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There was one thing resoundingly clear in the recent Closing the Gap review, and that was the government’s failure to recognise Aboriginal Community Controlled Organisations (ACCOs) as the way forward.

The Closing the Gap review examined the progress of the agreement, which was signed back in 2020, and on a national level, has echoed the thoughts and feelings of Aboriginal Community Services, as we navigate our existence as a service provider to First Nations communities.

“Governments are not adequately recognising that Aboriginal and Torres Strait Islander community controlled organisations have knowledges, expertise and connection to community that governments do not have. This means that ACCOs are often better placed than governments to design and deliver high quality, holistic and culturally safe services.” – Closing The Gap Review

ACCOs often become the heartbeat of Aboriginal communities and are relied on to provide necessary and sometimes life-saving services they aren’t appropriately funded for. ACCOs don’t exist as an organisation separate from community, we are embedded in it. Family ties, cultural understanding, and knowledge of how community functions, is what sets us apart from currently operating government bodies.

Through a First Nations Aged Care lens, this review is reaffirming, but it’s also a harsh reminder of all the ways our industry has not been improved since the Royal Commission in 2019. The Department of Health and Aged Care, and the Aged Care Quality and Safety Commission produce policy and legislation that does not result in appropriate support for First Nations people. The Closing The Gap Review asks the government, why are government policy-makers still charged with making decisions on what’s best for First Nations communities, when ACCOs are right here?

We see the consequences of this play out when the Department imposes one-size-fits-all policies on remote service providers, leading to non-compliances and neglect of real community needs that might not be covered by allocated funding.

This was highlighted in the executive summary of the Closing The Gap review, where it was written that governments often “…impose generic, pre existing models of service and program design, and require reporting against narrow key performance indicators (KPIs), instead of allowing ACCOs to design services and measure outcomes in ways that are most meaningful to communities.”

The Royal Commission into Aged Care Quality and Safety recommended that the government should support First Nations providers through flexible approval and regulation to ensure culturally appropriate support. This has not been reflected in legislation passed since then which excludes the purchases of many items deemed ‘general household items’ from being funded, leaving many Elders who are in financially disadvantaged positions without basic living necessities.

The current reality of remote aged care is that providing appropriate care will result in non-compliances against standards. The Closing The Gap review calls for the government to strengthen the ACCO sector by covering the full cost of service provision. At ACS we are currently funded to support 80 Elders in the Flinders and Far North Region. We support over 300.

The overwhelming message the Commission heard from ACCOs during engagements for this review was the need for ACCOs to have more control over the design and delivery of services so they can meet community needs and respond to changing priorities.” – Closing The Gap Review

Since the Royal Commission into Aged Care Quality and Safety was established, our CEO Graham Aitken has been advocating for better support from the government through his position on the board of the National Aboriginal and Torres Strait Islander Ageing and Aged Care Council (NATSIAACC), a peak body that was established in 2023. The Royal Commission made a series of recommendations back in 2019 regarding First Nations Aged Care that have still not been addressed, and that now, almost six years later, the Closing The Gap Review is echoing. What will it take for legislators to hear the voices of Elders and ACCOs?

The Royal Commission’s executive summary highlighted the clear gap in aged care, stating that Aboriginal and Torres Strait Islander people do not access aged care at a rate commensurate with their level of need. Graham explains,

Our Elders definitely want and need aged care, but they don’t understand the process or where it starts. If you can’t get to the first base, you can’t get to the service delivery at the end.”

Recommendation 48 of the Commission into Aged Care Quality and Safety outlined to government the importance of cultural safety at every stage of the aged care system, requiring all providers to train their staff in culturally safe and trauma-informed care. Since 2019 it’s been up to independent research bodies and ACCOs to address this recommendation. Highlighting once more the change-making work of Aboriginal organisations in comparison to the little decision-making powers they have. ACS is working with Wardliparingga Aboriginal Health Equity at SAHMRI to develop new training for First Nations Aged Care providers. However, it is up to the government on whether we see a shift in control when it comes to service design and how funding is allocated. After pledges from political parties and politicians to listen to community, to do things differently, and a clear failing to close the gap, ACCOs will continue to use their voice in the hopes that government will finally listen.

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