Special report: rural and remote aged care

To address the unique challenges faced by organisations operating in rural and remote areas, a 20 per cent boost to the Viability Supplement was a headline measure in this year’s Federal Budget. AAA speaks to the chief executives of three rural and remote providers to discover what impact the funding will have on their services.

To address the unique challenges faced by organisations operating in rural and remote areas, a 20 per cent boost to the Viability Supplement was a headline measure in this year’s Federal Budget. Australian Ageing Agenda speaks to the chief executives of three rural and remote providers to discover what impact the funding will have on their services.

“All aspects of service delivery are challenging,” says Robyn Batten, CEO of Blue Care, when asked of the specific challenges her organisation faces as a provider of aged services in rural and remote Australia.

Robyn Batten
Robyn Batten

Blue Care operates more than 260 centres in 80 communities across Queensland and northern NSW, totalling 4,460 beds (including 170 provisional bed licenses) and 1,146 community care packages. Its clients are cared for by 8,840 staff and 2,311 volunteers.

Many of Blue Care services are in remote locations, such as Thursday Island, Cloncurry in north-west Queensland and Cunnamulla in the south-west of the state.

In the Northern Territory, Australian Regional and Remote Community Services, which began operations on 1 July, employs more than 500 staff who provide residential and community care in 12 locations across the NT, including the very remote Docker River and Mutitjulu.

Discussing the challenges facing her organisation, Batten says that recruiting and retaining staff is the most difficult. “For example, in Docker River, all staff fly in on a rotation basis, live in the ‘compound’ and many of their hours of work are paid as overtime,” she says.

In Tenant Creek and Mount Isa, Blue Care community care staff may travel two hours each way to provide in- home care. “This care is of course even more crucial in isolated communities,” she adds.

Many of Blue Care’s remote services operate in harsh physical environments – for example, close to the sea on Thursday Island – which Batten says makes the maintenance of services very expensive. She says:

“In many regional areas, such as Gladstone, Mackay and Emerald, we are competing with the mining industry for staff. Often the mining industry pay more than double the wages we are able to pay.”

Given these challenges, Batten says that any improvement in funding, such as in the recently announced increase to the viability supplement, is welcome. However, she adds: “There are a number of current and recent past examples of rural and remote services that have not been sustainable and have had to be devolved to larger providers such as Blue Care.”

She says that even for a “large and capable organisation” such as Blue Care, it can be difficult to break even in the NT. “And several will make a major loss, even after the 20 per cent increase.”

Asked what impact the supplement increase will have for services on the ground, Batten says that “every cent received goes towards maintaining quality of care and staff conditions. This increase will reduce our deficits.”

Blue Care welcomed the opportunity to speak with Assistant Minister for Social Services Mitch Fifield and senior department officers about working together to develop more sustainable models of service delivery for rural and remote areas, Batten says when asked what further measures government could take.

“Long-term sustainable solutions are required and these are best developed in partnership between providers experienced in these areas and the department. I am optimistic this issue is taken seriously and we will have new opportunities to develop sustainable models,” she says.

Welcome, but more incentives needed

Lee-ann Irwin, CEO of the Whiddon Group, says one of her organisation’s greatest ongoing challenges is recruiting appropriately trained staff and professionals to work in their remote services.

Lee-ann Irwin
Lee-ann Irwin

The Whiddon Group, a large non-profit organisation, currently provides 1,397 residential places, 245 home care packages (including 76 CDC packages) and 363 independent living units in 26 locations across NSW – including in some of the state’s most remote areas, such as Condobolin, Walgett and Wee Waa. It employs over 1,700 people.

Along with workforce, Irwin says that the cost of goods and services in remote areas are also notably higher than in metropolitan areas and major regional centres due to transport. This adds the challenge of financial viability to the table, she says.

“From an internal perspective, our remote services are also hampered by a lack of communication infrastructure, such as suitable bandwidth, to provide telehealth services for clients, and e-learning and video conferencing,” she says.

Asked for her opinion of the increase to the viability supplement, Irwin says it is welcome, but adds that “it came off a low base.”

“For our services receiving this funding, the viability supplement in our services equates to approximately an additional $12,000. This helps, but it will not offset the provision of services in small remote communities where the residential facilities are between eight and 12 beds,” she says.

Asked what further measures to improve service provision in rural and remote areas, Irwin highlights improved communication services. This would enable staff to be contactable when providing community-based services, while “e-solutions” could be fully utilised for staff education and for clients to communicate more easily with family and friends, she says. She adds:

“The cost of care study, which is required for all aged care, will reflect the differences in rural/remote and metropolitan/regional centre locations. My suggestion would be that the government utilises the provision of annual accounts to thoroughly review the viability of facilities operating in rural and remote Australia, and match the viability supplement accordingly.”

Irwin would also like to see “encouragement and incentives” from government to prompt aged care providers and local health services to work in partnership and provide services such as respite care and training in rural communities.

A ‘vital’ boost

Like Irwin, Robert Barden, the CEO of Emmerton Park in Tasmania, cites the greater cost of supplies and services as among the major challenges his organisation faces.

Robert Barden
Robert Barden

He also lists access to, and cost of, allied health specialists, IT expertise, and recruitment of senior management, such as in HR and finance, as other ongoing challenges.

“Although we actively use Aged Care Channel, the cost of facilitating training sessions – for example, fire and emergency, manual handling – is expensive,” he adds.

Emmerton Park is located at Smithton in Circular Head, a rural and remote municipality located in far north-west Tasmania. Smithton is the major population centre, home to 3,000 people.

A community-based, not-for-profit organisation, Emmerton Park provides a range of services including 61 bed residential care, 73 independent living units, 16 home care licences and day respite care.

“We employ 96 local people and generate over $5 million into the local economy through wages and employing local contractors and suppliers,” says Barden.

The 20 per cent increase to the viability supplement is welcome, he says. He describes the supplement as “vital”, because it compensates the organisation for the additional costs incurred in providing care and services where it operates. He explains:

“For example, it has allowed us to expand home care to outlying areas of the municipality. We are a small community and we tend to support local suppliers and contractors, which benefits the community generally.”

As a result of the boost to the supplement, Barden says his organisation expects the increase to provide approximately $11,900 in additional supplement income to a total of $69,800.

“We have regularly maintained occupancy rates of greater than 99 per cent, however with the increasing frailty of new resident admissions we expect this to reduce to 98 per cent this year.

“We don’t expect any obvious impact to our bottom line, which has also been adversely impacted by the cessation of the Dementia Supplement that will more than offset any benefit resulting from the increase in the viability supplement.”

Discussing what impact the increase may have on the care provided, Barden says:  “We have established specific palliative and dementia teams this year to provide specialised support to residents/clients and resourcing these programs is a strategic priority for our organisation.

“These quality initiatives have necessitated considerable planning, implementation, staff development and community awareness processes which has been predominantly subsidised, to date, by community fundraising. The increased subsidy will predominantly be used to fund the coordination and development of these programs.”

In terms of further measures the government could implement to further support rural and remote providers, Barden says that with the cessation of the dementia supplement, he would like to see additional funding for caring for people with dementia and other behaviours.

“Many rural and remote providers have difficulty in accessing allied health professionals which can impact on pain management strategies and related ACFI scoring/claim. We have a number of staff undertaking allied health assistant training and would like to see changes to ACFI scores to allow pain management – for example, massage – provided by appropriately trained allied health assistants. Currently it is restricted to registered nurses or physiotherapists,” he says.

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Tags: Australian-Regional-and-Remote-Community-Services, blue-care, emmerton park, lee-ann-irwin, Robert Barden, robyn-batten, slider, whiddon-group,

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