Jan Erven

Improving Access to Transitional Aged
Care for Aboriginal People in NSW:
The Shoalhaven Experience
Jan Erven. Manager Transitional Aged Care,
Illawarra Shoalhaven Local Health District,
NSW

Local Health Districts in NSW

Illawarra Shoalhaven Local Health District
Hospitals

Shoalhaven Area
• 4660km 2 (136km from end to end)
• 49 towns and villages including Nowra
• Population 97,000
• 14% of population aged 70 and over
(highest in ISLHD)
• 3.3% of population identify as Aboriginal
live in the Shoalhaven area (highest in
ISLHD)

Demographics of the Aboriginal
Population
• 466 Aboriginal people aged over 50 years
live in the Shoalhaven area.
• There are a number of separate Aboriginal
communities in the Shoalhaven area:
o The Jerringa Community at Orient Point
o The Dharwal community at Sanctuary Point
o The Wreck Bay community at Jervis Bay in
the ACT
o Small communities in Bomaderry and Nowra

Housing issues for Aboriginal people
living in the Shoalhaven
• Aboriginal Communities (missions)
• Holiday homes
• Relocatable homes
• Caravan parks
• Rural properties (some with poor access)
• Some high crime areas
• Difficulties with modifying housing for
elderly people

Transport Issues
•Public transport virtually non-existent
•Long distances and time to travel to
access services, shopping and
community facilities
•Ambulance takes 20-30 minutes to
get to some areas
•Many villages have only poor single
road access

Health issues for Aboriginal people
•Have to “go to town” for many
services including the Aboriginal
Medical Service
•Heavy reliance on neighbours for help
•Outpatient services in few locations
•Medical Specialist access very limited

Shoalhaven Transitional Aged Care
Service (STACS)
• The Shoalhaven Hospital at Nowra
commenced Transitional Aged Care Services
in October 2006 with 10 places and has
grown to 30 community places in September
2011.
• From 2006-2010 the utilisation of the service
by Aboriginal people was low, with only 4
people completing the program.
• A number of strategies were implemented but
these did not increase the referral rate.

Factors influencing low referral rates for
Aboriginal people
• There were 570 emergency department
attendances of Aboriginal people over 50 years
in the Shoalhaven in 09/10 but only 32 inpatient
separations for the same period
• If Aboriginal people were admitted, they had a
very short length of stay (less than 48 hours)
and missed having an ACAT assessment, and
therefore missed the opportunity for TACP
• Aboriginal people living in some of the Missions
did not have access to the program

Some of the perceived barriers for Aboriginal
referrals to TACP
• Loss or breakdown of families
• Social difficulties including alcoholism, substance abuse,
violence and family violence in the communities
• Mistrust of mainstream health services by Aboriginal
people
• Lack of education and support for the chronically ill in
some of the Aboriginal communities
• Lack of role models
• Lack of knowledge of the program by local GPs, both
Aboriginal and non Aboriginal

Developing a new TACP model for Aboriginal
People in the Shoalhaven
• Consulted with the Area Manager for Aboriginal
Services and the hospital Aboriginal Liaison Officers
(ALO’s) to identify issues on low uptake of the
program by Aboriginal people.
• Reviewed hospital admission and separation data to
gain evidence of lower than expected numbers of
Aboriginal people admitted to hospital.
• Reviewed the existing model to identify any
improvements to be made on the access to the
service
• Proposed a new model to access the service for
Aboriginal people in the 10/11 3 rd tranche funding

Proposed plan for the new model in the
Shoalhaven
• Employment of an Aboriginal Enrolled Nurse who would
be accepted by the communities and provide case
management of the clients and their carers
• Admit Aboriginal people into the Hospital in the Home
program as an inpatient admission, if appropriate and
eligible, from the Emergency Department. As well as
target all inpatient Aboriginal patients over 50 years as
possible referrals to the program
• Carry out joint ACAT assessments with the Aboriginal
Enrolled Nurse and the ACAT worker in the hospital and
in the community for the Hospital in the Home clients
• Evaluate the effectiveness of the program after 12
months

Implementation of the model
• The extra 2 places allocated to the Shoalhaven
service commenced on 1 November 2010
specifically targeting Aboriginal people
• Employment of an Aboriginal EEN, Shane Smith
• Negotiation with brokered service, to provide
personal care services and domestic assistance
in the Aboriginal communities
• National registration scheme allowed medical,
nursing and allied health staff to provide
services in the ACT (Wreck Bay).

The Current STACS Team
• 1.0 FTE Nurse Manager
• 1.9 FTE Physiotherapists
• 1.9 FTE Occupational Therapists
• 2.0 FTE Therapy Assistants
• 1.6FTE Social Workers
• 3.0 FTE Clinical Nurse Specialists
• 1.0 FTE Registered Nurse
• 1.0 Endorsed Enrolled Nurse
• 0.5 FTE Dietician

Strategies that have been
implemented by the Aboriginal EN
• Visits to the local communities and health
workers to explain the program
• Liaison with the Aboriginal Liaison Officer (ALO)
in the hospital to increase referrals
• Education to increase awareness amongst allied
health teams on the wards that the program is
targeting Aboriginal people
• Liaison with the Aboriginal Home Care services
to promote the program being available to
Aboriginal people

Aboriginal Service Providers assisting with
access for Aboriginal clients to the program
• Wreck Bay community clinic
• Jerringa community clinic
• Nowra Aboriginal Medical Centre
• Weja Aboriginal Home Care Service
• Illaroo Cooperative Aboriginal Corporation
• Aunty Jean’s Chronically Ill Exercise
Workshop
• Bush Telegraph

Results for clients so far
• 12 Aboriginal people have entered the program in the
last 10 months
• 4 people returned to hospital and 1 died
• 1 person was non compliant
• 3 people have completed the program and require
minimal ongoing community services
• 8 clients improved their Barthel scores while on the
program
• 1 person completed the program without any further
community supports
• 2 people are currently in the program
• None of the Aboriginal people required residential care
following the completion of the program

Results for the Service
• The employment of the Aboriginal EEN within
STACS has increased the capacity of the staff to
meet the culturally needs of Aboriginal people.
• The new model has improved the utilisation of
the transitional aged care program by Aboriginal
people by matching intake processes to cultural
patterns of health care use.
• Very positive feedback from the Aboriginal
people and their families involved in the program

Results Continued
• Providing access to the program for Aboriginal
people, which was not previously available,
living in the ACT in the Wreck Bay community.
• The Aboriginal enrolled nurse has developed
partnerships, trust and relationships with the
local communities and services and has
improved the acceptance by Aboriginal people
of the program.
• Improved ability for SESIH to meet the needs of
this disadvantaged group in the Shoalhaven
community and assists in the “Closing the Gap”
strategy.

Future Developments
• Formal review of the program to commence in
November 2011. Participation in the review
process from the Australian Health Services
Research Institute, University of Wollongong
• Using this model for Aboriginal clients in other
services in NSW, living in urban areas
• More importantly, the Aboriginal EEN gained a
scholarship to present the model and the service
to the National Rural Health Nurses Conference
in Perth last week.

Ackowledgements
• I would like to thank Shane Smith and Kay Gilbert from
STACS who assisted in providing the information for this
presentation