The royal commission into aged care continued in Broome on Monday, with a focus on the needs and concerns of Aboriginal and Torres Strait Islander people.

Professor Leon Flicker, a professor of geriatic medicine at the University of Western Australia, told the commission Indigenous Australians often have to leave their country when they move into residential aged care, but they would prefer to stay closer to home because of their “innate” connection to the land.

When asked what constitutes culturally sensitive aged care, Prof Flicker said, “Firstly, it has to be… nearby.”

“If somebody doesn’t have a nearby service it means that they’re going to move from their family and friends, which happens for non-Aboriginal people as well, but the… thing that complicates the matter for Aboriginal and Torres Strait Islander people is they are moving from country.”

A connection to country can heal

Prof Flicker said, “A lot of Aboriginal and Torres Strait Islander people have an innate attachment to the land that they’re living in, and this is more than you would expect in a non-Aboriginal and Torres Strait Islander situation.

“So because of that, moving off country is a big deal for them,” he said.

The royal commissioners asked Yvonne Grosser, an enrolled nurse and member of the Noongar community, said how important it is that residents feel connected to their culture and country.

Ms Grosser replied that being back in country is part of their “healing”.

“What you see… at any nursing home of aged care, people are quite sad people. You could see that their heart is sad, and if they had it in country, they would be happy,” she said.

Ms Grosser said ways that country and culture can be brought into aged care include being able to eat traditional food “at least a couple of nights a week”.

Traditional “meals… would probably make them a lot happier, too, instead of eating westernised food 24/7, whereas cultural, gives them a bit of a feel of… being back in country,” she said.

Ms Grosser said going to see their people dancing or going to a “gathering” were also ways to help aged care residents feel more connected to their country.

She said she could only recall one time residents had been able to return to country.

“That was quite difficult,” she explained, and involved plane flights and doctors making sure residents were okay to get on the plane and connecting flights.

“It was a long journey for them just to get home… whereas I think if they had more nursing homes in those area zones, it would actually be a lot more sensible and more ideal for them.”

Food regulations make sourcing local food difficult

Tamra Bridges, the general manager of Pinangba, a Queensland aged care facility with 90 per cent Aboriginal and Torres Strait Islander residents, told the royal commission that the residents’ traditional diet was based on fish and ocean animals, but food regulations make if difficult to source local produce.

The residence, named Star of the Sea, is located on the sea shore. When it was built, Ms Bridges said its connection to the environment was the “number one thing”.

She said offering a fish-based diet has been “a challenge” but the home does its best to ensure access, and making sure traditional dance and songs are performed, for example when someone passes away or if a building is opened.

“There’s a lot of regulation around food safety and then also regulations in the aged care environment which prevent us from catching and preparing local fish in our kitchens,” she said.

There are three levels of regulatory compliance around food preparation, Ms Bridges said – local council, state, and aged care regulatory compliance.

“So we have to do work-arounds to ensure that fish is an affordable and regular item on our menu,” she said.

“We have to buy imported frozen fish… and have it delivered to Thursday Island, or we do work-arounds with family and we’re relying on the goodwill of family when we do that which is not really fair on them because it’s at a cost that they’re going hunting and providing these… fish, so they need to prepare it at home or in their kitchens and then bring it into the service to share with elders.”

Prof Flicker said it was “churlish” of regulators to interfere with Aboriginal people’s choice to eat traditional foods.

“Aboriginal people in remote communities often eat some traditional foods… The goanna that they hunt isn’t necessarily going to be certified as safe for human consumption but again, that’s such a traditional part of life of some of these small communities,” he said.

The majority of Star of the Sea staff are related to the elders they’re caring for, she said. “They see this as quite an honour and privilege to be able to provide that care for the elders.”

Home care waiting times “a matter of concern”

Paul Bolster, counsel assisting the royal commission, said waiting times for the delivery of remote home care packages are a “matter of concern”, and largely mirror the position in the rest of Australia.

In remote and very remote Australia there were 1,480 approvals for home care packages in 2018.

“Of those living in remote or very remote regions who were assigned their first package, regardless of level, in that period, only 38.8 per cent, that is 608 people, received that assignment within nine months,” Mr Bolster said.

“For most people, the time between approval and assignment exceeds nine months. There were significant numbers who had not been assigned a provider after 18 months.”

Costs in remote nursing homes almost double city rates

Craig Barke, CEO of not-for-profit provider UnitingCare Queensland, said the services he runs operate “at the edge of viability”.

“Our experience is that as you get more remote, the costs to provide services increase.”

Using the operating cost per resident per day as a measure of costs, Mr Barke said the rate in Brisbane is approximately $200 per resident per day. In Darwin, he said the rate is about $220, and in Docker River, that number is approximately $380.

“So the costs escalate as the remoteness increases and that’s what you would expect,” he said.

“Our experience is that fundamentally remote aged care is very, very difficult to be viable and you have to constantly be fine-tuning the operation of those sites and trying to squeeze every last dollar to make these sites work,” he said.

“While we would love to be able to pay our staff more, the funding model is simply not sustainable above the current level,” he said.

Improved access to respite care would make “a big difference”

Madeleine Jadai, an Aboriginal Mangala woman, told the royal commission about caring for her sister Betty, who is living with dementia, since their mother died.

“My sister, Betty Barney, gets aged care services, Betty is about 62. I care for Betty. I have been her carer for the last seven to eight years.

“After my Mum passed away, Betty got distressed. Her spirit went really down. I think losing Mum was really hurtful for her. Before Mum died, Betty was able to look after herself. I look after Betty now for her safety and wellbeing.

Ms Jadai said she knew little about dementia before her sister was diagnosed, and most people in her community still don’t understand the condition.

“At one point she [Betty] was suffering… and she would wander off. People in Bidyadanga do not understand dementia very well and would try to help her in some ways. Sometimes Betty would get really angry with them.

“Sometimes Betty gets angry with me, my friends and my family members.

“Now that Betty is older she is a bit calmer.”

“We are lucky in Bidyadanga to have access to doctors through the clinic. I am able to see a doctor when I need to, but I know that they have to fly in from Broome.”

Ms Jadai said her caring responsibilities take up all her time. As well as looking after her sister, Ms Jadai looks after her nieces and nephews and her own children and grandchildren.

“I love my family and I’m really proud of myself looking after them,” she said, but she conceded that looking after so many people “means I’m really tired all the time”.

“I would like my sister to be able to get better access to respite care,” Ms Jadai said.

“Sometimes I have asked whether or not Betty can get respite care in Broome, but I’m told that it is full.

“One time I had to go for a funeral out in the desert and I had to take Betty with me because I could not get her into respite care and I couldn’t leave her with other family. We drove over 1000 ks to the funeral. Betty got sick and needed antibiotics.

“Having more access to respite care would make a difference – a big difference – to me.”

Ms Jadai said she wanted people to understand what it’s like being a carer in remote communities.

“I really wanted to tell my story because we live out in the remote and people don’t know what we go through.

“Being out in a remote community we have to deal with our five language groups, family groups and to still have that connection around country. We have two cultural traditional owners along the coast and my family come from the desert so there’s three from the east.

“So we have to work together to live in harmony and to make what Bidyadanga that we really want it, to make it a better place for us and our children.”

Image: Madeleine Jadai speaking at the royal commission. (Image: Aged Care Royal Commission.)

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