royal commission into aged care quality and safety

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ROYAL COMMISSION

INTO AGED CARE QUALITY AND SAFETY

RESPONSE TO THE INTERIM REPORT

AND

PROGRAM REDESIGN CONSULTATION PAPER 1

BRYAN LlPMANN AM - CEO

TANYA ATKINSON

WINTRINGHAM

136 MT ALEXANDER RD., FLEMINGTON, VIC, 3031

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RESPONSE TO THE ACRC AGED CARE PROGRAM REDESIGN CONSULATION PAPER 1

INTRODUCTION

Wintringham has been honored to be involved in the Royal Commission into Aged Care

Quality and Safety. We have welcomed all the opportunities provided to us, including

written submissions, meetings with the Commissioners at our facilities, and presenting at

the public hearings in Perth.

Wintringham is supportive of the findings of the Interim Report. Many of the issues in the

provision of aged care services were expertly identified and explored.

As Australia's largest provider of aged care services to elderly homeless people, we are able

to provide feedback on the report as it relates to our clients.

Wintringham feels well able to comment given that our organisation was started as a direct

result of our inability to secure access to quality aged care services for our elderly homeless

clients. The fact that the industry was able to turn its back on such a vulnerable group of

people was, and remains, a national disgrace.

We would like to congratulate the Commission on much of the Interim Report - the aged

care industry is an extraordinarily complicated area and one that is not easily understood in

the relatively short time that you have had at your disposal. Many of the concerns that

Wintringham has, have been covered in the Report. You have given a voice to many of the

residents and families who have received poor services, and have shone a light onto aspects

of the industry which have caused some of us great concern.

The ACRC Aged Care Program Redesign: Services for the Future Consultation Paper 1 pa per

provides Wintringham with an additional opportunity to highlight the challenges faced by

organisations who support people within a system that was not designed for them. The

needs of this client group are different to most older people, and naturally the response to

their care needs must also differ.

We note that the paper does not specifically identify homeless people and their needs.

Much ofthe discussion about service delivery is based on the presumption that people will

have a home, and most often be homeowners. Through this paper we wish to re-iterate the

challenges faced by Wintringham, and no doubt other service providers who work with

older homeless people.

The Consultation Paper recognises that Aboriginal and Torres Strait Islander people require

"flexible, adaptable and culturally safe models from assessment through to service

delivery". This is also true for people who are homeless. For diverse populations, who are

different to the standard aged care recipient, the service system needs to be flexible enough

to meet their needs, rather than expecting the individual to bend to the needs of the

system. Vulnerable older people are entitled to the same aged care services as all older

Australians, and the system needs to be designed to support this.

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A further point we would wish to make is that while much of our work has been with the

elderly homeless, we are aware that there is a growing and worrying degree of

impoverishment within the aged community. People who have never considered

themselves homeless or even at risk of becoming homeless, are now presenting to our

doors in growing numbers. We would ask that the Commissioners be aware that the

problems identified by Wintringham are more severe that simply effecting the homeless.

We are now experiencing growing numbers of elderly Australians who have few if any of the

personal or financial resources that the aged care program appears to presume.

WHO IS WINTRINGHAM?

Guided by the principles of social justice, Wintringham has a single mission to provide

dignified, high-quality care and accommodation to those who are profoundly financially and

socially disadvantaged, especially those elderly men and women who are homeless, or at

risk of homelessness.

Our organisation operates an innovative and integrated range of programs providing a

continuum of care; ranging from assertive outreach, social housing (600 units; all with

housing support), in-home aged care (750 packages), a registered Special Residential Service

(SRS), and six residential aged care sites (289 beds), which are in receipt of the Homeless

Supplement.

With 650 dedicated staff, Wintringham supports 2,000 clients each day in Melbourne and

regional Victoria.

A fuller description of our services can be found in our Submission to the ACRC

https:/!agedcare.royalcommission.gov.au/submissions/Documents/public

submissions/AWF.500.00299.pdf and also at www.wintringham.org.au

Working with the elderly homeless presents particular problems for service delivery, in part

because the often noted incidence of premature ageing and complexity of care needs

(physical, psychological and social), combined with a general reluctance to accept services

due in part to a strong sense of independence and demeaning experiences with a range of

previous health or community care providers.

Our model of care has been developed in direct response to these 'special needs' of our

client group.

We are the largest provider of aged care services for elderly homeless Australians, yet we

are required to operate in a paradigm that governs aged care programmatic funding based

around a typical client type (older, female with a family who can provide support and

advice). Our clients are more likely to be younger, have a long and appalling history of

disadvantage, no family support, behavioural and mental health challenges and a significant

distrust of any service delivery system.

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All Wintringham clients are elderly (aged 50 and over) and in greatest need of housing and

related support. Our specialisation and focus means that we often support clients that

other organisations find too challenging and whom would remain or become homeless if

Wintringham did not exist. At Wintringham, we provide a 'home until stumps' for clients

that the mainstream aged care system refuse to accept.

Our innovative continuum of care model is recognised internationally, with Wintringham

awarded the United Nations World Habitat Scroll of Honour in 2011, the first and only

Australian organisation to secure this prestigious award.

Wintringham was pleased to be identified by the Royal Commission for its role in providing

"Person Centred Care". We are proud of the fact that we create a gentle and loving home

where our clients can experience often for the first time in their lives, an environment where

they can truly be their own person and are empowered to fulfil their personal wishes and

aspirations that have often lain dormant.

However it needs to be said that the Commission's interest in Person Centred Care needs to

be balanced with the recognition that the current aged care capital and recurrent funding

severely limits the provision of these services to the elderly poor and also the access to

them. Person Centred Care cannot exist without at first accessing that care.

HOW IS IT DIFFERENT SUPPORTING THOSE WHO HAVE EXPERIENCED HOMELESSNESS?

Within Aged Care there is a small cohort, who are desperately in need and eligible for

services but due to poor cognition and lack of any viable social support structure are unable

to plan and then implement actions necessary to trigger and then retain the services they

need in order to keep them safe and well in our communities.

Our current service systems assume that potential clients will seek out and actively engage

with services when needed. All are rational consumers, believing themselves entitled to

services and understanding and able to follow the steps needed to access appropriate

support through both formal and informal means.

What happens though, when a person has a life history of marginalization and poverty and

has come to a point where help is needed and those informal supports do not exist? Worse

still, how do they effectively survive when they also have a cognitive deficit which inhibits

their ability to plan and then implement actions that would enable them to access the help

they need? The fragmented services, which offer some support to this group, struggle to

work within restrictive, short-term frameworks, which cause worker frustration when they

see clients unable to follow simple directions - seemingly refusing help offered. A provider

with expertise in supporting people who are homeless sees these behaviours for what they

are, and will continue to persist and work with the person to build rapport and gain their

trust.

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ACCESS

Navigating the aged care system is challenging for all consumers, however most will have

inherently stable arrangements (housing, phone, internet access) and a support network

(spouse, children, other nominated representatives, health practitioners) that can assist to

navigate the referral system and gain access to assessments and services.

Marginalised and homeless consumers do not have these arrangements and supports in

place. Subsequently they find it difficult to gain access to assessments, and when or if they

do, will often miss appointments or notifications.

Through the methods of how My Aged Care is now accessed, the system is inherently biased

against homeless and marginalised consumers. They require dedicated advocates to

support them in securing access to the aged care system. Assistance with Care and Housing

(ACH) workers are uniquely qualified to provide this service.

Wintringham welcomes the acknowledgement in the Consultation Paper that vulnerability

will be considered as part of the assessment process, and that there is a recognition of the

importance of face to face contact. We know for homeless people that phone and internet

based services do not provide the flexibility required to appropriately meet their needs.

Wintringham supports the implementation of a 'system navigator or 'care finder' to support people

to find services that are the right fit. We recommend that these roles are provided by a range of

specialist providers who understand the diverse needs of the aged care population.

NAVIGATION

We know that, for older homeless people, assistance needed to retain service provision is as

much required as is the initial help needed to gain these services. We know that support for

this group is ongoing and lifelong and revolves around help to engage, coordinate and

effectively participate with the services they need to maintain their health, safety and well

being. While the need for intensive levels of support waxes and wanes, the potential for

assistance of this nature is ever present.

The Royal Commission is aware that there are significantly lengthy wait periods between

when clients become eligible for a Home Care Package and when they receive a

package. Our experience indicates that this wait time is currently over 12 months.

During this period, consumers predominately rely on pre-existing services and the support

of family and friends to successfully remain at home. Homeless and marginalised clients are

excluded from support services and very rarely have traditional family support networks to

call upon, resulting in a significant deterioration in their health and well-being during the

wait period. Homeless older people are disenfranchised and are more likely to disengage

from the service system. They often do not have the skills or self-confidence to advocate for

themselves.

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Specific funding is required to support these clients once their eligibility to access Home

Care services is confirmed. Homeless consumers require support and resources during the

period from when they are deemed eligible to access Home Care services, to when they

secure a package.

A common scenario we see is significant amounts of work conducted by outreach or housing

support workers to allow a homeless person to gain access to My Aged Care, and then

support them through the assessment process. Once they are deemed eligible for a

package they then have to wait, and wait for substantial periods oftime. During this time

they may forget the engagement with the assessment service, or withdraw from the idea of

support and decide they no longer want anyone to assist them.

When it comes time for a homeless person to be notified of their package allocation there

are a number of barriers. They may be transient and have no fixed address, so they never

receive the letter. They may not open their mail, they may not be able to read it, or they

may not be able to understand it. As a result they do nothing, and after a period oftime

they lose their entitlement. Without anyone there to help them understand the process,

encourage them to consider their options, help them look at a variety of providers they will

not be able to engage with an aged care package, and will continue to decline without the

aged care supports that they require. We also see examples where people decline services

because they do not have the insight to understand their benefits, or they have had such

negative experiences with services providers in the past that they do not trust this will be

any different.

For a more mainstream older person this support to engage and navigate the system would

be provided by a family member. For homeless clients they often have no one, and they

end up without the support they are entitled to, costing health, homeless ness and the

broader community significant expense as they move on without the aged care supports

they require.

Through Commonwealth Home Support Program - Unsolicited Funds, Wintringham has

been trailing a model of interim support, which provides vulnerable older people with Case

Management style support throughout the period of time that they are waiting for their

package to be allocated. It is still early days, however we are seeing great successes as a

result of this initiative.

Wintringham recommends that specific funding be made available to specialist providers to

appropriately support marginalised and homeless consumers whilst they wait to secure a Home

Care package.

YOUNGER PEOPLE IN AGED CARE

We recognise that many younger people are inappropriately housed in aged care, and

support the efforts for these people to locate suitable accommodation outside of the aged

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care system. At the same time, however, we seek to highlight the needs of those who find

suitable, appropriate accommodation and support within the aged care system.

The Interim Report identifies "people who are assessed as having an early need for aged

care services, such as people who have experienced homelessness and Aboriginal and

Torres Strait Islander people" as a broad group of younger people, residing in aged care.

Wintringham's focus on supporting those who are prematurely aged sees us supporting a

number of people under 65 years, who reside in Residential Aged Care. For these people,

they are living in the most suitable service for them. These aged care facilities, that they call

home, are often the first time in their lives that they have had security and the support that

they require. They are living with their peers, people of a similar age, with a similar life

experiences. Aged care can be a suitable service system for some younger people.

Please refer to Appendix A: a de-identified case study provided by a mother of a client of

ours who currently resides at our Ron Conn Nursing Home. Her story is a compelling

example of why residential aged care can be an entirely appropriate home for a prematurely

aged person.

Wintringham recommends that any aged care redesign ensures that people under 65 who are

homeless, and prematurely aged, retain access to aged care services.

COSTS UNIQUE TO SPECIALIST HOMELESS PROVIDERS

It is widely acknowledged that our existing aged care system relies heavily on the work

undertaken by a huge unpaid workforce comprising family, friends, volunteers, neighbours

or the ability of older people to purchase these supports privately. If we flip this over

though, this same system greatly disadvantages those who have no social resources or the

financial means to purchase these services.

As a specialist homeless service provider, we step into this gap, build a relationship and

provide support - no matter how simple or complex the problem is.

Our services are tailored to meet the needs of our clients and can range from facilitating

community inclusion, assistance to negotiate rents or find alternate accommodation, taking

a client to a health or specialist appointment, purchasing clothing, sorting out what has

gone wrong when the power is disconnected, through to negotiating on disputes with

neighbours and helping to escape from violent or abusive situations.

These services are important. They help to say to the person that they matter, they are

important, they have choices, they have rights and it helps them to meet their goals and

care needs. On a more pragmatic note, provision of these supports helps to reduce costly

interactions with our emergency services.

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Wintringham operates in a cost environment impacted by providing these necessary

services. These costs are not incurred in the mainstream aged care environment and not

recognised within the policy and funding framework.

Whilst specialist services that provide residential aged care for the homeless face a variety

of income and expense imposts that are unique in our sector, the core issue impacting

financial viability is the simple reality that the residential aged care funding tool (Aged Care

Funding Instrument; ACFI) has inadvertently been designed in a manner that inherently

under-funds services that support homeless residents.

This is evidenced in the following table that notes daily subsidy funding per resident at three

points over the decade from 2007 when the Resident Classification Scale (RCS) was replaced

by ACFI.

2007 2012 2017 (ACFI) % increase

(RCS) (ACFI) 2007 to 2017

National average $90 $135 $172 91%

Homeless service $91 $101 $130 43% avel

Funding gap $1 -$34 -$42

In 2007, homeless providers received $1 per resident per day more than mainstream

services. However, once ACFI was introduced, homeless providers have become materially

disadvantaged and the gap continues to grow.

Organisations like Wintringham take some of the most difficult clients in aged care and

provide for them in ways that other services are not prepared to. Yet in spite of this much

more challenging client group, we now receive $42 per client per day less of core funding.

The above table also ignores the reality that mainstream services (both for-profit and NFP)

generate additional income streams by charging for extra services (something that homeless

clients have no capacity to pay) which further increases the funding gap.

The subsidy gap created by ACFI is unsustainable for homeless services. We acknowledge

that as a result of extensive lobbying by Wintringham, the Australian government accepted

this fact and introduced the Homeless Supplement and the Viability Supplement in 2014.

Both supplements will be increased by 30% as recently announced in the Australian

Government Mid-Year Economic and Fiscal Outlook 2018-19. As welcome as this funding

increase is, it does not in any way equate to a level of funding as enjoyed by mainstream

providers.

1 Data points that Wintringham have obtained from Dept. of Health; Homeless service ave represents average daily funding for services eligible for the Homeless Supplement; most recent provided is for the 9 months to March 2017.

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Notwithstanding the introduction and recently announced recalibration of the Homeless

and Viability Supplements, Wintringham will be materially impacted from the revenue

impact of changes to how the Complex Health Care (CHC) ACFI domain is calculated. (The

changes include a new scoring matrix for assistance with medication and changes to scores

and eligibility requirements for certain CHC procedures.)

These changes came into effect on 1 January 2017 and we expect the full impact to filter

through by 2022/23 at which point, all other things being equal, the decrease in ACFI

revenue for Wintringham is estimated to be $1.06 million per year.

The CHC change is a blunt instrument to manage growth in ACFI. Whilst the revenue

reduction may be manageable for mainstream providers, specialist agencies such as

Wintringham have no viable option to replace this income stream yet our underlying cost

base remains the same.

The following graph identifies Wintringham's historical and forecast financial performance.

$,·000

Comparny w ide financial resu lt (actual from 2012 and forecast to 2023)

1,6 00 1---------::::===::-----------------------1 u:oo +_-----7''''--------='''''''''--------------------___1

BOO+---~~------------=~~-----~--------___1

~+-~~----------------~~-----~~~----___1

0 +---------------------~~----------___1

-~+_----------------------~~~-------___1

-BOO+_---------------------------~--~~-___1

-1,200 +-----,,---~--___,_--_,_--,__--.__-~--___,--_,_--..,__--,___-___1

2012 2013 2014 2015 2016 2017 2mB 2019 2020 2021 2022 2023

- Su rplus/ deficit (before depreciation, higher accommodation supplement and 2018/19 MYEFO announcement )

- Su rplus/ de fi cit (before depreciation an d higher accommodation supple me nt, but including the 2011>/19 MYEFO arnnDunceme nt)

It identifies that whilst the 2018-19 MYEFO announcement will improve our viability in the

short term, it only defers the reality that our organisation will be unviable if no remedial

action is taken.

Rues TRIALS AND THE PROPOSED NEW FUNDING MODEL

Wintringham welcomed the announcement of the Resource Utilisation and Classification

Study (RUCS) in 2017. In light of our concerns with ACFI, our organisation actively

participated in the RUCS trials, contributing to Study 1, Study 2 and Study 3. We also

attended the Department of Health RUCS Stakeholder Forum held in Canberra on 14 March

2019 and have recently been part of a Department pilot study at our Port Melbourne facility

and in the coming weeks, at our Ron Conn Nursing Home.

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Based on documents and data that is publically available, and a private briefing with the

designers of AN-ACC, it appears that the conclusions drawn from the RUCS and the resulting

proposed national classification and funding model (AN-ACC) is a superior tool for providers

seeking to support homeless clients.

As a background note, the AN-ACC captures what drives relative care costs in residential

aged care, both at a resident and facility level. It considers the functional consequences of

clinical and need characteristics of individual residents, rather than the condition itself and it

is these functional consequences that drive staff time and cost. Wintringham supports the

principle of establishing three components to the proposed funding model; a fixed, variable

and entry cost adjustment component.

In establishing a fixed component, it provides an opportunity to reflect the inherent higher

cost base incurred by specialist providers. The AN-ACC clearly identified this reality, noting

that there are higher costs for specialised services, such as those caring for homeless

people. This is something that we have identified and advocated for over 30 years of service

delivery.

Likewise, AN-ACC identifies several factors that drive individual care costs with the most

costly residents being those that have compounding factors such as behavioural issues; a

condition that is highly prevalent for homeless people. We are grateful that the AN-ACC

recognises the high cost of managing behaviours; it is something that ACFI was unable to do

particularly because it paid such a low level of income in the Behaviours domain.

Through the AN-ACC, it appears that for the first time, aged care funding recognises that our

clients require a specific and higher cost model of care.

Wintringham believe that the Aged Care Funding Instrument (ACFI) must be replaced with a fit-for

purpose funding tool that recognises the unique costs associated with providing high quality care to

consumers with a homeless background. We are encouraged that the proposed national

classification and funding model (AN-ACe) appears to recognise the true cost base of caring for

homeless clients.

CAPITAL FUNDING: WITHOUT ACCOMMODATION DEPOSITS, HOW CAN NEW FACILITIES BE BUILT?

A fair and equitable aged care system must enable all aged Australians to access quality

aged care services.

Construction of Aged Care facilities are primarily financed through consumer contributed

Accommodation Deposits and Accommodation Payments, highlighted by the fact that as at

30 June 2018, the sector held $27.54 billion 2 of such deposits. Organisations such as

2 Seventh report of the Funding and Financing of the Aged Care Industry; Australian Government Aged Care Financing Authority July 2019

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Wintringham who work with elderly homeless people receive few, if any, Accommodation

Deposits, eliminating access to this core avenue of capital. As a result, each of the six aged

care facilities built by Wintringham over the last 30 years have relied on negotiations to

achieve one-off capital grant funding from government and philanthropy

Wintringham has long argued that there needs to be a strictly quarantined, appropriately

funded capital pool that homeless persons' services can apply to in order to build new

facilities. Either that or revert to the excellent Variable Capital Funding Program that existed

in the early 1990s when Wintringham constructed its first three aged care facilities. Under

this scheme, for each resident that could not pay an Accommodation Bond, providers were

paid a capital amount equivalent for the cost of constructing a room for them.

Low or no-interest loans from the Commonwealth have occasionally been suggested as a

way forward, but this is no solution to organisations that cannot service or repay loans due

to the absolute poverty of our clients and the resultant extremely narrow margins that we

operate under.

Wintringham recommend that a guaranteed and strictly quarantined capital funding allocation be

available in order to build services that are made exclusively available to homeless consumers.

HOUSING AND AGED CARE

Wintringham has over 1,500 elderly people on our housing waiting list - 1,500 aged men

and women who are homeless or at imminent risk of homelessness and in need of housing

and support. Surely a terrible statistic for a country as wealthy as Australia.

The 2016 census shows that there are now 134,000 people aged 65 and over paying rents

more than 30 per cent of their income - an increase of 41.7 per cent in five years.

The vast majority of those people are in need of affordable housing.

The number of people aged 55 and over who accessed Specialist Homelessness Services in

Australia increased by 37 per cent between 2012-13 and 2016-17, with more than half (56

per cent) of these people being women. Older people in the 55 - 74 age bracket were the

fastest growing age cohort within the overall homelessness population, increasing by 55 per

cent in the decade to 2016.

In addition, older people represent one of the fastest growing groups seeking assistance

from specialist homelessness agencies, with an average annual growth rate of 8 per cent

each year between 2011-12 to 2016-17 compared to 4 per cent growth rate for other

specialist homelessness services clients.

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Older specialist homelessness services clients were more likely to be living alone (59 per

cent) when compared to the rest of the specialist homelessness services clients (29 per

cent).3

In order to address this massive housing shortfall, Wintringham has become a Victorian

Government registered Housing Association and through accessing capital funding, and

striking innovative partnerships with philanthropic trusts, Wintringham has now over 600

houses in Victoria that are made exclusively available to elderly homeless men and women,

who are then supported by a range of programs including Commonwealth Home Care

Packages.

It must be noted that from our 600 housing units, we have approximately 50 vacancies each

year. With 2,000 people on our housing waitlist, it highlights that demand far exceeds

supply.

There is currently no discernible connection between the Commonwealth Aged Care

Program and any Commonwealth or State Housing program. This must change. Residential

aged care facilities are expensive to build and operate. Wintringham's experience is that the

provision of affordable housing with appropriate levels of support can eliminate the need

for intensive residential aged care.

Similar to our argument relating to capital funding for residential aged care facilities for the

homeless, we recommend that there needs to be a strictly quarantined and regular capital supply

that enables organisations like Wintringham to build housing that can be rented at affordable rates

and combined with appropriate levels of aged care support being delivered on an as-needs basis.

ENTRY LEVEL SU PPORT

Wintringham recognises that entry level support can be incredibly effective when targeted

at the right people, at the right time. There are many people who end up homeless, who

indeed could have avoided this ifthe support had been there to engage and support them

to maintain their homes.

We see that investment in entry level support is particularly successful when it is flexible,

holistic, and is linked to ensuring people have access to appropriate housing. Low levels of

support can go a long way ifthey intervene before a crisis occurs.

Wintringham supports a user pay system, where people pay for the services they can afford,

and government resources can focus on those who are truly disadvantaged.

Block funding works well in this space to enable flexible service delivery. Block funding

enables clients and providers to determine the levels of intervention that the client truly

3 Australian Association of Gerontology: Older Women who are experiencing or at risk of Homelessness, 2018

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needs, rather than that which a policy has determined. Indivdiualised budgets restrict the

flexibility of service delivery and would reduce the effectiveness of early intervention.

Wintringham recommends that entry level support be block funded and flexible, to enable early

intervention. Entry level support should be linked with the provision and maintenance of suitable

affordable accommodation.

HOME CARE

SEPARATE BLOCK FUNDING FOR SERVICES OUR HOMELESS CLIENTS

Wintringham supports in principle the introduction of Consumer Directed Care (CDC) for the

Home Care program but wishes to advise that CDC does not work for our homeless clients.

Prior to the introduction of CDC, our Home Care workers were able to pool existing funding

and allocated to those in greatest need . Given the absolute poverty of most of our Home

Care clients, if any additional non-funded services were required, the cost of providing that

service could be 'borrowed' from the pool.

One such example was that every Christmas, staff would organise a catered party at a local

venue. The cost of the event and the expenses involved in transporting clients and providing

a meal, Christmas presents and entertainment would have been completely out of the

range of individual clients to afford. We used surplus income from the Home Care program

to pay for this event - which was usually the only party that our isolated clients went to for

the year.

This event is now unaffordable to Wintringham because we are unable to pool income.

There are numerous other examples, all or most revolving around the poverty and isolation

of our clients . We understand the wish of program designers to have a uniform policy, but in

the case of homeless people, certain changes or 'tweaks' to that policy will make the system

work more fairly and equitably.

We would argue for either the re-introduction of Bulk Funding for organisations working

with the elderly homeless, or the retention of CDC but with the introduction of a Subsidy or

Grant that would enable unusual or out of program expenses such as episodic assistance to

negotiate with landlords prior to eviction.

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AGEING PRISONERS

Older prisoners in Australia are a growing population. At June 30 2018 there were 5,554

prisoners aged SO years and over. This is an increase of 81.6 per cent between 2001 and

2010, and another increase of 67 per cent from 2010 to 2018. At the same June date there

were 1,156 prisoners aged 65 years and over.4

It is well documented that prisoners as a whole, not just the aged prison population, have

far greater health needs than the general population, with high levels of mental illness,

chronic health conditions, injury, communicable disease and disability. Further to this, it is

known and recently well documented that older Australian prisoners are visiting prison

clinics more often and for more health problems each time. Further to this again, older

prisoners with any form of cognitive impairment may not be able to follow prison rules

and run the risk of receiving institutional punishment (for disobedience): increased

sentences, confinement, transfer to higher security areas, or all of these which in turn may

further compromise their physical and mental well-being and burden the prison system

with higher costs of housing an inmate. 5

When an older prisoner's aged care needs arise and they can no longer be provided for in

the prisoner's cellblock, they are routinely transferred to an acute care setting (such as St

John's Hospital at the Port Philip Prison) where because of hospital prison protocols, they

are isolated for significant parts of the day.

There is no doubt correctional staff do care about the older prisoner; they are simply not

trained or experienced in observing the needs of the aged and whilst there is no doubt

prisoners within Victoria have access to health care; there is little evidence that aged

prisoners real aged care needs are being regularly addressed.

Health care in Australian Prisons has again been reviewed within the last year. The overall

finding was, not surprisingly, prisoners have significant health issues, with higher rates of

mental health problems, communicable diseases, alcohol misuse, smoking and illicit drug

use than the general community. The health of elderly prisoners is understandably worse

than their younger counterparts.

Services provided under the National Disability Insurance Scheme (NDIS) are able to be

provided to people with disabilities who are imprisoned. There are clear guidelines

outlining what is the responsibility of NDIS, and what is the responsibility of Justice, but

not when it comes to aged care .

Wintringham is proud of the unique services that we deliver into prisons, but would be

able to do much more, and at a significant financial saving to the community, if elderly

prisoners were entitled to access Commonwealth Aged Care.

4 Australian Bureau of Statistics: Pri soners in Australia Report 2018 5 https:/ /www.wintringham.org.au/fil e/2016/I/Best _practice _ su pport_ model_for _01 der _prisoners. pdf

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Wintringham recommends that aged prisoners should be entitled to aged care assessments and services, while they are incarcerated.

CONCLUSION

Homeless service providers work with a very different client group than mainstream

providers, in terms of the absolute poverty of the clients, premature ageing and behavioural

issues that arise from multiple complex needs, addictions and acquired brain injury.

Wintringham has demonstrated that it is possible to provide high quality services but the

aged care program needs refinement for this to be sustained.

We continue to maintain that there is something deeply troubling that organisations such as

Wintringham, who work with and provide services to some of the most difficult and

complex aged care recipients, people whom the aged care industry has by and large turned

its back on, are expected to provide these services with significantly less resources. As

documented earlier in this submission, we receive few Accommodation Deposits, receive

little or no support from residents' family, and are severely disadvantaged in both the ACFI

and CDC funding models.

If the Federal Government continues to maintain, as it should, that financially disadvantaged

elderly homeless people are entitled to receive aged care, then it is time that serious

attention is given to ensure organisations, such as Wintringham, who are willing to take on

that responsibility, are funded appropriately now and into the future. We want to ensure

that elderly homeless men and women receive the same high quality services that we

expect for all other Australians, whilst ensuring that organisations that provide these

services remain financially viable and sustainable.

Wintringham believes that any new program guidelines should avoid being too prescriptive.

Thirty years ago, when Wintringham started, we were able to do so because of the

innovation and flexibility of the aged care system, features that are now no longer so

apparent.

In spite of receiving numerous national and international awards, Wintringham continues

to struggle to remain financially viable.

The opportunities provided by an aged care program redesign give us hope that the future

of aged care is facilitating innovation, and providing opportunities for new and inventive

approaches to supporting older Australians.

Finally, Wintringham again wishes to remind the Commission that the current system does

not ensure that elderly homeless people can access aged care and nor does it ensure that

aged care providers can remain financially viable.

15 I P age

AWF.660.00066.0001_0016


Appendix A

Case Study of a 56 year old prematurely aged woman

16 I P age

To Mr Bryan Lipman

My name is Erica •••• ve met at the Ron Conn Christmas party (2019)

Where my daughter Jane •••••••• has recently become a resident.

Our conversation related to those who were under 6S years. but due to their

High needs require the ongoing. more intense care and support available at an aged care unit .

Despite the Federal Governments statement describing its plan to "rehouse" this age group which

Includes Jane.

Janes storey.

In reply to your request this is a shortened version of Janes life. illustrating

The present need for her to remain within the residentia l care offered by Wintringham Aged Care.

I have attached copies of ours and her case managers requests to VeATfor Guardianship and

Administration which illustrates recent years of support and the efforts to encourage Jane

t oward an independent improvement of her lifestyle which sadly failed.

Jane was a very attractive and popular girl who began and continued to make disastrous

relationships and life choices. she saw potential glamour in working in escort agencies. during

these experiences she began using drugs and alcohol which started her life on a downward spira\.

We gained Guardianship and Administration and were then able to cease Janes

Access to money at her accommodation at •••••••• we were then able to put in place a

repayment plan to pay back her debts to Wintringham plus commence a trust account for her

personal needs.

John~ referred to in the VCAT submission) in order to maintain some

control of Jane had male friends deliver money t o her at Angus Martin House for Cigarettes and

alcohol.

In one incident one of Mr~riends drove Jane down the Mornington Peninsular which made

her quite distraught because she had no idea where she was. Jane became very ill due to her

drinking following these visits. due to her vulnerable. I had to suggest to M~hat any more

involvement would mean that I would involve the police.

17 I P age

AWF.660.00066.0001_0017


Jane continued at ••••••• on a Alcohol and cigarette program,

also an extra carer was provided to assist in her personal and room care, the staff care, support

and tolerance of Jane although limited, was outstanding with special thanks to leanne_

for all the work she did to make Jane as comfortable as she could in her new surroundings.

However, Jane easily befriended any co-resident who was willing to supply

her with money and alcohol , but the condition of her liver accelerated a major decline in her health

and she was again admitted tQio ••• IHosPital (her 4th major admission), throughout this

admission of over two and a half months she presented as disoriented , unable to remember her

name, and unable to take care of her personal needs, she spent six and a half weeks in the

•••• Ii>'emetia Unit, where she was assessed as requiring such care as offered by an Aged

Care Service . Jane was subsequently admitted to _ Aged Care Facility, where

those with similar backgrounds are treated with care, dignity and respect which we have not

witnessed at other fatilities involving family and friends.

Although atthis time Jane presents as well as we have seen her in recent years we have noticed a

decline in her cognitive function and her world remains central to obtaining cigarettes and alcohol

and money. She is easily irritated t oward us over our refusal to give her money.

Jane has a son who is 26 years old, he is unable to cope with his mothers lifestyle

and does not contact her ,although her stories indicate otherwise, this also applies with her brother

and friends and relatives. Janes only advocates regarding her welfare are myself and her step-

father Georgei ••••......•. we are now both well into our seventies and it does take a toll both

mentally and physically.

I hope this information is adequate and useful to you in demonstrating that Jane would not survive

In a facility other than ~intringham Aged Care

Kind Regards