Building community ties
Building community ties
Community care is generally taken to mean ageing in place in a person’s own home, but as Sue Cartledge found out when she attended the recent national community care conference, community care covers a lot more than helping the elderly.
The Federal government continues to encourage more elderly people to stay at home with its A New Strategy for Community Care - The Way Forward’. According to DoHA, the strategy will “build on the current strengths of the community care system and outlines a number of ways to improve the system to reduce complexity and achieve greater consistency, as well as simplifying and creating a fairer system for people requiring care to stay at home.”
At the first national community care conference, held in Sydney in May, community care providers from all states and territories gathered to share their successes and challenges. Speakers covered a wide range of service areas – aged, home and community, mental and disability, indigenous, multicultural, rural and remote, public and for profit.
Among the important topics were how to ensure enough workers to provide services, how to ensure the services are right for the clients, will there be enough funding? The use of technology to assist people in their own homes, and provide security was showcased with a demonstration of Baptist Care’s new ‘Smart House.’ Here are just a couple of examples of outstanding community care:
Helping the Homeless
South Australia’s Royal District Nursing Service (RDNS) as been working to help some of the most helpless and needy in the community - homeless women survivors of child sexual abuse who have been misusing alcohol, drugs or gambling.
The project, a partnership between RDNS Research Unit, Catherine House Inc and Centacare, was a capacity building project undertaken in South Australia from 2003-2005. RDNS Senior Research Fellow Dr Anne Van Loon says the women participating in the study contended that health professionals could prevent them from becoming recurring A&E patients by acknowledging the links between addiction and child sexual abuse (CSA), understanding the impact of CSA, treating CSA survivors with compassion and understanding, and providing appropriate support and/or referral.
“The women acknowledged that they had ‘few dreams or hopes for the future’ and were using addictions to ‘escape’, ‘cope’ and even ‘survive’, recognising themselves that these were ‘toxic life patterns.’”
The participants were led through a series of group sessions to facilitate their transition to a more normal way of living in which they were in control by the ‘Look, Think and Act’ process. Each woman systematically names her problems/issues, decides what she can improve/change, and considers ways to action her decisions. The new Director of the RDNS Research Unit, Dr Debbie Kralic says this process can be used to assist other people transitioning from one lifestyle to another after significant disruption – such as accidents leading to disability, chronic illness, onset of Type 2 diabetes, the death of a partner.
“Health workers need to let go of control and let the client choose their own action, being encouraged to draw on their own strengths,” she says.
The RDNS Research Unit has produced a series of booklets on pain, fatigue, sexual health, and self-identity as resources for both healthworkers and clients.
“The booklets take the perspective of the person and helps them to identify the barriers to change, and enables them to decide how to act,” says Van Loon.
“It could lead to self-management of chronic illnesses.”
More information: http://www.rdns.org.au/research_unit/
Meeting the needs of Aboriginal people
National Aboriginal Community Controlled Health Organisation (NACCHO) Director, Henry Counsillor outlined the challenges and successes of Aboriginal community health services. NACCHO is the peak body in Aboriginal health in Australia. Established in 1976, it represents over 130 Aboriginal community-controlled health services (ACCHSs) around Australia, and is managed by a Board of elected Aboriginal representatives from every State/Territory.
Counsillor says that while Aboriginal people have a higher level of health need for almost every indicator, mainstream health systems and programs often ‘lock out’ Aboriginal peoples so that they access even less care than the average Australian;
“Specific health concerns necessitate supplementary and specific programs, and socio-cultural factors underpinning health necessitate culturally appropriate and Aboriginal community-controlled health services.”
ACCHSs deliver comprehensive primary health care across mpost of Australia, especially in remote areas. According to BEACH data, they deliver more expansive programs and clinic services than general practice. Over 1.4 million episodes of care were recorded by ACCHSs to Aboriginal & Torres Strait Islander peoples in 2003-04 vastly greater than private GP contacts. Counsillor says.
He is proud that not only do the centres provide primary care in a culturally sensitive manner, but that 70 per cent of employees are Aboriginal. The centres are a significant source of training for all health professionals Aboriginal and European.
Not only do ACCHSs provide medical services, they also support flexible and residential care to the elders, for whom the problems of ageing often set in long before the age of 65. Currently, there are 29 approved flexible aged care services (mixed residential and community care) to Aboriginal peoples across Australia and another 29 residential aged care services to Aboriginal peoples in places like Broome, Halls Creek, Derby and Fitzroy Crossing.
Like community service providers across the country, NACCHO is hampered by funding constraints.
“We would love for our old people to live longer and healthier,” Counsillor says. “For this to happen we need:
- More assistance for home care carers (human and financial)
- More aged care facilities in remote Aboriginal communities (aged care hostel) fully supported by government.
- Exemption for Aboriginal people to be able to receive their superannuation at 55 years.”
Serving the whole community
Not at the conference was a representative of the Royal Flying Doctor Service, yet RFDS is rewriting community care. Once seen as purely a mission of mercy to people on isolated sheep and cattle stations in the outback, RFDS has reinvented itself. A study in 1993, best for the Bush, identified the need to move into a primary care service rather than stay with the narrow, emergency response. The organisation needed to become pro-active in delivering services, including immunisation.
“It is generally accepted people in remote communities do not share the same health status as metropolitan residents, and statistically it has been shown they are more vulnerable to cardiovascular disease, asthma and injury,” says Captain Clyde Thomson, CEO of RFDS South-Eastern Region, covering most of NSW, Victoria and Northern Tasmania.
“In many remote communities there is also a high proportion of Aboriginal and Torres Strait Islander people who experience a poorer health status than other rural residents.”
Thomson says the lack of comparable health services for people in remote and isolated areas drove the change from emergency service to an integrated primary health service and education organisation, with partnerships in each state with universities, state health services, Aboriginal health services.
As a result, RFDS now provides medical clinics and after-hours GP care, clinics on women’s health, children and infants, diabetes, mental health and chronic diseases employs community nurses, GPs and rural registrars, and allied health professionals, and arranges consultations with dermatologists, dentists ophthalmologist and opticians, and psychologist.
While some of these are videoconferences, the majority of specialist consultations are face to face, organised at regular intervals. Rather than patients having to travel for many hours to the nearest city to see a specialist, RFDS brings the specialists to the people.
The new service is operating in NSW and Victoria, but funding constraints - a lack of agreement between the Commonwealth and the states – is holding back progress in some other states. However, Thomson is confident that the funding model will be sorted out over the next few COAG meetings, and within two years, RFDS primary care service will be available wherever needed.
While providing quality health care at primary, public, population and emergency levels is the primary purpose of the revamped RFDS, Thomson says there is an unexpected spin-off from the expanded service.
“By providing regular services at monthly, quarterly or six-monthly intervals in the population centres, we are helping people in isolated areas to come together and develop a sense of community. People can meet each other and talk about their concerns – especially about the effects of the drought and support each other.”
Stretched to the limits
According to the National Community Care Alliance (NCCA), while there are good community care services available to support people, they are limited by insufficient funding or rules about what they can and can’t provide. Most services cannot meet the needs of all existing clients let alone new people who require support.
- At least 2.5 million people are caring for family members or friends with a disability, mental illness, chronic condition or who are frail aged.
- Nearly 20 per cent of these are primary carers - the main source of unpaid informal support.
- Over 50 per cent said they provided care either because alternative care is unavailable or too costly, or that they have no choice.
- The 1998 Survey of Disability, Ageing and Carers reported that 40 per cent of people with a major disability who live independently and need assistance, felt their needs were only partly being met.
- Approximately 162, 000 Australians have a diagnosis of dementia, with a similar number in the early stages of dementia.
- Everyone over the age of 85 has a one in four chance of dementia.
- The combined Federal and States expenditure last year on the Home and Community Care program (HACC) was approximately $1 billion.
- The average amount of domestic assistance received by 198,746 HACC clients last year was just 38 minutes per week.
- The 46,919 HACC clients aged 65 and over receiving personal care assistance average 50 minutes per week.
- The 11,630 clients aged less than 65 receive on average 2.4 hours per week.
- At least 60,000 older Australians with very high care needs were formally assessed by Aged Care Assessment Teams in 2001-2002 as needing more community care than they were getting.