“Could I then turn to what is a good news story, and if we could go back to Bidyadanga. 

You will shortly hear from three people who deliver care in the Aboriginal community of Bidyadanga.  The community council there comprises two members of each of the five language groups.

 Primary medical care is delivered by the Kimberley Aboriginal Medical Service, KAMS, through the Bidyadanga Health Centre.  On Wednesday, you will hear from the general practitioner who works for both KAMS and the Broome Regional Aboriginal Medical Service. 

That’s BRAMS, and travels to Bidyadanga for two days on a weekly basis to work at the clinic.  Another doctor is also present for a number of other days during the week. 

The centre has four remote area nurses and one or two Aboriginal health workers.  One senior Aboriginal health worker, who is a senior community member, has worked at the facility for well over 10 years.

There are also currently three Aboriginal liaison officers who work part-time for the clinic and two full-time administration staff. 

KAMS also trains general practice registrars who come up on six to 12 month blocks to provide primary care and emergency services to the community.

 Through the prism of Bidyadanga, the Commission can see firsthand the critical intersection between primary health and aged care in a location where there is no residential care in the traditional sense “

Extract from Monday 17 June transcript for The Royal Commission into Aged Care Quality and Safety that is holding a public hearing in Broome this week .

See SMH media Coverage : Indigenous people believe aged care isn’t ‘culturally safe’, and ageing earlier

The Broome hearing of the Royal Commission focused on the ability of Aboriginal and Torres Strait Islander people to gain access to aged care services as well as the extent to which remote areas are included in the availability of aged care services.

Specifically, the Broome hearing inquired into:

• the unique needs of Aboriginal and Torres Strait Islander people when it comes to aged care services
• the perspective and experience of people who access aged care in remote areas including family members and carers
• the nature and scope of aged care services for Aboriginal and Torres Strait Islander people living in remote areas
• the barriers to accessing aged care services for people living in remote areas
• the challenges of maintaining an adequately skilled and culturally appropriate workforce in remote areas
• good practice care models for people living in remote areas

The Royal Commission heard evidence from witnesses from the local community and surrounding areas as to their experiences of aged care services.

For more information about the hearing consult the Hearings page on the website and more information about the community forum can be found on the Engagement page.

Proceedings can be viewed or listened to using the webcast on the Royal Commission website. Hearing transcripts will also be available at the end of each hearing day.

Public submissions

The Royal Commission into Aged Care Quality and Safety invites interested members of the public and institutions to make submissions to the Royal Commission using an online form (the link to the form is below). The Royal Commission will continue to accept submissions until at least the end of September 2019. A date for the closing of submissions will be announced in the second half of 2019.

The online form is designed to capture information that is relevant to the work of the Royal Commission and consistent with the areas of inquiry set out in the Royal Commission’s Terms of Reference

Online Form HERE

Download the full transcript-17-june-2019

Read all the NACCHO Aboriginal Health and Elder Care articles

Location of Indigenous-focused aged care programs See ANAO 2017 Report

”  Commissioners in this fourth substantive public hearing, the focus of the evidence will be on aged care in remote areas of Australia and the related issues of access and inclusion with specific attention being directed to Aboriginal and Torres Strait Islander people.  People who identify as being Aboriginal and Torres Strait Islander comprise 16 per cent of the remote population and 46 per cent of the very remote population.”

Mr Bolster Counsel Assisting

For this reason, it is important that the Royal Commission when inquiring into aged care in remote areas, consider aged care services for people who identify as Aboriginal and Torres Strait Islander.

It would, however, be a mistake to conflate Aboriginal and Torres Strait Islander people and life with regional and remote locations, remembering that over 60 per cent of Aboriginal and Torres Strait Islander people live in major cities or inner regional areas.

With that in mind, and while it will receive some attention in this hearing, the particular needs of Aboriginal and Torres Strait Islander people living in urban areas will be explored further in later hearings, including the Perth hearing next week.

What is remote aged care?

We commence the answer to the question by identifying examples that frame the experience of delivering aged care in some of the most remote locations imaginable.

At Docker River in the Northern Territory, close to its south-western corner, is a facility known as Tjilpi Pampaku Ngura Flexible Aged Care Service.  It services a population of 394 with a median age of 31 of whom 74 per cent are Aboriginal.

It is funded to provide care for 19 residential care places and 22 home care packages.  Tjilpi Pampaku Ngura is in the traditional lands of the Anangu people and the predominant language is Pitjantjatjara, English being spoken at home in only 14 per cent of households.

Alice Springs is nearly 700 kilometres to the east on principally dirt roads and involves an eight to nine hour drive or a chartered plane.  There are no regular airline services.  Diesel is the only fuel available.  The median annual income is $15,000, just over a quarter of what it is in Darwin.  We will be talking about Docker River shortly.

On the other side of the border in the Anangu Pitjantjatjara Yankunytjatjara or APY Lands in remote South Australia, 217 elders receive aged care services through Aboriginal Community Services SA from whom you will hear evidence, predominantly via the Commonwealth Home Support Programme as well as a limited number of home care packages.

Balgo, or Wirrimanu in the eastern Kimberley is a 250 kilometre trip south of Halls Creek and over 10 hours from Kununurra.  The drive is mainly on dirt roads that are often impassable in the wet season.

A population of between 500 and 600 is serviced by a health centre run by the Aboriginal Community Controlled Health Service with visits by doctors of the Kimberley Aboriginal Medical Service.  Aged care services, predominantly home care packages and CHSP, are delivered by Kimberley Aged and Community Services, an arm of the WA Country Health Service known as WACHS.

That’s in partnership with the local Aboriginal Corporation.  At Balgo, a loaf of bread and long-life milk cost around three times the price that you will pay for them in Kununurra.

Balgo is one of a  number of remote communities in the Kimberley where care is delivered through a place-based partnership model where there is a relationship with the local Aboriginal community corporation.  KACS, that is Kimberley Aged and Community Services,  also delivers home care packages directly at a number of other remote locations as well as undertaking client case management reviews, referrals to specialists, recruiting and training remote workers as well as quality monitoring at smaller locations.

On Thursday Island there is a 40 bed residential aged care facility known as the Star of the Sea where 80 per cent of the staff identify as Aboriginal or Torres Strait Islander.  Star of the Sea is the only residential aged care facility in the Torres Strait.  It contains a central meeting room known as the Ocean Room that overlooks the Torres Strait, thereby providing resident with a connection to the ocean to which that unique culture is inextricably attached.  As the High Court observed in Mabo v Queensland (No 2), “the Meriam people of the Torres Strait retain a strong sense of affiliation with their forebears and with the society and culture of earlier times.  They have a strong sense of identity with their islands.”  In the case of the Torres Strait, the geography is such that many of the islands are small and spread over a vast area as the map, which should be on display, identifies.

Finally, 200 kilometres south of Broome is Bidyadanga, one of the largest remote Aboriginal communities in Western Australia with a population of 700 to 1000 people.  It is home to five language groups, Karajarri, Juwalinny, Mangala, Nyungamarta and Yulpartja.  Bidyadanga has a dedicated aged care service with a CHSP-funded HACC centre, HACC being a reference to the former Western Australian Home and Community Care Program.  People in Bidyadanga have high care needs;  there are no residential care options available other than a move far away from country to Broome.  Consistent with what this Royal Commission has been told in earlier hearings, people in Bidyadanga have a strong preference for being able to stay in their own home.  Just as importantly, they want to stay on country for as long as possible.  Bidyadanga has a health centre, general store, and outposts of government agencies including Australia Post and Centrelink.  The local fishing is good.  I’m told the blue nose thread fin salmon cooked on coals is a good reason to stay there.

These are just a few practical examples of the remote places where aged care is delivered;  each will be the subject of evidence at this hearing.

Madeleine Jadai brought photos to emphasize the importance of family to Indigenous people requiring aged care. CREDIT:ROYAL COMMISSION ON AGED CARE QUALITY AND SAFETY

I turn now to the question of what “remote” means.

For the purpose of delivering services in remote Australia, the Commonwealth relies on at least two methods of classifying regions as remote or very remote.  The first of these, known as the Modified Monash Model is used for service delivery purposes by the Department of Health.  It has seven levels ranging from level 1 which represents major cities through to level 6 and 7 for remote and very remote.

It’s best explained by a chart that is – it should be coming up on the screen now.  The yellow portions are the very remote portions.  They’re MMM7.  And the MMM6 portions are the lilac colour slightly closer to the coast on the east coast.  And in the case of Tasmania, there’s another graph which we attach and the Commission will see that both in the case of King Island and the Flinders Island group, they are very remote.  There is a comparable ABS remoteness classification which is largely to the same effect and the relevant charts for that purpose will be in the evidence.  Any consideration though of remote aged care needs must extend beyond the States and the internal Territories and address the external Territories as well.

Of the seven external Territories only three support a permanent population, Christmas Island, the Cocos (Keeling) Islands and Norfolk Island.  All three are classified as very remote under the Modified Monash Model and the Commonwealth Department of Infrastructure, Regional Development and Cities has responsibility for health care on both Christmas Island and Cocos (Keeling) Island.  That is delivered through a standalone Indian Ocean Territories Health Service.  A recent March 2019 report by PricewaterhouseCoopers, prepared for the Commonwealth, noted that although each has a strong and easily accessible primary health care service, which is known as the Indian Ocean Territories Health Service, there is no aged care – residential aged care in either Territory.  Complex procedures are delivered in Western Australia.

The PwC report is currently with government and community consultations were commenced on Christmas Island in May and there will be future consultations on Cocos (Keeling) Island in June.  This is a significant issue and one that will be explored in further hearings.  The Norfolk Island situation is slightly different.  Norfolk is categorised as RA5 under the ABS remoteness classification.  It is not classified under the Modified Monash Model.  It is located within the South-East Sydney Aged Care Planning Region and the Central and Eastern Sydney Public Health Network.  Norfolk Island Health and Residential Aged Care Services is an integrated multipurpose service, and I will be talking more about multipurpose services later;  it provides 14 high-care residential aged care places on the island.

Can we turn now to the Kimberley.  The Kimberley Aged Care Planning Region is one of 73 planning regions across Australia and you’ve already heard evidence about the significance of such regions for aged care planning and funding purposes.  The Kimberley region provides a useful snapshot of the features of aged care in remote and very remote Australia.

Although it must be acknowledged that there are many differences between regions across the country, including cultural and geographic differences.  According to ABS census data from 2016 published by the Australian Institute of Health and Welfare on the generation aged care website, just over 31 and a half per cent of the region’s population aged 50 or over identifies as an Aboriginal or Torres Strait Islander person.  That’s to be contrasted with the national or state average of about one and a half per cent.  23 – 21.3 per cent of the population over 65 was born overseas as opposed to around 36 per cent nationally.  But there is a higher proportion of people over 65 for whom English is not their preferred language.

In terms of service delivery there are a number of features that stand out.  Although there are more residential aged care places per 1000 people than the state and national average, the vast majority of residential care places are provided by not for profit providers.  This equates to around 83 places per 1000 people over 70.  At this hearing you will hear evidence from and about providers that operate in Western Australia, particularly in the Kimberley, the Northern Territory, South Australia and Far North Queensland, servicing the Torres Strait.  Whilst a number of places are provided by government providers, roughly six per 1000, there are no residential aged care places provided by for profit organisations in the Kimberley, whereas on average there are 30 places per 1000 people aged 70 or over nationally and around 22 per 1000 in Western Australia provided by for profits.

In the Kimberley, unlike the position nationally, slightly more males use permanent residential aged care than females.  Similarly, unlike the position nationally and in the rest of the State, the majority of residents in the Kimberley are Aboriginal and/or Torres Strait Islander.  There is also a markedly higher proportion of people whose preferred language is not English, even though such residents were born in Australia or another English speaking country.  Perhaps the most significant comparison between the Kimberley and urban Australia is to be seen in the age profiles of those that use aged care and there’s a graph that should be coming up on the screen now.

Focusing for the moment on those that use residential aged care, it can be seen that as of 30 June 2017, the demand by Aboriginal and Torres Strait Islander males presents at a much earlier age than is the case in the typical urban cohort.  The graphs that follow provide a comparison between the demand for residential care and home care in the Kimberley, Alice Springs and inner west Sydney regions.  It gives much the same impression establishing that the largest cohort of men in the city is likely to be between 80 and 90 years old, whereas in the Alice Springs and the Kimberley the corresponding cohort is much young, spanning the years 65 to 79.  The position is roughly comparable in the case of women, although the gap would seem to be slightly smaller given that Aboriginal women tend to enter aged care later than males.

I turn now to the question of culturally safe care. 

There are also particular important considerations that arise in relation to the provision of aged care for Aboriginal and Torres Strait Islander people which will be explored at this hearing.  It’s important to note the diversity of Aboriginal and Torres Strait Islander cultures and language.  There are over 500 indigenous nations and over 250 different language groups across Australia.  An approach that works for one particular cultural group may not be appropriate in another setting.  At the forefront of these challenges, whether care is delivered in the city, rural or remote Australia, it needs to be culturally safe and culturally appropriate.  Whilst this encompasses many things and will hold different meanings for different cultural groups, for Aboriginal and Torres Strait Islander people we will hear that at its centre is the acknowledgement of the identity of the person and their connection to community and country, their community and their country.

One witness will tell you that this may mean different things in different parts of the country, and in that sense it has aspects that are location based and dependent on the particular cultural practices of the region.  It also has an individual element that depends upon the personal history of the person and in this respect, the perspective of people in the Stolen Generation comes to mind.  The following are common themes that the evidence is likely to demonstrate.

The first, as I’ve said, is connection to country.

We will hear about the importance of having connection with country and staying on country as people age.  For people who are no longer living in their country, having the opportunity to return to country is important.

You will hear how in Derby and in other places, the Juniper facilities, like other facilities across the country, arrange to transfer residents to country with support staff.  You will hear of the challenges for older people who may be forced with having to go off country to access health and aged care services, in particular when it comes to residential care.

 Secondly, there is the connection to family and community.

In this respect, we will explore the unique role of the elder in traditional Aboriginal and Torres Strait Islander communities and how the important cultural responsibilities associated with that role need to be understood when attempts are made to provide care.  We expect that you will hear evidence about a collectivist culture where there is a sharing of resources and the challenges in delivering home care to an older person in that setting.

Thirdly, there is language.

Language plays an important role for many Aboriginal and Torres Strait Islander people in their connection to culture, kinship, land and family.  And languages are the foundation upon which the capacity to learn, interact and to shape identity is built.  Fourthly, there are important cultural requirements in the lead-up to and immediately following the passing of an Aboriginal person.  You will hear evidence about how for some cultures a smoking ceremony is conducted in the deceased’s living space for religious and cultural purposes, together with ceremonies after death that may involve keeping the body in place for a period of time before burial in country.

In some cultures it may be appropriate for attendance by kin or community members at ceremonies associated with an impending death.  It would appear that there may be a need to provide notice that a person is dying so that arrangements can be made for necessary attendances for sorry time or sorry business.  Singing ceremonies before and after death need to be understood and respected.  You will hear of one service that has sought to have a separate palliative care residence where there is space for family and community to spend time with the older person.  At the same time, it needs to be borne in mind that some Aboriginal and Torres Strait Islander people have cultural reservations about discussing these matters.  We seek to approach this matter respectfully and in good faith so that these matters can ensure better delivery of culturally safe care.

Food, of course, plays an important role in culture.

You will hear evidence that delivery of cultural food at least once a week in a residential facility will enhance the experience of Aboriginal and Torres Strait Islander Elders.  Awareness of these relationships and a commitment to embrace them is critical to delivering culturally safe care and obtaining the trust of the resident and their community.  We will also explore what is culturally safe palliative care, an issue that can be complicated by some traditional approaches to death.

On another level, the everyday delivery of care may involve attention to significant male and female roles and kinship relationships.  Gender, clan and kinship can impact on whether it is appropriate for a particular person to provide care to another person.  This can present challenges in terms of workforce and recruitment.  Overall, the delivery of cultural safe care is based on trust on the part of the care recipient and this is an issue that will be considered by a number of the witnesses.  One witness is likely to tell you that it is best where care is provided as close as possible to home, by people who are sensitive to the history and culture and needs of that resident, and you will hear from some of those witnesses today.

Another witness will talk about place-based models of care.  You will also hear about the time that it takes to develop trusted relationships that are required to deliver care.  Ruth Crawford, a nurse for 45 years, is the manager of the Kimberley Aged and Community Services and she will give evidence tomorrow about the partnership model of care that operates in places such as Balgo, Bidyadanga and a number of other remote communities within the Kimberley.  You will hear that where care is not culturally safe, Aboriginal and Torres Strait Islander people are not likely to access services.  You will also hear about the challenges that Aboriginal and Torres Strait Islander people face in navigating My Aged Care.

The barriers that prevent access to the aged care system or getting the types of level of assistance they need come in many forms.  The aged care assessment process requires a person to talk about their intimate and personal health, their domestic situation;  all of this with a complete stranger.  That stranger may be of the opposite sex and may not have had any cultural awareness training.  You will hear that this framework leads to Aboriginal and Torres Strait Islander people avoiding the aged care system, withdrawing from the ACAT discussion.

You will also hear how My Aged Care assumes a level of literacy and good access to postal services as well as e-literacy and connection that is not a reality in some parts of Australia.  You will hear about the services that work to get around these barriers by wrapping around the older Aboriginal or Torres Strait Islander person.  They use their pre-existing relationship of trust to get the person to an ACAT assessment and support them through it.  Much of this work is done without aged care funding and depends upon the goodwill and flexibility of committed services and staff and members of the local community.  Language is also a barrier.  When an Aboriginal or Torres Strait Islander interpreter is required, in the limited circumstances that there is a professional interpreting service available, the person can be required to pay for this out of their home care package.

Can I turn then to funding structures.

Commissioners, you have already heard evidence about how aged care is predominantly delivered through residential aged care, home care packages, as well as the Commonwealth Home Support Program.  Some providers of residential and home care are also eligible for viability supplements in recognition of the additional costs of delivering care in remote settings or to people defined as special needs groups under the Aged Care Act, and that includes Aboriginal and Torres Strait Islander people.  While each of these programs operate in the context of remote and very remote Australia, there are additional programs that is will be under examination in this hearing which we would like to outline briefly.

The first and largest of those is the National Aboriginal and Torres Strait Islander Flexible Aged Care Program known as NATSIFACP or sometimes NATSIFlex which I will use because I think it’s easier.  The stated objects of that program are to deliver a range of services to meet the changing aged care needs of the community, to provide aged care services to Aboriginal and Torres Strait Islander people close to home and community, to improve access to aged care services for Aboriginal and Torres Strait Island people, to improve the quality of culturally appropriate aged care services for Aboriginal and Torres Strait Islander people and to develop financially viable cost effective and coordinated services outside of the existing mainstream programs.

NATSIFlex operates, as I said, outside of the Aged Care Act and providers are block funded based on an agreed allocation of aged care places and the types of places.  Unlike ACFI funding, there are two levels of residential care and two levels of home care, one high and one low.  The intention is to provide stability of funding and flexibility.  Nationally, the program funds 453 residential aged care beds, 11 respite places and 396 home care services in 30 organisations delivered through 35 services.  Currently the Commonwealth is prioritising the conversion to NATSIFlex status for which there are only limited opportunities, and this is to a very small number of services, those that are likely to struggle under mainstream funding arrangements.

Debate surrounds whether this is the right criteria or whether there should be any restriction on conversion of mainstream services to NATSIFlex status.  You will hear from the provider Juniper about how their 40 bed facility at Kununurra, built with a Commonwealth grant, is precluded from NATSIFlex funding by reason of these criteria.  There may, however, be reasons to prefer services that operate in the mainstream wherever possible and that they only – the conversion to NATSIFlex only be allowed if it’s necessary to ensure ongoing viability.

To put the matter in perspective, the Commonwealth projects that by 2029 the use of ACFI-funded residential care in remote and very remote Australia will have increased by nearly 700 places or 63 per cent on current levels.  Similarly the use of NATSIFlex-funded places will have increased by 227 or 61 per cent.  Resident pathways into NATSIFlex care are broader and more flexible than the pathways under the Aged Care Act.  ACAT assessment is not required and referral can be from a range of sources, including My Aged Care, CHSP assessors, GPs, social workers, etcetera.  Residential care can be either permanent or short term and you will hear evidence that in some locations residents take up the care, particularly during the wet season when travel is difficult.

At least one witness is likely to criticise the program on the basis that the flexibility of the system means that admission to residential care is often premature, expressing the view that care at home, funded by other programs, including the NDIS, would suffice and that such a result may be driven by providers looking to increase occupancy rates so as to increase their funding.

Witnesses are also likely to consider whether the number of Aboriginal and Torres Strait Islander people receiving aged care at an earlier age reflects gaps, whether current or historical, in primary health care and disability services, rather than premature ageing.  There is a real issue as to whether NATSIFlex funding enables service providers to respond to the pressures associated with the remote delivery of care, particularly having regard to the challenges of providing culturally appropriate care.  Grants only operate for periods of between two or three years and seem geared to provide the revenue associated with providing care to residents, not providing the basis for any capital development or improvement.  There are other avenues through which support, including for capital grants, is provided by the government, including the Aboriginal and Torres Strait Islander Aged Care Service Development Assistance Panel, the SDAP.

This program provides funding to enable providers to obtain specialist advice and assistance in a range of areas, including service delivery, sector support and financial and project management.

Australian Regional and Remote Community Services, or ARRCS as we will refer to it, is the largest NATSIFlex provider in the country, operating the facility at Docker River, previously referred to, and facilities at Mutitjulu, Tennant Creek in the Northern Territory.  Its related organisation, Pinangba, which operates in Queensland, is the operator of the Star of the Sea facility on Thursday Island.  ARRCS is one of the two providers through whom UnitingCare Queensland delivers aged care services to Aboriginal and Torres Strait Islanders.  You will hear from the group general manager of that organisation responsible for the regional and remote community services, along with the CEO of UnitingCare Queensland, the parent company.

A second relevant program is the funding of Multi-Purpose Services or MPS which are partnerships between the Commonwealth and State and Territory Governments to deliver integrated health and aged care services in very small communities, particularly in regions where it is not viable to operate a standalone hospital or a standalone aged care service.  Mention also needs to be made of the Aged Care Regional, Rural and Remote Infrastructure Grants funding round which provide support to regional, rural and remote aged care service providers to undertake infrastructure works.

Could I then turn to the issue of home care packages in this region.

Waiting times for the delivery of remote home care packages are a matter of concern and largely mirror the position in the rest of Australia.  Evidence from the Commonwealth is to the effect that in remote and very remote Australia there were 1480 approvals for home care packages in calendar year 2018.  Of those living in remote or very remote regions who were assigned their first package, regardless of level, in that period, only 38.8 per cent, that is 608 people, received that assignment within nine months.  For most people, the time between approval and assignment exceeds nine months.  There were significant numbers who had not been assigned a provider after 18 months:  218.

At the two year and beyond period, the figure was 68 and at the three year period, there were 28 people.  Evidence from the Commonwealth is that in the case of Aboriginal and Torres Strait Islander people they represent 3.1 per cent of participants, although it is not at all clear the extent to which they are required to wait for packages.

There is also a viability supplement paid to all of the providers referred to above, including NATSIFlex and MPS to recognise the higher costs of providing care due to the location, size and client mix of a service.  Despite all of this, the Aged Care Financing Authority warned in September of last year that there were a number of facilities in regional and remote areas that were experiencing significant financial difficulties and were likely to be forced to merge with or sell to a larger provider.

Could I then turn to what is a good news story, and if we could go back to Bidyadanga.

You will shortly hear from three people who deliver care in the Aboriginal community of Bidyadanga.  The community council there comprises two members of each of the five language groups.  Primary medical care is delivered by the Kimberley Aboriginal Medical Service, KAMS, through the Bidyadanga Health Centre.  On Wednesday, you will hear from the general practitioner who works for both KAMS and the Broome Regional Aboriginal Medical Service.

That’s BRAMS, and travels to Bidyadanga for two days on a weekly basis to work at the clinic.  Another doctor is also present for a number of other days during the week.

The centre has four remote area nurses and one or two Aboriginal health workers.  One senior Aboriginal health worker, who is a senior community member, has worked at the facility for well over 10 years.

There are also currently three Aboriginal liaison officers who work part-time for the clinic and two full-time administration staff.  KAMS also trains general practice registrars who come up on six to 12 month blocks to provide primary care and emergency services to the community.  Through the prism of Bidyadanga, the Commission can see firsthand the critical intersection between primary health and aged care in a location where there is no residential care in the traditional sense.

You will hear from Dr Martin Laverty, the CEO of the Royal Flying Doctor Service, on the importance of that sort of primary health care as a means of avoiding admissions to hospital, often far away, and unwanted entry into residential aged care, also far away from that country.

Tomorrow, you will hear from representatives of two providers from the eastern part of the Kimberley.  The first provider is Uniting Church who provide aged care services under the name of Juniper.  It operates the Juniper Ngamang Bawoona and Juniper Numbala Nunga facilities in Derby.  Juniper, from whom you heard evidence at the first Adelaide hearing, cross-subsidises its remote residential facilities with revenue from its more traditional aged care operations in Perth.  The second provider, Southern Cross Care, operates the Germanus Kent House here in Broome, and the associated Bran Nue Dae Day Centre.

We also expect that you will hear evidence from an Aboriginal enrolled nurse who has worked at Germanus Kent House, and that should occur within the next hour or so.

See full transcript to continue transcript-17-june-2019