The search for new models for rural Australia       

From blunting demand for residential aged care to increasing the use of telehealth, Linda Belardi explores different approaches being taken by providers to ensure the long-term viability of rural and remote services.

Forty-three local governments in Western Australia’s Wheatbelt region are trialling a new model of rural aged care delivery.

The local governments have identified aged care as a key priority for the region and embarked on a project with the Wheatbelt Development Commission, the region’s key economic development agency, to prepare a plan for the long-term viability of services and support for older people.

The Wheatbelt Aged Support and Care Solutions project commissioned Melbourne-based firm Verso Consulting to conduct a needs analysis at an individual shire level and identify new solutions for the region.

The project report found that due to a significant shortage of appropriate aged care services, older people in the Wheatbelt were often forced to leave their communities to access care, and many of the current residential care facilities, including multipurpose sites, were outdated or built as low care facilities. Significant refurbishment would be required for many of the small facilities to meet modern aged care standards.

After extensive research and public consultation, including 31 forums with over 560 community members and service providers, a new model was proposed to improve aged care delivery, which is made of up of four key planks:

1. Age-friendly communities
2. Appropriate and safe older person’s housing built to universal design
3. Delivery of the full suite of community aged care
4. Residential aged care.

Managing director of Verso Consulting Doug Faircloth says the vision is to blunt the demand for residential care by investing in age-friendly communities and appropriate housing to support older people to be cared for at home.

“Age-friendly communities can support health promotion, better restoration practices and reduce the speed of impact of ageing, as well as facilitating better transport options and the capacity for all the community resources to be used to support ageing,” he tells Australian Ageing Agenda.

Accessible housing built to universal design enables ageing in place and improves the capacity of a community to provide higher levels of community aged care, says Faircloth.

“If you have appropriate older persons housing, you begin to have a framework that would allow you to anchor aged care within a community, even within a small community,” he says.

Faircloth says a small township with as few as three houses could efficiently support high level home care if it utilised local employment that could be further supported by telehealth for clinical supervision.

Key to the model is sourcing local staff to deliver home support and packaged care and to raise awareness within communities about the value of community care.

During public consultation, it was clear the potential of home care packages to support a person to remain in their homes was poorly understood by both local communities and rural health professionals. Older rural Australians commonly associated aged care with residential facilities.

Faircloth says the need for residential aged care in this model will not be eliminated, and still remains an important feature of aged care provision, but will be developed in strategic locations.

Wendy Newman, CEO of the Wheatbelt Development Commission, says the region has too often turned to residential care as the default to meet the needs of older people.

“It’s an expensive solution, and there is incredibly high unmet demand, so we have to come up with these other models that promote universal design, accessible older person’s housing and the delivery of proactive services into the home, that will be both more cost-effective and supportive of people remaining in their communities longer,” she tells AAA.

Newman says Wheatbelt residents spend much longer than necessary in hospital due to a shortage of appropriate housing and access to the full range of community care options.

Following the report’s launch in October 2014, the Wheatbelt Development Commission has been working with Wheatbelt shire councils and key agencies to implement the report’s recommendations.

Using the WA government’s Royalties for Regions program, which returns 25 per cent of the state’s mining royalties to regional areas each year, the commission has funded the development of an age-friendly audit tool and a series of small projects across 37 councils to improve age-friendly infrastructure and services.

The projects, valued at over $1.7 million, included new age-friendly parks and open spaces, a sensory garden, improvements to footpaths and additional disability parking.

To support the development of accessible housing, the commission is working with nine groups of local governments to audit their current housing stock and plan for future investment in older person’s housing based on forecast need, says Newman.

Cluster housing model

As an alternate to residential aged care, particularly in areas where there are major quality and viability issues, the Wheatbelt Aged Support and Care Solutions report proposed piloting a new cluster model of accommodation and care involving eight independent living units and a secure garden, supported by home care packages and 24/7 staffing. The focus would be on high care clients and the site would be co-located with a primary health facility.

“There would also be added benefits of having family members able to live with their family member, or for short stays, and the delivery of dementia care,” says Faircloth.

However, he says for the model to be viable it would need to be block funded, which would require flexibility from the Department of Health to permit the pooling of home care packages in rural locations.

The Wheatbelt is currently examining the potential of a cluster model in the shires of Pingelly and Cunderdin,

Choice in rural settings

Newman says the WA rural aged care project is also reaching out to the Federal Government to discuss the importance of alternate models to market competition in rural Australia.

“We have written to the federal ministers responsible for health and aged care to begin a conversation about how we can foster a model that enables the bundling of services and a geographic footprint for any one provider so that they have a sustainable model,” says Newman.

Supporting the viability and capacity of a service provider that is able to deliver the full range of services required by a community can produce a better outcome than promoting choice and competition, she says.

Michelle McKay, Blue Care’s director of regional and remote services, agrees there needs to be greater discussion about the relevance of a competitive market approach in rural Australia and its potential to negatively impact the viability of services.

By encouraging choice of provider in a rural town, the risk is that it increases the vulnerability of both providers, McKay tells AAA.

“We would all want client choice, but it’s how you manage that issue in places where there is potentially market failure and where providing an opportunity for more choice actually increases the risk of failure, and that’s a real challenge for us all in the sector and government to grapple with.”

One way Blue Care supports the viability of its regional and remote services is by utilising a hub and spoke model to deliver clinical support and supervision to staff and clients located in small rural towns.

Through this arrangement, the organisation is able to reduce the need for management and clinical supervisors to be located in remote areas, which can be hard to fill.

“This model is about trying, as much as possible, to reduce those single points of failure that occur when you are looking at very small staffing numbers in rural and remote areas,” says McKay.

Blue Care is also trialling the use of telehealth and other technologies to support its rural and remote service delivery. “We have an advanced process in South West Queensland that is modelling the use of a range of technologies and we are testing that now with both clients and staff… Our intention is to be able to roll that out across the state.”

Faircloth says both commonwealth and state governments need to work together to have a clear plan for rural Australia and a set of guiding principles that will drive their planning.

“[Addressing these issues] requires a philosophical shift, that is, markets will not fix the problem in rural Australia. There has to be a clear recognition that there is already market failure and there will continue to be, so it needs a different deal.”

An extended version of this article was first published in the May-June edition of Australian Ageing Agenda magazine.

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