1 ROYAL REHABILITATION CENTRE SYDNEY ANNUAL REPORT 2006/07
2 C O N T E N T S WHO WE ARE We are a nationally recognised organisation providing specialist rehabilitation services to maximise people s abilities and optimise their life skills. About the Royal Rehabilitation Centre Sydney 01 About our Clients 2-3 some snapshots of our clients 4-5 Chairman s Report 06 OUR VISION Our vision is to establish state-of-the-art specialised rehabilitation and research services on our current site, together with a unique multi-purpose health and disability community centre for people living with a disability. These world class facilities will form the headquarters of a network of community based support services, integrating rehabilitation and Chief Executive Officer s Report 07 Highlights for Financial Summary 09 Our Volunteers, Supporters and Fundraising Activities 10 our volunteer program 11 Our Corporate Governance 12 Our Accreditation and Risk Management 13 disability services into the community where they are needed most. OUR VALUES client self-determination inclusiveness striving for excellence creativity responsiveness valuing difference teamwork innovation courage Providing and Developing our Services our disability services directorate our rehabilitation services directorate adult and aged care rehabilitation services 19 ambulatory care community-based programs clinical support services Improving our Organisational Structure and Infrastructure Understanding and Responding to Client and Stakeholder Needs Conducting Research and providing Education and Training Services Our Publications and Presentations publications and presentations for the centres for developmental disabilities studies publications and presentations for the rehabilitation studies unit Index 41 Annual Financial Report 2006/
3 ROYAL REHABILITATION CENTRE SYDNEY ANNUAL REPORT 2006/ About the Royal Rehabilitation Centre Sydney The Royal Rehabilitation Centre Sydney (Royal Rehab) is a not-for-profit charitable organisation with an independent Board of Directors. We provide statewide specialist rehabilitation services and operate as an affiliated health organisation under the Health Services Act Our goal is to work with our clients, after an injury or illness, to maximise their abilities and optimise their life skills. Providing Care since 1899 We have a 108 year history of providing care to the community. Our organisation was started by Susan Schardt a blind, compassionate and very religious woman. In 1899, she rented a cottage in Surry Hills to provide accommodation for patients being discharged from hospital as incurable. This cottage eventually became known as the NSW Home for the Incurables. In 1906 the Hon Henry Moses MLC offered his property in Ryde to be purchased by Ms Schardt and the fundraising committee so that the activities of the home could be expanded, and in December that year Weemala opened with 65 beds. Since then we have continued to expand our services and premises and in 1990 became the Royal Rehabilitation Centre Sydney. We provide significant rehabilitation services to people across NSW with a wide range of needs, as well as a long term accommodation service based in the community. However, as a not-for-profit organisation, we still rely on government subsidies, grants and donations to continue our specialist work and research. Her Excellency Professor Marie Bashir AC, Governor of NSW is the patron of the centre. Our Services We provide specialist inpatient rehabilitation programs for adults who have a disability as a result of a spinal cord injury, occupational injury, orthopaedic injury or illness, traumatic brain injury and neurological loss, burns and multi trauma, and age related illness or disease. These services are also offered through outreach programs run by our spinal outreach service and brain injury community rehabilitation team. Our home-based rehabilitation and pulmonary rehabilitation programs provide services to clients in their own homes. We also provide community based support services for people with disabilities through our Weemala extended care service (on site) and the community integration program. Royal Rehab is a registered training organisation and we deliver accredited courses in allied health, aged care and disability as well as a range of professional development activities throughout Australia. We also hold affiliated teaching status with the University of Sydney and have been accredited for our rehabilitation medicine and nursing training programs. Our Plans for the Future We have a long history in Ryde and a strong commitment to the local community. However our current facilities are old, out-of-date and inaccessible and urgently need to be redeveloped. We do not have the funds to do this but we own the 18 hectares of land that is now Royal Rehab so we are selling a significant portion of this land to help fund the redevelopment. The sale of the land will enable us to: build a new state-of-the-art rehabilitation centre with a range of specialist amenities such as community health, conference and child care centres expand our current community based services and supported living programs provide better services for all our clients, hopefully for another 100 years. The planned new facility will form the hub of a network of community and home-based services, effectively integrating rehabilitation and disability services into the community. Some of the key benefits for clients will include modern therapy facilities and private accommodation, a new and accessible recreational complex, improved transitional living and respite accommodation as well as short term accommodation for families supporting loved ones during their rehabilitation. We will continue to provide care and support for our clients currently living in Weemala, but in new modern homes not a 100 year old institutional building. Our academic research and educational units will remain on site but with improved facilities and will continue to teach medical, nursing and allied health students. We are also assisting the Riding for the Disabled Association with its relocation to a more appropriate facility. As part of the development we will be able to provide recreational facilities, cycling paths, lakelands, gardens and open space for all the community to enjoy. The number of residential dwellings on the site will be limited to 791, and buildings will be designed to fit in with the natural topography of the site. We will also be providing traffic calming devices and improving vehicular and pedestrian access to the site. We expect to start building our new rehabilitation facility in the early months of 2009, with minimal disruption to clients and no reduction in the services we provide. For more details about the concept plan for our new centre, please go to our web site at and follow the links to more information for new centre updates.
4 0 2 ROYAL REHABILITATION CENTRE SYDNEY ANNUAL REPORT 2006/07 About our Clients Our clients have similar characteristics to clients admitted to other rehabilitation facilities, although Royal Rehab is regarded as a specialist in complex care cases particularly those with a spinal cord injury, brain injury, stroke or multi trauma. Our clients are more likely to be younger, have lived with family and friends before admission, and stay longer at Royal Rehab than benchmarked groups. They are also more likely to have been employed or studying before their admission. Over 90% of our clients usually live at home in a private residence, nearly half come from surrounding suburbs such as Ryde, Gladesville, Eastwood, Epping and Marsfield, and more than 80% are referred to us from another hospital. Importantly, our clients achieve an average functional independence measure or FIM score gain of 17.1 compared to the Australasian Rehabilitation Outcomes Centre (AROC) benchmark of In : 52% of the 460 clients admitted to our rehabilitation units were male and 48% were female. However 75% of the clients in our spinal unit and 89% in our brain injury unit were male. Nearly 10% of our admissions were less than 29 years old, 14% were between aged 30 and 44, 18% were between 45 and 59, 19% were 60-74, 32% were and nearly 7% were over 90 years of age. 22% of clients admitted to Royal Rehab had an orthopaedic impairment, 22% had a brain dysfunction, 15% had had a stroke, 13% a spinal dysfunction, 10% experienced pulmonary impairment and 6% had a neurological impairment. The remaining 12% had impairments due to, for example, major multi trauma, an amputation, burns or arthritis. Of the more than 1000 registered clients we provided with non-inpatient services, 39% received spinal outreach services, 27% attended our driving assessment centre, 23% received home based rehabilitation services, and 11% received community rehabilitation for a brain injury. There were 34,114 occasions of services provided in in relation to our non-inpatient and community based services and programs. Our Commitment to our Clients We will help you to do as much as you can for yourself. We will try, wherever possible, to help you do things your way. We will talk to you openly and honestly about your rehabilitation and what we need you to do to help with your recovery. We will make sure that our staff supporting you are informed about the latest and best ways to help with your rehabilitation. Consumer Participation and Engagement There are two bodies that provide advice and comments to the Board and senior management of Royal Rehab on service delivery issues. The Weemala Residents and Advocates Committee is a long established group that meets regularly to discuss issues of concern to residents and family members of Weemala. In the Committee has been active in raising its concerns about the closure of Weemala and the provision of alternative supported accommodation for the residents in community settings. The Committee has been unanimous in wanting the continuation of on-site accommodation for the remaining 32 residents of Weemala when the Royal Rehab site is redeveloped, and the Board has committed to constructing new Weemala accommodation facilities that will meet the needs of the residents. The Community Integration Program Client Advisory Council represents the residents of our community integration program. There are 69 clients living in the community that receive ongoing care and support from Royal Rehab community integration program. Measuring Client Satisfaction We encourage all our clients to complete a client satisfaction survey or client perception response sheet. The feedback they provide about the care or service they received helps us to identify areas for improvement. Most of these surveys are completed by the clients themselves, but some are completed by both the client and their carer.
5 ROYAL REHABILITATION CENTRE SYDNEY ANNUAL REPORT 2006/ For example, in , more than 80% of clients who received adult and aged care rehabilitation services said they had been involved in their discharge planning, and over 90% said they were given adequate notice of their discharge date. Of the approximately 100 surveys returned between January and June 2007, over 90% rated our service as excellent or good, nearly 95% said they would recommend Royal Rehab for inpatient rehabilitation care, and just under 92% agreed they would come back to Royal Rehab if they needed rehabilitation servicesin the future. We are also happy to receive complaints or compliments from clients at any time, either verbally or in writing. If clients feel their concerns are not fully addressed by the specific unit / service manager or medical director, they may contact our Chief Executive Officer. If our consumers are not happy with how their complaint has been managed, they should contact the patient support officer at Royal North Shore Hospital. They may refer them to the Health Care Complaints Commission. Posters with a flowchart explaining the complaint process are displayed on all floors of Weemala and all clients receive information on their rights and responsibilities as part of their referral to Royal Rehab. Comments Thank God for you people. Would return but hope never have to Experienced caring professionals Very dedicated staff, good at what they do At any time help was needed it was gladly given The nurses are caring people with thought to the clients problems Good staff, friendly and caring, they are a happy helpful group More outdoor activities Colour, stimulation and orientation in group areas, say dining room 100 Overall Rating of Care Received 80 PERCENTAGE Poor Fair Adequate Good Excellent 2005 Jul - Dec 2006 Jan - Jun 2006 Jul - Dec 2007 Jan - Jun Choose to Return if further Care Required 80 PERCENTAGE Stronly Disagree Disagree Neutral Agree Stongly Agree 2005 Jul - Dec 2006 Jan - Jun 2006 Jul - Dec 2007 Jan - Jun Recommend Royal Rehab for Inpatient Care 80 PERCENTAGE Stronly Disagree Disagree Neutral Agree Stongly Agree 2005 Jul - Dec 2006 Jan - Jun 2006 Jul - Dec 2007 Jan - Jun
6 0 4 ROYAL REHABILITATION CENTRE SYDNEY ANNUAL REPORT 2006/07 Some Snapshots of our Clients Ms P Ms P was 16 years old when she contracted Guillain Barre Syndrome, a neurological disorder that leads to progressive weakness in all the muscles in the body. After a prolonged ICU admission at Royal North Shore Hospital, Ms P was referred to Royal Rehab and started a long period of rehabilitation to regain the ability to walk without a frame or assistance and improve the functioning of her arms and hands. Ms P participated in multidisciplinary therapy and, with the support of family and friends, made a significant functional recovery. When Ms P was discharged from Royal Rehab she was able to walk independently with no aids as well as eat, dress and shower without support. Mr V Mr V was admitted to Royal Rehab after his right leg had been amputated because of vascular problems. His rehabilitation involved medical care and training to regain the ability to walk using a prosthetic fitting. Mr V received multidisciplinary care including strengthening exercises, balance re-training and care for his medical needs. He had prosthetic fitting and training, and his home environment was assessed to ensure safe discharge. On discharge, Mr V could take care of himself and walked independently with the use of a walking frame. Mr B In May 2006, Mr B had a workplace accident and sustained burns to 85% of his body. Referred by the Royal North Shore Hospital, Mr B was seen by a team of specialised staff at Royal Rehab including doctors, nurses, clinical nurse consultants, speech pathologists, recreational therapists, physios, OTs, dieticians, clinical psychologists, social workers and compensible case coordinators. Mr B s therapy included scar management (stretches, massage, fitting of pressure garments, wound care), re-learning daily skills, mobility practice, outings/social integration, psychological support, pain management and dietary education. He was able to increase his ability to move and eat, shower and dress on his own and was discharged to a private hospital nearer to his family. Mr C Mr C had a significant stroke and, as a result, lost his ability to see and swallow effectively and use his left hand side. After specific rehabilitation, Mr C recovered his sight, balance and ability to walk independently. Fully recovering his ability to swallow has and will take a longer period, though the gains made to date have enabled him to return to full time work. Mr A Mr A is 90 years old and has a long history of mild dementia. He was admitted to hospital with dizziness and pain following a fall at home. He was not orientated to place or time and was initially admitted to the HomeReach program for two weeks intense rehabilitation. The Program included: Reviewing his medication, assessing his ability to function at home, taking his blood pressure twice a week, and discussing issues and concerns with his family. Three visits a week by a physiotherapist to improve his mobility and implement a functional balance and strengthening exercise program. Completing a falls prevention assessment and putting strategies in place such as taping down mats, placing power cords behind furniture, and purchasing a bath board and bed rail so Mr A was able to shower and dress safely. Weekly visits by a social worker to provide information on managing dementia, contacts for the Alzheimer s Association, and how to access a carer s pension and ongoing carer support services. Mrs G Mrs G was affected by chronic obstructive pulmonary disease as well as ischaemic heart disease. She was referred to Royal Rehab by her respiratory specialist. Mrs G s breathing was uncomfortable, she had to rest after five minutes of walking, and was having difficulty with household chores. She started the 8 week rehabilitation program of treadmill, bike, arm weights and functional exercise and received supplemental oxygen during her exercise sessions. She also learnt about how her lungs function and are affected by her chronic respiratory condition, how to manage her condition, breathing techniques, coping with chronic illness, diet, swallowing and energy management. Since completing the program some of Mrs G s medication has been reduced in strength, she is coping better with household jobs and enjoying life with family and friends. She is now an active member of her community support group Chesties Bonding, a patient representative for the Australian Lung Foundation, and was a guest of honour at the WORLD COPD DAY event in Martin Placey in November 2006.
7 ROYAL REHABILITATION CENTRE SYDNEY ANNUAL REPORT 2006/ Mr L Mr L has lived in Weemala for more than 50 years. He moved there when he was 26 years old to live in the mens ward on the ground floor. At that time there were more than 176 residents. Over the years, Mr L s supportive family have visited him regularly and taken him out. He has enjoyed the life with other residents, the fetes, the craft and the friends he has made and in 2002 he went on his first holiday to Queensland. Despite many residents moving out to homes in the community since 1993, Mr L has chosen to stay at Weemala. The Wall of Fame Each year during Brain Injury Awareness Week the Royal Rehab Brain Injury Unit recognises the outstanding achievements of a number of patients in its Wall of Fame. This event gives everyone involved in the process of rehabilitation an opportunity to celebrate and recognise the courage and tenacity demonstrated by individuals and the inspiration they provide for others. This year s Nominees were: Alan Borg Jhonnie Blampied Dimitry Reutov Trish McCarthy Emma Flanagan Dr Clayton King & Emma Flanagan Tim Grant In late February 2006, I was driving to church during a severe thunderstorm, when my car aquaplaned and went backwards into an oncoming semi-trailer. Luckily, a paramedic was travelling behind me and I was in a Westpac helicopter within ten minutes of my accident. I spent three months in John Hunter Hospital before transferring to Ryde. I was in a coma for three weeks and had post-traumatic amnesia for four months. Rehab was hard, and I guess I didn t know how serious my injuries were. At first I thought I was just having a bad dream. Being so unaware of my state I figured I would get better if I simply did as I was told. My rehab was rapid in retrospect. I first talked in August, then walked in September. It took me nearly a year to become more intelligible and confident enough to speak more freely. As a musician, not playing the piano or guitar was at first very upsetting. I have worked very hard to regain these skills, and that has been good therapy, both physically and mentally. I am hoping I can use my experience to encourage and inspire others to believe in their dreams, be positive and never get the blues. Emma F lanagan On the 23rd March 2005, I was involved in a serious car accident on the Pacific Highway on my way to Port Macquarie. A ladder fell off the back of a ute, I swerved to miss it and in doing so an oncoming vehicle slammed into my car. I suffered serious head injury, fractures to the skull and vertebrae, broken collarbone and ribs. I was flown to Prince of Wales Intensive Care Unit, where I remained in a coma for two weeks. I was eventually transferred to the Brain Injury Unit at the Royal Rehabilitation Centre where I spent the next two and a half months working hard with physio, speech therapy, occupational therapy and finally hydrotherapy. I have now returned to work, nine hours a week in my original position with the assistance of community rehab services. My aim is to get back to my original full-time hours and eventually get my license back. I still need to keep notes in my diary and reminders in my mobile phone to help remember appointments and everyday activities. My social life is not as active and I don t go to parties as often as I used to. I will never forget this experience or the people involved as it has been like starting my life all over again.
8 0 6 ROYAL REHABILITATION CENTRE SYDNEY ANNUAL REPORT 2006/07 Chairman s Report The Royal Rehabilitation Centre Sydney is in the middle of a significant transformation that will see the organisation reshape itself to better meet the needs of our current and future clients. Over the last year we have worked steadily to achieve our goals to build a new state-of-the- art rehabilitation centre, as well as provide more community based care and a greater continuum of care for people who live across NSW. Like many hospitals, we have experienced great challenges in our ability to maintain our infrastructure while ensuring quality of care. For some time we have also operated with a deficit budget, a position that is not sustainable in the long term. As a not-for-profit organisation providing significant public health services, our capacity to bring in extra income has been limited. The Board s decision to sell sixteen of the eighteen hectares of land we own at Ryde to provide us with capital to rebuild and grow our services was therefore a logical decision. We have acknowledged local community concern over the sale of the land, which we have endeavoured to accommodate where practicable. The sale will enable us to keep the doors open at Ryde and meet the needs of our clients and their families, both now and in the future. To meet these future demands, our organisation needs to become more flexible and responsive. We are witnessing an understandable change in the way people want their rehabilitation services delivered. They want to go back to their own homes and families as soon as possible, as well as return to work, a social life and their other important relationships. They also want individualised responses that can accommodate their lifestyle choices. This means that we have to change the way we work. Opening other clinics, enhancing our teams, making our teams more mobile and accessible to communities in need, looking at innovative technology, and reaching out through training and education are some of the ways we aim to achieve this in the coming year. We understand that some of the changes we are embarking upon can create unease and uncertainty. The Board has been very aware of the impact the closure of the existing Weemala building has had on the individuals who live there and their families and friends. It is an old building that is no longer suitable for the current residents and will need to close. We are in active consultation with residents and families about alternative accommodation, and are confident that we can continue to provide the same standard of care for current Weemala residents in new housing, either in the community or on-site. We are also aware that the preference of the residents and family members is for the residents to stay together and stay at Ryde. The Board has since confirmed their commitment to accommodate that preference. The Board are a committed group of experienced and well regarded individuals. I would like to take this opportunity to thank them for the considerable time and support they have provided to the organisation, in a purely voluntary capacity, over the course of this year. Clive Austin Chairman
9 ROYAL REHABILITATION CENTRE SYDNEY ANNUAL REPORT 2006/07 07 Chief Executive Officer s Report Working together, we can achieve the extraordinary... has been a key theme for Royal Rehab during , as the momentum of our efforts during the previous year has been realised. We have every reason to remain confident that our achievements will continue well into the future. Our focus this year has been to improve operational efficiency and performance without detriment to client outcomes and standards of care. We have successfully completed the implementation of a new directorate structure, aimed at achieving a stronger focus on client-centred care, accountability and responsibility. This restructure has involved the appointment of new key senior executive staff. They include Elizabeth Drolz (Director Nursing, Inpatient and Speciality Rehab Services), Delia Gray (Director Allied Health & Community Services), Professor Ian Cameron (Director of Medical Services and Clinical Support) Deborah Frith (Director Marketing & Organisational Development), Dr Phil Morath (Director Disability Services) and Frank Erdt (Director of Finance & Information Management). The Centre has accumulated operating losses from our reserves amounting to $3,237,754. Our consolidated financial surplus for of $241, 494 (2006: $1,815,235 loss) is encouraging. It should be noted however that our principal activities in resulted in a loss of $584,224 whilst our special purpose trust funds achieve a surplus result of $825,718. The net operating results for demonstrates our ability to deliver a positive and financially viable going concern. Centre admissions were up by 2.9% (2007:460; 2006:447) and non-inpatient occasions of services were 18% above last year activity (2006:30,189; 2007:35777). With this result and continued improvements, we can now pursue our redevelopment and service growth initiatives with a higher degree of confidence. Our redevelopment plans are now well advanced and we firmly believe that a project application can be lodged by the end of December Once this application is approved, we expect that our new centre can be constructed and occupied by We have aspirations and ambitions to extend the reach of our services. In anticipation of this, we have identified some priority areas of need and acted on these. For example, we have submitted proposals to government for new initiatives such as establishing a slow-to-recover rehabilitation service. We have achieved registered training organisation status, we are negotiating with an interstate agency arbias to establish a service in NSW for people with alcohol related brain injury, and we have made preparations for the introduction of the Motor Accident Authority life-time care scheme in October Our concerted push in extending the organisation s performance has resulted in the realisation of many of the outcomes articulated in our Strategic Plan Our efforts have helped prepare Royal Rehab for the challenges ahead, including constructing our new state-ofthe-art rehabilitation facility and expanding our services into the community. Our achievements in are testimony to the loyal and highly experienced staff at Royal Rehab. They are dedicated to providing the best quality, standards and safety of care for our clients. However it is our clients and their families and carers that continue to inspire us to achieve more. In we will work hard to continue to improve the journey for a better quality of life following injury or illness and to maximise abilities and optimise life skills. Peter Williamson Chief Executive Officer
10 0 8 ROYAL REHABILITATION CENTRE SYDNEY ANNUAL REPORT 2006/07 Highlights for Key Priority Area What we Achieved in What we Plan to do in Strengthening our Existing Services Developing our Services Improving our Organisational Structure and Infrastructure Understanding and Responding to Client and Stakeholder Needs Conducting Research, providing Teaching and Education Training Services Restructured Royal Rehab with a focus on client-centred care to maximise service performance and client outcomes. Ensured we maintained a positive and financially viable growth cycle. Enhanced our home-based rehabilitation service and outpatient clinic budget. Established a spasticity clinic and an academic dementia clinic. Collaborated with CDDS to establish a specialist disability medical clinic. Started our HomeReach service and TRANSPAC program. Implemented COGNOS to improve internal management reports. Achieved Australian Council on Healthcare Standards accreditation for organisation standards. Achieved Australian Medical Council accreditation for registrar training. Prepared a community communication and consultation strategy for the redevelopment of the new centre. Held consultation forums for Weemala families and residents to resolve the future accommodation needs of Weemala residents. Actively participated in relevant industry associations and steering committees Achieved RTO accreditation. Received continued sponsorship from O Donnell Griffin to support workplace safety awareness campaign. Established a lite-gait mobility assessment and research facility. Increase our current level of public admissions. Improve access to and performance of our services. Review and enhance transition support and respite programs to facilitate throughput. Improve bed management and operations. Seek opportunities to increase government and non-government funding for new programs. Increase numbers of patients. Expand ambulatory care and community based programs. Expand our capacity to provide a range of accommodation and service base options. Improve information and decision support systems and infrastructure. Redevelop our site. Renew our IT, communications and application software infrastructure. Identify and act on risks to the organisation s reputation and operations. Revise and review our corporate entity to ensure maximum performance. Develop and improve communication and community relations strategies. Create client / stakeholder participation in all aspects of service development and delivery. Develop the Rehabilitation and Disability Foundation. Expand our training and education service capacity and education profile. Integrate and expand our research capacity and develop an evidence based culture. Develop and implement a workforce planning strategy that underpins service development.