service and it was therefore withdrawn. The licence is maintained, however, so that, if there is a demand for this service, it could easily be re-offered.

Thuli Mahlangu, the chief director of care and services to older persons at the Department of Social Development, says the Older Persons Act, which came into effect in 2010, has introduced some protection for people living in retirement villages and homes, including the registration of frail-care facilities, but there are still many gaps. The department hopes to introduce amendments to the Act to Parliament to deal with some of these loopholes, she says.

Mahlangu says the department is aware of the issue of retirement villages not building healthcare facilities as promised, or, after opening them, declaring them too expensive and shutting them down.”

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