The first three witnesses to the stand were heavily involved in remote care, with substantial involvement in remote Aboriginal communities.
Dr Martin Laverty, Chief Executive Officer (CEO) at Royal Flying Doctor Service (RFDS), used his evidence to explain that whilst RFDS is not an aged care provider, they seemed to be doing a lot of primary care work, filling the gap were Medicare was not operating.
"Primary care plays an essential role in keeping older Australians, and indeed all
Australians, well and healthy... My evidence to this commission is that in remote Australia, primary care is failing older Australians,” says Dr Laverty.
“We know that in many parts of remote Australia, there is insufficient access to geriatricians services… There are between 220 communities that we visit on a scheduled basis for fly-in fly-out health care provision, that are of that small nature where Medicare is not viable to operate in those towns.
“The RFDS service footprint is where Medicare, because of small populations, does not work… Aged care doesn’t yet reflect choice or control. A citizen, particularly in remote areas, would likely choose to stay in [their] community, on country or within their own home, for as long as possible. That choice is very often taken away because of the absence of adequate care services.
Previously, dentists with RDFS were only going to remote communities to provide dental care, but are now also visiting residential aged care facilities to their rotation due to the absence of oral care importance known by care staff.
RFDS dentists have been teaching aged care staff how to provide oral hygiene to residents. When the dentist returned to the site, they saw an obvious improvement in dental health.
Dr Laverty stated that preventative hospital admission in metro areas is 27 per thousand head of the population, but this amount triples in remote areas, such as the Kimberley in Western Australia.
He says primary care needs to be drastically improved to stop these high admission rates. If a person’s acuity is higher, it means they will require a higher level of care.
From 2014 to 2017, there were 23,377 air retrievals by the RDFS for patients over the age of 65.
Dr Laverty says this wouldn’t be the case if aged care or health services were better in remote communities.
To some extent Medicare is one of this nation’s greatest assets, but it does not serve the health interests of remote Australians, and because of the interdependence of primary care access with aged care, we are letting older Australians down by a failing primary care system in remote Australia," he says.my age
Dr Laverty wants the Royal Commission to recommend expectations for reasonable standards of primary care access in remote areas in their findings that best reflects the needs of people not living within metropolitan areas.
Graham Aitken, Aboriginal Community Care (ACC) South Australia CEO, followed by Ruth Crawford, Kimberley Aged and Community Services (KACS) manager, both expressed a desire for better functionality on My Aged Care, which is letting down their clients.
A big concern raised by Ms Crawford and Mr Aitken was around My Aged Care not being accessible in remote communities, where there is no phone reception or internet access, but is a necessity to receiving an assessment for aged care services.
Ms Crawford told the Commission it can sometimes take KACS up to 10 hours to get to remote communities in the Kimberley’s, only to find issues with accessing Government packages.
She says that even if people have been found to need high quality care and are given a Level 4 Home Care Package, they still have to wait years to receive anything.
“[My Aged Care] is a very difficult system to use. It relies on people having the telephone, internet, being at a fixed address and speaking English, and being cognitively intact and not being too frail to not have the energy to deal with the system,” says Ms Crawford.
“Eighty percent of the residents had no access at all to the internet... And three of our remote communities only got mobile phone access last year in July... There is still patches of areas of the Kimberley with no mobile phone access and therefore no internet.
Mr Aitken’s agreed that assessment is challenging for clients and logging into aged care services is difficult adding that many Elders are reluctant to leave their land for any treatment.
He says providing aged care services in remote areas rely on trust, reliability, respect, cultural understanding and consistency and having a majority Aboriginal workforce reassures Aboriginal Elders who do not or no longer trust the Government.
Mr Aitken also highlighted that there is still a lot of distrust and trauma amongst Elders from those affected by the Stolen Generation, which makes it difficult to provide care.