Damien Conley Consultancy March 2011
The Uniting Church in Australia Northern Synod
Crisis
Accommodation
Needs
in
Tennant Creek
Authored by
Damien Conley Consultancy
for
The Congregation of the Uniting Church Tennant Creek and Frontier Services
March 2011
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Contents
Acronyms ...... 4 1.0 Executive Summary ...... 6 2.0 Key Features ...... 9 2.1 Frontier Services ...... 9 2.2 Tennant Creek Uniting Church ...... 11 3.0 Recommendations ...... 12 4.0 Background ...... 15 4.1 Demographics ...... 15 4.2 Frontier Services ...... 18 4.3 Tennant Creek Uniting Church ...... 18 5.0 Methodology ...... 20 5.1 Consultations ...... 20 5.2 Desktop Review of Contemporary Accommodation Models ...... 21 5.3 Opportunity and Risk Analysis - Frontier Services ...... 21 5.4 Opportunity and Risk Analysis - Tennant Creek Uniting Church ...... 21 6.0 Accommodation ...... 23 6.1 Homelessness ...... 23 6.2 Homelessness Overseas ...... 25 6.3 Aboriginal and Torres Strait Islander Homelessness ...... 26 6.4 Strategic Indigenous Housing Infrastructure Project (SIHIP)...... 27 6.5 Public Housing ...... 28 7.0 Demand Findings ...... 29 7.1 Medical Patients ...... 29 7.2 Aged Care ...... 38 7.3 Indigenous Mothers‟ Facilities ...... 39 7.4 Transition from Emergency Accommodation ...... 42 7.5 Youth Accommodation ...... 43 8.0 Service Model Findings ...... 44 8.1 Service Type ...... 44 8.2 Opportunity and Risk Analysis - Frontier Services ...... 46 8.3 Opportunity and Risk Analysis - Tennant Creek Uniting Church ...... 47 8.4 Analysis of Community Capacity ...... 49 9.0 Flexible Service Models ...... 51 9.1 Tennant Creek Flexible Service Model (TCFSM) ...... 51 9.2 The Multi Purpose Service (MPS) ...... 51
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9.3 Flexible funding pool for Remote Service Delivery ...... 52 9.4 Flexible Learning and Development ...... 53 10.0 Government Priorities ...... 55 10.1 Health Care ...... 55 10.2 Aged Care ...... 59 10.3 Indigenous Mothers‟ Facilities ...... 60 10.4 Transition from Emergency Accommodation ...... 60 10.5 Youth Accommodation ...... 61 11.0 One stop community and health reference centre ...... 62 12.0 Budget ...... 63 12.1 Frontier Services ...... 64 12.2 Tennant Creek Uniting Church ...... 68 Attachment A: Consultation List ...... 70 Attachment B: Community Services Accommodation – Tennant Creek ...... 71 Attachment C: Temporary Accommodation – key findings from overseas ...... 72 Attachment D: Summary of Consultations/Findings ...... 75
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Acronyms
ABS Australian Bureau of Statistics
ACAT Aged Care Assessment Team
ASH Alice Springs Hospital
BRAG Barkly Regional Advisory Group
BRADAG Barkly Region Alcohol and Drug Abuse Advisory Group Inc
CACP Community Aged Care Package
COAG Council of Australian Governments
DEEWR Department of Education, Employment and Workplace Relations
DoHA Department of Health and Ageing
DRG Diagnostic Related Groups
EACH Extended Aged Care at Home
ENT Ear Nose Throat
ESRD End-Stage Renal Disease
FaHCSIA Department of Family Housing Community Services and Indigenous Affairs
HACC Home & Community Care
ICC Intensive Coronary care
ICU Intensive Care Unit
IMAF Indigenous Mothers Accommodation Fund
MPS Multi Purpose Service
NTCOSS Northern Territory Council of Social Services
PATS Patient Assistance Travel Scheme
RASS Remote Air Services Subsidy Scheme
RDH Royal Darwin Hospital
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SACS Social and Community Services
SIHIP Strategic Indigenous Housing Project
SCN Special Care Nursery
TCUC Tennant Creek Uniting Church
TCWR Tennant Creek Womens Refuge
YDUCA Youth Development Unit Crisis Accommodation
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1.0 Executive Summary
Damien Conley Consultancy was appointed to undertake detailed research and consultations with key stakeholders to identify innovative approaches to resolve the crisis accommodation situation in Tennant Creek. The project was funded by the Northern Territory Government and coordinated jointly by the Uniting Church Tennant Creek Congregation and Frontier Services.
A draft report proposing two projects in Tennant Creek on vacant land owned by Frontier Services and the Uniting Church Tennant Creek Congregation was presented to the Barkly Regional Advisory Group (BRAG), the Uniting Church in Australia Northern Synod and Frontier Services on 21 February 2011. The draft report was endorsed by these groups.
The two main proposals of this report are:
Frontier Services (Peko Road site)
The consultant found that the availability of accommodation in Tennant Creek is being impacted through the huge regional growth in the mining, construction and transport sectors. This growth coupled with pre-existing unmet need for public and private housing has led to an accommodation crisis in the town.
While the unmet demand for long-term public and private housing in Tennant Creek is undeniable the Tennant Creek community is adamant that there is another priority group at greater risk. This group includes, but may not be restricted to, the following:
Barkly region patients transitioning to and from Alice Springs Hospital Barkly region patients eligible for transition care Young homeless people in Tennant Creek Young mothers from the Barkly region Older people People seeking emergency accommodation; and Barkly region renal clients receiving treatment in Tennant Creek
There are limited accommodation and support options available for these priority groups in Tennant Creek however each priority aligns with existing programs funded by the Northern Territory and Federal Governments in Darwin, Alice Springs and Katherine. Whilst Tennant Creek and the Barkly are funded for a range of health, community and housing programs this consultancy found that the region is under-represented with regard to funding allocations to the identified priority groups.
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The expressed needs of the Tennant Creek community were to develop a flexible accommodation model that meets the unique needs of their community.
Stakeholders identified that in small communities like Tennant Creek government funding models that allocate funding on a programmatic basis and for a specific purpose do not work well. Stakeholders often referred to these funding models as silo funding.
Barkly region stakeholders recognised that within Tennant Creek the number of people in each of the identified priority groups was individually too small to justify a stand-alone facility for each group; however, combined there were sufficient numbers to justify a shared facility. Stakeholders expressed a genuine commitment to supporting a flexible accommodation model in Tennant Creek that would address existing and emerging needs.
This report recommends that a new 24 bed facility be developed adjacent to the Frontier Services Pulkapulkka Kari Nursing Home (Peko Road); the new facility would leverage off Pulkapulkka Kari‟s existing nursing, catering and ancillary services.
The recommended funding model is to pool funds from a range of government agencies to enable a flexible response to crisis situations proposed in this report.
Uniting Church Tennant Creek Congregation (Paterson Street)
Uniting Church Tennant Creek Congregation has vacant land in the main street of Tennant Creek. Whilst a number of accommodation options were considered the community generally felt that the location‟s exposure to both pedestrian and vehicular traffic would potentially put clients in crisis at risk.
However, throughout the consultation phase there was strong support for a „one stop shop‟ referral service in Tennant Creek that was designed and developed in partnership with the community. The purpose of this facility would be to provide a quiet and sheltered location for community people to relax in a safe, welcoming and comfortable environment (potentially with landscaped gardens, leafy areas, benches, shade cloth). Further, with limited public transport in Tennant Creek a „one stop shop‟ would enable people to resolve a range of issues at the one location.
It was proposed that it would be an ideal meeting place for visiting and local government and non government service providers. The proposed facility could have serviced offices and meeting rooms available for direct client contact or to present weekly seminars on a range of initiatives impacting on Tennant Creek residents.
This would allow community people to receive general assistance and specialist advice on a range of issues including, service delivery information, referrals, interpreting and writing letters, completing forms and liaising with a range of key agencies. Some service providers
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Stakeholders felt that the church grounds in Paterson St were an ideal location to collocate such a facility.
Summary
This report reflects the views of a vibrant and unified community committed to finding sustainable solutions to a range of issues.
This community is extremely cohesive, energetic and determined to propose service models that are feasible, effective and efficient and which will meet the unique and changing needs of Tennant Creek and the Barkly communities.
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2.0 Key Features
The following key elements and the 30 findings inform the 5 recommendations for this report at Section 3.0.
2.1 Frontier Services
2.1.1 Target Group
The community are seeking a flexible approach to service delivery to meet the needs of Tennant Creek.
Given the core competencies and expertise of Frontier Services it is proposed that a service operated by Frontier Services should include services to older people, young mothers, people seeking short term accommodation, renal dialysis clients, transition care clients, some people exiting emergency accommodation and where appropriate youth.
2.1.2 Service Model
The service would focus on short-term interventions aimed at providing clients with the skills they need to live safe and healthy independent lives. Whilst this may vary according to need the focus is on promoting a healthy community and developing pathways which enable a person to return to their community.
For Short-term Patient Accommodation Facility, transition care clients and renal clients this would include education and training to assist in the treatment and management of their medical conditions Young people, including young mothers, would receive training and support in home maintenance, nutrition and living skills. Young mothers would also be provided with baby rearing skills and health and nutrition advice specifically for babies.
2.1.3 Design
The flexible service model would provide segregated accommodation for 24 people with a central dining, kitchen and lounge areas and landscaped gardens. The accommodation would consist of 12 x 2BR rooms with ensuites.
Frontier Services are acknowledged nationally for their expertise in the design and structure of culturally appropriate residential care facilities.
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2.1.4 Funding
The preferred funding model would be based on a flexible innovative service model which enables crisis accommodation needs in the Barkly to be addressed as they occur. Pooled funding models such as the Flexible funding pool for Remote Service Delivery and the MPS model provide the impetus to progress with a new model.
It has been suggested that a number of places would be dedicated for older people and renal patients leaving the remaining beds for a range of community people. This is to be determined following further community consultations.
In some cases accommodation may only be for an overnight stay on transfer to or from ASH or for a specified period if transitioning from hospital. Initial estimates suggest that the transitional clients would require accommodation on average seven days per month and the length of stay for other clients may vary.
It is not the intention of this facility to have all beds occupied by long term clients.
Funding will be sought from a range of government agencies as well as client contributions.
2.1.5 Governance
The energy, expertise and professional skills of key stakeholders in the Tennant Creek community working collaboratively with Frontier Services would ensure a flexible, innovative and seamless service that would meet a broad range of crisis accommodation needs.
2.1.6 Training
Ninety per cent of all residents at the Pulkapulkka Kari residential care facility on Peko Road are Indigenous. In 2006 special funding for remote training enabled Frontier Services and Alzheimer‟s Australia NT to provide Certificate 3 in Aged Care Work for the staff at Pulkapulkka Kari and six staff graduated from the program. Given the success of this program a Bachelor of Nursing course was developed with the Northern Territory Department of Health & Community Services, Batchelor Institute of Indigenous Tertiary Education and Frontier Services. Ten staff began the course with lecturers initially travelling from Darwin to Tennant Creek and a full
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The benefit of having an innovative and flexible accommodation service adjacent to Pulkapulkka Kari provides a valuable opportunity for staff to extend their skills in a range of health related skills and in a culturally appropriate way.
2.2 Tennant Creek Uniting Church
Community support for the Tennant Creek Uniting Church to develop a „one stop shop facility‟ in the main street in partnership with an existing provider received strong support.
Further, accommodation for visiting staff is at crisis point in Tennant Creek whether they be government or non –government officials and the Paterson Street site would be ideal because of its location.
1 http://nrha.ruralhealth.org.au/cms/uploads/publications/pl%2031%20final%20oct%2007.pdf
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3.0 Recommendations
Recommendation 1
That this report is presented to the relevant Federal and Territory Government agencies highlighting the need for a flexible and versatile accommodation service in Tennant Creek.
Finding 2 There is an accommodation shortage in Tennant Creek. The increase in dialysis treatment in the Barkly will require Finding 5 additional accommodation Transition care in Tennant Creek is a high priority for Barkly Finding 6 residents. There is an urgent need for independent living accommodation for Finding 7 older people. An assessment of aged care needs in the Barkly would inform future Finding 8 accommodation needs A flexible Indigenous Mothers Accommodation Program is a high Finding 9 priority for the Barkly Emergency accommodation for the substance misuse program to be excluded from a new proposal as people with alcohol and drug Finding10 dependencies require a more specialised service model than what is proposed in this report. Finding 12 There is a shortage of Youth accommodation in Tennant Creek. A flexible and versatile service is best suited to the needs of Finding 13 Tennant Creek. The provision of on-site accommodation for visiting community Finding 18 services workers is a priority. Discussions regarding the flexible service facility to include Finding 26 independent living options for ageing Indigenous people and broader aged care opportunities for the Barkly region. Youth accommodation could be included in the new flexible service Finding 29 facility to relieve pressures on the Mulga camp accommodation funded through FaHCSIA.
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Recommendation 2
That a flexible pooled funding approach is supported by government to achieve accommodation outcomes.
Stakeholders keen to progress discussion with government to Finding 20 develop a pooled funding model. The Australian and Northern Territory Governments have shown a Finding 22 willingness to support short term accommodation Urgent need for accommodation in Tennant Creek for renal Finding 23 patients and FaHCSIA have funded renal beds in a number of Aboriginal Hostel sites across Australia. The Australian Government has shown a willingness to fund transitional accommodation services for homeless people that Finding 24 provide integrated case management to reduce the longer-term need for more expensive medical assistance. Urgent need for an expansion of the Northern Territory transition care program funded jointly by DoHA and the NT Government to Finding 25 include Tennant Creek who have no residential transitional care places The Australian Government is committed to closing the gap Finding 27 between Indigenous and non-Indigenous child health and has demonstrated a willingness to fund Indigenous mothers‟ facilities.
Recommendation 3
That a partnership be established with Tennant Creek providers to develop the model.
Opportunities for partnerships with clients from the Womens Finding 11 Refuge in a new proposal The availability of land adjacent to the Tennant Creek Uniting Finding 17 Church does provide opportunities to progress a „one stop shop‟ referral service in partnership with an existing agency.
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Recommendation 4
That the model has a focus on building on existing best practice in Tennant Creek to provide a seamless services for clients.
Cooperation between service providers to ensure a seamless service Finding 3 for clients travelling to and from Alice Springs is a requirement of a new service. Short-term Patient Accommodation needs to be coordinated from Finding 4 admission in Tennant Creek through to discharge from ASH or return to Tennant Creek. Frontier Services is acknowledged nationally for its ability to Finding 15 develop coordinated outcomes for clients. The availability of land adjacent to the existing residential aged care facility provides an opportunity to establish a residential Finding 16 service that leverages off the aged care facility‟s existing nursing, catering, and ancillary operations. Unlike BRADAAG the TCWR has no transitional program. Transition to the flexible service facility may provide opportunities for Finding 28 training and placement which could be financially supported by DEEWR and the NT government.
Recommendation 5
That this model focuses on community engagement drawing on the expertise of all key stakeholders.
It is essential that any proposed service is sensitive to the culture Finding 1 of Aboriginal and Torres Strait Islander people. Frontier Services has expertise in the delivery of a broad range of Finding 14 client focused residential and community care services in Tennant Creek. An overarching steering committee comprising key community, Finding 19 government and non-government representatives would enhance the service by providing advice and support to the provider. The new flexible accommodation facility will provide an Finding 21 opportunity for staff to be multi skilled and access training opportunities across a range of health and community services. A one stop shop facility on the Tennant Creek Uniting Church site to be progressed with the development to include shaded Finding 30 landscaped areas where people and families can communicate in a secure and safe environment.
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4.0 Background
The Uniting Church Assembly Ltd (Frontier Services) has noticed a pressing need for crisis accommodation in Tennant Creek. Frontier Services and the Tennant Creek Uniting Church both have vacant land in Tennant Creek and are keen to explore opportunities to develop each site to address some of the towns accommodation needs.
With this in mind, Frontier Services submitted an application for funding to the Northern Territory Department of Housing, Local Government and Regional Services under the 2010-2011 Community Housing Program in May 2010. The submission requested financial support to engage a consultant to identify crisis accommodation needs in Tennant Creek.
In September 2010 the Minister for Public and Affordable Housing the Hon Dr Chris Burns advised Frontier Services that they had been successful with their application to „engage a consultant to identify crisis accommodation needs in Tennant Creek‟.
Frontier Services employed Damien Conley Consultancy to undertake research and consultation for this project. Mr Conley visited Tennant Creek and Alice Springs and undertook a range of consultations over a six-day period.
This report collates the findings from those consultations, provides an analysis of the issues identified and recommends the development of an accommodation service that builds on the core competencies of Frontier Services leveraging existing infrastructure and services and addresses the needs of the people of the Barkly region.
It should be noted that whilst a new model is being proposed to be managed by Frontier Services options are also outlined in this report for the Tennant Creek Uniting Church.
4.1 Demographics
The town of Tennant Creek on the Stuart Highway connects the Northern Territory‟s two main urban centres, Darwin and Alice Springs and serves as the administrative centre for the surrounding Barkly Tableland region. It is located a little over 1000 km
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Map 1: Barkly Region of the Northern Territory
Source: Department of Regional Development, Primary Industry, Fisheries and Resources, 2009
2 http://www.nt.gov.au/justice/licenreg/documents/liquor/100909_TC_evaluation_revised_final.doc%20Sept%202010.pdf
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The geographic profile of Tennant Creek indicates that the Barkly region occupies more than 304,045km2, which is about 22 percent of the Northern Territory‟s land mass and in comparative terms is larger than Victoria.3
Tennant Creek is the fifth largest town in the Northern Territory with a population estimated at around 3,500 people, of which one-third (1,176) are Indigenous. There are five Tennant Creek community living areas with a population estimated to be 540 people. The region‟s median age is 30 years with the Tennant Creek town average 33 years of age and 45% of the region‟s population is 24 years and under. The town is well serviced with infrastructure with a range of different shops and community facilities.4
Table 1: Estimated Resident Population by locality (ABS Census 2006)5
3 http://www.auinfo.com/Victoria.htm 4 http://www.fahcsia.gov.au/sa/indigenous/pubs/nter_reports/Documents/nt_eval_rpt/2_method.htm 5 ABS, 2006 Estimated Resident Population by locality
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4.2 Frontier Services
Frontier Services is the leading national provider of health, aged care, community care and children‟s services to people in outback Australia. The organisation has been operating for 97 years, initially as The Australian Inland Mission. More than 600 staff deliver a range of services including: residential and in-home aged and disabled care, remote nursing and health clinics, assistance to isolated families, including childcare and early childhood education, migrant settlement assistance, student accommodation, provision of short-term volunteers to assist families in need and pastoral support
Frontier Services works with people across 85% of the continent in regional centres, and in Aboriginal communities, isolated properties and mining sites. It is the only organisation, public or private, providing these services across the whole of remote Australia.
Frontier Services is a charitable/not for profit organisation auspiced under the National Assembly of the Uniting Church.6
Frontier Services have vacant land on Peko Road Tennant Creek adjacent to their Pulkapulkka Kari residential care facility.
4.3 Tennant Creek Uniting Church
The Tennant Creek Uniting Church is small congregation but committed to expanding its role. In July 2009 members of the congregation undertook an information gathering exercise to determine community expectations and town needs for property use in the Main Street. The Tennant Creek Uniting Church has 3 lots in Paterson Street Lot 179 (A frame Church Building) Lot 180 (Mission hut) and Lot 181 (Spare block of Land).
„Accommodation‟ was among the needs identified which included emergency/short term/hostel type accommodation for older people and independent living units for long term residents. In January 2010 the congregation developed a „Property Development Framework – Short Story Document”.7
6 http://www.frontierservices.org/about/history.htm 7 Property development Framework – Short story Document – Tennant Creek Uniting Church.
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The Property Development Framework proposes to develop across the 3 blocks owned by the church in the main street of Tennant Creek but retaining the A Frame Church building and the original frontage of the Mission Hut (the front facing west). The property and land could be redeveloped to meet community needs and at the same time provide a greater awareness and visibility of the Uniting Church in the Tennant Creek community.8
The Uniting Church in Tennant Creek seeks advice on the following:
Developing partnerships for temporary or emergency accommodation
Rental accommodation for workers
Commercial office space providing care services in Tennant Creek9
8 Ibid 9 Ibid
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5.0 Methodology
This report proposes a number of crisis accommodation options for consideration and wherever possible qualitative and quantitative data has been provided to substantiate why a particular service type or client group is recommended. Supporting data has been gathered through local consultations with stakeholders, service providers and community groups and desktop research to identify contemporary accommodation support models. This data has been balanced by an analysis of opportunities for Frontier Services and the Uniting Church, Tennant Creek.
Data was collected to answer key factors such as location, the preferred model and why, what risks and benefits there may be and the ability of any proposal to compliment the core values of the proponents. This is outlined in this report.
To validate the findings and recommendations from this project it is recommended that a draft report be presented to stakeholders in 2011 for comment prior to any funding submission proceeding.
5.1 Consultations
The consultant visited Tennant Creek and Alice Springs and undertook a range of consultations over a six-day period in November 2010.
A week before consultations, the Homelessness Summit in Darwin identified, as one of the ten key issues raised, that “Peaks and the sector must also investigate ways of capturing the views and ideas of client groups in order to give them a voice”. This provided an ideal opportunity to commence consultations in Tennant Creek and in particular meet with the Barkly Regional Advisory Group (BRAG) who had scheduled their meeting the week of consultations.
A range of Central Australia service providers and peak bodies are represented on the Barkly Regional Advisory Group (BRAG). The importance of consulting with this advisory group is that in addition to representing the major providers of accommodation support services in the region it is one of the primary advocates for accommodation needs in the Barkly.
Discussions with the Central Australian Policy Officer NT Shelter (Alice Springs) and the Minister Tennant Creek Uniting Church assisted the consultant in planning and
- 20 - Damien Conley Consultancy March 2011 scheduling meetings in Tennant Creek. All the main service providers both government and non government with an interest in or responsibility for accommodation programs met with the consultant. (Stakeholder listed at Attachment A).
5.2 Desktop Review of Contemporary Accommodation Models
Internet searches, literature reviews and direct contact with service providers and government officials were undertaken to inform this report. This process included assessment and analysis of existing service delivery models and best practice examples. Detailed analysis was undertaken to assess government policies and priorities for homelessness to help inform this project.
Analysis of programs was also undertaken with respect to international findings.
5.3 Opportunity and Risk Analysis - Frontier Services
Any proposal for Frontier Services to establish an accommodation service in Tennant Creek should not only address an existing unmet need, but should also align with Frontier Services core services and competencies.
A desktop analysis of Frontier Services Tennant Creek operations was undertaken to identify client groups, service types, and service delivery models that complemented existing operations and built on existing competencies.
The desktop analysis was complemented by interviews with staff from Frontier Services.
5.4 Opportunity and Risk Analysis - Tennant Creek Uniting Church
The consultant met with the Tennant Creek Uniting Church congregation and worked through the key priorities outlined in their Property Development Framework.10 This document highlights temporary and emergency accommodation, community opportunities and possible commercial office accommodation options. Whilst a strong commitment to being actively involved in any development the Tennant Creek Uniting Church expressed a keenness to pursue a partnership arrangement which enabled another service to manage any perceived development.
10 Property development Framework – Short story Document – Tennant Creek Uniting Church.
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The consultations with the congregation and the Framework document formed the basis for identifying the Tennant Creek Uniting Church‟s strengths, opportunities and risks.
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6.0 Accommodation
Tennant Creek is on the verge of another major growth period with economic projects coming on line through mining, construction and transport.11 This has had a huge impact on the ability of people to purchase or access rental accommodation and/or motel, camping ground or caravan park accommodation, which prior to the town‟s expansion was consistently available.
In October 2010 the Northern Territory Government released 28 housing lots for public auction on the corner of Peko Road and Hilda Street – 25 lots were zoned for single dwelling and three for multiple dwelling blocks. All were purchased indicating the urgency for accommodation in Tennant Creek.12
Between 15 December 2010 and 15 January 2011 the Wankana Kari Hostel (Aboriginal Hostels) which normally accommodates remote secondary students utilised the vacant 39 places (over the school holidays) to assist with the crisis accommodation needs in Tennant Creek. All beds will be occupied.
These examples reflect the innovative and progressive networking of the community to address current and future accommodations issues.
A list of community service accommodation providers for Tennant Creek is at Attachment B.
6.1 Homelessness
The Northern Territory has the highest rate of homelessness in Australia at 248 per 10,000 people (ABS 2006 Census). This figure is 3.5 times greater than that of Queensland, the jurisdiction with the next highest rate of homelessness at 68.6 per 10,000 people. 13
The Northern Territory Balance has a population of 84,910 and includes Alice Springs (population 23,895), Katherine (population 8191), and Tennant Creek (population 2922). There were 49,902 people in remote communities. As shown in Table 2 the rate of homelessness in the Northern Territory Balance was 272 per 10,000, slightly
11 http://tennantcreek.yourguide.com.au/news/opinion/editorial/general/tennant-creek-on-verge-of-major-growth/1781030.aspx 12 http://newsroom.nt.gov.au/adminmedia/mailouts/7432/attachments/GMcCarthy%20081010%20Tennant%20Creek%20land%20auction.pdf 13 http://www.federalfinancialrelations.gov.au/content/national_partnership_agreements/HO002/implementation_plans/IP_Homelessness_NT.pdf
- 23 - Damien Conley Consultancy March 2011 higher than the Northern Territory average. While homelessness rates vary dramatically across the Northern Territory Balance, from a high of 507 per 10,000 people in Katherine to 147 per 10,000 in Tennant Creek, the rate of homelessness in all locations across the Territory vastly exceeds the Australian average of 53 homeless people per 10 000. 14
Table 2: Number of Homeless People and Rate per 10,000 of the Population, Northern Territory Balance
Tennant Katherine Alice Springs Remote All Creek Number 415 43 446 1,403 2,307 Rate 507 147 187 281 272 Source: Census of Population and Housing 2006; SAAP Collection 2006; National Census of Homeless School Students 2006.
Interestingly, during consultations there was a general perception15 that few Indigenous people in Tennant Creek considered themselves to be homeless and this might be why the number of 43 homeless people appears so low. Members of BRAG suggest that the Indigenous homelessness problem is far greater than the census data suggests because Indigenous people in the Barkly have close family ties in Tennant Creek and therefore can be accommodated with family, extended family or friends which in their view means “they are not homeless”. This can distort accurate data as Indigenous people do not see themselves as homeless if they are staying with friends or family.16
Access to appropriate and affordable housing is an issue for every client group in the Northern Territory. With waiting times for public housing increasing, and rent prices in the private market now beyond the reach of most low -to-moderate income households, the gap in the housing system increases every day forcing more and more vulnerable Territorians into homelessness, or unsafe, overcrowded, or otherwise inappropriate accommodation.17
14 Chamberlain C, MacKenzie D 2009. Counting the homeless 2006: Northern Territory. Canberra: AIHW. 15 Meeting in Tennant Creek between Mr Damien Conley and the Barkly Regional Accommodation Group on 16 November 2010. 16 Meeting in Tennant Creek with the BRAG 17 http://www.ntcoss.org.au/sites/www.ntcoss.org.au/files/Pre-Budget%20Submission%202011-2012.pdf
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6.2 Homelessness Overseas
In 2008 FEANTSA, the European Federation of National Organisations Working with People who are Homeless, wanted to explore the issues at the heart of this divergence of opinion to see what conclusions could be drawn about the importance of housing policies to the fight against homelessness. Housing was therefore chosen as FEANTSA‟s annual European theme for 2008.
A questionnaire was drafted at European level setting out detailed questions on national situations and policies concerning housing and homelessness. This questionnaire was used by members of the FEANTSA network to produce a series of national reports on housing and homelessness. This European report presents the main findings from the national reports of 18 EU countries. It highlights the areas of substantial agreement across Europe as well as setting out areas of disagreement or difference in perception or approach between countries.
The conference found that there are five key structural housing issues which can lead to homelessness:
a) unaffordability of housing - for buying or renting
b) lack of availability of appropriate housing - both in the social and private sectors
c) poor quality of housing - living in which can lead into homelessness or already constitute homelessness
d) overcrowded housing - which again may already constitute homelessness and particularly affects immigrant populations and families with children
e) evictions - which can both reveal previously invisible problems and also trigger new problems.18
Overviews of the findings from individual countries are at Attachment C and interestingly these findings are not dissimilar to the problems confronting Tennant Creek.
18http://www.feantsa.org/files/Housing_Annual_Theme/European_Report/08_European_Report_FEANTSA_Housing_final_EN.pdf
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Importantly the FEANTSA 2008 Report found that “Hostels and emergency shelters can play a role in providing a springboard out of homelessness, however their usefulness is largely determined by the availability of pathways into long-term housing solutions”.19
6.3 Aboriginal and Torres Strait Islander Homelessness
It has been recognised that the definition of homelessness among particular cultural groups, including Aboriginal and Torres Strait Islander people, may need to be widened to include people in 'grossly overcrowded' accommodation, people in 'impoverished dwellings' and people in culturally inappropriate settings.
In 2005 Urbis Keys Young20 consulted extensively with Aboriginal and Torres Strait Islander people - a project which led to a definition of five types of homelessness among these particular cultural groups:
Spiritual homelessness - which may be defined as: 'A separation from traditional land, a separation from family and kinship networks, or a crisis of personal identity wherein one's understanding or knowledge of how one relates to country and Aboriginal identity systems is confused.''21
Overcrowding - a hidden form of homelessness.
Relocation and transient homelessness, which results in temporary, intermittent and cyclical patterns of homelessness.
Escaping from an unsafe or unstable home.
Lack of access to any stable shelter - 'nowhere to go'.
The Urbis Keys Young report emphasises the importance of an approach to these cultural groups that is sensitive to their particular culture and 'outside the legacy of colonialisation'.
Finding 1: It is essential that any proposed service is sensitive to the culture of Aboriginal and Torres Strait Islander people.
19 Ibid 20 http://www.facs.gov.au/sa/housing/pubs/homelessness/Urbis_rpt/Documents/1_current.htm#f_13 21 http://www.facs.gov.au/sa/housing/pubs/homelessness/Urbis_rpt/Documents/1_current.htm#f_14
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Studies of Aboriginal and Torres Strait Islander homelessness have identified a variety of reasons for why people experience either short or long-term homelessness. A report prepared by the Department of Aboriginal and Torres Strait Islander Policy (Qld) in 200222 identified the following key causes of Aboriginal and Torres Strait Islander people sleeping rough in the Mount Isa, Queensland area:
personal or other dislocation (a death, personal or community dispute, severe domestic violence) within their home community that results in a person having, or choosing, to leave their community or dwelling;
staying on after having come to town for medical or legal reasons;
eviction;
a long-term transient lifestyle for a variety of reasons;
short-term homelessness while visiting friends or relatives but having no place to stay; and
a desire to associate with homeless people (some people with secure housing will spend limited periods sleeping rough to maintain associations with friends and relatives that are homeless).
Consultations with stakeholders in Tennant Creek identified that the reasons for homelessness are not dissimilar to Mount Isa.
6.4 Strategic Indigenous Housing Infrastructure Project (SIHIP).
The Strategic Indigenous Housing Infrastructure Project (SIHIP) in Tennant Creek had an allocation of around $36 million allocated to housing and infrastructure works with the aim of improving the town camps (now known as community living areas) and upgrading these to the same standards as other areas of the town.
In December 2010, Remote Housing NT reported that the program will complete all major work in Tennant Creek by the first half of 2011 and to date the rebuild of 70
22 Department of Aboriginal and Torres Strait Islander Policy (Qld), Homeless Peoples’ Project: Mount Isa Report & Blue Print For Action, 2002
- 27 - Damien Conley Consultancy March 2011 houses had already been completed and New Future Alliance would supervise the rebuild of eight additional houses by Julalikari Council Aboriginal Co.23
Consultations on the success of SIHIP on the Tennant Creek community living areas varied initially when the project commenced with stakeholders proposing that there was debate over whether new houses should be built rather than a major refurbishment program. Whilst the SIHIP may not immediately redress the accommodation shortage on community living areas it will relieve some of the overcrowding as there were a number of houses that were unliveable prior to the SIHIP program which can now be occupied.
There is general acknowledgement however that the community living areas program (coordinated by Julalikari Council) has made a real change with curbing, guttering, fencing and lighting making the community living areas looks like newly designed suburbs of Tennant Creek.
6.5 Public Housing
Whilst work is being undertaken on the community living areas in Tennant Creek the broader issues of accommodation in the town are at crisis point. The pace of development particularly the influx of an increasing workforce due to SIHIP, mining, increasing government and non governments sectors and more people from remote communities visiting the town has meant that accommodation options which were previously available such as caravan parks, camping grounds and motels are now fully occupied and unavailable.
As at December 2010 there was a wait list of up to two months for head lessee rentals (available only to Government Employees) and the waiting list for public housing is 2 -5 years, with on average between 100 – 120 people/families waiting to be housed. This figure could be significantly higher with an estimated 25% of the Tennant Creek population under seventeen years of age who are in desperate need of accommodation. Centrelink advise that this group are ineligible for public housing.
Finding 2: There is an accommodation shortage in Tennant Creek.
23 http://tennantcreek.yourguide.com.au/news/local/news/general/more-bad-news-for-sihip/2022397.aspx
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7.0 Demand Findings
Given their considerable experience and exposure to crisis accommodation priorities in Central Australia, particularly the Barkly region, consultations were held at the same time as the BRAG met in Tennant Creek. This enabled individual BRAG members and the advisory group collectively, to provide valuable input into the identification of accommodation needs and the development of accommodation solutions.
The BRAG vision is “Through a holistic approach, to provide all people within the Barkly region safe and affordable, appropriate and accessible accommodation, which meets the diverse needs of the community and to establish pathways that ensure people, have access to adequate shelter and supports services in order to attain self sufficiency".24
A summary of key findings from the consultations is provided at Attachment D.
7.1 Medical Patients
Alice Springs Hospital
The Alice Springs Hospital (ASH) has 189 acute care beds, including 6 psychiatric beds managed by NT Mental Health Services. The hospital manages an off-campus Renal Dialysis Unit and 8 acute care dialysis ports are located in the hospital. The unit also coordinates renal transplantation services.
ASH provides a range of services and employs staff specialists in emergency medicine, level 2 ICU, level 2 SCN, obstetrics, paediatrics, general medicine, renal services, palliative care, rehabilitation, general surgery, orthopaedics, ENT and ophthalmology. Visiting specialists provide neurology, oncology, rheumatology, urology, cardiology, respiratory, gastroenterology, plastic surgery, dermatology, endocrinology and spinal rehabilitation services. Allied health professionals provide rehabilitation, physiotherapy, occupational therapy, speech pathology, social work and dietetic services. Comprehensive diagnostic radiology facilities and pathology services are based on campus.
24 Submission to Aboriginal Hostels Ltd Alice Springs April 2008.
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Sixty percent of patients admitted to ASH are Indigenous. The baseline health status of many Indigenous people, especially those in remote areas, means that the hospital is often dealing with people with complex co morbidities and who present to the service with higher levels of acuity. Statistics indicate that Indigenous patients remain in hospital, on average, longer than non-Indigenous patients and occupy approximately 80% of occupied bed days at any time.
Aboriginal consumers come from the following main language groups and are identified as: Arrente, Warlpiri, Luritja, Warumungu, Anmatjerre, Ngaanyatjarra, and Pitjantjatjarra. Within these groups, 25 different dialects are spoken. English is often a second, third or fourth language and consequently there is a varied degree of understanding and literacy with the English language. A team of Aboriginal Liaison Officers assist with patient management by providing interpreting services and support the social, emotional and cultural needs of Aboriginal patients through provision of cultural brokerage and practical welfare.25
Tennant Creek Hospital
Tennant Creek Hospital services the 7500 residents of the Barkly region extending south to Ali Curung, north to Elliott, west to the Western Australia border and east to the Queensland border.
The Hospital has 20 beds and on average 12 of these are occupied. The Hospital provides 24-hour accident and emergency care (90% of presentations to accident and emergency are alcohol related), outpatients with visiting medical, surgical and paediatrics specialists, review clinic, which covers recall patients, chronic diseases patients and paediatric patients, minor operations, medical, paediatric and minor surgical inpatient services, antenatal, postnatal and emergency midwifery services, renal dialysis, clinical support services (radiography, and pathology) and aero medical retrieval and medevac service.26
25 http://www.nursing.nt.gov.au/IMG/pdf/ASH_Fact_Sheet.pdf 26 http://www.health.nt.gov.au/Hospitals/Tennant_Creek_Hospital/Services/Emergency_Department/index.aspx
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Patient Transport Scheme
Tennant Creek residents whilst supporting their own hospital were critical of the Patients Assistance Travel Scheme (PATS). The PATS assists Northern Territory residents to access a range of essential specialist medical/surgical services where services are not available locally, from within the Northern Territory or from visiting services. PATS provide assistance with travel, and if applicable, accommodation costs to residents of the Northern Territory who are required to travel more than 200kms to the nearest specialist medical treatment.27
There was criticism regarding the travel options to and from Alice Springs and the limited accommodation choices available within the PATS allowance when arriving in Alice Springs. There was also consistent comment relating to a lack of coordination regarding supports in Alice Springs with a number of people advising that being away from family was a major concern for many clients
Finding 3: Cooperation between service providers to ensure a seamless service for clients travelling to and from Alice Springs is a requirement of a new service.
7.1.1 Acute Care
Acute Care is included in this report because it was consistently raised throughout consultations. Clearly all stakeholders would prefer mores services at the Tennant Creek hospital and whilst this is noted, the aim of this report is to propose opportunities which may mean that some people return earlier to Tennant Creek rather than languishing in Alice Springs.
It is certainly not the intention of any proposed new service model to have an acute focus.
7.1.2 Short-term Patient Accommodation Facility
Barkly residents requiring medical services that are not available in Tennant Creek are referred to Alice Springs Hospital by inter hospital transfers though air ambulance or the Patient Assistance Travel Scheme (PATS).
27 http://www.health.nt.gov.au/Hospitals/Patient_Assistance_Travel_Scheme/index.aspx
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In 2009 the Northern Territory Council of Social Services (NTCOSS) conducted forums in Alice Springs, Tennant Creek and Katherine on regional transport. The resulting report provided an overview of the issues people confront28. Interestingly the report identified Tennant Creek as a location with a range of unresolved issues. More recently NTCOSS in their report to the Northern Territory Government identified that the absence of effective public transport in remote NT and the crisis in affordable accommodation combined make it very difficult for people living in the bush to gain access to medical treatment.29
Transport was an ongoing issue during consultations and tended to revolve around coordination, appropriateness, length of journey, lack of supports and costs.
Whilst transport for patients was consistently raised as an issue it would appear that some improvements are now in place with the introduction of the Centre bush bus Service to Alice Springs and return. The bush bus to Alice Springs now leaves at a reasonable time, compared to the previous option of the interstate bus service which passes through Tennant Creek in the middle of the night, leaving passengers stranded in an unsafe environment. It should be noted however that whilst the bush bus takes five hours to reach Alice Springs on three days, the other three days it does leave the highway to pick up community people, which extends the length of the journey.
The overall transport issue was presented to the Northern Territory Government by the Northern Territory Council of Social Services (NTCOSS) in their 2011-2012 pre budget submission:
“More funding is urgently required for transport for remote community residents, both between communities and major centres, and within regional centres. While there has been an increase in the bush bus service between Tennant Creek and Alice Springs, one service stops only on the side of road at community turnoffs, and the other bus takes nine hours. Locations like Epenarra and Canteen Creek still have no service. Residents of Tennant Creek using the other commercial service must wait in a roadhouse for the 3am bus
28 NTCOSS Regional Transport Forums Summary of 2009 Forums held in Alice Springs, Tennant Creek and Katherine. 29 http://www.ntcoss.org.au/sites/www.ntcoss.org.au/files/Pre-Budget%20Submission%202011-2012.pdf
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to depart. The return service arrives back at 2am at a pizza shop, where there are no toilets or public phones, creating obvious safety concerns.30
The Ghan train service is also available but expensive. Alternatively patients may elect to drive to Alice Springs and receive mileage allowance, but a number of people implied that the mileage allowance did not cover costs.
In November 2010 the Australian Government through the Remote Air Services Subsidy Scheme (RASS) approved a new air service for Tennant Creek and is seeking a commercial air operator to tender for the service. The service will provide residents with essential access to health and other professional services. It will also provide access for professionals providing services to communities. It is expected that the operator will commence during the first quarter of 2011 with a passenger capacity of up to nine.31
Frontier Services/Tennant Creek Uniting Church (the sponsor) would be able to offer clients accessing their programs access to a seamless coordinated transport program within Tennant Creek town and with the sponsor having services in Alice Springs there is the capacity to coordinate return travel.
Finding 4: Short-term Patient Accommodation needs to be coordinated from admission in Tennant Creek through to discharge from AHS and return to Tennant Creek.
7.1.3 Renal Services
The rate of death from chronic kidney disease among Aboriginal and Torres Strait Islander people is approximately nine times the total Australian rate.32
In the Barkly region of the Northern Territory standardised end-stage renal disease (ESRD) incidence among Indigenous Australians is up to 30 times the national incidence for all Australians33. The number of dialysis treatments in the NT is
30 Ibid 31 http://www.minister.infrastructure.gov.au/ck/releases/2010/November/CK005_2010.htm 32 Cass A, Cunningham J, Wang Z & Hoy W Regional variations in the incidence of end-stage renal disease in Indigenous Australians, MJA, 2001: 175: 24-27 33 Cass A, Cunningham J, Wang Z & Hoy W Regional variations in the incidence of end-stage renal disease
- 33 - Damien Conley Consultancy March 2011 doubling every two years34 and the rate of hospitalisations for regular dialysis increased by 58 per cent in the Territory from 2000-01 to 2007-08.
As shown in Figure 1 between 2000-01 and 2007-08 the rate of hospitalisations for regular dialysis and the rate of other hospitalisations where chronic kidney disease was the principal diagnosis both increased faster than the Australian rate.
Figure 1: Ratio of Northern Territory to Australian rates of chronic kidney disease hospitalisation by type of diagnosis(a), 2000-01 and 2007-08
(a) For the purposes of the AIHW report chronic kidney disease (CKD) hospitalisations have been split into three groups – regular dialysis, other hospitalisations where CKD was the principal diagnosis, and hospitalisations where CKD was an additional diagnosis. Source: AIHW Cat No. PHE 127
In 2007-08 the Territory had the highest rate of hospitalisations for regular dialysis of all jurisdictions at 21,806 per 100 000 population, which is approximately five times the national rate of 4445 per 100 000 population.35
The Territory had the largest increase in hospitalisation rates for regular dialysis of all jurisdictions from 13,702 per 100,000 population in 2000-01 to 21,806 in 2007-08.
The Tristate Agreement of March 2010 „Responding to renal growth in Central Australia‟ estimates that 40 new patients will commence therapy each year in Alice
in Indigenous Australians, MJA, 2001: 175: 24-27
34 http://www.eniar.org/pdf/2_population_profile.pdf 35 http://www.nt.gov.au/ntt/economics/publications/social_briefs/soc_ind_sept10.pdf
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Springs with a net increase of 20 patients annually. This projection has been based on historical data and includes patients originating from cross border regions.36
The Clinical Nurse Manager Flynn Drive Renal Unit, Alice Springs, advised that when the Nephrocare Dialysis Unit on Gap Road commenced in May 2010 providing dialysis services for an additional 48 patients per week, Alice Springs dialysis services now supported 160 patients per week.37
Impact on the Barkly
Barkly renal unit currently has 8 chairs with capital works well underway to provide additional services for another eight chairs. With the eight new chairs in operation later in 2011 the number of clients per week will double to sixty four. Accommodation for the additional 32 dialysis clients will be an issue in 2011. NT Department of Health and Families staff advised that separate and secure accommodation is essential as it provides a clean, safe environment and one which could store medications. Further, safe and secure accommodation in a flexible service facility provides the real option for nutritional food opposed to what may be limited cooking facilities in current accommodation.
NT Department of Health and Families staff also advised that there are up to 10 Barkly residents receiving renal dialysis treatment in Alice Springs. Most of these clients are likely to be from remote communities in the Barkly and not necessarily Tennant Creek residents who will therefore need accommodation when they return to Tennant Creek. It is anticipated that this client group will place additional pressure on accommodation options when they are relocated to Tennant Creek when the extensions to the renal unit are completed.
Accommodation for all of the 32 new clients when the 8 new chairs are operational was unclear, although the NT Department of Health advise that they have applied for capital funding for 12 accommodation units to be built at the Tennant Creek Hospital under Round 3 of the Commonwealth Health & Hospitals Funds program. Stakeholders were unsure who the new units would accommodate.
36 http://www.papertracker.com.au/pdfs/Tri_State.pdf 37 Discussions with Consultant Damien Conley November 2010.
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Finding 5: The increase in dialysis treatment in the Barkly will require additional accommodation.
7.1.4 Transition care
A consistent need identified through consultations was for a transition care program enabling people who are returning from Alice Springs (and/or South Australia) after an episode of care. These people may originate from Tennant Creek or communities such as Epenarra, Canteen Creek, Elliott, Brunette Downs, Ali Curung, Murray Downs, Mulunja, McLaren Street Station, Kurraya Homelands, Camooweal (Qld) and Borroloola.
Principally there would be demonstrated benefits through an early intervention program at the Alice Springs Hospital enabling people to return home to Tennant Creek and be close to country and family and at the same time undergo a coordinated transitional care program in a safe and secure facility. 38
Stakeholders proposed that a number of Barkly people would benefit from an early discharge program in a familiar environment with the support of a coordinated care plan where they could return to their community rather than occupying an acute bed in Alice Springs.39
Alice Springs health staff agreed, supporting a coordinated transition care program located in Tennant Creek as this would significantly reduce the pressure on the ASH as often patients from outside of Tennant Creek who are unable to manage on their own are required to stay in the ASH for longer periods than necessary.
It was also highlighted that on occasion‟s patients from the Barkly self discharge and do not receive the appropriate supports in their community which can lead to readmissions to acute care.
If a transition care facility was available in Tennant Creek people could be discharged earlier with a coordinated discharge and rehabilitation plan to be provided in a new facility in Tennant Creek.
38 Discussions with Manager Residential Care Frontier Services NT and stakeholder input. 39 Ibid
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It is extremely difficult to suggest discharging patients is a financial saving to any acute facility as in most cases the bed is immediately filled. Approximating all the known costs and from discussions with the Acute Care Information Unit from the NT Department of Health and Families an estimated cost per bed could be in the vicinity of $1700 in the ASH. This estimate excludes all ancillary costs which would increase the figure to approximately $4133/day.40 The Productivity Commission estimates that an aged care bed cost around $100/day and the former Federal Minister for Ageing, Justine Elliott advised in 2008 that “It costs almost 11 times as much to provide a hospital bed than it does to provide an aged care place.”41
Clearly the costs of transition care compared to acute care are significantly less. The overarching benefit however is that a person has the opportunity to access a rehabilitation program in their own country. As has been demonstrated in other transition care programs in the Territory people who have a structured and culturally appropriate care plan are rarely readmitted to acute care. For the acute facility it enables a bed to be „freed up‟ for a client who may have greater health needs.
Frontier Services are acknowledged in the Northern Territory as the leaders in the provision of transition care programs with 16 residential transition care places across the Territory in their facilities in Darwin, Katherine and Alice Springs. Based on average occupancy rates across the Territory estimates suggest that as many as 190 people could be discharged from Alice Springs Hospital to undergo a rehabilitation support program in Tennant Creek. This estimate would provide transition care to a broader range of people and would not necessarily restrict admission to eligible aged care clients.
Finding 6: Transition care in Tennant Creek is a high priority for Barkly residents.
40 Discussions with Analyst Acute Care Information Unit RDH 41 http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr08-je-je023.htm
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7.2 Aged Care
Services for older people in the Barkly extend over a large geographical area with remote communities being managed by the Barkly Shire Council and town services by either Julalikari Council or Frontier Services.
Table 3: Barkly Aged Care Services42
Service Provider Location Aged Care service Places Residential 17 high and 2 PulkaPulkka Kari Tennant Creek respite Frontier Services 6 CACP‟s and HACC Tennant Creek Community Care Barkly Julalikari Council Tennant Creek 12 CACP‟s and HACC Ali Curung Aged Care Ali Curung 9 CACP‟s and HACC Frontier Services Ali Curung Respite service Community Care Barkly Elliott Aged Care Service Elliott 6 CACP‟s and HACC Alpurrurular Aged Care Lake Nash 10 CACP‟s and HACC 320 km North East of Alice Ampilatwatja 5 CACP‟s and HACC Springs 270km northeast of Alice Urapurtja 10 CACP‟s and HACC Springs - Utopia Ali Curung provides some No CACP‟s Murray Downs services (Meals) Note: there are no Extended Aged Care at Home (EACH) packages which are not unusual for remote communities, however it is a program that could be pursued as it provides higher level supports to older people enabling people to remain at home.
Stakeholders were also concerned that there were a number of older people on remote communities who may be eligible for a range of aged care services but as yet may not have been assessed by Aged Care Assessment Team (ACAT). Discussions with Remote ACAT Alice Springs advised that plans were in place to increase the frequency of assessments.
Respite care was consistently raised as a priority for older people and younger people with disabilities.
42 Source - Remote ACAT Alice Springs
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A consistent service gap was the need for independent living accommodation units providing safe accommodation for older Indigenous people who are not eligible for residential care. This group of older Indigenous people are not necessarily frail which means they are ineligible for a high or low care residential place but they urgently require secure and safe accommodation with quality care and supports to maintain an independent lifestyle. “The Road Home, A National Approach to Reducing Homelessness” report consistently highlighted the need for accommodation for older people who are homeless as a priority43 and in the Australian Newspaper 8 January 2011, a spokesperson for Acting Indigenous Affairs Minister Mark Arbid said the Little Children are Sacred Report recommended flexible accommodation options including accommodation for single and older people “It says this would help overcrowding in family homes”.44
Finding 7: There is an urgent need for independent living accommodation for older people.
Finding 8: An assessment of aged care needs in the Barkly would inform future accommodation needs.
7.3 Indigenous Mothers’ Facilities
With no Indigenous Mothers‟ Facilities in Tennant Creek the difficulties confronting expectant mothers is daunting. Arranging transport and accommodation in Alice Springs pre and post natal can be very costly if people are paying commercial rates, even after the PATS subsidy is taken into account.45 Adding to this is the uncertainty of what accommodation options are available and the likelihood that young women may often be alone without family supports.
It was noted however that the support from Anyinginyi Congress Aboriginal Corporation and NT Department of Health & Families in the Barkly was of the highest
43 http://www.fahcsia.gov.au/sa/housing/progserv/homelessness/whitepaper/Documents/the_road_home.pdf 44 Weekend Australian 8 January 2011 45 http://www.ntcoss.org.au/sites/www.ntcoss.org.au/files/Pre-Budget%20Submission%202011-2012.pdf
- 39 - Damien Conley Consultancy March 2011 level for expecting mothers and some mothers with new babies but there was an urgent need for improved supports for new mothers returning to the Barkly.
In 2007 Rosalind Beadle in her research project „Improving Life Chances: Investigating the Accessibility and Appropriateness of Services for Young Aboriginal Mothers in Tennant Creek‟ reported that young mothers consistently raised concerns about travelling to Alice Springs to give birth to their babies.46
Figure 2 demonstrates that nearly 50 per cent of Aboriginal females residing in Tennant Creek in the age group 15-25 years have children. This is far greater than the 19 per cent of non-Aboriginal women in Tennant Creek who have children.47 It should be noted however that the ABS Census only records motherhood for women 15 years and over.
Figure 2: Percentage of 15 – 24 year of girls in Tennant Creek with children
Indigenous Non-Indigenous
46 http://www.nt.gov.au/health/youth_affairs/pdf/Round%20Table/2007/round_table_2007_young_mums.pdf 47 http://www.nt.gov.au/health/youth_affairs/pdf/Round%20Table/2007/round_table_2007_young_mums.pdf
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Table 4: Maternal age, by Indigenous status and district of usual residence, NT mothers, 2005
As shown in Table 4 during 2005 one-third of Indigenous mothers in the Barkly region of the Northern Territory were under 20 years of age when they gave birth.48
This data demonstrates that the teenage birth rates for the Barkly region are substantially high compared with other areas in the Territory and consultations indicated significant support for the provision of pre and post natal support and education for young mothers.
The consultations supported these findings and the need to urgently explore opportunities for improved supports for expecting and new mothers when they travel to and return from Alice Springs to Tennant Creek. These related to the discharge and planning for the mother and child, the return trip to Tennant Creek or a Barkly community and the overall supports in some communities to support mother and baby. Postnatal care and related services are urgently required as not all mothers
48 http://digitallibrary.health.nt.gov.au/dspace/bitstream/10137/259/1/M%26B%202005_v9%20c.pdf
- 41 - Damien Conley Consultancy March 2011 are able to take their babies back to their communities and families for some time after the new child is born.49 There was a consistent view that there is a significant gap in the education for new mothers and a placement in a flexible service facility with dedicated supports would benefit both mothers and babies.50
Finding 9: A flexible Indigenous Mothers Accommodation Program is a high priority for the Barkly
7.4 Transition from Emergency Accommodation
The Tennant Creek Womens Refuge (TCWR) and Barkly Region Alcohol and Drug Abuse Advisory Group Inc (BRADAAG) both provide extremely professional services with the management team and staff of each committed to excellence and innovation in service delivery. Whilst in most instances demand outweighs capacity each service has demonstrated high level skills in creativity and flexibility in meeting the needs of all clients.
BRADAAG in particular has a range of service types for their client group and due to the specialist nature of their care these clients may not be suitable for a transition program provided through a flexible service facility.
Finding 10: Emergency accommodation for the substance misuse program to be excluded from a new proposal as people with alcohol and drug dependencies require a more specialised service model than what is proposed in this report.
The TCWR however could develop a progressive transitional program for their long term clients to gradually return to the community through a placement in a new facility not dissimilar to the concept of the BRADAAG Units (Blain Street). This transition option would „free up‟ places at the TCWR allowing new clients in crisis access to the refuge.
The Tenant Creek Womens Refuge are extremely keen to progress a partnership opportunity with a new accommodation facility.
49 http://www.ahl.gov.au/pdf/Annual_Report/813309%20Annual%20Report%20Text.pdf 50 Meeting and telephone discussion with in Tennant Creek health staff and non government service providers.
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It was also proposed that there may be opportunities for transitional clients from the TCWR to assist in the delivery of programs at the new facility. This will require further discussion.
Finding 11: Opportunities for partnerships with clients from the Womens Refuge in a new proposal
7.5 Youth Accommodation
The Julalikari Youth Development Unit Crisis Accommodation (YDUCA) which offers a structured safe environment with 24 hour supports has 12 residential beds for young Indigenous people aged between 12- 17. Accommodation is provided in two houses (female and male) set aside in Mulga Camp. The program is designed to offer transitional accommodation to young people to improve school attendance, enhance training opportunities, remain engaged with family and attain the necessary life skills.51
The service was not operating during the consultations but this was only a temporary arrangement (school holidays), with an anticipated recommencement in January 2011.
Stakeholders proposed that the youth population in the region was 25% for <17 years of age and any new proposal should consider the option of providing emergency accommodation for younger town people in the event that the Julalikari YDUCA is fully occupied.
Finding 12: There is a shortage of Youth accommodation in Tennant Creek.
51 http://www.federalfinancialrelations.gov.au/content/national_partnership_agreements/HO002/implementation_plans/IP_Homelessness_NT.pdf
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8.0 Service Model Findings
8.1 Service Type
The Tennant Creek community emphasised the need to develop a model that did not focus on the one service type and which had the flexibility and versatility to meet a range of needs as they arise.
There was also a strong view that because of the remoteness of the Barkly and the competitive nature of Commonwealth and Territory funding that a flexible model that provided supports to an identified group of people, at risk, in a safe and secure environment would quickly address some of the immediate accommodation needs.
The BRAG delegates, who attended the Northern Territory 2010 Homeless Summit in Darwin in November, advised that there was a „push‟ by delegates for governments to be more flexible and move away from silo funding. (Silo funding is normally defined as funding that is allocated to a specific purpose with strict conditions regarding expenditure).
Stakeholders in the Barkly were consistent in the view of the need for a new approach to government funding where funding is pooled (not unlike a Multi Purpose Service (MPS) model) would remove stringent programmatic requirements enabling greater flexibility and opportunities to resolve immediate crisis accommodation issues as they arise. Since 2007/08 when the Rudd Government abolished the Special Purpose Payments Program to improve the delivery of real and improved services for all Australians52 the opportunities for greater flexibility have been realised.
With greater funding flexibility applied to this model in the event where there were vacant respite beds in the new facility and emergency accommodation was required for a person in transit to ASH, this bed could be occupied by that person. Current funding agreements can tend to clearly stipulate that funded beds can only be filled in accordance with the criteria stipulated by the approved provider.
A revised variable approach would provide immediate solutions to emerging problems, particularly in remote localities, allowing the service provider to provide crisis accommodation to individuals as the need arises.
52 http://www.theaustralian.com.au/news/nation/rudd-ties-funds-to-results/story-e6frg6nf-1111115162180
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The Department of Family Housing Community Services and Indigenous Affairs (FaHCSIA) Flexible funding pool for Remote Service Delivery ($46 million over 3 years) allows Government to respond flexibly and quickly to projects that are identified as high priority by community members, reducing red tape and bureaucratic delays. 53
Whilst Tennant Creek is not one of the 29 remote Indigenous communities eligible for funding under the Federal Governments Remote Service Delivery Flexible Funding Pool, if the same flexibility of this program was applied to this project on a trial recurrent basis for the new crisis accommodation in Tennant Creek immediate gains would be realised.
The Council of Australian Governments (COAG) set the following six high level aims for reform of government funded services:
Targeting of existing and future investments in housing, homelessness, education, employment, health and early childhood services to address Indigenous disadvantage in urban and regional areas.
Improved access by Indigenous people to better coordinated and targeted services.
Local need/place-based approaches enabling initiatives to be delivered in a manner appropriate to needs in a particular location.
Strengthened Indigenous capacity, engagement and participation to promote a strong and positive view of Indigenous identity and culture and strengthening individual, family and community wellbeing and capacity as a necessary impetus to improved access to, and take-up of, services.
More effective program accountability and sustainability, with governments required to enhance statistical collection services and other information sources to improve the detail and accuracy of reporting on outcomes.
53 http://www.jennymacklin.fahcsia.gov.au/mediareleases/2010/Pages/jm_flexible_funding_pool_11february2010.aspx
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COAG monitoring progress in utilising Indigenous-specific and mainstream National Partnerships (NPs) to improve outcomes in urban and regional locations54
All six of the COAG priorities support a flexible and versatile funding formula for remote communities.
Finding 13: A flexible and versatile service is best suited to the needs of Tennant Creek.
8.2 Opportunity and Risk Analysis - Frontier Services
Frontier Services manages a 19 place residential care facility known as Pulkapulkka Kari which provides 17 high care places and two respite places, six Community Aged Care Places, a Home & Community Care program for 17 clients and a day respite service funded under the National Respite for Carers program for 6 clients. These services are provided on the site known as Lot 1012 on Peko Road.
Finding 14: Frontier Services has expertise in the delivery of a broad range of client focused residential and community care services in Tennant Creek.
A key success measure for the project is the ability to work with clients to develop options post placement (see 4.2)
Finding 15: Frontier Services is acknowledged nationally for its ability to develop coordinated outcomes for clients.
As shown in Figure 3, Frontier Services has significant vacant land adjacent to Pulkapulkka Kari at Lot 1012, Peko Road to develop a new facility which could complement the existing aged care service and provide a viable accommodation option.
54 http://www.ahuri.edu.au/publications/p70569/
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Figure 3: Lot 1012, Peko Road, Tennant Creek
Finding 16: The availability of land adjacent to the existing residential aged care facility provides an opportunity to establish a residential service that leverages off the aged care facility’s existing nursing, catering, and ancillary operations.
8.3 Opportunity and Risk Analysis - Tennant Creek Uniting Church
Tennant Creek Uniting Church has vacant land in the town‟s main street, Paterson Street as shown in figure 4. Some stakeholders expressed concern regarding the location of this site and it was suggested that the location may attract unnecessary attention from passing pedestrians and also that any residential facility, particularly if accommodating older people, might be at risk in the main street from the volume of vehicular traffic.
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There was however, interest in a „one stop shop; referral agency in partnership with an existing service provider which would offer the opportunity for people seeking a range of services to have a coordinated referral service from the Patterson Street site. This facility would create an opportunity for the community to interact and relax – and provide a referral service to coordinate the plethora of service that are available in the community but require a range of referrals and meetings to navigate. It was also proposed that as a quiet venue it could be used for basic health checks, education, counselling and other community/health requirements.
Figure 4: Lot 181, Patterson St, Tennant Creek
The attraction of this development is that it could provide a „place‟ central to town to relax and congregate in a secure friendly location with landscaped (gardens, shade, leafy areas, benches) modelled on a joint cultural theme from the community and the Mission of the Tennant Creek Uniting Church.
There are a number of community examples where this model has been applied. For example, at the City of Armadale Champion Centre in Perth Western Australia a
- 48 - Damien Conley Consultancy March 2011 range of information seminars, community gatherings and supports are provided in a „one stop shop‟ in the town centre for Indigenous people which ultimately reduces duplication and due to public transport issues enables people to have a range of issues resolved at the location. Further, the Boorowa Multi-purpose Service in the southern slopes of NSW developed as part of their multipurpose service a „serenity garden‟ with sustainable native plants, paths and other facilities in the grounds to allow the community to enjoy the garden as well as maintain community contacts. The model of a peaceful secure environment for proactive community engagement auspiced by a local provider in partnership with the TCUC was strongly supported.
Finding 17: The availability of land adjacent to the Tennant Creek Uniting Church does provide opportunities to progress a ‘one stop shop’ referral service in partnership with an existing agency.
A secondary and important option on the Uniting Church Paterson Street site would be too undertake further assessment of the development of a section of the site to accommodate visiting community and health workers from either the government or non government sectors.
Finding 18: The provision of on-site accommodation for visiting community services workers is a priority
8.4 Analysis of Community Capacity
Consultations with the Tennant Creek community members found a cohesive vibrant community committed to discussing a range of options that might provide a resolution to the accommodation challenges in the community.
The consultant was also encouraged by the commitment of BRAG delegates to work collaboratively to address evolving issues.
A number of stakeholders were of the view that the auspicing body (service provider) would benefit from cultural and service delivery advice and support. Given the expertise across the Barkly an overarching steering committee including experts from the community, government and non-government would enhance the design and development of the service.
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Finding 19: An overarching steering committee comprising key community, government and non-government representatives would enhance the service by providing advice and support to the provider
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9.0 Flexible Service Models
9.1 Tennant Creek Flexible Service Model (TCFSM)
A model based on a pooled funding concept would be a workable option for a new accommodation service in Tennant Creek providing „funders‟ (government agencies) were prepared to have individual programs cashed out and targeted to the priority accommodation needs of the community as they arose. The FaHCSIA Flexible funding pool for Remote Service Delivery and the DoHA Multi Purpose Service (MPS) model both provide examples of flexible and innovative programs of which some components could be adapted to address the crisis accommodation needs in Tennant Creek.
The premise for Tennant Creek the model is the ability to use the allocated places as needs arise not to have vacant beds due to programmatic restrictions.
Section 10.0 provides opportunities from where funds might be sourced for the Flexible Service Model based on existing programs.
9.2 The Multi Purpose Service (MPS)
The MPS program has been in existence since the early nineties and there are now 126 MPS sites Australia wide (the NT has one site at Nhulunbuy). The concept was developed to make health and aged care services sustainable in regional communities where hospitals were not viable.
The Multi Purpose Service (MPS) model involves the pooling of Commonwealth and State health and aged care funds within regional areas, and the use of these funds enables flexibility across all health and aged care programs providing opportunities to address community needs as they arise.
Some of the advantages the MPS model can offer to small communities include:
The ability to be innovative in service delivery by removing existing rigid program guidelines e.g. meals can be provided from one site, hospital nurses can take on community and domiciliary roles, hospital gardeners can also provide home gardening support for the elderly.
The opportunity for small communities to access Commonwealth funds to meet aged care needs in small communities.
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The opportunity to attract and retain staff by offering them flexible and multi-faceted roles.55
The greatest attraction of the MPS is that the program is community driven there is the ability to be innovative in service design and delivery and the ability to pool funds, design and deliver flexible services, and forge strong local relationships is paramount. Further, in the evaluation undertaken in 2009 a consistent finding was that the MPS program has strong management and flexible staffing arrangements that build competence, commitment, multi skilling, mobility, address career development pathways and provide a supportive environment to guide and manage change.56
Whilst the MPS model is flexible it still has relatively strict controls and reporting requirements to funders and in some jurisdictions the State and Territory Governments maintain an overarching governance role. This is not the preferred option for the TCFSM.
9.3 Flexible funding pool for Remote Service Delivery
The FaHCSIA Flexible funding pool for Remote Service Delivery identified 29 locations across all jurisdictions using the investment principles set out in the schedules to the Remote Service Delivery National Partnership Agreement. This will mean that the Government can respond flexibly and quickly to high priority needs that are identified by community members, reducing red tape and bureaucratic delays.57
Communities were selected based on factors including:
significant concentration of population
anticipated demographic trends and pressures
potential for economic development and employment
pre-existing shortfalls in government investment in infrastructure and services
55 http://www.wacountry.health.wa.gov.au/default.asp?documentid=406 56 http://www.aushealthcare.com.au/documents/publications/173/MultiPurposeServices.pdf 57http://www.fahcsia.gov.au/about/publicationsarticles/corp/BudgetPAES/budget10_11/Documents/indig_factsheets_funding_pool.htm
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potential to build on other significant investment already in progress or on community-based initiatives.58
According to Macroeconomics59 the program will:
improve working relationships between Australian Government departments and service providers so that programs can be better tailored to individual community needs
better alignment between community needs and Government funded programs
more streamlined reporting requirements and better feedback on performance for service providers
clears and more consistent information from government departments60
This model sits well with this project, however, discussions with FaHCSIA Central Office staff advised that whilst funding is pooled between three Commonwealth agencies the funding is one off and not recurrent. Commonwealth officers did suggest that joint discussions with relevant agencies for a new initiative such as pooled funding for this project may lead to flexible funding agreements.
Finding 20: Stakeholders are keen to progress discussion with government to develop a pooled funding model.
9.4 Flexible Learning and Development
Ninety per cent of all residents of the Frontier Services Pulkapulkka Kari residential care facility are Indigenous. Recognising the need for qualified Indigenous staff special funding was sort in 2006 for remote training enabling Frontier Services and Alzheimer‟s Australia NT to provide Certificate 3 in Aged Care Work for the staff at Pulkapulkka Kari.61
58 Ibid 59 http://generationone.org.au/uploads/assets/Macroeconomics-Indigenous-Budget-bulletin-July-2010.pdf 60 http://www.finance.gov.au/oea/docs/ESDRIC.pdf 61http://nrha.ruralhealth.org.au/cms/uploads/publications/pl%2031%20final%20oct2007.pdf
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Given the success of this program a Bachelor of Nursing course was developed with the Northern Territory Department of Health & Community Services, Batchelor Institute of Indigenous Tertiary Education and Frontier Services. Ten staff began the course with lecturers initially travelling from Darwin to Tennant Creek until a full time lecturer was appointed to reside in Tennant Creek for the duration of the three year course. A total of twelve RN‟s and EN‟s graduated.
The benefit of having an innovative and flexible Tennant Creek accommodation service adjacent to Pulkapulkka Kari provides the opportunity for staff to work with a range of different clients with varying needs including : aged and community care, young mothers, medical transition clients, renal patients and younger people all of which provide a plethora of career challenges and opportunities for development pathways enabling staff to extend their skills across a range of health and community related skills.
Finding 21: The new flexible accommodation facility will provide an opportunity for staff to be multi skilled and access training opportunities across a range of health and community services.
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10.0 Government Priorities
10.1 Health Care
The Health Care section provides examples of existing programs that are funded by governments in the following priorities for Tennant Creek:
short-term patient accommodation
renal services
transition care
10.1.1 Short-term Patient Accommodation Facility
In a joint media release62 on 23 September 2010 Federal and Territory Ministers announced funding to establish a short-term patient accommodation facility at the campus of the Royal Darwin Hospital (RDH).
The Australian Government provided $22.7 million in funding, while the NT Government has provided a $3.4 million in-kind contribution of the land, to fund the Darwin Indigenous mothers‟ facility and a 50-unit accommodation complex providing short term accommodation for people from rural and remote areas who require extended treatment at RDH.
The Hon Mr Vatskalis (Northern Territory Minister for Health) said, “The hostels will give patients adequate time to fully recover from hospitalisation before returning home to the community with ready access to medical care if needed.”
He said, “The hostel will assist improvements in hospital performance by freeing up hospital beds for acute patients.”
The Australian Government‟s contribution to the 50-unit complex was funded through the $3.2 billion Health and Hospitals Fund. The purpose of the Health and Hospital Fund is to boost the economy by creating new jobs while supporting long- term improvements to the health and hospital system.
Similarly the Tennant Creek project is viewed by all stakeholders as a high priority given that people travelling to and from Alice Springs can often be stranded without
62 http://www.jennymacklin.fahcsia.gov.au/mediareleases/2010/Pages/jm_m_royaldarwin_23_sept_2010.aspx
- 55 - Damien Conley Consultancy March 2011 accommodation either waiting for transport to Alice Springs or returning to Barkly communities. The need for secure and safe accommodation for residents of the Barkly was highlighted by NTCOSS in their 2011-2012 Pre Budget submission to the NT Government.63
Whilst the NT Department of Health and Community Services currently funds two full time beds at the Sid Ross Hostel in Alice Springs for Barkly patients64 there is no reciprocal accommodation in Tennant Creek. Accommodation and coordinated transport to and from Tennant Creek were highlighted as one of the highest priority.
Frontier Services have demonstrated across Australia in all their services to rural and remote Australians their ability to adapt service provision in the provision of vital services for people whose health care needs go beyond what can be provided in their home communities, and for their families. The Tennant Creek Flexible Service Model will enable out-of-town families to accompany their children and other family members when travel to Tennant Creek is necessary.
Frontier Services could offer clients receiving an accommodation program access to a seamless coordinated transport program within Tennant Creek town and with the sponsor also having services in Alice Springs capacity exists to coordinate admissions, discharges and travel arrangements to and from ASH.
Finding 22: The Australian and Northern Territory Governments have shown a willingness to support short term accommodation.
10.1.2 Renal Services
One of the consistent messages from renal professionals is the need for safe and secure accommodation but with the opportunity to still connect with country. A family member of a Yuendumu dialysis patient was quoted as saying that "They need someone to check on them and look after them in Alice Springs - take them on a picnic, cook up some meat." 65 This is a key activity which Frontier Services currently provide to their respite, community and residential clients and which could be
63 http://www.ntcoss.org.au/sites/www.ntcoss.org.au/files/Pre-Budget%20Submission%202011-2012.pdf 64 http://www.ahl.gov.au/pdf/Annual_Report/813309%20Annual%20Report%20Text.pdf 65 http://www.clc.org.au/Media/publications/community%20development/FINAL_2009_CLC_CD_newsletter.pdf
- 56 - Damien Conley Consultancy March 2011 expanded for any renal dialysis clients in a new facility in Tennant Creek. Further, the expertise that Frontier Services have at Pulkapulkka Kari particularly in care and other services, including meal preparation for their residential and community clients would enable the renal clients to access appropriate food and nutrition to meet their dietary requirements.
The Aboriginal Hostels‟ Topsy Smith facility in Alice Springs currently provides accommodation for 40 renal patients, a number of whom are from the Barkly. Currently a dedicated facility in Tennant Creek specifically for renal clients would not be viable therefore discussions should occur with FaHCSIA (the funder for Aboriginal Hostels) to support an agreed number of beds for renal patients in a flexible service facility in Tennant Creek.
Finding 23: Urgent need for accommodation in Tennant Creek for renal patients and FaHCSIA have funded renal beds in a number of Aboriginal Hostel sites across Australia.
10.1.3 Transition Care – Homelessness Services
In South Australian the Transition Beds Project66 was established in 2006 after it was identified that 44 of the 100 most frequent presenters to the Royal Adelaide Hospital Emergency Department were homeless; these people presented on average 16 times per year. Funding was provided for four transition beds in the community offering different levels of support to ensure that homeless people attending the Emergency Department were not discharged to the streets. The purpose of the project was to:
Provide short term specialised service for homeless people who are too sick to discharge to streets but not sick enough to be admitted.
Provide a safe, secure environment to address issues of homelessness as well as health and wellbeing of clients.
Provide an opportunity for human services to work collaboratively to improve the service delivery to people experiencing homelessness.
66 Lewis, M. 2010 Transition Beds for Homeless People Presenting to Emergency Department, presentation at the 6th National Homelessness Conference, 2 September 2010, Brisbane, Australia.
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The program provided up to a two-week stay in a Transition Bed for homeless males or females aged 18 years or older requiring accommodation to avoid hospital admission. Clients had to be medically and psychiatrically stable as well as capable of performing Activities of Daily Living (ADLs). Clients were also required to sign a Client Consent Release and Access Information form and agree to be case management by S2H (Street to Home).
However, clients meeting the eligibility criteria were excluded from the service if they required medical or psychiatric admission, were unable to abstain from alcohol or illicit drugs, or would not comply with their care instructions.
Key aspects of the service included the development of referral pathways, case management plans focused on health, housing & identified needs and the successful resolution of acute conditions and stabilisation of chronic conditions. Linking clients to additional services such as substance abuse services, community mental health services, primary care providers and local boarding houses facilitated the transition to more permanent tenure for many clients.
Over a 15-month period 31 clients were placed with an average length of stay of 13.9 days. After 12 months 16 clients hadn‟t re-presented to the emergency department and three clients had re-presented only once. Of the original 31 clients, after two years six clients had never represented and another eight clients had represented, but less frequently than before the project. Given the poorer health of homeless people generally, and the frequency of emergency department presentations in this cohort in particular, any intervention that reduced the longer-term need for emergency medical treatment in nearly half the client group must be viewed as a success.
Finding 24: The Australian Government has shown a willingness to fund transitional accommodation services for homeless people that provide integrated case management to reduce the longer-term need for more expensive medical assistance.
10.1.4 Transition Care – Aged Services
DoHA and NT Department of Health and Families currently fund Frontier Services for transition care places in three Northern Territory sites (Alice Springs 4 places,
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Katherine 8 places and Darwin 4 places). Funding is a combination of a daily occupancy fee by DoHA, a recurrent allocation from the NT Government and per day client contribution.
Referrals to each facility are either through the ACAT or hospital with the aim to support the client to return home with better function. Whilst DoHA fund according to eligibility for older people indications suggest that a number of Indigenous people under age 50 would benefit from this program if available in Tennant Creek.
Tennant Creek does not have a transition care program and data provided by the NT Acute Care Information Unit Department of Health and Families indicates a program in Tennant Creek would be viable.67
Finding 25: Urgent need for an expansion of the Northern Territory transition care program funded jointly by DoHA and the NT Government to include Tennant Creek who have no residential transitional care places.
10.2 Aged Care
Stakeholders constantly raised the need for the provision of independent living units or beds for older Indigenous Barkly people. Like many remote locations there are no separate accommodation options for older people, separate to residential aged care, and this accommodation option was seen as an intricate component of a flexible service facility providing older people with a safe and secure accommodation and at the same time the liberty to interact with the community.
An aged care strategic statement for the region was also identified as a priority as some providers felt that the Barkly was overlooked when compared to the broader Central Australia region.
Finding 26: Discussions regarding the flexible service facility to include independent living options for ageing Indigenous people and broader aged care opportunities for the Barkly region.
67 Discussions between Damien Conley and NT Acute Care Information Unit Department of Health and Families
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10.3 Indigenous Mothers’ Facilities
The Indigenous Mothers Accommodation Fund (IMAF) funded by FaHCSIA provides accommodation for Aboriginal and Torres Strait Islander mothers from remote areas when they travel to regional centres to access pre-natal obstetric and post-natal medical care and related services. Specialised health care is often located a long distance from rural and remote communities and this service offers a safe, supportive and affordable place for Indigenous mothers to stay.68
The facility in Katherine known as the Katherine Womens Medical Hostel caters specifically for Indigenous women and provides a service for up to three weeks (or full term) and one to two weeks post birth depending on the needs of baby and mother. The Katherine facility has 20 beds available and occupancy varies with an overall occupancy of 70 mothers in 2010.69
Whilst this project will not be able to redress the existing necessity to attend the Alice Springs Hospital it would be able to provide a post-natal service enabling the mother and baby to return to Tennant Creek to access parenting programs and other related services. Further, given the existing supports through Anyinginyi Congress Aboriginal Corporation and NT Department of Health & Families in the Barkly it would be expected that a coordinated travel, accommodation, discharge plan and care package on return to Tennant Creek could be carefully implemented.
Finding 27: The Australian Government is committed to closing the gap between Indigenous and non-Indigenous child health and has demonstrated a willingness to fund Indigenous mothers’ facilities.
10.4 Transition from Emergency Accommodation
The Tennant Creek Womens Refuge (TCWR) is an eight bed facility which provides an excellent service to clients with a minimum stay of up to three months, a wide range of supports/skills provided: legal advice, counselling, financial management,
68 http://www.fahcsia.gov.au/sa/indigenous/progserv/families/Pages/MothersAccommodationFund.aspx 69 Discussion with Manager Katherine Women’s Medical Hostel.
- 60 - Damien Conley Consultancy March 2011 child management, resolving family conflict. The facility is alcohol free with three full time staff and four Indigenous staff who share overnight sleepovers.
Discussion with the TCWR Coordinator indicates a keenness to develop a transition care model for clients preparing to relocate to community through a flexible service facility.
Finding 28: Unlike BRADAAG the TCWR has no transitional program. Transition to the flexible service facility may provide opportunities for training and placement which could be financially supported by DEEWR and the NT government.
10.5 Youth Accommodation
The Tennant Creek „Support for Young People‟ Shared Responsibility Agreement (SRA) established a youth accommodation service for young people affected by family breakdown. Funding amendments means that the program is now funded through the National Partnership Agreement on Homelessness Program which is a joint Federal Territory initiative operating since 2009.70
Whilst accommodation is intended for 12 young people at the Mulga Camp in two separate houses, with an estimated 25% of the Tennant Creek population under seventeen years of age and homeless there is an urgent need for transitional accommodation until permanent options are made available.
Finding 29: Youth accommodation could be included in the new flexible service facility to relieve pressures on the Mulga camp accommodation funded through FaHCSIA.
70http://www.federalfinancialrelations.gov.au/content/national_partnership_agreements/HO002/implementation_plans/IP_Homelessness_NT.pdf
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11.0 One stop community and health reference centre
The Tennant Creek community through both the government and non-government sectors provide a broad range of community and health services, albeit from a number of locations dispersed across the town. In the absence of public transport access to services and advice can often be difficult. Another service gap is that there is no „casual‟ facility that enables people to simply gather and communicate.
There was a strong view that a „one stop‟ shop, where people could access essential information daily, have basic health checks on scheduled days and seek detailed information from all service providers on a rostered schedule, would lead to a more informed and healthier community. The consultant researched a number of options for such a facility and made direct contact with the City of Armadale Champion Centre in Perth Western Australia. The Champion Centre is the place for a wide range of programs and activities aimed at the regions Indigenous community. These programs include driver training for young people, to women‟s gatherings, Indigenous children‟s programs, workshops for parents and carers of children, school holiday programs and a range of other programs. Importantly the facility is a central meeting place where delegates from both the non government and government centres attend twice weekly on scheduled times to inform the community and respond to queries that people may have regarding a broad range of health and community matters. Representatives from key Indigenous organisations and government agencies (Police, Health, Community Services, Housing, Counselling, Youth, and the Local Council) are invited to present or simply interview clients and/or respond to individual enquiries.71
Accepting that some of these services are currently provided by service providers in Tennant Creek there is an opportunity to diversify and explore new approaches to community engagement.
Finding 30: A one stop shop facility on the TCUC site to be progressed with the development to include shaded landscaped areas where people and families can communicate in a secure and safe environment.
71http://www.armadale.wa.gov.au/Home/Publications/Media_Releases/2010/June/Champion_Centre_programs_for_Indigenous_community
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12.0 Budget
The cost estimates presented in this report are based on employing workers under the Social and Community Services (SACS) award at the following rates.
Table 5: Social and Community Services employee weekly salary rates
Pay point Pay point Pay point Pay point 1 2 3 4
SACS Level 3 - Crisis Accom Level 1 $724.22 $745.07 $760.93 $776.39
SACS Level 4 - Crisis Accom Level 2 $797.24 $818.12 $838.97 $857.84
SACS Level 5 - Crisis Accom Level 3 $878.69 $897.56 $918.43
SACS Level 6 - Crisis Accom Level 4 $939.29 $960.14 $981.00
SACS Level 7 $1,001.86 $1,022.71 $1,043.59
SACS Level 8 $1,064.44 $1,085.30 $1,106.16
All salaries have been costed at Pay point 2. The District Allowance of $6510 for employees with dependants has been used for all employees and the following SACS award penalties applied:
Table 6: Social and Community Services penalty rates
Shift Details Rate
Any shift that commences earlier than 12 Weekdays – day shift 100.0% noon and finishes at or before 7.00 pm.
Any shift which finishes after 8.00 pm and Weekdays – afternoon shift 112.5% at or before 12 midnight Monday to Friday.
Any shift which finishes after 12 midnight or Weekdays – night shift commences before 6.00 am Monday to 115.0% Friday.
Hours worked between midnight on Friday Saturdays 150.0% and midnight on Saturday.
Hours worked between midnight on Sundays 200.0% Saturday and midnight on Sunday.
Any time worked between midnight on the Public Holidays night prior to the public holiday and 250.0% midnight of the public holiday.
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With salary on-costs applied to the base salary and overtime component of wages (but not applied to the District Allowance) as shown below:
Table 7: Salary On-costs
Percentage Cost Element of salary Leave Loading 1.35% Superannuation 12.75% Long Service Leave 2.10% Workers Compensation Insurance 5.00% Payroll Tax 0.00% TOTAL 21.20%
Also, operating costs have been estimated at 22% of the salary-related costs.
12.1 Frontier Services
The following sections present initial cost estimates for the development and operation of a flexible service providing 24 bed accommodation facility in Tennant Creek.
12.1.1 Capital
The capital costs presented in this section assume the facility will be located on the Peko Rd site owned by Frontier Services and that the purchase of land is not required.
Recent estimates of the cost to develop a residential facility of a similar size in Tennant Creek were suggested to be as high as $8 million. At a per bed rate this is a significantly more expensive than the proposed 50 bed facility in Derby recently developed by Frontier Services at an estimated cost of $7.6 million (approximately $152,000 per bed).
The actual capital costs of developing a 24 bed facility in Tennant Creek is likely to be far less than the $8 million estimate yet the per bed cost is likely to exceed the costs of the Derby facility. The proposed flexible service model will require specialist construction to enable it to adequately meet the accommodation needs of the full range of clients proposed. The facility will need to ensure sufficient privacy for all clients, provide adequate security for some vulnerable clients and provide the
- 64 - Damien Conley Consultancy March 2011 care facilities required to care for some higher needs clients. The cost of developing this facility is likely to exceed the $152,000 per bed of the Derby facility and is more likely to be somewhere in the vicinity of $200,000 per bed, or an approximate total cost of $4.8 million to develop.
The capital costs associated with this service will depend on the specifics of the service delivery model that is proposed, particularly the proposed client mix. A more detailed estimate of the capital component of this proposal will be developed as the details of the proposed model are further refined.
12.1.2 Staffing Model
The staffing model used in the costing scenario, developed to support a 24 bed Flexible Service Facility to be operated by Frontier Services, comprises the following:
one manager (SACS Level 8) available during normal business hours (position is not backfilled when the manager is absent),
one caseworker (SACS Level 6) available during normal business hours (position is not backfilled when the caseworker is absent),
one support worker (SACS Level 3) rostered on at all times (approx 5.2 FTEs). (Positions are backfilled when a support worker is unavailable.)
12.1.3 Recurrent Costs
A detailed budget is being developed for the recurrent component which will be based on a negotiated, contemporary staffing model that is also consistent with national funding formulas for the services being proposed.
However, initial estimates based on a 24-bed facility and the proposed staffing model suggests the recurrent cost would be in the vicinity of approximately $816,000 recurrent per annum. This includes a maintenance cost of $240,000 per annum based on $4.8 million in assets estimated in Section 12.1.1.
The workings are shown in Figure 5.
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Figure 5: Costing Model for 24 bed Accommodation Facility in Tennant Creek
Hostel size 24
Client : Staff ratio Day Night Weekday 24 24 Weekend 24 24
Client : Caseworker ratio 24
Staffing Make-up Level Salary Manager SACS Level 8 $56,436 Caseworker SACS Level 6 - Crisis Accom Level 4 $49,927 Support Workers SACS Level 3 - Crisis Accom Level 1 $38,744
Support Worker Coverage Mon Tue Wed Thu Fri Sat Sun 6am to 10pm 1.0 1.0 1.0 1.0 1.0 1.0 1.0 10pm to 6am 1.0 1.0 1.0 1.0 1.0 1.0 1.0
Operating costs 22.0% Salary on-costs 21.2%
District Salary On- Staffing Costs Base Overtime allowance Sub-total costs FTEs TOTAL Manager $56,436 $6,510 $62,946 $11,962 1.0 $74,908 Caseworker $49,927 $6,510 $56,437 $10,583 1.0 $67,020 Support Workers $38,744 $10,372 $6,510 $55,626 $10,411 5.0 $330,182 TOTAL 7.0 $472,110
Staff Coverage Mon Tue Wed Thu Fri Sat Sun 6am to 9am 1.0 1.0 1.0 1.0 1.0 1.0 1.0 9am to 5pm 3.0 3.0 3.0 3.0 3.0 1.0 1.0 5pm to 10pm 1.0 1.0 1.0 1.0 1.0 1.0 1.0 10pm to 6am 1.0 1.0 1.0 1.0 1.0 1.0 1.0
Cost of Building and Assets $4,800,000 Maintenance Rate 5.0%
Salary costs $472,110 Operating Costs $103,864 Building Maintenance $240,000 TOTAL $815,974
Cost per bed $33,999
12.1.4 Recurrent funding sources
Based on an estimated operating cost of approximately $816,000 per annum for a 24 bed facility Frontier Services needs to secure approximately $34,000 per bed per annum to cover these costs.
The Commonwealth, through DoHA, FaHCSIA and DEEWR, and the NT Government all provide various levels of funding for the range of services that are proposed for Frontier Services.
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Table 7: Potential Government Funding Sources
Potential Service Type Funding Sources
DoHA Short-term Patient Accommodation NT Government
Out-Patient Accommodation - Renal FaHCSIA
DoHA Transition Care – Homelessness NT Government DoHA Transition care – Aged Care NT Government
Aged Care DoHA
Indigenous Mothers‟ Facilities FaHCSIA
DEEWR Transition from emergency accommodation - Women NT Government
Youth Accommodation FaHCSIA
The Australian Government, through the Department of Health and Ageing (DoHA), currently pay a fee-for-service of $167.67 per person per night for the provision of transition care for elderly patients. These services aim to allow early discharge from hospital of elderly patients with a view to supporting them to return home or to improve their level of functioning.
Based on three existing services provided by Frontier Services, Old Timers (four dedicated beds) Rocky Ridge (eight beds) and Tracy Aged Care (four beds), during the four month period between July 2010 and October 2010 there were 727 bed- nights provided across the three services. This equates to and average of 136 nights per bed per year. Using DoHA‟s funding formula of $167.67 per person per night this equates to $22,803 in DoHA funding per bed per year.
In addition, the NT Government also contributed top-up funding in excess of $240,000 to these three services, or approximately $15,234 per bed.
If Frontier Services were to dedicate four beds and achieve similar levels of utilisation and support they could expect to receive DoHA funding of approximately
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$91,212 per annum for these services and additional funding from the NT Government of approximately $61,000 per annum.
Based on these figures there is an alignment between the estimated annual cost of service provision per bed $34,000 and the nominal per bed annual funding provided by government for these types of services $38,037 ($22,803 per annum per bed from DoHA and $15,234 per annum per bed from the NT Government for Transition Care for the elderly).
12.2 Tennant Creek Uniting Church
The following sections present initial cost estimates for the development and operation of a one stop community and health reference centre in Tennant Creek.
12.2.1 Capital
The capital costs associated with this service will depend on the specifics of the service delivery model that is proposed. An estimate of the capital component of this proposal will be developed when the service delivery model is finalised.
12.2.2 Staffing Model
The staffing model used in the costing scenario, developed to support a one stop community and health reference centre to be operated by the Tennant Creek Uniting Church, comprises the following:
one manager (SACS Level 7) available during normal business hours,
one support worker (SACS Level 4) available during normal business hours.
(Neither position would be backfilled if a worker was unavailable.)
12.2.3 Recurrent Costs
A detailed budget is being developed for the recurrent component which will be based on a negotiated, contemporary staffing model that is also consistent with national funding formulas for this type of service. Further work to more specifically define the outputs being produced will be required to develop a robust cost model.
An initial estimate, shown in Figure 6, and based on the scenario proposed, suggests a recurrent cost in the vicinity of $157,420 recurrent per annum. This cost does not include the cost of building maintenance as the capital costs are unknown.
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Figure 6: Costing Model for one stop community and health reference centre in Tennant Creek
Operating costs 22.0% Salary on-costs 21.2%
District Salary On- Staffing Costs Base Overtime allowance Sub-total costs FTEs TOTAL Manager $53,181 $6,510 $59,691 $11,272 1.0 $70,963 Caseworker $42,542 $6,510 $49,052 $9,017 1.0 $58,070 Support Workers $38,744 $6,510 $45,254 $8,212 0.0 $0 TOTAL 2.0 $129,033
Staff Coverage Mon Tue Wed Thu Fri Sat Sun 6am to 9am 0.0 0.0 0.0 0.0 0.0 0.0 0.0 9am to 5pm 2.0 2.0 2.0 2.0 2.0 0.0 0.0 5pm to 10pm 0.0 0.0 0.0 0.0 0.0 0.0 0.0 10pm to 6am 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Cost of Building and Assets $0 Maintenance Rate 5%
Salary costs $129,033 Operating Costs $28,387 Building Maintenance $0 TOTAL $157,420
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Attachment A: Consultation List
Uniting Church Congregation Tennant Creek Patient Assistance Travel Officer Tennant Creek Hospital Barkly Regional Accommodation Group Tennant Creek Women‟s Refuge Julalikari Council (Deputy CEO) Manager Renal Dialysis Unit Tennant Creek Tour of Tennant Creek Town Camps/Living Areas CEO NT Shelter Darwin Coordinator Dept of Health & Families Alice Springs Northern Territory Department of Housing, Local Government and Regional Services Manager and staff FaHCSIA Tennant Creek CEO Tennant Creek (Barkly) Council PulkaPulkka Kari Urban Housing (Dept of Housing) Manager Barkly Regional Alcohol & Drug Abuse Group Inc NT Department of Health and Families – Sexual Abuse Unit Centralian College – Alice Springs Frontier Services Alice Springs and Darwin General Manager Tennant Creek Hospital Manager Aged & Disability Services Tennant Creek Anyinginyi Congress Aboriginal Medical Service Frontier Services Electoral Office for the Member for Barkly. NT Department of Health and Families – Mental Health Unit Centre for Remote Health Alice Springs CEO St Vincent de Paul Society Darwin NT Shelter and NTCOSS Central Australia
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Attachment B: Community Services Accommodation – Tennant Creek
Organisation Purpose Beds Pulkapulkka Kari 17 places plus 2 respite Frontier Services Residential Aged Care places Women‟s refuge Tennant Creek 8 beds places Women’s Refuge Crisis accommodation for women & their children 13 Units at Blain Street for Barkly Region transitional housing Alcohol and Drug Alcohol rehabilitation 16 beds sobering up shelter Advisory Group 20 beds rehabilitation 1 Family House - rehab Transition Community living areas 10 Units at Blain Street Julalikari Council (Currently being used to rehouse
families from camps while houses renovated) 2 houses with 24 hour Indigenous residents with severe support - supported Julalikari Council disabilities accommodation for people with disabilities Christian Outback Crisis Accommodation 2 Units at Blain Street Fellowship Accommodation for 34 Student Accommodation secondary students from remote areas. Wangkana Kari Temporary for school holidays (39 places to be available for Hostel (AHL) 1 month from December 15 Indigenous transient hostel 2010 to Jan 15th 2011 to 15 Dec 2010 – 15 Jan 2011 meet crisis accommodation demands in Tennant Creek). Providing 12 residential beds Julalikari Council for young people aged Youth Crisis Accommodation in between 12 – 24. Youth Tennant Creek Development Unit Girls House – Mulga Camp Boys House- Mulga Camp Tennant Creek Acute care 20 beds Hospital
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Attachment C: Temporary Accommodation – key findings from overseas72
Country Findings Denmark The Denmark report found that Hostels in Denmark have a duty to draw up a plan for a person‟s stay, covering elements such as: clarification of acute problems; overview of financial circumstances; assessment of opportunities for employment or education/training; and any health- related problems. This plan should serve as a „manual‟ for the residency, and as a basis for subsequent solutions and initiatives. France The French report notes that first generation immigrants are particularly vulnerable to living in indecent conditions with the negative effects that can have on people‟s physical and mental well-being. Germany In Germany, households which do not have humane housing are defined as homeless. People in vulnerable positions are not always able to fight for improvements to inadequate accommodation, even where they have legal rights. Challenging the landlord may result in expulsion with no guarantee of either the return of any deposit or finding better accommodation elsewhere. Greece The Greece report observes that people living in unsuitable housing are often led to seek emergency accommodation, thus showing that their housing situation amounts to homelessness. Ireland The Irish National Social Partnership agreement „Towards 2016‟ aims “to enable every household to have available an affordable dwelling of good quality, suited to its needs, in a good environment and, as far as possible, at the tenure of its choice.” Crucially, the Irish Housing Ministry produced a local Social/Affordable Housing Action Plan and Local Homeless Action Plan with the following guiding principles: Emergency accommodation should be short-term Settlement in the community should be an overriding priority through the provision of long-term housing A continuum of care should be provided to homeless people from the time they become homeless Poland The Polish report observes that the lack of social housing often leaves vulnerable women with children with little alternative but to seek shelter in hostels for the homeless, particularly when trying to escape situations of family violence. The lack of social dwelling units, where they would be given help and support, therefore directly influences the number of women with children who become homeless. The Polish report talks of quite extreme conditions where it would appear that as much as 35% of Polish people live in bad or very bad conditions.
72 http://www.feantsa.org/files/Housing_Annual_Theme/European_Report/08_European_Report_FEANTSA_Housing_final_EN.pdf
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Overseas Hostels and emergency shelters73
At the most basic level, hostels can play an important role in giving people a safer alternative to rough sleeping or in stopping a downward spiral towards homelessness for people living in very insecure or inadequate housing. They can provide a setting for vulnerable people to receive specific help appropriate to their circumstances or needs, which it would be difficult to provide on the streets or for the invisible homeless.
Temporary accommodation can be a place where people receive advice and encouragement to restore self-belief and training to regain necessary social, hygiene and household skills and develop self-responsibility. For people who have experienced chaotic lifestyles, a good quality hostel can provide a platform from which to move towards a permanent solution. At the same time, staying in a hostel is not a necessary step towards independent living for all homeless people. Some people who find themselves facing homelessness will be best served by directly accessing housing with appropriate associated support, rather than passing through a hostel. Where hostels are going to function effectively, it is crucial that they are able to provide the appropriate training and support to those who need it, without forcing everybody to jump through unnecessary hoops. However, there are problems where hostels were not originally designed for the purpose of homeless service provision, but just to provide temporary shelter. This can limit the ability of support staff to work effectively in addressing the needs of homeless people.
There is increasing recognition in some countries that the idea of moving step-by- step towards independent living does not work for all homeless people. Different individuals will be capable of and require different levels of independence and support and many people will be better off moving directly into supported housing.
With this in mind, hostels in Denmark have a duty to draw up a plan for a person‟s stay, covering elements such as:
clarification of acute problems;
overview of financial circumstances;
73 Ibid
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assessment of opportunities for employment
or education/training; and any health-related problems.
This plan should serve as a „manual‟ for the residency, and as a basis for subsequent solutions and initiatives.
Similarly, the Dublin Homeless Agency recommends that there should be comprehensive needs assessment when a person enters a hostel to guide the support offered.
Hostels clearly work best when providing a temporary solution. However they can become part of the problem if homeless people become stuck in them - as happens all too often in many countries. The Hungarian report highlights the dangers that exist if there is a lack of pathways out of hostel accommodation. Failed attempts to move out of hostels can reinforce a feeling of failure for both service users and support workers. There is evidence from several countries that the more time a person spends in hostel accommodation, the less able they are to live independently - they become institutionalised.
Hostels and emergency shelters can play a role in providing a springboard out of homelessness; however their usefulness is largely determined by the availability of pathways into long-term housing solutions. Nor are they a necessary step on pathways out of homelessness.
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Attachment D: Summary of Consultations/Findings
Topic: The Town
Observations Findings
Local people struggle to find time to General commitment to work towards resolving the develop coordinated outcomes as all accommodation crisis key stakeholders are on a plethora of Town very cohesive group of government and non government committees/working parties and with officials all focused on working collaboratively to find solutions. their own roles do not have the time to Welcomed the appointment of a consultant to research and devote to coordinating resolutions to engage and develop options. (cooperation prior to, during and homelessness. post the consultations were excellent). The pace of development in Tennant Consultant only able to make a determination on available data. Creek - with the influx of an increasing workforce due to the SHIP, mining and General view that Tennant Creek homeless is not as severe as general infrastructure and communities Alice Springs where the latter may have greater loss of increasing visits to the town has meant connectiveness. Barkly people have closer links to family ties that accommodation options which were and therefore opportunities for temporary accommodation. previously available such as caravan Innovative solutions to homelessness are occurring. For parks, camping grounds and motels are example, 39 places to be available for 1 month from December now fully occupied. 15 2010 to Jan 15th 2011 to meet crisis accommodation Actual homeless numbers may be demands in Tennant Creek at the Wankana Kari Hostel which inaccurate. normally accommodates remote secondary students. This clearly indicates that with all beds to be filled there is an immediate accommodation crisis in Tenant Creek. General acknowledgement that the Living Areas program (coordinated by Julalikari Council) has made a real change with curbing, guttering, fencing and lighting making the areas looks like newly designed suburbs of Tennant Creek.
Topic: Acute Care
Observations Findings
Tennant Creek Hospital Significant support for an accommodation facility that takes the Average occupancy 12/20 beds. pressure from the Health providers and provides a range of flexible service types. 90% emergency department presentations are alcohol related Evacuation Pilot and air ambulance on 24 hr call.
Topic: Patient Assistance Travel Scheme (PATS)
Observations Findings
Funding inadequate. NTCOSS undertook Regional Transport Forums in Alice This issue was raised consistently but is Springs, Tennant Creek and Katherine in 2009. A summary of deemed to be outside of the scope of those findings are available from NTCOSS. this project.
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Topic: Accommodation
Observations Findings
The model Consistent view that small remote communities like Tennant Flexible, innovative accommodation Creek are restricted in addressing emerging problems – model that is not governed by program suggested that they are consistently expected to fit the structures restricting the flexibility to ‘problem’ into the funding that is advertised or available. This meet emerging needs including: can mean that a range of accommodation options may be addressed, but there is no flexibility to react when issues do alcohol rehabilitation arise in small locations. domestic violence Strong emphasis on a new approach to crisis accommodation. medical transition clients Reluctance to use the term ‘Multipurpose Service’ as it is too older people aligned with aged care. post prisoner release New facility should have staff accommodation included. transition care post discharge young Mums post natal youth renal patients
Topic: Alcohol Rehabilitation
Observations Findings
Barkly Regional Alcohol and Drug Excellent service, however the wait list for services is continuing Abuse Advisory Group has a range of to increase. accommodation facilities and programs: Capable of developing specific services for its clients group 13 Units at Blain Street for transitional very supportive of a flexible service facility in Tennant Creek. housing 16 beds sobering up shelter 20 beds rehabilitation 1 Family House - rehab
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Topic: Medical transition
Observations Findings
To and from Alice Springs improved The transport issue varies depending on who you talk to. coordinated travel pre and post Some people are of the view that with the Centre Bush Bus discharge is a major concern. Service access to Alice Springs has improved albeit a five hour journey. (3 days per week passengers are picked up along the highway to Alice Springs and return – departs at 0700 arriving Alice Springs at 12.00 midday – the alternate option is Tues, Thurs and Saturday where the bus ‘pulls in where required’ to communities off the highway). There is still a view that for people from across the region travelling to Tennant Creek or being dropped off in Tennant Creek from Alice Springs and wanting to return to communities in Barkly tableland experience lengthy delays. There were some major issues raised regarding the `comfort’ of the bush bus. McAfferty's bus the other alternative. People catch the bus and/or return to Tennant Creek in the early hours of the morning, but have been stranded with no safe accommodation in Tennant Creek or coordinated transport back to country. A facility providing a range of services would enable an improved coordinated approach to transfers between Alice Springs and Tennant Creek and could also provide emergency accommodation for people, who are dropped off in the early hours of the morning or who are waiting for return to their community. In November 2010 the Federal Government - Department of Infrastructure and Transport approved funding under the Remote Air Services Subsidy Scheme (RASS) to operate a commercial flight between Alice Springs and Tennant Creek which would provide residents with essential access to health and other professional services. Funding is expected to be released in the first quarter of 2011 – and the new service will be equipped to carry up to 9 passengers. (Media statement 20 November 2010)
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Topic: Older people
Observations Findings
Identified needs. Older people need independent living options rather than residing in overcrowded accommodation. Independent living accommodation No EACH packages – allocation to the region may reduce early Respite care admission to residential care – however no evidence that there Extended Aged Care Packages (EACH) was demand at time of consultations. Further analysis of ACAT Transition care (Alice Springs to the data is required. Was raised that there may be difficulty in Barkly region) delivering an EACH package in a remote community. Analysis of the aged care needs across the Barkly would inform future planning. Transition care consistently raised - too many cases where people self discharge from Alice Springs return to Tennant Creek to inappropriate accommodation which impacts on rehabilitation and ultimately can mean readmission to the acute sector. Transition care program would bring people home and closer to country. Independent living accommodation is rated as a priority for older people.
Topic: Post prisoner release
Observations Findings
To be developed Limited knowledge regarding the progression of this program. Around $2 million has been committed Likely to be excluded in this proposal as stakeholders identified to establish a program where low higher priorities and at the time of consultations the proposal security prisoners would spend their was unclear. sentence working in Tennant Creek. The outreach plan includes a purpose built camp for prisoners who would develop life, work and education skills during their time here in the program. Offenders would be released into the community to attain skills, training and employment opportunities.
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Topic: Indigenous mothers program
Observations Findings
High rates of teenage pregnancies - Poor parenting skills and options to gain skills in Tennant Creek hospital staff suggested up to 30 at any pre and post birth. given time – this was not confirmed. Since December 2005 all expecting mothers sent to Alice Springs. Transport to and from Alice Springs to give birth is ‘trying’ and expecting mothers sent weeks before the due date Expecting mothers sent to Hostels in Alice Springs. Often poor accommodation, long distances from family, unfamiliar surroundings, loneliness Language barriers when women get to Alice Springs – few people speak Waramungu Due to lack of employment opportunities and therefore, few desirable or achievable goals in sight for young Aboriginal mothers, ‘hopelessness’ is perpetuated and in many cases, passed on to their children. The Report Improving Life Chances: Investigating the Accessibility and Appropriateness of Services for Young Aboriginal Mothers in Tennant Creek 2007, is an excellent overview of issues and possible solutions which identified the need to: Enhance parenting skills Improve education opportunities This report could be used as a basis for implementing programs Topic: Youth
Observations Findings
Identified needs Under 17 years of age is not an adult, according to Centrelink and therefore cannot gain references to apply for housing – so Huge youth problem in Tennant Creek this large group are ‘couch surfing’ from house to house – many suggested by a number of stakeholders with kids. that 25% of the Tennant Creek There is a need in Tennant Creek for a service that offers population are under the age of 17 yrs of transitional accommodation to young people whilst providing age. them basic skills in home maintenance, nutrition with a focus on assisting this vulnerable group in basic independent living skills.
Topic: Governance
Observations Findings
Interest in a local working group to To ensure a successful tangible facility would be beneficial to develop the new service. encourage participation by key service providers in Tennant Creek and people with expertise in their field to work as a steering committee to progress the agreed project.
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Topic: The sites
Observations Findings
Significant interest in the suitability of Support for the Peko Road site due to location, ability to access sites. complimentary services and acceptance of Frontier Services considerable record in providing accommodation services for Indigenous people. Paterson Street (Main Street) Tennant Creek some reservations that location may attract attention from passing pedestrians and the possibility of placing clients at risk with increasing vehicle traffic. Substantial interest in a ‘one stop shop; referral agency in partnership with an existing service provider for this site. St Vincent De Paul Society interested in this report as they also have vacant land and are keen on partnering opportunities.
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