service delivery in
rural & remote
communities “Aged care” has a different meaning in our Aboriginal Communities. It begins at a much younger age and has complex service inputs and cultural overlays. Focused organisational capacity development and strong linkages with Australia’s primary healthcare system are required for sustainable long term service delivery.
ounger is relative term. Years are the commonly used measure either under either the Gregorian or Julian calendars and is the orbital period of the Earth moving in its orbit around the sun (365.25 days).
This common measure of ‘age’ has a different meaning when translated into an Aboriginal aged care setting. Chronic disease, increased rates of youth suicide, poor diet, and a range of other social determinates all result in lower average life expectancies for Aboriginals. According to the Australian Institute of Health and Welfare (AIHW), for the Aboriginal and Torres Strait Islander population born in 2010–2012, life expectancy was estimated to be 10.6 years lower than that of the non-Indigenous population for males (69.1 years compared with 79.7) and 9.5 years for females (73.7 compared with 83.1).
Complex service inputs and cultural overlays First and foremost is access to locally-based skilled staff. This can be challenging at the best of times across Northern Australia where many Aboriginal communities are located and arguably where culture is the strongest. The tyranny of distance, geographic isolation, work conditions all combine to make it difficult to attract the best and brightest. Understanding of western medicine and health care also impact on local employment pathways and provision of the right care at the right time. Cultural overlay cannot be underestimated. Poison cousins (an Australian Aboriginal kinship term used to describe a relation
Heath Shonhan Partner I Bentleys Qld National practice leader Bentleys Health & Ageing team
one is obligated to avoid) women’s/men’s business are both examples of customs which dictate who can and can’t deliver what services to whom. Meanwhile a distrust of western medicine impacts on timely delivery of events of care, ongoing health management, and overall community members’ views around the relevance of the service delivery. The financial inputs of service provision into Aboriginal communities are consequently significantly higher directly due to a lack of economies of scale, increased travel costs due to distances between communities and limited service providers. Cultural practices (e.g. town closure when someone has died), and increased remuneration requirements to attract, house and feed skilled staff (where fresh food costs are significantly higher than metropolitan areas) also contribute significantly to additional input costs. The healthcare data silos existing between health care service providers, hospitals, community controlled Aboriginal Medical Services, and aged /community care providers lead to fragmented health outcomes, and service fatigue (when community members received multiple visits from different agencies).
Thinking ahead Our work in recent years with community controlled healthcare providers in Aboriginal communities in far north Queensland and Cape York indicates that continual focus on improving organisational capacity definitely improves service delivery sustainability (or being ‘deadly’ as one Aboriginal Chairman of a successful Aboriginal healthcare provider asked us to task them against!).