Consumer directed care has failed in remote regions of Australia but flexible arrangements available for indigenous communities offer a model which a researcher believes should be extended to all remote areas.
The National Aboriginal and Torres Strait Islander Flexible Aged Care Program (NATSIFACP) currently funds organisations to provide culturally appropriate aged care to older Aboriginal and Torres Strait Islander people close to home and community.
Heather Gibbs, a principal research fellow with the college of indigenous futures, arts and society at the Northern Institute at Charles Darwin University, says the program should be available to non-indigenous communities in remote parts of the country as well.
“Mainstream aged care funding models are generally poorly adapted to providing aged care and care for people with disabilities, in remote communities,” Gibbs writes in a recent research paper.
“The NATSIFACP funding system … offers a viable model to regional councils that could result in sustainable ways of providing aged care.
“Findings from this study … endorse the recommendation from other aged and disability advocate organisations as well as the Tune Review, to consider the NATSIFACP funding system as the most appropriate model for use across all remote communities in Australia.”
Challenges of providing services in remote communities
For their study, Profiling capacity to support older people in remote communities to age in place, Gibbs and her colleague Dean Dempsey focused on remote indigenous communities and interviewed the people directly servicing those communities via local and region government, NGOs and Aboriginal-run health services.
They found the provision of aged care services to remote communities presented a raft of unique challenges, including:
- Lack of residential, respite and palliative care
- Lack of aged care providers
- Infrastructure maintenance issues (power and water, health centres)
- Long distances for food transport and travel
- Accessibility issues due to remoteness and seasonal conditions like flooding
- Lack of trained workforce, burnout of non-indigenous staff
- Unique cultural issues
- Reluctance to communicate with people outside kinship groups
Gibbs says the “marketisation” of aged services under consumer directed care isn’t working for remote communities.
The shift of aged care to a market economy had led to providers withdrawing from remote communities, leaving the whole of central Australia, radiating out from Alice Springs to the top end and remote WA, with only one provider operating out of Darwin.
In addition, the logic of CDC was “anathema” to the development of local services, such as primary health clinics and local and regional government bodies, which were stepping in to fill the gaps.
Extending flexible programs to non-indigenous communities
Gibbs says there’s an assumption from a service-provision point of view that all non-indigenous elderly people are the same, but her research has shown this isn’t true.
“You’re facing many of the same conditions whether you’re indigenous or non-indigenous once you’re ageing in a really remote community,” she says.
“Non indigenous people in remote communities are a very different species to an older person living in Melbourne or Sydney or Adelaide. They have a very clear idea about their relationship to the land and why they’re there.
“They want things done in a way that preserves their connection to community and to the country, they don’t want a provider coming in and telling them what they need according to a menu, which is what we do when we assess people in the city.”
Gibbs says systems to support ageing in place are important for people in remote communities. Not only because residential facilities in centres like Alice Springs and Tennant Creek are at capacity, but because people are in remote communities are there because of their relationship to the land – whether they are indigenous or stockmen who have lived on stations all their lives.
Unique needs of indigenous Australians
However Gibbs acknowledges that indigenous communities have specific cultural practices and kinship relationships that govern their care needs in a unique way. A sub-group among indigenous Australians in remote areas that is poorly understood, Gibbs say, is the Stolen Generation, many of whom have been relocated to cheap housing in mining towns.
“These people were taken from their homes as children and they can’t go back to their homelands because they don’t fit there,” she says.
“Non-indigenous older people tend look to their community as their family … but indigenous people fit very much within a complex kinship system.
“The care given to an indigenous person is through the kinship system. The Stolen Generations are away from their country, they are away from their kinship system, but they don’t have the capacity to branch out and become part of the community of that town, so they are the loneliest of all.”
Where remote care is working
- Commonwealth programs like NATSIFACP, which have enhanced care by funding providers to take control of their own aged care and ensure flexible training
- Direct services provided by regional and local governments and indigenous-controlled organisations
- Provision of home care (personal care, housework, Meals on Wheels by local community members
- Remote people need specific forms of personal care
- Need for a reliable respite system
- Need for local palliative care
- Need for creative ingenuity, resilience and resourcefulness in coming up with solutions
- Need to explore ‘one the ground’ partnerships
- Need for partnership between layers of government
- Need for a forum for communication and consultation between governments, local community and indigenous organisations.
You can access the study here