Appropriate Services for Older Care Leavers Experiencing, Or at Risk Of, Homelessness ACKNOWLEDGEMENTS

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APPROPRIATE“Don’t be frightened toSERVICES take AAG’s purpose is to improve FORon people OLDER in ‘the system’”CARE LEAVERS the experience of ageing through CONNECTING RESEARCH, EXPERIENCING, OR AT RISKPOLICY and PRACTICE OF,“Safety HOMELESSNESS is a basic human right” A collaborative paper on what needs to be done endorsed by: Australian Association of Gerontology, Alliance for Forgotten Australians, Healing Foundation, Housing“We need for Aged a joined-up Action Group and Wintringham Aprilresponse 2020 for victims”

“Men need to be having these conversations but I’m the only one in this room”

“Police need to be called at the earliest opportunity”

“We need to make people care enough to act”

“We should ask for dedicated workers in CASAs to support older people”

“We need a human rights-based framework for responding to sexual abuse”

“We need to grab hold of what’s happening around elder abuse and make sure sexual abuse is included too”

“Older trans and gender diverse people experience sexual abuse too” 2 Appropriate services for older care leavers experiencing, or at risk of, homelessness ACKNOWLEDGEMENTS

ACKNOWLEDGEMENT ACKNOWLEDGEMENT OF COUNTRY OF FUNDING The Australian Association of Gerontology (AAG) Funded by the Australian Governement through the Conference workshop that was the basis for this paper was Dementia and Aged Care Services Fund. held on the land of the Kulin Nation. We acknowledge the people of the Kulin Nation as the traditional owners of the land on which the workshop was held and thank them for welcoming us. The Australian Association of Gerontology acknowledges Traditional Owners of Country throughout Australia and recognises the continuing connection to lands, waters and communities. We pay our respect to Aboriginal and Torres Strait Islander cultures; to Elders past, present, and emerging; and to all Aboriginal and Torres Strait Islander peoples, including members of the Stolen Generations.

WARNING TO ABORIGINAL AND TORRES STRAIT ACKNOWLEDGEMENT ISLANDER PEOPLE OF CONTRIBUTORS Aboriginal and/or Torres Strait Islander readers AAG extends its thanks to those who planned, convened are warned that this document may contain images and/or facilitated the workshop that created the foundation of deceased persons. for this project:

u Dr Sandra South and Dr Victoria Cornell, AAG

u Mr Ian Hamm and Ms Lisa Hillan, The Healing Foundation

u Ms Caroline Carroll and Ms Lyn Langanke, Alliance for Forgotten Australians and Open Place

u Mr Boris Kaspiev, Alliance for Forgotten Australians

u Mr Bryan Lipmann AM, Wintringham

u Ms Fiona York, Housing for the Aged Action Group (HAAG) We also thank those who participated in the workshop - a full list of participants is provided as an Appendix to this report. This report has been prepared by Ms Kate Gainer, AAG.

A collaborative paper on 3 what needs to be done ABOUT THIS PROJECT Joan was born in the Moreland This paper reflects the proceedings and outcomes of the Hospital and grew up in Melbourne. Australian Association of Gerontology (AAG) workshop focusing on Appropriate services for older care leavers Due to abuse by her father, she left home experiencing, or at risk of, homelessness, which was held as a young child and spent some time on 20 November 2018. The recommendations in this paper in a children’s home and in the foster have been developed by AAG in collaboration with the care system. partners in this project, following the workshop.

The workshop was hosted by AAG in conjunction with the Australian Association of Gerontology has partnered in this Alliance for Forgotten Australians, the Healing Foundation, project with organisations that work with and advocate for the Housing for the Aged Action Group and Wintringham people who identify as the Stolen Generations, Forgotten as one of the pre-conference workshops for AAG’s 2018 Australians, and Former Child Migrants, and others National Conference. This was the first AAG workshop to experiencing homelessness whose choices may be limited look in detail at the needs of older care leavers experiencing by their mistrust or fear of institutional services. or at risk of homelessness. The Healing Foundation works with members of the Stolen The Aged Care Act 1997 (Cwlth) definition of people with Generations, delivering trauma-informed, healing-focused special needs includes both ‘care-leavers’ and ‘people who models of care for Aboriginal and Torres Strait Islander are homeless or at risk of becoming homeless’.1 Special people who were separated from their family in childhood. considerations may apply to groups of people with special The Foundation works with communities to create places needs when the Act is implemented. AAG has previously of safety, providing an environment for Stolen Generations led a collaborative project on older women who are members and their families to speak for themselves, tell experiencing, or at risk of, homelessness’,2 in collaboration their own stories and be in charge of their own healing. with a wide range of experts and organisations who The Alliance for Forgotten Australians (AFA) is an support older people at risk of, or experiencing, organisation which promotes the interests of the estimated homelessness in Australia. 500,000 people known as Forgotten That project identified care leavers as a specific group of Australians, who experienced institutional or other individuals at high risk of homelessness. The initiation out-of-home care as children and young people in of the 2018 workshop reflected that action is needed to the last century in Australia. ensure services meet the needs of these older people at the Open Place is a support and advocacy service that intersection of two special needs groups. coordinates and provides direct assistance to address the Care leavers are characterised by their experience of needs of people who grew up in Victorian orphanages and institutional or other out-of-home care as children and homes during the last century. young people. The group is heterogenous as far as the reasons for their experience of out of home care, however— particularly for the older aged members of this group— there is commonality of health needs, based on the high incidence of physical, emotional and/or sexual trauma experienced as a result of being placed in ‘care’. 3

1. Section 11-3 paragraphs (f) and (g). 2. Three papers launched in August 2018 as the final products of the project are available at https://www.aag.asn.au/news-publications/ policy-papers/aag-collaborative-project-on-older-women-experiencing-or-at-risk-of-homelessness. 3. The word ‘care’ will be used in this report in reference to the institutional/official arrangements in which these people spent their childhood, but inverted commas will be used to reflect that those who experienced these arrangements did not consider that they provided for the basic needs necessary to constitute care.

4 Appropriate services for older care leavers experiencing, or at risk of, homelessness Wintringham is a specialist aged care service provider, which has established a range of housing and services to aged people who were living in poor and insecure conditions. Wintringham’s services were set up for older people who the aged care system refused to care for. In addition, Wintringham’s gradual and long-term approach to building trust enables better outcomes for people who have a fear of institutions. Housing for the Aged Action Group (HAAG) and their Home at Last service support older Australians to access and navigate appropriate social and aged care services. Their outreach work with different community groups increases their ability to reach out to and connect with care leavers who may have a distrust of institutions. Australian Association of Gerontology is a membership organisation whose purpose is to improve the experience of ageing through connecting research, policy and practice. Since 1964, AAG has been Australia’s peak body linking professionals working across the fields of ageing. The multidisciplinary membership includes researchers, aged care leaders, geriatricians, nurses, allied health professionals, policy makers, advocates for older people and others with expertise in ageing. The workshop included presentations from representatives of these groups, followed by a panel discussion, consideration of case studies and personal experiences in groups, and a collection of the thoughts arising from those discussions. This paper does not attempt to transcribe the conversations, but to summarise the thoughts that emerged on the day in a way that suggests future pathways to better access to appropriate services and supports for care leavers as they age.

A collaborative paper on 5 what needs to be done CARE LEAVER RESOURCES In 2016, the Department of Health published the Caring for Real Care the Second Forgotten Australians, Former Child Migrants and Stolen Time Around Generations information package. This was produced with Helping Hand, a South Australian provider of aged care the input of care leaver groups. The package was intended services, has produced a guide Forgotten Australians, Real to assist professionals working in aged care to understand Care the Second Time Around. The guide aims to help the concerns, fears and anxieties of Forgotten Australians, aged care providers respond to and support the needs of Former Child Migrants and Stolen Generations in being re- those who have experienced trauma as children in state institutionalised when they access aged care. and institutional care. The Package resources include: Services such as Find and Connect Support Services—an u an information booklet covering issues and aged care Australian Government-funded initiative designed to assist requirements of Forgotten Australians, Former Child with the search for records and other critical information Migrants, and the Stolen Generations held by past provider organisations and government u a training facilitator guide including case studies agencies—are available to support care leavers, including on care issues of Forgotten Australians, Former those who are using aged care services. Child Migrants, and Stolen Generations. Carers are Services include: encouraged to use this guide to facilitate group discussions and information sessions to other carers u specialist trauma informed counselling

u a PowerPoint Presentation for information and training u referral services sessions u social support programs

u a video to be viewed on YouTube. u help to locate and access records

u reconnect with family members (where possible). Aboriginal and Torres Strait Islander people are warned More information on the Find and Connect Support that the Package’s resources may contain images and Services can be found on the Department of Social voices of deceased persons. Services’ website.

References: https://www.myagedcare.gov.au/eligibility-diverse-needs/ care-leavers http://helpinghand.org.au/wp-content/uploads/2019/01/ Positioning-Statement-Forgotten-Australians.pdf https://www.findandconnect.gov.au/about/

6 Appropriate services for older care leavers experiencing, or at risk of, homelessness CONTEXT

BACKGROUND—IMPACT The Senate Inquiry into Children in Institutional Care (2003–2004, ‘Forgotten Australians’)7 was ‘the OF CHILDHOOD last instalment in a trilogy of inquiries into Australia’s past treatment of children’: the first was the National INSTITUTIONALISATION Inquiry into the Separation of Aboriginal and Torres Participants in the workshop discussed the past Strait Islander Children from Their Families (1995–1997, experiences of people who spent all or part of their ‘Bringing Them Home’),8 which was followed by childhoods in institutions and out-of-home ‘care’, the the Inquiry into Child Migration (2000–2001, Lost way in which this affects their feelings about aged Innocents’).9 These inquiries revealed to the Australian care, and the need for those who work with them to public for the first time the historical injustice take this into account. of the practice of institutionalising children, and its There is limited published research in Australia to terrible legacy.10 inform policy around aged care (and palliative care) The Forgotten Australians report recommended the practice to improve outcomes for care leavers. establishment of a Royal Commission into the abuse The relevant page on palliAGED4 references only of children and young people in institutions. Several one research study5 on life outcomes for children subsequent inquiries at a State level, together with growing up in ‘care’ in the twentieth century in continuing advocacy from survivor support groups, Australia. The limited research on this specific group resulted in an increasing public awareness and may be accounted for by the recency of awareness increased pressure for a national response. The then of ‘the widespread abuse and neglect of children Prime Minister, the Hon. Julia Gillard, MP, announced in institutions, as well as its aftermath for the decision to establish a Royal Commission into thousands of people’.6 institutional responses to child abuse on 12 November 2012.11

4. palliAGED is an online evidence-based guidance and knowledge resource about palliative care in aged care for use by health professionals and the aged care workforce: https://www.palliaged.com.au/. 5. Fernandez, E., Lee, J.-S.,Blunden, H., McNamara, P., Kovacs, S. and Cornefert, P.-A, No Child Should Grow Up Like This: Identifying Long Term Outcomes of Forgotten Australians, Child Migrants and the Stolen Generations. University of New South Wales Kensington, 2016. Accessed at http://www.forgottenaustralians.unsw.edu.au/sites/default/files/uploads/LOW%20 RES%2012859_UNSW_FASS_ForgottenAustralians_Report_Nov16_LR_FA.pdf on 29/8/2019. 6. Cate O’Neill ‘Forgotten Australians in the library: resources relating to Care Leavers in Australian libraries’, The Australian Library Journal Volume 65, 2016 - Issue 3: The Library–Archive Confluence: The eScholarship Research Centre, University of Melbourne. Accessed at https://doi.org/10.1080/00049670.2016.1204977 on 29/8/2019. 7. The Senate Community Affairs References Committee, Forgotten Australians: A report on Australians who experienced institutional or out-of-home care as children, August 2004 accessed at https://www.aph.gov.au/Parliamentary_Business/ Committees/Senate/Community_Affairs/Completed_inquiries/2004-07/inst_care/report/index on 29/9/2019. 8. Human Rights and Equal Opportunity Commission, Report of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families, 1997, accessed at https://www.humanrights.gov.au/sites/default/files/ content/pdf/social_justice/bringing_them_home_report.pdf on 29/9/2019. 9. Senate Standing Committee on Community Affairs, Lost Innocents: Righting the Record - Report on child migration, 30 August 2001, accessed at https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/ Completed_inquiries/1999-02/child_migrat/report/index on 29/9/2019. 10. O’Neill, ibid. 11. Accessed at https://pmtranscripts.pmc.gov.au/release/transcript-18905 on 6/3/2019.

A collaborative paper on 7 what needs to be done Through these inquiries there is now a body of u Poor health and disability due to: anecdotal evidence and oral histories that have • untreated physical injuries; illuminated past practices of out of home care, failings • untreated childhood illnesses; and the consequences of childhood institutionalisation. The consequences of childhood institutionalisation • physical effects of sexual or other forms of assault; and associated abuse or neglect are numerous and • premature physical and cognitive ageing.12 profoundly affect lifetime health and wellbeing outcomes u Mental health and related issues including: for the individual. At the risk of oversimplification—and ignoring the prevalence of lifetime poverty as both cause • psychological distress; and effect—the following summary lists some of the key • ongoing anxiety, depression, flashbacks, dissociation, long term outcomes for care leavers. phobias, mistrust and paranoia, instability of mood, suicidality and self-harm, poor impulse control and hypervigilance; Joan worked as an enrolled nurse • inability to establish/maintain long term adult for many years, and raised her two relationships or other forms of social support, with sons as a single mother after separating increased likelihood of perpetration of violence from her husband. She provided a stable towards an intimate partner or others; home environment for her family in • compromised parenting, impaired ability to engage private rental but she had minimal with partners and children, often leading to estrangement from children; savings or superannuation. • addictions including to alcohol, drugs and gambling; • inability to undertake adult education and/or paid employment.

u Life skill deficits including: • lack of literacy and numeracy due to incomplete or ineffective formal education; • underdevelopment of socioemotional skills necessary to access rewarding work; • inadequate self-care skills.13

12. It is useful here to define ageing: ‘At the biological level, ageing results from the impact of the accumulation of a wide variety of molecular and cellular damage over time. This leads to a gradual decrease in physical and mental capacity, a growing risk of disease, and ultimately, death. But these changes are … only loosely associated with a person’s age in years.…Beyond biological changes, ageing is also associated with other life transitions such as retirement, relocation to more appropriate housing, and the death of friends and partners. In developing a public-health response to ageing, it is important not just to consider approaches that ameliorate the losses associated with older age, but also those that may reinforce recovery, adaptation and psychosocial growth.’ World Health Organization Fact Sheet Ageing and Health, accessed at https://www.who.int/news-room/fact-sheets/ detail/ageing-and-health on 29/8/2019. 13. Based on Fernandez et al.

8 Appropriate services for older care leavers experiencing, or at risk of, homelessness The health and social outcomes for care leavers Fernandez et al. describe service needs and call represent an almost perfect demonstration of ‘the for ‘a far better developed health safety net … to social determinants of health’. Richard Wilkinson and support the increasing frailty, illness and disability Michael Marmot in the foreword to the World Health within this vulnerable and ageing cohort... Audiology, Organization report on the Social Determinants of pathology, optometry, dentistry, physiotherapy, Health describe how economics, sociology and occupational therapy, prosthetics and orthotics are just psychology combine with neurobiology and medicine some of the ancillary health services which participants to create a picture of the interactions between ‘material need on an ongoing basis. These are in addition to their disadvantage and its social meanings’. primary health care needs for ongoing assessment, It is not simply that poor material circumstances are review and management of chronic health issues…’ harmful to health; the social meaning of being poor, As well as the deficit of health services, this work unemployed, socially excluded, or otherwise stigmatized indicated an undersupply of specialist services to meet also matters. As social beings, we need not only good needs in the following areas: material conditions but, from early childhood onwards, u permanent mental health services; we need to feel valued and appreciated. We need friends, we need more sociable societies, we need to feel useful, u family and social networks and recreational support, and we need to exercise a significant degree of control including programs targeting the social, emotional, over meaningful work. intellectual and recreational needs of care leavers;

Without these we become more prone to depression, u housing; drug use, anxiety, hostility and feelings of hopelessness, u appropriate aged care. which all rebound on physical health.14 Discussion of the last of these is the focus of the remainder of this report, however in taking this focus, ‘appropriate aged care’ will be defined as care that When Joan retired at 65, she found meets the first three of these needs. AAG’s partners in this project demonstrate how, to deliver appropriate herself struggling to cope with the support as care leavers age, services must respond to rent and bills with the age pension as care leavers’ health and housing needs, but must also her main form of income. Joan became respond to the social meaning of the experiences of very fearful of the consequences of losing individuals as they age. her rental home by eviction or rent rises. The mainstream aged care system—from entry to She became afraid to ask for repairs from her service provision—is underprepared to provide adequate landlord and put up with a hot water service support for this group. While trauma-informed care is that broke down continually. She got used well understood in mental health services (and to a lesser to having cold showers and boiling the extent services responding to homelessness or risk of homelessness), the need for a trauma-informed approach kettle to do the dishes. to support the needs of relevant groups in an aged care context is not well recognised.

14. Wilkinson R & Marmot M (eds) 2003. Social determinants of health. The solid facts. 2nd edn. Copenhagen: WHO. Accessed at http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf?ua=1 on 29/8/2019.

A collaborative paper on 9 what needs to be done As an example, the National Screening and Assessment The NSAF includes questions about housing status Form (NSAF) does not give an individual the opportunity and care leaver status at the end of the assessment. to self-identify as a care leaver (or a member of a specific The question “Client has experienced adverse effects of group of care leavers such as Stolen Generations) if they institutionalisation and/or systems abuse (e.g. spending choose. Nor does it assist an assessor to identify the time in institutions, prisons, foster care, and residential need for a trauma-informed approach. This lack of care or out of home care) and is refusing assistance or opportunity for the individual to feel heard is inconsistent services when they are clearly needed to maintain safety with ensuring that aged care does not perpetuate the and wellbeing?” appears in linking supports and special trauma of care leavers. considerations. There is no specific mention of Stolen Generations or Forgotten Australians, nor does a response indicating the potential need for additional supports pre-populate in the support plan or prompt any further Out of the blue the landlord questions to inform such supports. The form does include doubled her rent. Joan was left with options for further assessment i.e. Modified Barthel Index less than $40 a fortnight to live on for independence in daily living activities, mobility and after the rent and bills. continence; OARS for function and activities of daily living; caregiver strain index, however the outcomes of the further assessments need to be added to support plans manually. The client profile asks about living situation, i.e. privately owned, public rental, homeless, shelter etc. This is the only place where housing status is noted, however this information does pre-populate into the support plan.15

A friend told Joan about Home at Last. Within three months of interviews, filling in applications and obtaining medical support information, Joan’s life was transformed when she moved into a brand new social housing unit. Her new home is Joan’s ‘for life’, affordable and designed with no steps, a walk-in-shower and open plan living room and kitchen. Her rent is capped at 30 per cent of her income, and she has friends and neighbours close by.

15. Personal communication.

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Figure: Summary of the risk factors contributing to homelessness in care leavers in Australia. Individual risk factors are compounded by the systemic problems of lack of access to information and support, and lack of affordable, appropriate and secure housing.

A collaborative paper on 11 what needs to be done A survey by the Care Leaver’s Australasia Network (CLAN) Workers in this part of the sector therefore speak of the in 2011 asked 577 members about the prospect of entering importance of simple ways of accommodating these needs, or being placed in an aged care facility. Their attitudes such as ‘defendable spaces’ in accommodation. This may be reflected that many care leavers feel they cannot trust a lockable door to a private room with bathroom, but also a the government or other organisations run by churches defendable private outdoor space or respect for a resident’s or charities due to past experiences. Many have extreme preference to speak with staff somewhere other than their anxiety about being placed in an institution again. For room. This means that residents have a space that many, spending their older years in a nursing home is their is theirs only, is defendable and where they can feel safe. greatest fear. Responses included flat rejections of living in It is something that residents of Wintringham’s services care again, with a preference to die or to live on the streets who have suffered from institutional abuse as children say rather than live in a residential aged care facility. For this that they particularly appreciate. reason, CLAN considers support for older care leavers to remain in their own homes a need, not a preference.16 Research about how care leavers experience aged care is lacking, however anecdotal reports indicate that common aged care environments (e.g. locked wards) and practices (e.g. personal care) can affect care leavers differently to those without these experiences. Receiving aged care services introduces a power imbalance that requires the survivor to trust both a providing organisation and the person delivering the care. The individual is also generally required to accept limitations to their choice and control, directly threatening the most important component of recovery from trauma. Personal care, food provision, unfamiliar support workers, shared living spaces, closed doors, noise, lighting, medical procedures, and other aged care practices and environments can trigger trauma reactions in ways that are difficult for care staff to understand. The survivor’s response to the perceived threat can appear out of proportion (e.g. ‘explosive’ anger or fear, aggression, hoarding) or go entirely unnoticed (e.g. dissociation, hopelessness, withdrawal), posing risks to physical and psychological wellbeing. 17

16. Care Leavers Australasia Network (no date) Submission to the Australian Government Department of Health in response to the discussion paper: ‘Future Reform: An Integrated Care at Home Program to Support Older Australians. Accessed at https://www.clan.org.au/wp-content/uploads/2019/01/1.pdf on 29/8/2019. 17. Dr Monica Cations, Flinders University – discussion paper in preparation.

12 Appropriate services for older care leavers experiencing, or at risk of, homelessness As increasing numbers of care leavers are accessing— KEY MESSAGES FOR or are in need of—services as they age, it is critical to address general awareness in services sectors as well as APPROPRIATE SERVICE the underlying challenges leading members of this group to become or be at risk of homelessness. CLAN’s key DELIVERY TO CARE recommendations include: mandated training for all those LEAVERS who are funded to provide aged care or to care for a care leaver, advocacy to assist in accessing aged care services, 1. Language and associations and specialised funding to care leavers to keep them in It was a common practice for children in ‘care’ to be their homes for longer. referred to by a number or for their birth name to be replaced. Names can therefore have great importance for care leavers as signifiers of identity. Spell names correctly. Pronounce names correctly. Joan has since lost weight, given up smoking and no longer needs Noting the intersection of the groups, the practical challenges to accessing the aged care system for care medication to control her diabetes. leavers who are also people who are experiencing or Now 75 years old, Joan has support and are at risk of homelessness will be similar to those for social connection through her church and older women in that situation. The AAG report on older neighbours, as well as being a long-term women at risk of, or experiencing, homelessness noted member of HAAG where she tells her that assessment teams and aged care gateway (My Aged story to people so that they can get Care) are not identifying people at the assessment stage and establishing referral pathways to organisations that help also. can help.18 The language must be right because some people don’t self identify as ‘care leavers’. The NATSIA survey for example asks ‘do you have a lived experience of removal?’. The My Aged Care screening form has questions designed to identify when individuals have complex needs, and specifically whether they are care leavers (or more generally have experienced personal abuse) but assessors need to be trained to ask questions with sensitivity to this group’s specific needs and with access to appropriate pathways to assist with finding appropriate services if they do disclose.

18. Lipmann B. Viability of specialist homelessness providers and other related matters. Wintringham; May 2018 cited in AAG, Background Paper: Older women who are experiencing, or at risk of, homelessness, 6 August 2018.

A collaborative paper on 13 what needs to be done Some individuals identify themselves as care leavers, 2. The need for a specific approach while others will not use this term as they reject the Care leavers need an action plan as well. There should idea that they were ‘cared for’. Likewise, the term be one for each special needs group under the Act. ‘Forgotten Australians’, though accepted by the Alliance for Forgotten Australians as the least likely to offend and In looking at the [need for a] homelessness Action used in the National Apology to Forgotten Australian Plan, it makes a difference whether you take the and Former Child Migrants 19, is not universally accepted perspective of ‘homeless people’ who are ageing or ‘owned’ by care leavers. People may refer to their versus aged people who are homeless. The emphasis care-leaver status using nicknames such as ‘homies’ or makes a difference. ‘wardies’, but these terms also have a history of being The point to make is not that the aged care system used offensively. needs to change to suit the subgroup, but rather that Too many people with complex issues fall through you need to address the unintended consequence of systemic gaps; frontline workers need awareness of the aged care system on these subgroups. The aged this and of how to avoid this happening. 20 care system needs to be able to support all Australians, not just the average. There are two aspects to this issue: accessibility of the system as a whole and, once the system is accessed, the These comments are consistent with thinking about capacity of the system to deal sensitively with the needs complex health/social issues in terms of ‘systems of care leavers. Frontline workers—across all services approaches’.21 A systems approach is a way of analysing that may come into contact with care leavers, not just the design of interventions aiming to address the social in the aged care or health systems but also for example drivers of poor health outcomes, with an emphasis on MyAgedCare and Centrelink staff—need to understand identifying the points in the system that will be most not only that care leavers exist as a special needs group effective in improving outcomes, and interventions that but are at greater risk of homelessness (amongst other are most likely to have a sustained effect, because they complex needs). are most resistant to the tendency for social systems to return to the status quo. 22 Research in this area suggests that the most effective measures will be targeted not at individual interventions but towards creating change in the system. In the case of designing interventions to improve health outcomes for older care leavers at risk of homelessness, this might mean that our concept of the ‘aged care’ system needs to be sufficiently broad to enable that system to take responsibility for ensuring that, where necessary, housing services are provided alongside health and other services, to support equal access of individuals to care in the community if this is what they need. Access to ‘aged care’ services is then enabled via access to safe and secure housing.

19. On 16 November 2009, on behalf of the Australian Government, Prime Minister Kevin Rudd delivered an unqualified apology to Forgotten Australians and Former Child Migrants who suffered abuse or neglect in care. He was supported by the (then) Opposition Leader, Malcolm Turnbull. The transcript was accessed at http://parlview.aph.gov.au/mediaPlayer.php?videoID=314492&operation_ mode=parlview#/3 on 30/8/2019. 20. See for example statements quoted in the Forgotten Australians report. 21. Systems approaches recognise that a range of factors operating within a system interact and/or are interdependent. In terms of designing interventions to correct system ‘failures’, the approach calls for measures that recognise the way in which the system operates, its component parts, and the positive and negative ‘loops’ created within the system. 22.Carey, G and Crammond B., Systems change for the social determinants of health’, BMC Public Health 2015 15:662, accessed at https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1979-8 on 29/9/2019.

14 Appropriate services for older care leavers experiencing, or at risk of, homelessness Care leavers have a lower than average rate of home The Australian Government Department of Health ownership and a higher than average rate of social worked with national experts and consumer groups housing rental. In the 55–64 year age range of care to develop the Aged Care Diversity Framework, leavers in Fernandez et al.’s study, the percentage of which was launched in December 2017. Under the home ownership was 46.3 per cent for participants Diversity Framework, Action Plans are developed compared with 80 per cent for people in the general to assist providers to identify actions they can take community. Twenty-two per cent were renting privately to deliver more inclusive and culturally appropriate and nineteen per cent were renting in social housing, services for consumers who are members of which is three times higher than the Australian average 23 specific priority groups. (5 per cent). Many participants reported episodes of homelessness, evictions and multiple changes Although not underway when the workshop was of address as a result of financial disadvantage and held, the Australian Government has commissioned housing shortages. These experiences of instability then an Action Plan under the Aged Care Diversity contributed at times to their own families breaking down, Framework for older and prematurely aged people and even in children being removed from their care. 24 experiencing, or at risk of homelessness (the Homelessness Action Plan). This is part of the The importance of establishing security of housing work towards realising the Aged Care Diversity through specialist housing services for care leavers as Framework’s vision that ‘All older people experience they age cannot be understated. The best approach a high-quality aged care system that ensures to homelessness will involve a prevention approach equitable access and outcomes and embraces and improving the entire system to reduce the risk of their diverse characteristics and life experiences’. homelessness for all people as they age. The Diversity Sub-group of the Aged Care Sector Committee is responsible for development of the Homelessness Action Plan. Further information, including consultation draft Action Plans for use by Consumers, Providers and the Australian Government, is available on the Housing for the Aged Action Group (HAAG) website. References: https://agedcare.health.gov.au/support-services/ people-from-diverse-backgrounds/aged-care- diversity-framework https://www.oldertenants.org.au/i-want-change/ projects/aged-care-homelessness-action-plan (accessed 17/10/19)

23. Fernandez et al., citing Martin, C., Pawson, H. and van den Nouwelant, R. (2016). Housing policy and the housing system in Australia: an overview. Report for the Shaping Housing Futures Project. UNSW: City Futures, in relation to the general population rate of home ownership. 24. Ibid

A collaborative paper on 15 what needs to be done Housing is the number one factor affecting health outcomes. The aged care system is however Although no single model of aged care can be predicated on a choice between residential care and recommended to cater for Stolen Generation ‘home based’ care and supports. The false assumption survivors, there are important underpinning principles: that people needing services in the community are in Self-determination Co-design is fundamental to stable housing creates a cohort of people that have planning and delivering aged care services for survivors limited access to services they need. of the Stolen Generations Premature entry into residential care is commonplace Choice Survivors of the Stolen Generations require both for Aboriginal and Torres Strait Islander and services and models of delivery that encompass for those who have experienced social and financial flexibility and avoid assumptions—not every survivor disadvantage; indeed funding for residential care is will want an Aboriginal service; some will have families targeted to these groups, notwithstanding mainstream who can assist, but not all; not everyone has residential aged care being so problematic for many re-connected to Country who have experienced forms of institutionalised care. Trauma aware and healing informed approaches will Strategies to improve care leavers’ choices about avoid re-traumatising survivors and their families, and where and how they receive supports as they age assist services to understand the expression of trauma would include comprehensive community-based services, including accessible health and Assistance Trust Support should be available from (or in With Care and Housing services. Many in this cohort partnership with) organisations that are trusted by the are particularly afraid of entering residential aged care individual survivor—these may not be accredited aged due to distrust of institutions and government, so care providers specialised accommodation services that are tailored to Holistic Services should provide holistic wraparound meet the needs of care leavers are needed. support that deals with each person’s cultural/spiritual There is a need to increase the understanding of and kinship contexts as well as delivery for ageing, human rights principles in the aged care sector. health and, housing services There is never going to be a ‘Stolen Generations’- Reference: specific service sector—there are only two Aboriginal Healing Foundation, AAG and ATSIAAG Stolen and Torres Strait Islander -run aged care providers Generations Aged Care Forum Report, August 2019 in Victoria, and one might close. This means the accessed at https://www.aag.asn.au/documents/ mainstream services need to take the needs of the item/2991 on 29/9/2019. Stolen Generations into account.

16 Appropriate services for older care leavers experiencing, or at risk of, homelessness Members of the Stolen Generations will have specific The aged care system assumes people can and should issues relating to the embeddedness of cultural advocate for themselves, but the system should be identity in country, family, culture and community, advocating for them—the outreach program should be and the ways in which these links were disrupted by expanded to go out and find people [to assist them to removal practices. There are examples of facilities that access services they need]. aim to provide residential care that is safe and culturally The workshop coincided with the launch of a new appropriate. These are however rare, which raises the report by the Australian Institute of Health and Welfare, risk of individuals with high needs and insecure housing ‘Stolen Generations 50 and over’26 which found 32 per being placed in aged care away from social and family cent of Aboriginal and Torres Strait Islander people are supports, and from Country. Similarly, the experiences of descended from members of the Stolen Generation. Forgotten Australians have often been of chronic social The transgenerational trauma this represents disconnection—individuals either experiencing or at risk amounts to a huge population — the children and of homelessness need access to specialised, secure grandchildren of members of the Stolen Generations and supportive housing, especially in the later years continue to be affected. of their lives. Well-defined models of trauma-informed care exist and can be implemented in these contexts. For leavers of care it is a frightening prospect to go back into an institution in your older age. Resources such as the recently released ‘Forgotten Australians Real Care the Second Time Around’25 are essential to raising awareness of those in the sector to the needs of care leavers, and ways in which these needs can be better met so that mainstream aged care does not create negative outcomes for care leavers. Improving the responsiveness of the care system is critical, however this will not address the systematic failures that have led to and continue to the health issues experienced by this group, or the lack of secure housing that contributes to those issues.

25.Accessed at https://www.helpinghand.org.au/wp-content/uploads/2019/01/Positioning-Statement-Forgotten- Australians.pdf on 29/9/2019. 26. Accessed at https://www.aihw.gov.au/reports/indigenous-australians/stolen-generation-aged-50-and-over/contents/ table-of-contents on 29/9/2019.

A collaborative paper on 17 what needs to be done At Wintringham, it is acknowledged that the ‘tools’ for 3. Specific health issues and awareness get dated and need to be refreshed. Just as the service needs sector has made progress in meeting the needs of CALD and Aboriginal and Torres Strait Islander groups as they We need to look at the cost of failing to address this age, the industry needs to understand—and meet—the properly—unfortunately a more persuasive argument for needs of care-leavers as a significant cohort that is now in investment than ‘do it because it is the right thing to do’ the ‘aged care’ target age group. or that an individual has a human right to access services that will lead to equitable outcomes for them. It is not possible here to explore the history of out of home care, but it is important to acknowledge that, just as there Specific health issues experienced by many care leavers have been ‘waves’ of immigration that need to be taken into include those common to individuals growing up in account in meeting the needs of CALD groups, there were situations of extreme underprivilege. For example, dental ‘waves’ of out of home care as institutional arrangements issues are particularly prevalent due to the lack of dental gave way to fostering and other approaches. This reinforces care as children. the importance of seeing individuals and their needs and The research around the social determinants of health making no assumptions about the impacts of ‘care’ or how would also suggest a higher than average incidence of it has affected the individual. chronic, preventable diseases. People who are socioeconomically disadvantaged have, on average, greater levels of cardiovascular disease (CVD), diabetes and chronic kidney disease (CKD). In 2016, males and females living in the lowest socioeconomic areas of Australia had higher prevalence rates of type 2 diabetes and treated end-stage kidney disease; higher heart attack rates; and higher CVD, diabetes and CKD death rates than those living in the highest socioeconomic areas.27 The correlations are even stronger looking at levels of educational attainment (rather than just locality). The solution: to partner with a cohort-specific service and tailor health services to them. As noted above, there is limited research that relates to the needs of care leavers, although through the Royal Commission there was a review of literature relating to health outcomes and treatment responses to childhood sexual assault.

27. Australian Institute of Health and Welfare 2019. Indicators of socioeconomic inequalities in cardiovascular disease, diabetes and chronic kidney disease. Cat. no. CDK 12 accessed at https://www.aihw.gov.au/getmedia/01c5bb07-592e-432e-9fba- d242e0f7e27e/aihw-cdk-12.pdf.aspx?inline=true on 29/9/2019.

18 Appropriate services for older care leavers experiencing, or at risk of, homelessness The complex combinations of physical and mental health The gap in resourcing is implicit in the Legislated Review issues and ‘life skills’ issues call for wraparound services of Aged Care (The Tune Review), which pointed to a similar to those now increasingly common in community ‘concerning’ ‘lack of information and evidence in relation services for people experiencing homelessness or those to aged care for both care leavers and the parents at risk of homelessness. Wintringham is one example of children who were forcibly adopted. The report of services specific to older people who are homeless, stated that ‘[g]iving people the opportunity to identify however there are other service models such as as coming from a group with a special need such as the Foyer model28 —which is often catering to young these, and having that recorded in the client record, people leaving the care system—that could be adapted is one step toward understanding the population and for older groups. responding to them, but more needs to be done in terms of the provision of care, and of training the assessment 4. Resourcing workforce.29 The report, by way of supporting the UNSW30 recommendation that non-institutional forms Initially resourcing for aged care in this area was good, of aged care be looked at to support care leavers who but has been reduced over time. Staff do not have time may require aged care services as they get older, referred to learn from those with lived experience, even if this to Recommendation 7—introduction of a Level 5 home were accepted as a legitimate form of training within care package, which would allow for a higher level of the sector. The experience … is that having peers talk care to be provided outside of residential care (noting and educate each other is so powerful and should be that Tune does not acknowledge the heightened risk of part of the professional learning process. homelessness for this group). Human rights are part of the quality standards/ obligations. Sometimes service providers are tired and just trying to survive. While care leavers are identified as a group having ‘special needs’ this is not currently reflected in terms of funding arrangements for services specialising in meeting the needs of care leavers, although there are supplements paid in respect of individuals in residential care services for those who would otherwise be homeless. The single aged care quality standards framework mandates that aged care must be individualised, respectful, safe, and co-designed—care that doesn’t consider the needs of care leavers cannot be said to meet this standard. There is no recognition in the funding model of the additional needs of this group.

28. See www.foyer.org.au. 29. Commonwealth of Australia, Department of Health, Legislated Review of Aged Care, 2017 accessed at https://agedcare.health.gov.au/legislated-review-of-aged-care-2017-report on 29/9/2019. 30. Fernandez et al. is referred to as the UNSW report by Tune.

A collaborative paper on 19 what needs to be done The Aged Care Funding Authority31 points to the financial The Resource Use and Classification Study was pressures faced by providers of residential aged care released in March 2019 so its implications for the services to people experiencing homelessness, in addition specialist homelessness sector were not discussed to those experienced across the sector, under current at the workshop. Though its recommendations are funding arrangements. Their 2018 report points to ‘the limited to the residential aged care funding model, significant constraints facing these providers, including it is significant in that it recognises high cost structures and the very limited ability they have ‘[s]ignificantly higher costs … for facilities with to achieve a contribution from residents’ and recommends specialisations in Indigenous care (although these that ‘consideration should be given to enhancing the services also tend to be small and remote), and support provided to these providers’. Services that provide homelessness services’ and goes on to recommend accommodation to people experiencing homelessness ‘the development of a blended funding model generally have 100 per cent supported residents and no that comprises a fixed per diem price for the fixed access to refundable accommodation deposits (RADs) or costs of care, including shared, non-individualised other forms of consumer contributions through additional care, and a variable price per day for the costs of services, although they do have access to capital grants. individual care’. In addition, the vast majority of their residents have no family connections or support and as such providers have AAG will review the Study and develop to perform tasks that would normally be undertaken by a recommendations around the evidence that family member. additional supplements should continue to be paid in respect of care leavers in residential care. 5. Workforce and training Reference: How do we acknowledge people’s apprehension when McNamee, J., Kobel, C., and Rankin, N. (2019) offered a service? Often people are ‘difficult’ as a defence Structural and individual costs of residential aged mechanism. The skills that assessors need to move past care services in Australia. The Resource Utilisation defensive behaviours and talk to people about their and Classification Study: Report 3. Australian lifetime experience isn’t necessarily there. Very high Health Services Research Institute, University of skills [are needed] not just to be administrative people. Wollongong accessed at https://agedcare.health.gov. We need to get specialist skill sets into the broader aged au/reform/resource-utilisation-and-classification- care system. Care leavers represented the largest group study-rucs-overview-and-reports on 29/9/2019. of survivors of abuse identified by the Royal Commission into Institutional Responses to Child Sexual Abuse.32 Materials to educate members of the workforce exist but need to be updated to remain currency, for example as best practice in trauma-informed service provision evolves.

31. Update on funding and financing issues in the residential aged care industry, September 2018, accessed at https:// agedcare.health.gov.au/reform/acfa-update-on-funding-and-financing-issues-in-the-residential-aged-care-industry on 29/9/2019. 32. See https://www.childabuseroyalcommission.gov.au/.

20 Appropriate services for older care leavers experiencing, or at risk of, homelessness The Australian Government has developed the ‘Caring The Living Longer Living Better reforms were for Forgotten Australians, Former Child Migrants and formulated in a spirit of optimism: ‘Australians can Stolen Generations Information Package’ for aged care now expect to have an extended period of healthy, providers to help them understand and support Care active retirement that was unimaginable in the past. Leavers (see text box above). There was a view expressed Our challenge is to make sure that as we live longer, in the workshop, that key stakeholders were insufficiently we continue to lead happy, healthy, productive and engaged in the development of this package and that connected lives.’ It is a continuing challenge for the aged there is no accountability for implementation of measures care system to accommodate the needs of diverse groups to ensure that services are accessible to care leavers. and those coming from backgrounds or with histories Training of the aged care workforce is usually very other than those of the majority. ‘mainstream’. Every person in the system needs an It was observed in the workshop that there could be appropriate capacity to recognise trauma-related representatives of these groups (i.e. care-leavers) in behaviours and needs and how to respond, particularly management in the sector, as well as staff with lived when more specialised support is needed. Then experience at operational levels. This would be consistent specialised support services need to be readily available. with the Diversity framework, which includes suggestions The message needs to be that there is nothing such as ‘ensuring the diversity of consumers and the ‘wrong’ with the person, that it is understood that community is represented in organisational governance’. something happened to you. Talking about a person’s In the case of care-leavers, particularly those who are needs and history can put the ‘responsibility’ on to them experiencing or at risk of homelessness, to explain, but a relational approach will establish the [r]ather than ‘consulting’ on what is needed, having trust needed to support a genuinely ‘person-centred’ consumers or people with lived experience in the assessment process. Board room will influence the culture of the organisation Many of these people were told daily that they were ‘ugly’ from within. It is more than understanding trauma, but or that they were unwanted. Skills of genuine empathy— about understanding people and how to provide the capacity to recognise the individuality of experience person-centred care. and to be present to the needs of the other—are necessary How do we get people with a diversity of experience to to creating the trust relationship needed to ask how a run these services, not just receive them? Diversity in person would like their needs to be met. management will shape industry change. Asking difficult, potentially triggering questions up front Participants highlighted the opportunity for people with is not safe or appropriate. There needs to time allowed a lived experience to educate aged care service providers to build trust with the person. The competitive ‘market and workforce, and to participate in that workforce. There based’ approach in this space could be seen to enable are significant barriers to care leavers entering the aged trauma-informed care as a marketable service advantage care workforce—for example challenges with literacy and and an opportunity to provide innovative, person- therefore formal education systems. centred services. The challenge is to create a space where these individuals go beyond the first contact with MyAgedCare.

A collaborative paper on 21 what needs to be done [At Berry Street we] have only two workers with lived experience. It undermines the intent of ‘nothing about us The Terms of Reference for the Royal Commission without us’. include the following matters that are particularly Aboriginal Health Workers and Social and Emotional relevant to care leavers, particularly those who are Wellbeing counsellors should also be integrated into service homeless or at risk of becoming homeless: delivery, including through Multi Purpose Services. u the quality of aged care services provided to The aged care industry needs to ensure that the work Australians, the extent to which those services they do to implement the Aged Care Workforce Strategy meet the needs of the people accessing them, identifies and addresses barriers to entry into the sector by … the causes of any systemic failures, and any members of special needs groups including care leavers actions that should be taken in response; who have experienced homelessness. u the future challenges and opportunities for 6. The Royal Commission into Aged Care delivering accessible, affordable and high quality Quality and Safety aged care services in Australia, including:

The aged care sector is at risk of losing its social licence u what the Australian Government, aged care through the Royal Commission process [that commenced industry, Australian families and the wider in January 2019]. community can do to strengthen the system The Royal Commission creates a good opportunity to of aged care services to ensure that the insist services need to be different for the group coming services provided are of high quality and safe; through in the next 10–20 years. u how to ensure that aged care services are person-centred, including through allowing people to exercise greater choice, control and independence in relation to their care, and improving engagement with families and carers on care-related matters;

u how best to deliver aged care services in a sustainable way, including through innovative models of care, increased use of technology, and investment in the aged care workforce and capital infrastructure.

22 Appropriate services for older care leavers experiencing, or at risk of, homelessness CONCLUSION AND AAG notes these messages and acknowledges: RECOMMENDATIONS ON u the current inequity in access to specialist health, housing and aged care services for care leavers in APPROPRIATE CARE FOR general and those who are homeless or at risk of OLDER CARE LEAVERS homelessness in particular; and The thoughts and ideas expressed by workshop u the potential for failings in the system to lead to participants conveyed the great importance of ensuring adverse outcomes for this group. that the aged care system encompasses services that AAG considers: deliver good outcomes for care leavers, particularly those experiencing or at risk of homelessness. There are u addressing this inequity should be a high priority resources available to ensure that this happens. for government and the sector; and

Participants’ key messages fall into six broad areas: u measures to address this inequity can best be considered in the context of the Aged Care u the way in which the experience of childhood Diversity Framework, and therefore creation of an care creates issues around language and associations, Action Plan for aged care for older care leavers and how this may impact on interactions with aged should be prioritised. care services; Australian Association of Gerontology joins with u the need for a specific approach to considering the partners in this work to call for the implementation needs of this group as the basis for ensuring that the of the following recommendations to improve equity aged care system works for tailored services that of access and quality outcomes in aged care for care cater to care leavers; leavers as they age, particularly those experiencing u a call to recognise that a range of range of health or at risk of homelessness. and other issues are associated with a history of ‘care’ and that the cost of not meeting these health needs is high; u the importance of adequate funding for services to meet the social obligation to individuals who live with the consequences of unsafe childhood ‘care’; u that it is critically important that front line workers know this group exists and have the skills necessary to deliver safe, relational services; and u that the Royal Commission into Aged Care presents the opportunity to bring the needs of this group to the attention of decision makers.

A collaborative paper on 23 what needs to be done RECOMMENDATIONS

Recommendation 1: Recommendation 6: Develop and formulate a national housing framework with Establish a capital pool to enable specialist aged care support from all Australian governments that delivers long- providers to build residential aged care facilities for older term solutions to ensure affordable, appropriate and secure people who have experienced homelessness that is 33 housing supply. appropriate for their financial, wellness and health needs.

Recommendation 2: Recommendation 7: The Australian Government commits to ensuring there is Extend availability of specialist services to meet need, adequate housing supply for older Australians, including whether through residential care or care in the community. implementation of the recommendations made in the National Aged Care Alliance’s 2018 Position Paper ‘A secure, Recommendation 8: affordable home for older Australians’.34 Ensure that supplements and payments to providers of specialised services for older care leavers generally, but Recommendation 3: particularly care leavers who have experienced or who are Strategies to ameliorate the impacts of childhood at risk of homelessness, meet the costs of providing care experience of institutional or unsafe out of home care and that meets their needs. prevent homelessness in later life are co-designed with stakeholders and implemented as a matter of urgency. Recommendation 9: Establish a dialogue and linkages between the Recommendation 4: aged care, housing and homelessness sectors to develop Include questions addressing housing and the risk of, or specific approaches to considering the needs of this experience of, homelessness in the aged care assessment group as the basis for ensuring that the aged care processes, supported by improved skills of members of system works for tailored services that cater to care the aged care workforce to understand and respond to the leavers in the community. unique circumstances and needs of care leavers. Recommendation 10: Recommendation 5: Support Specialist Homelessness Services to understand and be able to refer people to appropriate aged Review and enhance the Assistance with Care and Housing care services, from services providing Assistance with Sub-Programme of the Commonwealth Home Support Care and Housing for older people to those providing Programme to better meet the needs of older care leavers specialised residential aged care for people who have at risk of, or experiencing, homelessness. experienced homelessness.

33. The evidential rationale for this recommendation is set out in Australian Association of Gerontology (2018) Position Paper. Older women who are experiencing, or at risk of, homelessness, accessed at https://www.aag.asn.au/documents/item/2235 on 29/9/2019. 34. National Aged Care Alliance (NACA). A secure, affordable home for older Australians, March 2018, accessed at https://naca. asn.au/wp-content/uploads/2018/11/Housing-Position-Paper-2018.pdf on 29/9/2019.

24 Appropriate services for older care leavers experiencing, or at risk of, homelessness RECOMMENDATIONS

Recommendation 11: Educate and support disability, social service (e.g. income support), aged care, and health providers so that they know about, and are able to support people’s access to, services for older care leavers, including for those experiencing, or at risk of, homelessness.

Recommendation 12: Ensure that older care leavers who have experienced homelessness and are eligible for aged care from 50 years or older, or from 45 years or older for Aboriginal and Torres Strait Islander people, have a choice in how their needs are met, for example they are not forced to apply to the National Disability Insurance Scheme (NDIS) or restitution schemes for which they may be eligible.

Recommendation 13: Include outreach services to support older care leavers at risk of homelessness in the face-to-face hubs to support aged care system navigation as it evolves.

Recommendation 14: As part of the Aged Services Workforce Strategy encourage providers and other stakeholders to explore training and workforce models to increase the representation of those with lived experience of care in the sector, and address barriers to employment of care leavers in the sector.

A collaborative paper on 25 what needs to be done APPENDIX:

WORKSHOP PARTICIPANTS Ms Maurya Bourandanis, Port Melbourne Neighbourhood Centre Ms Caroline Carroll OAM, Alliance for Forgotten Australians/Open Place Dr Victoria Jane Cornell, ECH and Convenor of AAG’s Housing and the Built Environment Special Interest Group Prof Michael Fine, Macquarie University Miss Jan Grey, Voices Of The South Side/Community Member, Port Melbourne Neighbourhood Centre Mr Ian Hamm, The Healing Foundation Ms Lisa Hillan, The Healing Foundation Ms Heather Johnson, Your Future Options Ms Wendy (Tip Yan) Li, Christian Family Service Centre Mr Bryan Lipmann AM, Wintringham Ms Deb McIntosh, Voices of South Side/Port Melbourne Neighbourhood Centre Ms Tonye Segbedzi, AAG Dr Sandra South, AAG Ms Lisa Tribuzio, Hume Whittlesea Primary Care Partnership Mrs Carolina Valencia Coleman, West Metro Sector Development Team Ms Catherine Wong, Christian Family Service Centre Ms Fiona York, Housing for the Aged Action Group

26 Appropriate services for older care leavers experiencing, or at risk of, homelessness NOTES

A collaborative paper on 27 what needs to be done Lorem ipsum

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