Better health and ageing for all Australians

Interim Evaluation of the Northern Territory Aboriginal and Torres Strait Islander Community Aged Care Workforce Development Projects - Attachments

2. The Northern Territory Community Care Programs and Workforce

Up to Publications

prev page| TOC |next page

2.1 Introduction

The NT community care workforce delivers services through the Home and Community Care program, and Commonwealth funded packaged care programs CACP: Community Aged Care Packages; EACH: Extended Care at Home and EACHD: Extended Care at Home Dementia; NRCP: National Respite for Carers Program and Aboriginal and Torres Strait Islander Flexible Aged Care services (providing both residential and community care services).

Aboriginal and Torres Strait Islander clients are eligible for these funded services if they have a permanent functional disability and are over 50 years of age or a younger person with a disability (for HACC services) or have been assessed as being eligible for Commonwealth funded aged care packages by an ACAT assessor. NRCP services can be accessed by carers of individuals who require respite services to assist them in providing caring services to eligible individuals.

The focus of the NT Aboriginal and Torres Strait Islander Workforce Development Projects is on the communities and services delivering care and support through HACC, CACP and Flexible Aged Care services; however, at two of the case study services also provide National Respite Carers Program (NRCP) services so these will be able to also be explored through the evaluation.

In addition, training is offered to other Aboriginal and Torres Strait Islander community members working in other sectors such as child care, if they wish to participate or it is identified that the training will assist in their skill development relative to their occupation.

2.2 The Home and Community Care Program

The Home and Community Care (HACC) program in Australia provides basic care and support to aged and disabled clients and their carers in the community. The HACC program is a joint Australian, State and Territory Government Initiative managed under the Home and Community Care Act 1985.

The aims of the HACC program are to10:
  • Provide a comprehensive, coordinated range of basic support services to enable older Australians and those with a disability to live independently
  • To support people to be more independent at home and in the community, to enhance their quality of life and/or prevent their inappropriate admission to long term residential care.
The HACC program provides a number of services including11:
  • Domestic assistance
  • Personal care
  • Nursing care
  • Allied health care
  • Respite care
  • Social support
  • Transport
  • Meals and other food services
  • Home modification and maintenance
  • Goods and equipment
  • Assessment
  • Case management
  • Client care coordination
  • Counselling, support, information and advocacy.
The HACC workforce mapping12 project identified that domestic assistance, meals at home and centre based day care are the most commonly delivered HACC services.

The Australian Government provides around 60 per cent of the funding for HACC services. State and Territory governments provide the remaining 40%. The national budget for HACC services in 2008-2009 is $1.788 billion, an increase of more than 8% from the 2007-2008 budget13.

The state and territory governments are the primary contact for HACC service providers and consumers. They are responsible for program management, including approval and funding of individual HACC services in their jurisdictions14.

As at 30 June 2008, there were approximately 3 300 active HACC funded organisations delivering services to approximately 831 500 people15. Of those people recording Indigenous status (89%), 2.6% of people receiving HACC services were Aboriginal or Torres Strait Islander.

The Australian Government conducted a national aged care workforce survey to provide a comprehensive profile of who currently provides direct care to people in residential and community care settings, their skills, types of employment, career paths and levels of job satisfaction.

The results of this survey are presented in the report Who Cares for Older Australians? A picture of the residential and community based aged care workforce 200716.

Limited information was collated on the Aboriginal and Torres Strait Islander community care workforce; of the 50 community care services interviewed, 86% did not have Aboriginal and Torres Strait Islander staff and 14% had one or more Aboriginal and Torres Strait Islander staff.

The study revealed that there are benefits to employing culturally and linguistically diverse and/or Aboriginal and Torres Strait Islander workers. The main benefits cited by managers employing these workers were:
  • Cultural understanding and activities (67.7%)
  • Language (58.1%)
  • Good work ethic (14%)
  • Linking clients to ethnic communities (10.8%) and
  • Linking organisation to ethnic communities (6.5%)17.
Specifically, 17 of the 63 managers who identified the benefit of cultural understanding and activities were from Aboriginal and Torres Strait Islander based organisation highlighting the importance of having workers with an understanding of the culture of clients. The evaluation will explore the employment of the Aboriginal and Torres Strait Islander workers to further identify the benefits and challenges of supporting and developing this workforce.

In 2004 the Australian Government released The Way Forward - A New Strategy for Community Care which outlined how the Australian Government, in partnership with state and territory governments, aimed to improve and strengthen the community care system in Australia. The strategy has defined actions in the following five broad areas:
  • Addressing gaps and overlaps in service delivery
  • Easier access to services
  • Enhanced service management
  • Streamlining of Australian Government programs, and
  • A partnership approach.
Since August 2004 a phased approach has been used to review, conduct consultations and develop strategies to realise improved community care initiatives. In 2007 a revised HACC agreement was negotiated and signed by the Australian Government and all state and territory governments. This agreement commits the states and territories to progressively, over three years, develop implementation plans for the common arrangements being developed under The Way Forward.

In June 2009, the final report of the National Health and Hospitals Reform Commission titled: A healthier future for all Australians was released which identifies actions that can be taken by governments to reform the Australian health system. In relation to the provision of community care, the report outlines the following18:
  • The recommendations for aged care services aim to ensure greater choice, ensure the most effective use of public monies and create a robust and sustainable aged care sector.
  • Recommendations relating to community aged care include:
    • Aged care providers to ensure standardised information on service quality is made publicly available.
    • Consolidation of aged care under the Commonwealth government thereby making the HACC programs a direct Commonwealth program.
    • Development and implementation of streamlined, consistent assessment for eligibility for care across all aged care programs. This will include integrating assessment for HACC services with the more rigorous assessment for higher levels of community and residential care.
    • A more flexible range of care subsidies for people receiving community care packages, determined in a way that is compatible with care subsidies for residential care.
    • People that can contribute to the costs of their own care should contribute the same for care in the community as they would for residential care.
    • People supported in the community should be given choices on how the resources allocated to their care and support are used.
    • The Commonwealth government should assume all responsibility for the policy and public funding of all primary health care services, including community health.
    • The Commonwealth Government should assume all responsibility for public funding of aged care, including HACC programs for older people and aged care assessment.
These recommendations have wide ranging implications for the provision of community care into the future and suggest that the structure and funding of community care be changed to promote more flexible service provision.

Though there is no evidence until these recommendations have been implemented it is envisaged that this approach would be favourable to the provision of community care services in NT communities by being able to target services to individual needs and reducing the administration burden for service providers. In addition, it is envisaged that the implementation of the consolidation of community aged care programs will strengthen the development of the workforce to accommodate the needs of older Australians as they age.

The workforce development aspect is particularly pertinent in the Northern Territory where much of the community care provision is delivered in remote locations, requiring the development of the local workforce (who have the appropriate local and cultural knowledge) to deliver care to older people in their community.

The Council of Australian Governments (COAG) in December 2009 agreed that the national health reform will be a central priority for 201019.

In March 2010 COAG released the National Health and Hospitals Agreement20 that outlines the agreement to improve health outcomes for all Australians and the sustainability of the Australian health system. The Agreement sets out the architecture and foundations of the National Health and Hospitals Network, which will deliver major structural reforms to establish the foundations of Australia’s future health system. The Agreement is yet to be accepted by all parties and implemented.
Top of page

2.3 Packaged Care Programs

Packaged care programs are funded by the Commonwealth Government through the Department of Health and Ageing and are administered by state and territory offices. Packaged care encapsulates: CACP - Community Care Aged Care Packages; EACH - Extended Care at Home; EACH D - Extended Care at Home Dementia; and NRCP - National Respite for Carers Program. Since 1992 the Australian Government has provided community care services for clients with complex care needs in the form of CACPs21.

CACPs aim to provide personal assistance with any of the following:
  • bathing, showering, or personal hygiene
  • toileting
  • dressing or undressing
  • mobility
  • transfer
  • preparing and eating meals
  • assistance with nutritional needs
  • sensory communication, or fitting sensory communication aids
  • laundry
  • home help
  • gardening and
  • short-term illness.
In conjunction with these services, a CACP may also include:
  • assistance with a special diet
  • control and administration of medication prescribed by a medical practitioner, subject to legal restrictions on providing the medication
  • rehabilitative support, or helping to access rehabilitative support, to meet a professionally determined therapeutic need
  • administration of treatment such as eye drops, back rubs, dressings and urine tests, subject to legal restrictions on providing the treatment
  • emotional support and direct supervision
  • having at least one responsible person or agency, approved by the organisation providing the CACP, reasonably near and continuously on call to give emergency assistance when needed
  • transport to help the person shop, visit a medical practitioner or attend social activities
  • temporary respite care
  • home maintenance, including modification, reasonably required to maintain the home and garden in a condition of functional safety and provide an adequate level of security
  • arranging social activities, providing or coordinating transport to social functions at a reasonable frequency and other out-of-home services that help prevent social isolation
  • advocacy services to help protect the person’s interests
  • support services to maintain personal affairs and
  • other services required to maintain the person at home.
In the NT, and especially in remote communities, the majority of packaged care services provided are CACPs (in addition to HACC services). The majority of services provided under these programs are the provision of meals, personal care and transport.

2.4 Aboriginal and Torres Strait Islander Flexible Aged Care Services

The Australian Government funds approximately 750 places in 29 Aboriginal and Torres Strait Islander Flexible Aged Care services nationally. The aim of the services is to provide culturally appropriate aged care to Aboriginal and Torres Strait Islander people; in the main these services are located in rural and remote areas. Allocated places include the provision of residential and community care services.

In the Northern Territory there are 11 Flexible Aged Care services providing care to Aboriginal and Torres Strait Islander people. The Australian Government has made commitments to further the provision of Flexible Aged Care places through the $46 million Indigenous Aged Care Plan23 that includes:
  • In-principle approval to create eight flexible care beds in Mutitjulu and staff accommodation
  • The provision of staff accommodation at Docker River to promote staff retention and
  • In-principle approval to create a 10 place flexible residential aged care service in East Arnhem.

2.5 The Aboriginal and Torres Strait Islander HACC Workforce

Gevers Goddard Jones (GGJ) conducted an investigation into the size and nature of the Aboriginal and Torres Strait Islander HACC workforce in Australia as part of the National Aboriginal and Torres Strait Islander Home and Community Care (HACC) Workforce Mapping Project24.

GGJ conducted a survey of 166 service providers and identified the following25:
  • There are approximately 295 Aboriginal and Torres Strait Islander focused HACC services throughout Australia
  • The workforce in Aboriginal and Torres Strait Islander focused HACC services comprises approximately 1,900 paid staff
  • 74% of the workforce in Aboriginal and Torres Strait Islander focused HACC services (approximately 1,390 staff) is Aboriginal and/or Torres Strait Islander.
Of the Aboriginal and Torres Strait Islander staff working in Aboriginal and Torres Strait Islander focused HACC services:
  • The majority of staff (77%) work in direct care
  • 81% of staff are women
  • The majority of staff (63%) are aged 35 or more. Only 10% of staff are aged 16 to 24 years
  • Most staff (53%) have worked in the HACC service less than two years
  • 9% of staff have completed Year 12 of high school or a university degree
  • 18% of staff have completed a Certificate III in Aged Care
  • 72% work part-time with most of these working between 16 to 34 hours per week
  • Most staff (81%) earn less than $20.00 per hour with most direct care workers earning around $15.00 per hour
  • 37% of staff are participants in the Community Development Employment Projects (CDEP) Program
  • 43% of the services in the sample employed CDEP participants
  • 67% of CDEP participants are located in remote areas
  • 63% of HACC services with CDEP staff are located in remote areas
  • 87% of CDEP participants work in direct care work
  • There are few volunteers (90) working in Aboriginal and Torres Strait Islander focused HACC services
  • Aboriginal and Torres Strait Islander people comprise approximately 1.3% of the mainstream HACC service workforce
  • Aboriginal and Torres Strait Islander people comprise 11% of the HACC service workforce in remote areas.
There is very little accurate data about the Aboriginal and Torres Strait Islander workforce contributing to the care of frail aged and disabled people in the community. However, it is identified that engaging Indigenous people in the care of their own frail and disabled people is paramount to the overall improvement in health outcomes. The report Health and Community Services Labour Force26 notes that the health and life expectancy of Australia’s Aboriginal and Torres Strait Islander peoples can be improved by health care provided to Indigenous people, by Indigenous people.

It is acknowledged that utilising this Aboriginal and Torres Strait Islander workforce within health and community care services requires planning, training and support for the workers and special consideration to other impacting issues. These were referred to by Hogan in the review of residential aged care27 and included the provision of male and female staff to provide gender specific services and maintaining staff in their role through the provision of training, transport and additional staff to relieve staff from their roles when cultural demands took them away from the workplace.

The evaluation specifically focuses on consultation with Aboriginal and Torres Strait Islander workers and their view of their work, training requirements and feedback regarding the changes to CDEP arrangements. It is hoped that the collection of this information will further inform the most appropriate mechanisms to support these workers into the future.

2.6 Aboriginal Health Workers

The development of specific training programs for Aboriginal and Torres Strait Islander Health Workers has enhanced the delivery of primary health care to Aboriginal and Torres Strait Islander people. The model supporting the training and development of Aboriginal and Torres Strait Islander Health Workers focussed on providing relevant training to prepare the workers to contribute to the provision of primary health care services to Aboriginal and Torres Strait Islander people. Likewise, the certificate based training programs provided through the training projects are contributing to the training and development of the community care aged care workforce.

To date, the Aboriginal and Torres Strait Islander health worker role has not usually included roles within HACC or other community based aged care programs such as Community Aged Care Packages. This is likely to be because the training currently provided to these workers, although variable throughout Australia is focused on primary health care in the clinic based setting and not on community based aged care.

There have been significant steps to ensure the development of National Competency Standards for Aboriginal Health Workers and Torres Strait Islander Health Workers to further develop these important workforces; however, these workers do not routinely contribute to HACC service provision. These workers generally work within the context of primary health care and their services are aimed at providing acute and preventative health services and providing an important link between Aboriginal and Torres Strait Islander clients and non-Indigenous health professionals, from both a language and cultural perspective.

In February 2010, the Minister for Indigenous Health, Rural and Regional Health and Regional Services Delivery revealed that the government was funding 83 Indigenous Outreach Workers, with eight positions in the NT. A total of 160 places will be funded over four years to build the capacity of the Indigenous health workforce. The Aboriginal and Torres Strait Islander Outreach Workers will help increase community engagement with health services, including increasing the uptake of Indigenous health checks and identifying Indigenous people who would benefit from improved access to health services.

In addition, they will assist Indigenous people to access other health services, including follow-up care, specialist services and community pharmacies. It is hoped that these workers will be able to provide some support to aged care providers and provide a link between health services and aged care services to promote the health and wellbeing of the aged.

It is hoped that the Workforce Development Projects will, as has been achieved through the development and training of Aboriginal Health Workers in the primary health care sector, assist in developing a community aged care workforce to provide high quality care to older and disabled Indigenous people.

The Aboriginal and Torres Strait Islander Health Workforce National Strategic Framework29 endorsed by the Australian Ministers Advisory Committee (AHMAC) builds on the collaboration between state and territory governments to reform the Aboriginal and Torres Strait Islander Health Workforce to ensure a competent health workforce with the capacity to meet the needs of Aboriginal and Torres Strait Islander peoples.

The role of Aboriginal Health Workers in objective three of the strategic framework30 cites the need for specific skills regarding mental health, sexual health, environmental health and oral health. Aged care is not cited. Much of the research regarding the aged care workforce has focused on primary health initiatives (and the associated workforce made up of health professionals and Aboriginal/Torres Strait Islander Health workers) and residential care workers31.

2.7 Developing the Community Aged Care Workforce

Strategies for developing the community aged care workforce have and are being implemented with the overall aim of improving the health and wellbeing of the Indigenous aged care population and ensuring a sustainable workforce to provide community care to this vulnerable group in rural and remote areas into the future.

The workforce Projects being evaluated as part of this project aim to identify if the capacity and sustainability of the Indigenous aged care workforce has been enhanced, whether the quality of aged care services has improved, whether there has been a positive impact on the NT aged care workforce as a result of the projects and to evaluate whether the training capacity in the NT has improved.
Top of page

10. Australian Government Department of Health and Ageing 2008 Ageing and Aged Care in Australia Canberra
11. Government of Australia 2007 Home and Community Care Program Fact Sheet http://www.dadhc.nsw.gov.au/NR/rdonlyres/39C1876A-27F6-4C70-ABAD-CAD56D4F64E1/2737/HACCfactsheet.pdf
12. Gevers Goddard Jones 2007 Mapping of the National Aboriginal and Torres Strait Islander Home and Community Care (HACC) Workforce Department of Health and Ageing Canberra
13. Government of Australia Department of Health and Ageing 2009 Home and Community Care Program Overview http://www.health.gov.au/internet/main/publishing.nsf/Content/hacc-index.htm
14. Ibid
15. Government of Australia Department of Health and Ageing 2008 Home and Community Care Minimum Data Set Annual Bulletin 2007-2008 http://www.health.gov.au/internet/main/publishing.nsf/Content/01C290085087BFBCCA2575A90017C06A/$File/ExcSummary.pdf
16. Martin B and D King 2007 Australian Government National Institute of Labour Studies Flinders University SA Who cares for older Australians? A picture of the residential and community based aged care workforce 2007 Canberra Department of Health and Ageing
17. Ibid
18. Commonwealth of Australia 2009 National Health and Hospitals Reform Commission A Healthier Future for all Australians: Final Report Canberra ACT
19. Australian Government http://www.coag.gov.au/coag_meeting_outcomes/2009-12-07/index.cfm?CFID=483590&CFTOKEN=53302232#hreform
20. Australian Government Council of Australian Governments 2010 Communique of the National Health and Hospitals Agreement Canberra ACT
21. Australian Government Department of Health and Ageing 2007 Draft Community Packaged Care Guidelines Canberra ACT
22. Ibid
23. http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr09-je-je03.htm?OpenDocument&yr=2009&mth=1
24. Gevers Goddard Jones 2007 Mapping of the National Aboriginal and Torres Strait Islander Home and Community Care (HACC) Workforce Department of Health and Ageing Canberra
25. Ibid
26. Australian Institute of Health and Welfare and the Australian Bureau of Statistics 2001 Health and Community Services Labour Force
27. Australian Government Department of Health and Ageing 2004 Pricing Review of Residential Aged Care WP Hogan Canberra
29. AHMAC 2002 Aboriginal and Torres Strait Islander Health Workforce National Strategic Framework Canberra
30. Australian Health Ministers' Advisory Council 2002 Aboriginal and Torres Strait Islander Health Workforce National Strategic Framework Canberra
31. Australian Government Department of Health and Ageing 2004 Pricing Review of Residential Aged Care WP Hogan Canberra

prev page| TOC |next page