Aboriginal and Torres Strait Islander Elder Care News : Read or download both NACCHO’s 15 Recommendations and @AMAPresident 42 Recommendations in submissions to the Royal Commission into Aged Care Quality and Safety

” Older Aboriginal and Torres Strait Islander people are being let down by the aged care system.

 They are significantly underrepresented in residential aged care services, at under one per cent, and their uptake of dementia services is very poor.

Yet older Aboriginal and Torres Strait Islander peoples experience at least 2.3 times the burden of disease as other Australians and are also 3-5 times more likely to experience dementia.i

 It is a sad indictment of the system that the care needs of our ageing First Peoples are not being met.

The needs of older Aboriginal and Torres Strait Islander peoples require urgent attention by the Australian Government and the health and aged care systems.

NACCHO Submission to the Royal Commission into Aged Care Quality and Safety 30 September 

Download the full NACCHO Submission HERE

NACCHO submission_Royal Commission Aged Care Quality and Safety_September 2019_FINAL (1)

Read previous NACCHO Aboriginal and Torres Strait Islander Elder Care articles

 ” The Royal Commission, we know, has been extended to 2020, November 2020.

And they’re having to encounter and deal with an enormous number of submissions, of stories that we see making the front pages of our papers and the headlines on our evening news day after day after day.

They’re stories of neglect, they’re stories of lack of care, of stories of lack of access at the appropriate and necessary time of their life.

The Aged Care Commission will deliver its findings in November 2020 and they need that additional time – it’s just been announced that their findings will be delayed another six months, because they’ve got to deal with all the necessary work and all the submissions they’re receiving.

But the message I want to leave with you today is that we can’t wait for the findings of the Royal Commission to start investing in aged care.

AMA President, Dr Tony Bartone, and ANMF President, Annie Butler, Doorstop, Parliament House, Monday, 30 September 2019 Pictured above :

Aboriginal and Torres Strait Islander people living in regional, rural and remote Australia experience particular challenges in accessing culturally and linguistically appropriate aged care services and supports.

Ongoing investment into programs such as the National Aboriginal and Torres Strait Islander Flexible Aged Care Program (NATSIFACP) is essential in supporting the growth and development of aged care services for Indigenous Australians. ” 

AMA Recommendation 40 of 42 see in full Part 2 below or Download 

As the Commissioners will be aware, the population of First Peoples aged 65 and over is projected to grow by 200 per cent between 2011 -2031.ii

This unprecedented population growth combined with the complex health issues that our people experience as they age presents major challenges for providers of both aged care and primary health care to respond to increased service needs from Aboriginal and Torres Strait Islander elders.

We believe it is imperative that the Australian Government commits to resourcing more innovative, efficient and effective solutions that address the barriers to accessing aged care solutions for older Aboriginal and Torres Strait Islander peoples.

NACCHO welcomes the opportunity to provide this submission to the Royal Commission into Aged Care Quality and Safety.

We wish to acknowledge the comprehensive nature of this inquiry, including the different ways in which members of the public, aged care providers and other interested agencies have been invited to contribute.

The Royal Commission hearings have provided ample evidence of the key components and conditions that make up best practice aged care for older Aboriginal and Torres Strait Islander peoples.

They have also provided evidence of systemic failures to provide culturally safe, accessible care. It is also evident from the hearings, however, that there is a genuine interest among all participants to better understand the needs of older Aboriginal and Torres Strait Islander people in order to inform recommendations on how to improve their health and aged care outcomes.

NACCHO’s vision is that all Aboriginal and Torres Strait Islander peoples be able to enjoy quality of life through whole-of-community self-determination and individual spiritual, cultural, physical, social and emotional well-being.

To enable this vision, our people must be granted agency in the development and implementation of policies and programs that impact on their lives, as enshrined in the Aboriginal and Torres Strait Islander Act 2005 (Cth) and the UN Declaration on the Rights of Indigenous Peoples 2007.iii

We believe the next step forward in addressing the needs of older Aboriginal and Torres Strait Islander peoples as outlined in this submission, is a genuine commitment from the Australian Government to work in partnership with Aboriginal and Torres Strait Islander peoples and their representatives to develop solutions and oversee their implementation in services on the ground.

This submission addresses the Royal Commission’s Terms of Reference in relation to the criteria of:

  • Person-centred aged care;
  • Challenges and opportunities for delivering accessible, affordable and high quality aged care services; and
  • How best to deliver aged care services in a sustainable way, including through innovative models of care and investment in the aged care

NACCHO’s response to the Terms of Reference includes feedback received from our member services, Aboriginal Community Controlled Health Organisations (ACCHOs), who deliver a range of services in urban, rural and remote communities across Australia.

NACCHO Concluding comments and recommendations

It is imperative that, given the population projections of older Aboriginal and Torres Strait Islander peoples, the burden of disease they carry, and their underrepresentation in the aged care system, that their needs and preferences are given urgent priority.

NACCHO believes the next step forward is for the Australian Government and providers to deliver on what works, in genuine consultation with Aboriginal and Torres Strait Islander peoples and their representatives.

Aboriginal and Torres Strait Islander peoples need to be decision makers on what a culturally safe aged care system looks like.

NACCHO is strongly committed to and interested in being part of the solutions to address the care needs of our people and is confident that, with adequate resourcing, the Aboriginal community controlled health sector has the knowledge and experience to make a positive difference to older First Peoples’ health and aged care outcomes.

The following list of recommendations are based on our consultations with Aboriginal and Torres Strait Islander representatives, including our member services.

NACCHO recommends that:

  1. Cultural safety be embedded across all areas of aged care services, compliant with what is outlined in the Aged Care Diversity Framework and Action xxxvi
  2. Cultural safety be a mandatory part of accreditation
  3. As part of their accreditation requirements, mainstream aged care services commit to work collaboratively with local ACCHOs, including seeking their advice on issues relating to cultural safety and trauma-informed
  4. Aboriginal community controlled organisations be funded to deliver regular cultural competency training, tailored to local protocol, to mainstream aged care
  5. Regular cultural safety training be mandatory for all aged care assessors and call centre staff.
  6. There must be a concerted effort to increase the numbers of Aboriginal and Torres Strait Islander peoples who receive higher levels of package care (levels 3 and 4).
  7. That the Australian Government commit to undertaking feasibility studies on the need for additional residential aged care services in remote and very remote locations in close consultation with Aboriginal local communities, including exploring options for:
    1. additional National Aboriginal and Torres Strait Islander Flexible Aged Care Services; and
    2. establishing Aboriginal and Torres Strait Islander specific, community-based, small scale hostels with formal ties to local ACCHOs and/or residential aged care services.
  8. Funding for interpreters be available for Aboriginal and Torres Strait Islander language speakers as it is for other
  9. Aboriginal and Torres Strait Islander run aged care services become eligible to access block
  10. Aboriginal Community Controlled Health Organisations receive an increase in their baseline funding in recognition of:
    1. the vital roles they play in keeping older Aboriginal and Torres Strait Islander peoples healthy and well in community and residential aged care settings;
    2. the projected population growth of this age group; and
    3. the significant burden of disease and complex health conditions experienced by older Aboriginal and Torres Strait Islander
  11. ACCHOs are designated as preferred providers of aged care navigation services for older Aboriginal and Torres Strait Islander peoples, through the aged care application and assessment
  12. ACCHOs are designated as preferred providers of primary health care for all Aboriginal and Torres Strait Islander residents of aged care
  13. The Australian Government increase its investment in integrated primary health and aged care exemplified by
  14. The Australian Government, at a minimum, reinstate aged care workforce funding to the same level prior to the 2015
  15. Aged care services are funded to employ Aboriginal liaison

PART 2 The AMA makes the following recommendations to the Royal Commission and looks forward to further working with the Royal Commission and the Australian Government to further improve the aged and health care systems.

Aged care workforce

Recommendation 1: Retaining and increasing the number of doctors interested in working in the aged care space should be the focus of any future reforms in aged care if appropriate clinical care is to be provided. Investing in primary care particularly for patients in aged care settings will save on public hospital expenditures.

Recommendation 2: Further investigation and research is needed into the demographics and movements of GPs in the aged care sector due to the decreasing trend in GP aged care visits and an ageing medical workforce. The research needs to take into consideration the forward-looking trends of expenditures related to Australia’s ageing population and the projected need for the medical workforce.

Recommendation 3: Medicare rebates need to increase in excess of 50 per cent to begin to adequately compensate for the additional time and complexity involved in comparison to a GP attendance in their own consulting rooms.

Recommendation 4: Introduce an MBS telehealth item for phone calls between the GP, RACF staff and relatives. This may reduce some barriers to accessing medical services after hours. The Government should consider introducing telehealth for RACFs for afterhours consultations as a pilot. Outcomes of such a pilot program will help inform government policy and provide an evidence base for informed decision making.

Recommendation 5: The Royal Commission should investigate the absence of routine roles for geriatricians and psychogeriatricians and how this should be addressed to better support GPs.

Recommendation 6: Further research is needed into improved funding and workforce models for medical care of older people.

Recommendation 7: Aged care providers need to provide basic equipment and facilities to support doctors to carry out their services in aged care settings. This includes access to a consulting room, a computer and appropriate clinical software.

Recommendation 8: Education and training for Doctors in Training and medical students on caring for older people should be increased.

Recommendation 9: Registered nurses should be available on site, 24 hours a day in RACFs to ensure older peoples’ medical needs are adequately met, including the appropriate administration of medicines.

Recommendation 10: There should be a mandatory minimum qualification for personal care attendants that includes basic health care.

Recommendation 11: Government should provide additional funding for specialised training of the aged care workforce, primarily personal care attendants. This should include a professional development leave option for those wanting to further develop their skills.

Recommendation 12: Implement a streamlined process to improve access to respite care for people who have not yet been assessed by an ACAT/RAS or who have not yet entered the aged care system.

Recommendation 13: Minimum mandatory staff-resident ratios should be researched and then introduced in RACFs that reflect the level of care need of older people and ensure 24 hour on site registered nurse availability.

Recommendation 14: The Aged Care Safety and Quality Commission should investigate staff turnover when assessing and auditing aged care providers.

Recommendation 15: The effectiveness of the aged care assessment process should be improve by including the patient’s usual doctor in the assessment arrangements.

Fragmentation between health and aged care systems

Recommendation 16: Communication between doctors, hospitals and aged care providers must be improved through minimum standards and guidelines.

Recommendation 17: Government must make more home care packages available to older people to address their care needs and to prevent the need for more complex care in RACFs and hospitals.

Aged care regulation

Recommendation 18: More specific Aged Care Quality Standards, including a Medical Access Standard should be developed for RACFs that helps to facilitate access to doctor services and high-quality clinical care.

Recommendation 19: Quality Indicator data should be made an integral part of the accreditation/audit reports conducted by the Aged Care Quality and Safety Commission.

Quality of care in aged care settings

Recommendation 20: Palliative care must be built into any aged care model, by defining the skills and staff requirements and recognising that palliative management is a basic RACF service. The funding model must be flexible enough to account for increased needs at the end of life and be responsive enough to allow for reassessment when required.

Recommendation 21: AMA members support mandating the requirement that all RACFs residents should have a current up to date ACD. AMA members also contend that there should be an MBS item/fee available for GPs to complete ACDs with their patients living in RACFs or their SDMs.

Recommendation 22: Further work is needed to raise awareness among aged care service providers on advance care planning, the role of aged care providers in ensuring the development and implementation of advance care plans, directives and communication around hospital transfers and the person’s usual GP, the need for caring staff to be aware of existence of ACDs, My Health Record and advance care planning, as well as the role of ACDs in clinical care.

Recommendation 23: Expand the Better Access to Mental Health Initiative to ensure older people living in RACFs receive the same access to mental health services as the rest of the population.

Recommendation 24: Improve dementia management and behavioural training for nursing and personal care staff attendants to reduce prescription of antipsychotic medication.

Recommendation 25: Doctors must be able to maintain clinical independence in order to make the best treatment recommendations for patients, based on current evidence, preserving their own clinical judgments regarding treatment recommendations.

Recommendation 26: Medication reviews should occur annually, and when there is a significant change in an older person’s medication and/or medical condition.

Recommendation 27: A National strategy on polypharmacy should be developed, along with evidence-based guidelines for prescribing to the elderly. Having a strategy and guidelines may reduce adverse events, hospitalisation and PBS costs.

Recommendation 28: Develop and implement national nutrition standards for aged care facilities, ensuring menus are varied and food is appealing and palatable.

Recommendation 29: Continuing education on elder abuse and neglect of the profession, including doctors, nursing aged care staff and personal care staff is essential to evaluate and mitigate medical and psychiatric consequences for the victims.

Recommendation 30: Introduce relevant safeguards for whistle-blowers in aged care, along with regulation for urgent mandatory investigations into their revelations.

Recommendation 31: Older people should maintain the choice of their preferred medical practitioner in residential care.

Recommendation 32: Simplify the aged care navigation process and ensure access to more information on aged care provider performance against the Aged Care Quality Standards.

The use of technology in aged care

Recommendation 33: Greater transparency for GPs and patients to be able view the progress of aged care assessments. This will provide GPs with confidence that their patients are being provided with the necessary care in a reasonable timeframe, as well as enable GPs to take action if this is not occurring.

Recommendation 34: More investment in innovation, digital technologies and telehealth in aged care.

Recommendation 35: Use of digital technologies in aged care in the future should be planned now by the Government and in coordination with relevant stakeholders.

Aged care in regional, rural, and remote Australia

Recommendation 36: Government needs to develop comprehensive plans to better support the provision of health and aged care in regional, rural, and remote Australia, and to commit to significant funding increases to bridge the gap between city and country.

Recommendation 37: Multi-purpose model of services for rural and remote communities should be further supported by the Government, particularly with the implementation of new Aged Care Quality Standards and accreditation under those standards for multi-purpose providers.

Young people living in residential aged care facilities

Recommendation 38: Options other than residential aged care facilities should be explored and implemented by the Government for younger people with disabilities who are currently serviced by residential aged care facilities.

Recommendation 39: Better coordination between disability and aged care systems is required to enable seamless transition between different services for people living with disability. Coordination with primary care in the process is crucial as well as other service sectors including allied health.

Aged care for special needs groups

Recommendation 40: The AMA calls for more research into health and aged care needs of special needs groups, including but not limited to CALD, ATSI and LGBTQI. These groups have particular needs around culturally appropriate and culturally safe services, which should be further documented and enable equity in accessing services and service provision.

The need for research on the care of older people

Recommendation 41: More research into care of older people in the future, including appropriate aged care and health care data collection to inform future policy and regulation.

Recommendation 42: Conduct a scientific evaluation of the impact of government policies on the wellbeing of older Australians. This will lead to proper policy adjustments and revisions as needed.

Have your say about Elder Care what is needed to make real change in the lives of Aboriginal and Torres Strait Islander people #HaveYourSay about #closingthegap

There is a discussion booklet that has background information on Closing the Gap and sets out what will be talked about in the survey.

The survey will take a little bit of time to complete. It would be great if you can answer all the questions, but you can also just focus on the issues that you care about most.

To help you prepare your answers, you can look at a full copy here

The survey is open to everyone and can be accessed here:



NACCHO Aboriginal Health and #ElderCare : Broome hearing of the Royal Commission focuses on the ability of our mob 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

 “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












Aboriginal Health and #Respectourelders @KenWyattMP Launching education for aged care facilities cultural considerations caring for elders


Caring for Indigenous Australians: Aboriginal and Torres Strait Islander People is an important program which will help address the fundamental need for culturally appropriate care for Aboriginal people, some who may need to use aged care services at an earlier stage of their lives

Programs like this are a vital part of ensuring the care of senior Indigenous people is as culturally continuous as possible”

Minister for Aged Care and Indigenous Health Ken Wyatt has welcomed the new course, which coincides with his announcement of a new North West Ageing and Aged Care Strategy which aims to create age-friendly communities across the Pilbara and the Kimberley, while encouraging more seniors support services and greater local employment in aged care.

Photos above Ken Wyatt meeting with the elders from the Yindjibarndi Aboriginal Corporation in Roebourne WA\.

The launch of Caring for Indigenous Australians: Aboriginal and Torres Strait Islander People will be streamed live via the Aged Care Channel at 10.45am AEDT on 22 November with Aboriginal Elder Mr Elliot taking part in answering live questions from members.

Developed by the Aged Care Channel (ACC) in partnership with the Department of Health, the Caring for Indigenous Australians: Aboriginal and Torres Strait Islander People course aims to help inform aged care facilities across Australia of the cultural considerations of caring for Indigenous Australians.

ACC Group Manager Content and Production, Steve Iliffe says the program took six months to put together with the help of research, lots of resources, government input and guidance of Indigenous people as well as visits to different aged care facilities in Pilbara and northern Adelaide.

“We thought it was an important program to do because Indigenous Australians do have a series of complex needs different to the rest of the population due to their history and access to health in areas,” he explains.

“They have a connection to the land, a connection to their family and want to still have access to bush tucker and do things that they traditionally do.

“We went out to a number of different aged care facilities to talk to the people there about what they do to provide tailored care.”

ACC Learning and Development Manager Nicola Burton says providing culturally-appropriate care is a crucial part of the person-centred approach.

“The goal of this program is to recognise how to respond to the cultural needs of Indigenous Australians receiving care,” she says.

“There are significant regional differences between Aboriginal and Torres Strait Islander groups, each with complex and diverse ways of life.

“Language, music and art vary in each area, but a connection with culture, community and the land seems to be common to all Aboriginal and Torres Strait Islander people.”

While working of the course and program, the ACC team spoke to and sought the advice of subject matter expert Ngarrindjeri elder and Chair of the Aboriginal and Torres Strait Islander Ageing Advisory Group Mark Elliott.

“It was important for us to work with an indigenous leader – he guided us through the process and the research,” Mr Iliffe says.

“With this new course, we hope that we can increase understanding between cultures because at the end of the day, it’s about creating a home for people in aged care and providing them with a life they are still living.”

The new Strategy announced by the Minister includes short, medium and long-term goals, from the engagement and inclusion of seniors in local communities, through to tailored home and residential care support.

“[Caring for Indigenous Australians: Aboriginal and Torres Strait Islander People] is an important program which will help address the fundamental need for culturally appropriate care for Aboriginal people, some who may need to use aged care services at an earlier stage of their lives,” Minister Wyatt says.

“Programs like this are a vital part of ensuring the care of senior Indigenous people is as culturally continuous as possible.

“It will contribute to this goal by helping staff understand the impact of historical events and past government policies, along with broadening their appreciation of Indigenous culture and the health challenges faced by some people.

“Giving staff these insights can contribute to better care, and I encourage everyone involved in indigenous aged care to take the course.”

He adds that the aim of the North West Ageing and Aged Care Strategy is to foster quality and culturally relevant residential aged care facilities that allow people to stay connected to community and age safely with dignity.

“Hopefully the new course will contribute to achieving this outcome,” he says.

“The program showcases the Pilbara’s Yaandina residential aged care facility, whose staff are experienced in providing residents with culturally sensitive care.”

Mr Iliffe says the result of the research and creation of the program is close to the hearts of all involved.

“The people involved had the most amazing time and it is something they will cherish forever,” he says.

“These experiences help us more closer to closing the gap.”

The launch of Caring for Indigenous Australians: Aboriginal and Torres Strait Islander People will be streamed live via the Aged Care Channel at 10.45am AEDT on 22 November with Aboriginal Elder Mr Elliot taking part in answering live questions from members.

NACCHO Aboriginal Health #CarersGateway : Free online resources to support #Aboriginal #carers

It’s rewarding work, but without help Dolly finds herself emotionally and physically drained. Dolly reached out and found that she could get services to help her.

Like Dolly, millions of people in Australia care for others who need help with their everyday lives.

A carer may be someone who looks after their husband or wife, partner, grandparent, uncle, aunty, cousin, child, grandchild or any other family member, a neighbour, a friend or someone in their community who needs help.

Everyone’s situation is different. Some carers look after someone who is an older person or who is unwell or has difficulties getting around. Some carers may look after someone who has a disability, a mental illness or dementia, a chronic condition or a long-term illness or drug and alcohol problems.

Many people looking after someone else don’t think of themselves as carers. They just see caring as what they do to help their families or friends or people in their communities.

Carers need help too – someone they can talk to and find out about services that can help. Carer Gateway is a free, Australian Government funded service that provides information for carers and helps people get in touch with their local services. People can ring up and have a private chat or go online and find out about support in their area, free financial and legal help and what to do in emergencies.  They can also get tips on how to look after themselves so they don’t get burnt out while caring for someone else.

Carer Gateway has short videos about real-life carers in the community – showing how they cope and deal with problems – and how they make the most of the time they spend caring for someone in need.

The videos include Dolly’s story. Dolly is a mother and full-time carer for her two adult daughters, who both need support with their everyday needs.

“It’s pretty much 24/7 around the clock. Four years ago, I realised I was doing a care role and I was also a working mum so quite busy. I thought you know what, it’s time for me to step back and start looking after my own,” she said.

There are free online resources to support Aboriginal carers, including a guided relaxation audio recording and information brochures and posters for use by health and community groups  which can also be ordered from the Carer Gateway ordering form and a Carer Gateway Facebook page to keep up to date on services and supports for carers.

To find out more, Carer Gateway can be contacted on 1800 422 737, Monday to Friday between 8am and 6pm,

or by visiting carergateway.gov.au

You can join the Carer Gateway Facebook community by visiting https://www.facebook.com/carergateway/