Care in the bush – lessons from Mildura

Mildura is about 550kms from Melbourne, more than 1,000kms from Sydney and almost 400kms from Adelaide.

Last month, it hosted the Tri-State Regional Aged Care Forum, run by Dr Anne Webster MP, Federal Member for Mallee and the Shadow Minister for Regional Health, and facilitated by Dr Nick Coatsworth. The forum covered the Sunraysia, the Riverland and far west NSW, where the nearest metropolitan hospital, specialist or assessor can be hours away.

Most of the room was bustling with older people and their families, with Catholic Health Australia and providers making up the rest. There was a tangible sense that policy is mostly written in capital cities, and consumers in the room gave voice to the ways in which this approach falls short.

Some of the challenges were familiar, particularly that being approved for care is not the same as receiving it. A Support at Home package doesn’t help much when the nearest provider has a long waitlist or doesn’t cover your town. Several people told stories of hospital patients who were ready to go home but stuck in a ward, waiting for a ramp, a set of handrails or a cleaner. A common theme was a limited number of providers in a position to offer the Commonwealth Home Support Program. Several providers in the room said they had sought CHSP funding without success.

Other challenges were specific to the bush. Older people with patchy internet and little confidence online are being sent to a digital front door. Some have been told to go to a Services Australia office just to reach My Aged Care – plainly a challenge when the nearest office may be a long drive away. Phone assessments drew the strongest criticism. An assessor in another state can’t see a loose rug, an empty fridge or a medication routine that has stopped working. The Forum heard repeated calls for face-to-face assessments, with particular support for Government-funded local care co-ordinators. The government-funded Care Finder program is thinly spread in the region, and many Catholic and not-for-profit providers fill the gap unfunded, so coverage is patchy.

Providers in the region deliver care under conditions most metropolitan services never face. Among them are Catholic providers such as Southern Cross Care Broken Hill, which has served the far west for more than 50 years and runs homes in both Broken Hill and Mildura. Providers cover huge distances. They compete for workers with mining, agriculture and the public health system, often with no local housing to offer new recruits. Home care visits can involve hours of travel that isn’t always funded. In residential care, a single fall can take up an entire day.

Under standard practice, a resident who falls is often transferred to hospital for imaging, even with no sign of a fracture. In the bush that can mean an ambulance trip of several hours, a long wait in emergency and a return journey late at night. For a frail older person, especially one living with dementia, the transfer can do more harm than the fall.

However, it wasn’t all doom and gloom. Regional providers spoke of finding their own answers. One provider shared a story about investing in its own X-ray capability so residents can be imaged on site after a fall. It also built a partnership with the local health service so the images can be read and acted on quickly. If there’s no break, there’s no hospital trip. The resident stays in their own bed, with familiar staff, and the ambulance stays free for the next emergency.

That kind of thinking cuts needless transfers, eases pressure on regional hospitals and protects residents’ wellbeing. But it relies on providers finding the capital themselves and on goodwill between local organisations. Current funding settings don’t recognise or reward it.

What we heard in Mildura supports CHA’s long-standing advocacy for a regional care model. That means thinking deeply about the implications of centrally-planned policy for regional areas. This could variably include:

The messages were not just for Government, but providers as well. Older Australians spoke to the need for clear, trustworthy pricing, particularly for home modifications and subcontracted services. Being transparent about costs is how the sector earns the trust it needs to make the case for better funding. CHA co-designed a package of consumer protections with consumers and took it to government, including a Department-published list of reasonable prices and powers for the Aged Care Quality and Safety Commission to claw back inappropriately charged co-contributions.

CHA thanks Dr Webster and Dr Coatsworth for bringing people together. CHA will continue to advocate for care and funding models that improve delivery of aged care in the regional areas our members operate and beyond.