Transcript: Recognising the Individual - Why Community Nursing makes a Crucial Difference in Regional, Rural and Remote Australia

We speak to Registered Nurse and health-care veteran, Stephen, about the benefits of community nursing, and how to get the most out of the aged-care journey.

You can also listen to the full episode, or view more podcasts and transcripts on our Live Well Podcast Page.

Liz
Hello, and welcome to the Live Well Podcast. I'm Liz Moore, a Communications Partner at integratedliving Australia, and I'm speaking to you from Gubbi Gubbi Country on the Sunshine Coast. integratedliving Australia acknowledges Aboriginal and Torres Strait Islander peoples as the traditional owners and custodians of this country. We pay our respects to them, their cultures and customs, and to elders past, present, and emerging. 

Today, I'm very pleased to be joined by one of integratedliving's Registered Nurses, Stephen. We'll be discussing Stephen's long career in healthcare and the differences he's experience between regional community nursing and other types of nursing. He's a wealth of knowledge and experience. I'm very glad to have him with us. 

Thank you for joining us, Stephen. 

0:43 Stephen 
Hi, Liz. Good to be here from Gumbaynggir Country.  

0:46 Liz 
Thank you. Wonderful, around Dorrigo?  

Stephen 
Yes. 

Liz 
Stephen, can you please tell us a bit about your history as a nurse and what inspired you to enter the profession? 

0:56 Stephen 
When I first left high school, one of my friends went and worked in a big place up the road called a Home for Incurables. And it was a time after I left school when I wasn't working, so I went up and joined him there and it was a really fun place to work. There were all these young adults and lots of really old adults and we mixed together and had this fantastic camaraderie. 

So years later when I had done a few other things and was out of a job, I decided to go and apply to Sydney Hospital. In the middle of Macquarie Street, Sydney, to work as a wardsman. And I did that for about 11 months. And I thought I quite like being here. I really liked being in hospitals. I love the combination of practicality and theory. 

And so I decided to sign up to be trained as a Registered Nurse. In those days you did it within the hospital and so it was like an apprenticeship. You did six weeks on the ward and a month in class and over a three-year period, I trained at Sydney Hospital and did work experience at Children's Hospital, St. Margaret's Women's Hospital and Gladesville Psychiatric Hospital.  

I finished my nursing training after three years being paid with a piece of paper, so it was a way of paying for qualifications. And I just loved being around, I loved the 24-hour nature of it. I loved that you didn't know what was gonna happen next. And also, I loved the camaraderie of the people who I worked with. That was really important.  

So anyway, I worked in a number of high-tech wards, ICU and coronary care recovery at St. Vincent's Hospital where there was Dr.Victor Chang, obviously. I worked in oncology at Manly Hospital and Hornsby Hospital. I worked in coronary care at Prince Henry Hospital and then I followed my heart to Kempsey as it were. And I got a job in community health soon after that cos I wanted to play football and it was the only way I could play football and be a nurse cos we didn't work all weekends. 

So I had the great pleasure of becoming the community health nurse responsible for a number of tight-knit, little isolated villages on the coast. And this is back in the day where only two of those places had a doctor. There was two chemists between the three towns. There was no mobile phones and it was isolated nursing. Then I moved to Newcastle and started working in the geriatric rehab ward at John Hunter, which satisfied my interest in gerontological nursing. 

I did a post-grad certificate in 1991. And yeah, I worked at John Hunter Hospital in the geriatric rehab ward for about eight years, and it was fascinating. I just loved looking after the older people. I loved understanding the particular changes in the body that occur as you get older and ways of responding to them. 

And also the fact that it was rehab. So it's taking people from a very fragile, broken part of their lives to the point where they could go home and hopefully resume their lives. Then I also was seconded to a community health program there, which was really exciting. And so eventually when I decided to move out of the hospital, ‘cause I got sick of doing shift work, I got a job with integratedliving cos it was community health nursing, particularly of older people, which was my personal area of expertise. 

4:35 Liz 
Stephen, you've covered a lot of countries since then as a nurse, a community nurse with integratedliving. Can you tell us a bit about your current role?  

4:46 Stephen 
About three years ago I moved to Dorrigo working on the clinical help desk, which meant that I work from home so I don't actually have to go out and visit people anymore and can just provide expert clinical advice to staff. I can do from home, and I can live in this lovely little town.  

5:05 Liz 
And an enjoyable role drawing on a lot of your experience.  

5:09 Stephen 
It's a really good role. It really does utilise communication skills clinical knowledge and clinical experience. There are three very important things that I bring to bear in this role.  

5:23 Liz 
So how many years of nursing is it now?  

5:26 Stephen 
I started my training in 1982, February 82. So it's a long time  

5:35 Liz 
You've earned your stripes, that's for sure. 

5:39 Stephen 
I quite often preface statements by saying, oh, I've done this, or I used to do this, or back in the day, and I'm not really harking back to that as a golden age, just comparing the differences.  

5:52 Liz  
Yes. Some incredible experiences that you've had in very large variety of areas. 

6:01 Stephen 
So I worked as I also worked for the ACAP team, Aged Care assessment team in the McCleay Valley. That was really good. Because they opened the first ever indigenous aged-care facility there. So I had to do all the assessments for people who wanted to go into that aged-care facility. 

So I went into all the homes of all the older Aboriginal people who I knew around town, which was quite exciting. I also did a stint as a palliative care community health nurse, and there were some things that I did in that which, they required everything, every skill that I had to the nth degree to try and keep people comfortable at home. 

6:38 Liz 
Can you tell us a bit about the difference between nursing and community nursing? What is community nursing?  

6:47 Stephen 
See, when you are in a hospital and there's an old joke, the leg in bed 37 Mr Smith, he's the leg in bed 37. Whereas if you see Mr Smith in the community, he's in the home that he's lived in. He's with his family, he's with his possessions. And so you get to see Mr Smith who has, but for a bad leg, been living in the community safely and happily for the last 78 years. And so you are in their space. So it behaves us to be respectful and it also informs our practice to a great deal. 

And so what we are trying to do in the community is to enable people to stay there as long as possible, to make choices about what we provide them to help them stay so, as client-directed care. Whereas in the hospital, it's doctor-directed care. And in the community, it's client-directed care. 

So we obviously give people advice, but it's really important that if they choose to say, we don't want to take your advice, we accept that, and we do it all the time. So within the community, you don't have all the structure around you of a hospital, like a room we can go and get all your dressings or a room where all the drugs are, or a telephone call to the nearest doctor, or, someone falls out of bed, get an extra.  

In the community, you are working within someone's house so the structure that you have to support you and keep you safe is the clinical governance, is the policies and procedures and the protocols so that you do things according to the rules so that you don't damage someone, damage yourself, or get into trouble. 

Although all those rules feel constricting, they're not, they're actually the thing that allows us, that they're like our life support system.  

8:45 Liz 
And would you say that community nursing is even more important in regional, rural, remote areas where there's not so much access to hospitals? 

8:56 Stephen 
It's very important. When I first started in the community, I was talking about 45 kilometres to the nearest hospital. There are people who we look after who are hundreds of kilometres to the nearest hospital. So what we're trying to do is build in resilience and make use of all the resources in the community, public and private. 

And that's one of the really interesting things about being a not-for-profit private organisation who is funded by the government. We're somewhere in the middle. We're not public sector. We're not private sector in that we are not there to make profits for our shareholders. 

We're there to provide the best quality service for our clients and be directed by them as to what services we provide. You're not going to take ridiculous directions, but you can't say, no, tomorrow we're doing this. You have to say, Mrs Jones, ‘would it be okay if tomorrow we did this? Cos I think it'd work best for you. I'll make it comfortable. I'll get you transport, whatever. But how do you feel?’ And if she says, ‘no, I don't want to do it’, then your job is to then find another way of providing her with the outcome that she needs. It's very important.  

Like when I first started, I was the only health provider in the town. There was no chemist, no doctor. And that's happening more and more in the community where general practitioners are leaving the bush and moving to the city. Where I live, there's a tiny little place called a multi-purpose centre with two beds. Two beds, and I just saw the doctor the other day and he's leaving town. That would be an hour and a half to the nearest doctor.  

So when you are a community health nurse in the community and in the rural and remote, what you are doing is you're setting up systems which will support the person setting up emergency systems. You're setting up management of chronic diseases, management of disability, and you're setting up public-private partnerships because if we don't have the number of support workers or if there isn't a physiotherapist or something we have to arrange that. 

And like integratedliving, we can get a remote occupational therapy assessment of your home. We can get a remote physiotherapy session so you can do your exercises with them watching you. We have remote social work, remote psychology. We're very attuned to providing remote services. 

11:29 Liz 
Yes. And can you tell us a little bit about how your father and his influential values have shaped your career and your choices?  

11:40 Stephen 
My father's father was a wharfie who got injured in World War I and came back to Australia disabled. And he could have been a TPI, Temporary Permanently Incapacitated, but he didn't, he worked on the wharfs and he drove Derricks so that he didn't have to use his left arm, which didn't work anymore.  

My father went to Sydney Boys High, which was both a G P S and a CHS high school. And he wore a suit his mother bought from St Vincent de Paul, with a patch in it. And there were lots of boys there who were very wealthy, but he had the suit and his attitude was always that he was as good as anybody. He was fiercely egalitarian. He came from that lowest of the low, the wharfie, and he was rubbing shoulders with children of famous surgeons and criminals and all that sort of stuff. 

And by the quality of his person, he became a prefect. And he became a good sportsman. And he showed me the value of not giving up and the value of just standing there and saying I'm good enough for this place. That fiercely egalitarian principle enabled me to work all through a medical system, which is fiercely hierarchical. 

And some people tend to think that the fact that they've got lots of numbers after their name or letters after them makes them a better person. My job was always to see the best, as in my training. I worked in Sydney Hospital where there were people off the streets out of Hyde Park, and there were people from the highest echelons of society. 

And my job was to relate to them as a person. Not as a better person. I just happened to be the guy who could do this job for them. And it was really fascinating when I first worked in theatres to work with some of these famous surgeons from Quarry Street and realised that they were not much different to plumbers. 

They did this, they did leg bones or they did bowels. They didn't do the whole range, that there weren't many general surgeons. So just to see that they had their job to do and I had my job to do. There was a wonderful thing that my dad used to say: ‘Who depends on who, like they depend on you, or do you depend on them or both? If you left, who's gonna help the surgeon? He's not gonna have anything around him. He's not gonna have all that structure. But if he left then you could basically do nearly everything except for cutting people up.’  

14:08 Liz
That’s a good leveller. 

14:09 Stephen 
You just tip the pyramid upside down and find out that everyone's as valuable as everyone else. So yeah, my dad also had this principle, his favourite movie star was a guy called Roy Rogers. When Roy Rogers always said, ‘I never met a man I didn't like’. And so my father was always looking for the thing in a person, the quality within a person that was likeable, that they could be proud of, and that you could relate to. 

And that's really held me in good stead all the way through my career. So whenever I'm with anybody, I can find something that we have in common. And that we can talk about and we can share. And there's the six degrees of separation, but it's closer than that. When you're looking for something to share with somebody, ask a couple of questions and next thing you know, you were both interested in speedboat racing when you were teenagers or you've both loved reading Dickens, or you both like to do your footy tips on Thursday night. Doesn't matter what, as long as there's something in common.  

One more thing in there please. The other thing was to engage with people, and to encourage people to trust you, do a good job. 

Liz 
How do you do that?  

Stephen 
How do you do it? You just do it to the best of your ability. Yeah, but never be slack. I think that's the best way to gain trust so they know that you are working to your best. So dad, yeah, he was a man. He never had to prove a thing because he never felt that he needed to prove a thing, so he just looked confident and I was like that.  

16:03 Liz 
Oh, that's a wonderful thing to pass to the next generation, isn't it? 

16:08 Stephen 
Sure is.  

16:11 Liz 
What are some of the highlights that you've had in your career since joining integratedliving?  

16:17 Stephen 
I've done some fascinating things with integratedliving. Some people may know that I appeared in advertisements for integratedliving about 2018. I still get stopped in the street by people who have seen them and say, ‘are you that guy on that ad?’ And I go, ‘yeah, that's me.’ Yes.  

In 2018, integratedliving sent me to Central Australia with a multidisciplinary team to deliver low-vision wellness education to indigenous people. And we had the pleasure of going to some remote villages, one called Titjikala, which is southeast of Alice Springs, 120Ks out near the where the Fink River Desert Race occurs. 

And it's this amazing little community that we went to and had time with. That was really good. We also went up to Nhulunbuy which is up in East Arnhem Land, which is where all the Yunupingu family come from. And that's a town where if you want to buy alcohol and take it away from the pub, you've gotta go to the tribe and ask them permission and get a letter to say you're allowed to take alcohol away, which I just thought was fantastic. 

So yeah, we worked up there and in Alice Springs and Tennant Creek for about six weeks and that was quite an experience. Really enjoyed that. I ran a dementia care support group in Port Stephens, which was the most inspiring group that I've ever been involved in in my life. It was about a dozen people on any given day, of people who were caring for their friends or partners who had dementia. 

So the good thing about it was that there were people who had sent their loved one to an aged-care facility. And we're now coming back to support the group. There were people who were just starting to notice that their partner was a bit strange, and then there were all the other people in the middle. 

So what we would do is we'd get a room, cup of tea, couple of biscuits, sit around for 90 minutes, and I'd start off with some preamble about something I'd learnt or something new in the news about dementia. And within 10 minutes, they'd be people pouring their heart out in over 90 minutes, every single person would've laughed and cried and put their arms around somebody, and everybody walked away feeling really good.So that was quite an experience.  

I was seconded for 12 months to a group called the Supporting Care Project, and the idea behind the Supporting Care Project was that there were lots of people who were clients of integratedliving who just weren't spending their money. And there were people with tens of thousands of dollars in the bank, that they weren't spending and weren't getting the benefit of. And so what we did was we said, ‘oh, that's easy’. They gave us the list of the people with the 50 most amount of money, and we found the first one, and we worked out everything she needed. 

We read it all, we read all her files, all her tests and everything. We came up with five things she needed, and then we rang her up and spoke to her. We got her case manager to speak to her, and she said, ‘oh, okay, no thanks’. I don't want any of them. And what we realised that what our project was doing wasn't identifying what people needed. 

It was identifying the ways in which people communicated, which gave them the opportunity to say yes to things in a way that they didn't feel like they were giving something up, letting go of their independence being pushed. So what we did over 12 months was we developed lots of educational material and protocols and procedures for the staff to improve the quality of their communication. 

How to make someone trust you. How to get past a barrier. When someone says no thanks. How to find out why, the why. So if someone says, no, I don't want it, don't just say yes, say, and what is it about it that you don't want? What is it that scares you? And you might find some little thing that you can fix, and then they'll be open to all sorts of other stuff. So we had some wonderful success. And also to some extent our outcomes were limited by bureaucracy, which is a normal thing. So you aim for the stars and you achieve the top of the mountain. That's okay. That was a wonderful experience.  

20:47 Liz 
Yes. Can you explain that? That the money that they had access to was not there’s, that it wasn't their money.  

20:54 Stephen 
Okay, so in the home-care package system, a person is assessed by the Aged Care Assessment team as needing this much money to support them at home over a year or they'd been in an aged-care facility, which would cost them and the government a lot of money also to keep them out of hospital, which is also very expensive. 

That's what integratedliving does. It keeps people safe and happy at home. And there were people who had been assessed as requiring $55,000 a year who hadn't spent anything for the last three years and had huge amounts of money. Meanwhile, it's a funny thing that people who are, have a chronic disease or are of a certain age where they’re more likely to be frail or have some cognitive impairment living in the own home, if nothing changes, what they don't realise is they're going backwards. 

So you have to go in there and you have to say, ‘all right, listen, this bathroom that you've been using for the last 30 years, it's got a lip in it. So if you broke your hip, you couldn't walk in and out of it or this bed that you've had for 30 years, which is, is your family bed, it actually doesn't support you anymore cause it's too low and it's hard for you to get up out of the bed and you're likely to fall over.’ 

So what we did was we engaged with a whole lot of people who were able to predict and to support so that we had to educate people to see that standing still is actually going backwards. So if they engage themselves with the things that we can offer, the things that the government has decided they need then they're gonna be more independent for longer. It's like a paradoxical thing. By accepting support, you remain independent.  

22:49 Liz 
Yes, that's really interesting. Could you talk a little bit more about that and your experiences of that particularly in the last few years? 

23:08 Stephen  
We've had lots of fantastic outcomes with people in integratedliving and in specifically the clinical help desk and the supported care project of learning how to communicate with people to allow them to say yes to things. We have situations where we worry about people being subject to elder abuse or physical abuse or financial abuse. We have complex family relationships. And in, in every day we never really know what's going to happen, but one of the things we've done in the clinical help desk is we've we get together with all these multidisciplinary people and we have case conferences and we talk about things and we talk about them as long as we need to we set an hour, but we might have six case conferences. 

And it's really interesting, once you create a situation where everybody in the meeting feels like they're respected and that their expertise is respected, but also their experience is respected, we start with these absolutely insurmountable problems. And then over a period of time and over a number of meetings, these ideas come up. 

How are we gonna fix that? Some, I have an idea here, and it's almost a gestalt, you've got the factors in the meeting and then something arises out of it, which is above and beyond. And it's just a matter of giving people the freedom to feel safe when they talk. 

And just facilitating those conversations. And we have people in meetings from senior managers to support workers, and it's really exciting when ideas come that we can then go forward with. And so we write down, actions from the meeting and we say, we'll see you in a couple of weeks. Come back, and as often as not big changes have been made. Good things. Very rewarding.  

25:14 Liz 
There's something special about being a part of wonderful groups. It's interesting, it seems to be a thread of your life. And I know that you are heavily involved in your local community of Dorrigo. What is it that you enjoy so much about getting involved? 

25:37 Stephen  
 
It's funny, I've always enjoyed that. It's not so much recognition, although when I go down the street to go shopping, I always know somebody these days. And I really enjoy that. I really enjoy seeing people in their work and out of their work and in the shops and with their kids and that sort of stuff. 

But the old saying of Think Global, Act local. That's something I really believe in. And I can't change the world, I can't make sure that Donald Trump doesn't get re-elected, but what I'm doing here is trying to improve the resilience of my community to cope with the radical changes in the climate which are occurring. We've had three years of really heavy rain up here, and we are looking at a very dry winter.  

And that there are lots and lots of people in my community who are asset rich and cash poor. I've got a friend who lives in a house and he's so poor that he doesn't burn the wood in his backyard because he can't afford to buy anymore, so he goes to bed at five o'clock. There are lots of people in my community like that. So they're suffering because of increases in the cost of basic things.  

So we're starting a community garden, which is part of a community nursery. The community nursery's aim is to grow local plants, grow plants that work well here to seed sell the seeds so they can be regrown. But not only that is we go and collect seeds out of the bush, out of the rainforest, and package them and grow them into seedlings. And you start off with a tray this big, with 300 seedlings in it, and you end up with things this big that you can sell for $15. No one's getting rich out of it. 

We do completely depend on voluntary labour to do everything. But the thing about the community garden, which we worked out, is that we could use the seeds, which we have grown from our garden organically to grow vegetables to give to people who are having trouble affording them. So the idea is to create an area where we can grow in abundance, the local vegetables and fruit that we create. But not only that, to create a space where people of different generations, different ethnic backgrounds, different abilities, can get together and get their hands dirty and have a laugh and sit down and have a cup of tea afterwards and talk about how hard they worked or, stuff like that. 

They go home with a bag of veggies, or even create an abundance so we can, we know the people in town who aren't able to do it for themselves and to give things away. That's one of the things that I'm involved in town, in this town now, which gives me incredible pleasure. As they say, if you wanna be happy, volunteer. I really agree with that.  

Liz  
Yes, indeed. And at 64 years of age, you are also a grandfather of six and, until very recently, carer for your 91-year-old mother?  

Stephen 
I am a grandfather of six and I'm very proud of my kids, two of my daughters-in-law are, one of them has Pacifica genes, and one of them is a Dunghutti woman from down near Kempsey, south of here. So my children are Aboriginals, my grandchildren are, and I'm so proud of that. Yeah, so that's really great.  

But in terms of my mother, in 1991, I went off to college and studied and got a postgraduate certificate in Gerontological nursing. I came back and became a clinical nurse specialist, and ever since then, people had been paying me to tell them how to do it. And my particular interest has been dementia care. That's why I got to be the person who ran the dementia care support group. And, even when I was working in the wards, I was always the person who got rostered, the man with dementia who wasn't coping. 

And I always found that I could use qualities that I have, and professional knowledge that I had learned, to diffuse situations and make people feel safer and less threatened. And then my 91-year-old mother, who has had Alzheimer's for eight or nine years, came to live with me because she'd sold the family house and she needed somewhere to live and she lived with me. 

And I realised that I didn't know anything. I was just as stumped as thousands of people I've advised in the past.  

30:15 Liz  
Wow, how is that?  

30:17 Stephen  
It just happened. And the thing is you have to put yourself in the perspective of patience. You've gotta be really patient. You've gotta love the person and see the qualities they used to have expressed in the things they say. Understand that what they're saying doesn't really have any relationship with the topic they're using. It's just they're expressing their anxiety or their happiness or their comfort, and look, my mother flooded the house a couple of times. In fact, about 16 time. Once she did it twice in a day.  

And the reason why she did it was because the plumbing in my house is that the laundry tub goes down the hole in the middle, not in the hole at the back. And she'd be walking around and she'd see the hose from the washing machine loose in the tub and she'd put it in the back. It's not plumbed.  

I never knew what I was gonna see next. I'd walk out there, and there'd be some small item of chaos and you'd just have to be infinitely patient. And that's a quality that I wasn't any better at than other people.  

Liz  
Really?  

Stephen 
Yeah, for sure. I had to look deep into myself to be the best person I could for her. And so it's given me a huge respect for people who are carers and people who are carers without my knowledge, and without my ability to live in the same house. People who don't feel good about themselves, caring for people they don't understand. 

And so I really think respite is a really important thing. Every single person who's a carer needs respite. Every single job in the world has a holiday except caring, and you've gotta be able to say, I need a break. And we did that a few times and it was really good.  

Liz  
How long was your mother with you? 

Stephen 
Less than six months, but it was such an insight to me. And the thing I thought about, the thing that I found out about my mother, is that she thrived in the community. I would send her next door to the community nursery and she'd stand there for three hours, re-potting seedlings, and then she'd go and have a cup of tea and tell them all their stories. And they're the same stories. But the people who also volunteer at the community nursery came to appreciate that you could give her a job and she'd do it. And that she was quick-witted and that she had an amazing life story. That if you heard the same story, starting, ask her a question about it and you get a different slant. 

She had almost an Indian summer here where she had a couple of friends who she’d go off with. She plays the violin. She'd go off and play the violin with her friends every second Sunday. She'd go and play Scrabble with people. She'd ask them who they were every time she'd sit down and then win, how did that happen? 

33:19 Liz 
Yes. That is the mystery of it, isn't it? And then win at Scrabble. 

33:23 Stephen  
Yeah, I think for me a person with dementia needs to interact with people in the community. They need to get out and about because the thing that you use your brain with most is conversation in public. You can do a million sudokus and crosswords. But if you have a conversation with three people where you've gotta be socially aware, you've gotta be articulate, stuff like that is really using your brain. That's what keeps your brain going.  

And getting good feedback from people, getting people accepting who you are. And this is accepting you for not who you are now, but who you have been and what is the best of you. This is what you have to relate to. It's like enablement, and this is one of the important parts of community health nursing, is that you don't talk about the man with the bad leg in bed 35. You talk about M. Jones who's got an incredible garden, and if his leg wasn't so painful, he could be out there all the time. So you are working from a state of he's the best of him, and working ways around, solving problems around the things are not working properly anymore. 

34:41 Liz  
Yes. It's a very different perspective, isn't it? 

34:44 Stephen  
Yes, and it's really interesting because it's really hard not to think about a person with dementia as, what's the biggest thing about them? They've got dementia. There's as much dementia as there are holidays. It's such a variety. There's so many varied ways it expresses itself in people. 

35:02 Liz 
Yes, and Stephen, I know you've encountered much hesitation from clients over the years, my goodness, over a long time, about having a male nurse tending to their needs. How do you overcome this?  

35:17 Stephen 
I started washing older people in hospital when I was 19, and clearly I wasn't as good at it. I think you have to be good at your job. I think you have to be dextrous and compassionate and thoughtful, and you have to be organised. They have to feel like they're in good hands, and they have to feel like you're doing a good job. Like you are washing them the way they want to be washed.  

When you're a nurse, you learn how to clean someone or help them clean themselves in a way that's respectful and safe and cognisant of the quality of their skin, the quality of their joints, the quality of their eyesight, the quality of, if they're really thin, they're gonna have less resilience with cold, all sorts of things. 

There's so many different things to think about. So do a good job, that's the important thing for me. And be really sensitive so always explain what you're going to do so they're not surprised, and always get consent as you're doing it. So given that, ‘I'm gonna give you a shower now. All right, this is how I'm gonna do it. Is that all right? Okay, good. Now I'd actually…’  

‘Steve, can you leave that towel there?’ ‘Sure, no problems. How much do you want me to wash and how much do you want to wash?’ And the answers are always there. 

36:38 Liz  
I know it's been a while since you've had to wash anyone. What about when it doesn't involve washing, or it's just a discomfort, around maybe having to share, what otherwise they wouldn't share with a man? 

36:50 Stephen  
I think if they believe that you are interested in them, and if they believe that you are respectful. So this is one of the things that I do as a registered nurse. When I'm going to meet a new client, I have this little general rule, and that is that the things that they're most proud of in their lives are displayed on the walls of their lounge room. So there you'll see the photos of the grandchildren there, you'll see their degrees there, you'll see the pictures of their horse or their motorboat or their holiday in Spain or whatever.  

So you spend the first five or 10 minutes of any visit, say 10% of any visit, talking to the people about what is important to them and being interested. I'm interested in everything. I'm curious. I have curiosity and so I can always find something to talk about.  

And having spent 10 minutes being interested in them, when you say, ‘look, okay, I'm here for integratedliving. There's a couple of things I have to do. I have to do a memory test, and I know that the last time someone did one of them, you got annoyed and frustrated. If you do feel annoyed and frustrated this time, let me know, and we'll stop. So you're okay. There's nothing to fear here, let's do that.’  

Or ‘look, I have to talk to you about incontinence because it's a problem. You had to go to hospital last week, so now you're home again. And my job is to keep you outta hospital.’ So I have to understand those things, so then we can talk about that. But the thing is to build the foundation of trust and make people feel like they're interesting.  

38:33 Liz  
And everyone's interesting, right? If you're willing to find that spot.  

38:37 Stephen 
Yeah, that's right.  

38:38 Liz 
In the last few minutes, can you tell us a bit about your colleagues and the nursing team as a whole at integratedliving? That must be an interesting bunch and quite a diverse bunch with different backgrounds? 

38:49 Stephen  
They certainly are. And I'm now one of the OGs. I was in a meeting the other day with the senior nurse managers and I looked at them and I thought, I remember this meeting when only you worked here, and all you other people have arrived latterly. So that's interesting. And then some of them, I've met them when they were just new into nursing and starting with the company and now they're senior managers and it's wonderful to see how they've grown. 

And everybody that I've met in integratedliving who wants to get something extra, who wants to do something extra, has been able to. It's been really surprising. There are people who just like to puddle along who for whatever reasons, they might have four kids or a husband with a disability or whatever it might be, their real life interest might be pottery. 

But there are people who've come to this company, who've been given jobs and responsibilities and cos I've been here long enough to see them grow into those jobs, it's really quite exciting. So it's really good camaraderie within the health services team of people who have grown into their jobs and appreciated their peers. And it's really good to see.  

Liz  
That's good to hear. And as someone with such a broad range of experience across the health and aged care sectors, what advice can you give to people who are finding it hard to navigate or don’t know where to start? 

Stephen  
It's really hard. Yes, if you're on your own and you haven't got a person of a younger generation to navigate the system for you, it almost feels like it was set up by them, for them, and not for you. So it's really hard. I would just say reach out to the services that are out there and make a phone call to them. A lot of them say they're portals and a lot of them give you the opportunity of chatting. But on the internet, find the phone number, make a phone call, and there are people there who are very happy to help. 

41:03 Liz 
That's good advice, so where would you be calling? 

41:10 Stephen 
If you have a person who you know who's got dementia, you'd ring Dementia Support Australia or Dementia Australia. They're both the most wonderful organisations. There is My Aged Care portal, which is, one of these huge government departments with this tiny little portal. It's like a black hole. It's all very intense in there, but ring them up and talk to them. 

If you're not sure about aged care, ring up the Aged Care Assessment Team in your local community, or, ring up the community health centre. There'll be people there who'll talk to you. And even if you are within integratedliving and you've got somebody who's just getting meals or who's just getting transport, there is a pathway for them, and there's all sorts of people employed by the company to make it easier for you to navigate that pathway. So talk to whoever your contact is, and ask them who they would suggest and just go to that person.  

42:11 Liz
Great Stephen, thank you so much for your time and your expertise. I really appreciate it. It's been wonderful talking to you. 

42:18 Stephen
What I'm gonna do now is remember all the things I forgot to say.  

42:25 Liz
There's always more. We'll have to get you on again. Thank you.