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Assistance with Care and Housing for the Aged (ACHA) Program - Program Activity Report 2011-12

The Assistance with Care and Housing for the Aged (ACHA) program supports older people who have insecure housing arrangements, or who are homeless.

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Program Overview

The Assistance with Care and Housing for the Aged (ACHA) program supports older people who have insecure housing arrangements, or who are homeless.

The program helps clients live in, participate, and feel included in the community of their choice, by facilitating access to sustainable and affordable housing. This includes activities such as locating suitable accommodation, providing advice on housing applications, coordinating removals and assisting access to accommodation-related legal and financial services.

The type of assistance provided for ACHA clients varies to suit the needs of the individual. ACHA is also a program that links clients to appropriate community care and welfare services, not a program that provides ongoing care.

Due to the low number of providers in Tasmania, the data are combined with that of Victoria throughout the report.

Funding

In 2011/12, the Government invested $4.637 million (GST exclusive) in ACHA services around Australia. Table 1 shows the total amount of funding provided to ACHA services across Australian states and territories between 1 July 2011 and 30 June 2012.

Table 1 ACHA Funding¹ by State and Territory 1 July 2011 - 30 June 2012

State/Territory	Providers	Service Outlets	$ million (excluding GST)
NSW	9	10	$1.357
VIC & TAS2	13	15	$1.441
QLD	2	5	$0.550
SA	5	5	$0.405
WA	4	4	$0.414
ACT	3	3	$0.260
NT	3	3	$0.209
TOTAL	39	45	$4.637

Notes:

1. Funding reflects contract values including indexation.
2. Due to the low number of providers in Tasmania, the data are combined with that of Victoria throughout the report.

Summary Service Data

ACHA Program Key Facts

• Number of service providers: 39
• Number of service outlets: 45
• Number of clients assisted over 2011/12: 4,239
• Number of active clients as at 30 June 2012: 1,037
• Number of clients re-housed: 2,003
• Average age of clients: 70 years
• Average time to re-home clients: 23 weeks

Clients assisted

In 2011/12, the ACHA Program funded 39 service providers operating 45 service outlets (Table 1). The Program assisted 4,239 clients (Table 2). The number of people counted as clients includes everyone in the household requiring assistance. They comprise primary clients (sole clients or older clients in a household of clients) and secondary clients (chiefly the spouse of the person seeking assistance, carers and younger dependents).
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Table 2 Summary of ACHA Services and Clients 1 July 2011 - 30 June 2012

State/Territory	Total Clients1	Primary Clients	Housing Only Clients	Housing and Care Clients	Care Only Clients
NSW	1,219	1,083	562	543	115
VIC & TAS	1,899	1,754	774	1,023	95
QLD	255	219	161	93	02
SA	339	302	100	216	20
WA	214	169	80	97	0
ACT	207	175	72	135	0
NT	106	95	78	28	0
TOTAL	4,239	3,797	1,827	2,135	229

Notes:

1. Total Clients may not equal the sum of other categories due to recording information gaps.
2 Client numbers less than 10 are not reported.

While the number of clients is higher than in 2010/11 when the Program assisted 3,858 people, the reporting methodology for 2011/12 for the first time incorporates some double counting of clients (about 300 clients) who were referred between ACHA service outlets. The methodology was changed to recognize that such referrals between ACHA service outlets is an activity meriting recognition due to resources required in assessing clients at the referring outlet.

There were 3,797 primary clients and 507 secondary clients. The number of clients being actively assisted at 30 June 2012 was 1,037 and a similar number of clients would be receiving assistance at any particular time. It is important to note that not all housing clients counted as being assisted can be assumed to have moved to secure accommodation (see discussion under Housing referrals section). Some of these clients may return at a later date while other clients who have previously been assisted may also return. There were 1,038 such clients in 2011/12.

There were 230 clients who did not require any housing assistance. Although the ACHA Program is specifically targeted to assist clients with insecure housing, many service outlets are co-located with other parts of their organisation which deal with older clients with high service needs. It is therefore unusual but not unknown for ACHA services to receive walk-ins or referrals for service-only assistance.

Remoteness

The great majority of ACHA clients assisted were from service outlets in major cities (Table 3).

Services in the ACT and South Australia assisted clients solely from major cities while in Victoria 98 percent of clients came from major cities and 93 percent in New South Wales. Northern Territory ACHA service outlets assisted the highest proportion of clients from outer regional, remote and very remote areas while Western Australian service outlets assisted 29 percent of clients from remote areas. Queensland assisted 29 percent of its clients from outer regional areas.
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Table 3 ACHA Clients by Remoteness Category* 1 July 2011 - 30 June 2012

State/Territory	Major Cities	Inner Regional	Outer Regional	Remote	Very Remote
NSW	1,136		83
VIC & TAS	1,827	53	19
QLD	180		75
SA	339
WA	151			63
ACT	207
NT			70	23	13
Total	3,840	53	247	86	13

Note:

Remoteness categories used are as defined in the Australian Standard Geographic Classification

Client profiles

Population diversity

The ACHA Program assists a significant number of Aboriginal and Torres Strait Islander, and, Culturally and Linguistically Diverse (CALD) people. There were 202 Aboriginal and Torres Strait Islander clients and 1,213 clients from other CALD backgrounds (Table 4). In 2011/12, these groups represented 5 and 29 percent of all ACHA clients respectively compared with 2.5 percent¹ and about 20 percent² of the population nationally.

Both Northern Territory (39 percent) and Queensland (25 percent) have relatively high numbers of Aboriginal and Torres Strait Islander clients through this program (Table 4) which exceed the relative proportions of that group in those populations (32 percent and 4 percent respectively^{2 & 3}). Victoria (40 percent) and the ACT (28 percent) serve a high proportion of CALD clients. For some Aboriginal and Torres Strait Islander clients in remote areas, ACHA support can be semi-permanent.

Age distribution

The average age of an ACHA client is about 70 years. The largest group of clients is the 60 - 69 years category representing 33 percent of ACHA clients (Figure 1) closely followed by those from 70 – 79 years (32 percent). Only 6 percent of clients were below 50 years of age. Clients younger than 50 years include spouses, dependants and carers of older clients who are the target group, as well as Aboriginal and Torres Strait Islander clients who are eligible for aged care services at a younger age.

Table 4 ACHA Clients by Population Diversity 1 July 2011 - 30 June 2012

State/Territory	Aboriginal & Torres Strait Islanders	Culturally and Linguistically Diverse
NSW	26	252
VIC & TAS	21	751
QLD	65	14
SA	23	92
WA	28	17
ACT	0	77
NT	41	10
TOTAL	202	1,213

Note:

Client numbers less than 10 are not reported.
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Figure 1 Client Age Distribution 1 July 2011 - 30 June 2012

Gender distribution

There were slightly more male than female clients however the difference was less than one percent of clients. There were variations between states and territories with NSW clients having a higher proportion of male clients (56 percent) while Victoria had a higher proportion of female clients (53 percent) (Figure 2). Other states had similar variations but are less significant statistically due to their smaller client numbers. Service activity reports also indicate that gender ratios vary between services but why this occurs is not known. The inclusion of all householders requiring assistance (secondary clients), prevents analysis in greater depth since applicants for ACHA services are not distinguished from their dependents.

Figure 2 Client Gender 1 July 2011 - 30 June 2012

Client sources

The main source of clients were non-government welfare organisations (734 – 19 percent) closely followed by self-referrals (699 – 18 percent) (Figure 3). Referrals from public housing authorities and various state and local government agencies also comprised a significant proportion of sources (576 – 15 percent) as well as medical or health related sources (520 – 13 percent). The remaining referral sources together accounted for around a third of all referrals.

Housing referrals

ACHA made 3,018 referrals to housing suppliers in 2011/12. Many, though not all clients, were referred to more than one housing supplier. Most referrals were to public housing (1,038 – 34 percent), with the next highest category identified being private rentals (360 – 12 percent) (Figure 4). There were 202 referrals to crisis and transitional accommodation. ACHA coordinators frequently reported clients’ needs for more emergency and crisis accommodation and that more referrals would be made to this category if it were available. The large number of referrals to other ACHAs, is largely reflective of a single provider which carries out client assessments and service referrals but uses a separately funded arm of its organisation for housing referrals.

The number of ACHA clients successfully housed in 2011/12 is estimated to be 2,003. Some client outcomes were not able to be counted as they lost contact during the support period or changed circumstances after a period and their existing housing arrangements become secure. Fourteen percent of clients required assistance for up to four weeks, while 41 percent required assistance for more than six months (Figure 5). The average ACHA client receives housing support for about 23 weeks.
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Figure 3 Sources of ACHA Clients 1 July 2011 - 30 June 2012

Figure 4 Client Referrals to Housing by Type 1 July 2011 - 30 June 2012

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Figure 5 Duration of Clients’ Assistance 1 July 2011 - 30 June 2012

Care referrals

ACHA services demonstrated the program’s role as a care linkage program through the number of client referrals to non-housing services (4,071 referrals for 2,365 clients). Insecure housing is often associated with physical illness, frailty and mental disability. The largest group of referrals were to general medical and allied health services (1,093 – 27 percent) followed by non-government charitable support (844 – 21 percent) and government community care programs (644 – 16 percent) (Figure 6). A separate health category of alcohol, drug and mental health referrals (210 – 5 percent) shows the inter-relationship to homelessness of mental health social issues. Similarly, there were a relatively small but significant number of referrals relating to protective representational services (209 – 5 percent. This group of referrals includes guardianship, police, legal and ombudsman services demonstrating the social vulnerability of ACHA clients.

The average length of assistance required to link clients with appropriate care services was about 20 weeks which is slightly shorter than that required for housing assistance. A higher proportion of clients were linked with services in less than four weeks (23 percent compared with 14 percent for housing) while the proportion requiring more than 26 weeks assistance in being linked with services was 35 percent (Figure 6).

Other assistance

Although the ACHA Program does not fund them for this purpose, many ACHA service outlets provide incidental services to clients through their organisations’ funds, or direct physical assistance such as help in packing and moving belongings. The major form this assistance takes is the provision of transport in relation to appointments and viewing prospective accommodation (1,609 instances) (Figure 7). ACHA workers also helped directly through physical assistance (mainly cleaning and helping with removals – 1,192 instances and also purchased goods (899 instances) and services (448 instances).
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Figure 6 ACHA Client Linkage Referrals to Welfare & Care Services 1 July 2011 - 30 June 2012

Figure 7 Incidental Services Provided to ACHA Clients 1 July 2011 - 30 June 2012

Cost effectiveness

The average value of ACHA services provided per client is $1,094 (GST exclusive). This is based on allocated expenditure of the program in 2011/12 and the number of clients reported during the period, whether housed, exited without housing, or, remaining under assistance. The smallest ACHA service assisted 13 clients while the largest assisted 688 clients. The highest average cost of ACHA services by an ACHA centre was $5,746 per client and the lowest was $267 per client (Figure 8).
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Figure 8 ACHA Clients and Cost of Services per Client (GST Incl) 1 July 2011 - 30 June 2012

The highest two values come from two inner regionally located service outlets with few clients (33 and 20). Trend analysis shows that generally the cost of providing services to ACHA clients falls as the number of clients increases ( Figure 8) but this trend is not entirely uniform due to the attributes of local clients, regional factors and co-location with other social programs which allow the sharing of resources. For example the average cost per client of services in outer regional, remote and very remote locations is $1,757 but the average cost per client of services in major cities and inner regional locations, for equivalent sized ACHA service outlets, is $1,430.

Influences on ACHA Program activities

The 2011/12 program activity report shows that the ACHA Program continues to deliver a high value service for a small investment. There are however, a number of factors which affect the effectiveness and efficiency of the program, and, its capacity to achieve objectives.

As with 2010/11, the largest factor identified over 2011/12 relates to housing supply (Figure 9). There remains a tight rental market in most states and territories with correspondingly high rents, waiting times for public housing remain long while the number of older people in the client age group continues to grow. Similarly the next highest influence on service delivery again relates to client attributes. Older clients are typically financially less dependent, less mobile, and less connected to tools of communication necessary to view accommodation, obtain and complete forms etc. Insufficient finances and poor health restrict the ability to access and maintain housing which correlates with high rents in restricting housing options. Other client issues that make it challenging for ACHA workers to assist clients include communication barriers due to language, difficulty contacting clients due to their lifestyle, as well as the reluctance of most clients to move from localities close to social networks and facilities.
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Figure 9 Influences on ACHA Activities 1 July 2011 - 30 June 2012

Systematic issues and resourcing were both cited less frequently than in the previous year reflecting that improved systematic efficiency or funding are less important than overall supply and financial affordability.

Notes:

• Supply includes factors relating to accommodation shortages such as unavailability of housing and rentals and high competition from other accommodation seekers.
• Client related factors include physical and mental disability, difficulties communicating with or contacting clients, financial and other social issues.
• ACHA resourcing includes insufficient funding to service demand including the need to transport clients, assist with packing and other arrangements normally undertaken by younger healthier accommodation seekers.
• Remoteness includes isolated small communities as well as remoteness from services in outer urban locations.
• Systematic problems such as excessive paperwork, lengthy delays or difficulties in communicating with various government agencies (Commonwealth, state or Local), that deal with housing or housing assistance.
• Community includes lack of public awareness of ACHA Program or, community opposition to some types of ACHA clients or public housing.

Case-study

ACHA clients come from a variety of circumstances. Some find themselves in financial difficulties following the bereavement of a spouse or other partner in co-habitation or lose their independence through illness. In most cases clients will be faced with changed circumstances where longstanding and affordable housing arrangements are lost or increasing frailty puts them at risk from previously manageable circumstances. Many older people living in boarding houses and caravan parks, live a fearful existence sharing space with drug and alcohol dependant younger people who may be prone to anti-social, even violent behaviour. The case-study following represents one such scenario. Names are changed for privacy reasons.

Life in a Boarding House

Phil is an older gentleman who lived in a boarding house where his only private space was an unlockable bedroom. He was a victim of domestic violence by a relative with an untreated mental health condition. He was exposed to harassment and intimidation from other tenants who sometimes knocked on his door asking for cigarettes or “loans”. He reported feeling increasingly socially isolated as he did not want his friends and family to visit him while he was living in this circumstance.

Phil’s fears for his safety meant that he avoided the shared kitchen, which impacted on his physical wellbeing and health. His arthritis got worse and he lost weight. Phil’s asthma symptoms worsened due to the many smokers at the boarding house requiring increased medication.

He was referred to the ACHA program to look at some ongoing, sustainable housing. An ACHA Coordinator visited Phil in the boarding house and worked on a plan of action for Phil to find better accommodation. Phil had previously applied to the State Housing Commission but was given only a Category 3 rating.

The ACHA Coordinator made referrals on Phil’s behalf to a number of housing associations. ACHA referrals to financial counsellors assisted Phil to prepare budgets. The ACHA Coordinator helped Phil to obtain a letter from his doctor supporting his accommodation bid. During this time the ACHA Coordinator discovered and rectified a miscommunication with the Housing Commission whereby inaccurate living circumstances were listed in their system. After four months Phil was offered secure accommodation which suited his needs perfectly at this stage of his life.

Phil had been sleeping on a camp bed at the boarding house and now needed essential household items. Phil enjoyed spending an afternoon out with the ACHA coordinator choosing a fridge and a bed for his new home, improving his comfort and ability to remain living independently.

Phil’s new accommodation has a courtyard in which he is growing a small vegetable garden to prepare healthy meals. He now safely invites friends and family to visit him making him feel connected again. His new home is close to public transport and local shops so he can maintain and increase his independence, community networks and social inclusion.

Through follow-up visits by the ACHA Coordinator, Phil’s physical wellbeing has improved with better food, no sleep disturbances from noisy tenants and Phil is feeling safe and secure. Through the case management, advocacy, planning and support of the ACHA program, Phil has improved his general wellbeing and changed his life for the better giving him a renewed sense of optimism and direction.

1. 4705.0 - Population Distribution, Aboriginal and Torres Strait Islander Australians, 2006.
2. In 2006, 15.8 percent of Australians had been born overseas and 15.8 percent spoke a language other than English at home. Australian Bureau of Statistics, (2006). Country of birth of person by sex, count of persons, based on location on Census Night (Vol. 2068.0 – 2006): Canberra.
3. 4705.0 - Population Distribution, Aboriginal and Torres Strait Islander Australians, 2006.

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