‘Geographic narcissism': the battle to fund aged care providers in rural Australia
In the final stages of Angiolina Moro's dementia journey, she would revert to speaking Italian.
'She was in her late 20s when she arrived in Australia,' her son, Joe Moro, says. 'So as her dementia creeped in, she lost the capacity to speak in English.'
Angiolina died in February. She spent the final five years of her life at an aged care facility in Mount Kooyong, 50km north of Mareeba, the far north Queensland town where she had lived most of her life.
Moro says his mother would have preferred to stay in Mareeba, where language wasn't as much of a barrier. Ten per cent of Mareeba's population is Italian.
'I know the staff [at Mount Kooyong] spent a lot of effort trying to communicate,' he says. 'I think they did a fantastic job.
'A lot of older people in the [region] are the first lot of immigrants who came back in the 50s and worked hard and are now deteriorating and ending up in homes. So language is a big barrier up here for getting good outcomes in care.'
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Moro says because of the relative isolation of the region there are limited options for aged care. Some travel to Cairns, about 60km from Mareeba, to fit in with their adult children's work schedules. But, Moro says, most of their elderly parents would prefer to stay in smaller communities.
Ross Cardillo sold his business several years ago to help around the family lychee and longan farm at Mareeba. He and his sister are supporting their mother, 77, who is providing in-home care for their father, 83.
'There's just not sufficient care in Mareeba,' Cardillo says. '[Dad] wants to stay home, which is fair enough. If he goes to an aged care facility, he will die. And my mother won't let him die.'
It is a common story in rural Australia. In-home aged care services are limited the further you travel from capital cities and regional centres. Cardillo has many friends who travel an hour to access aged care homes and the distances increase as you move further inland.
Cardillo is the chairman of Mareeba and Communities Family Healthcare, a social, not-for-profit enterprise founded five years ago to provide improved medical services in the town.
'We are trying to cater for our ageing population with little or no support from anyone else,' he says. 'As a community, we see it as valuable and important and we're pursuing that.
'It's about opening up funding to more providers that are available up here.'
In May, the enterprise set up an outreach clinic in Mutchilba, 35km south-west of Mareeba, to service the 600 locals. 'Most of them are elderly, so we didn't want them to travel as far,' Cardillo says.
Moro, who is also the Mareeba Chamber of Commerce president, says Mareeba and Communities Family Healthcare was set up to focus on general medical services but could expand to aged care if there was adequate 'dollars, cents and expertise'.
'We have an overall shortage here,' he says. 'There are numerous councils trying to get investment and there's talk of something going to happen – at the end of the day it's an investment issue.'
A 2023 report by the National Rural Health Alliance estimated that rural Australians missed out on $850 worth of healthcare services each year due to a lack of access to or availability of services in their local area – equating to a total annual rural health underspend of $6.5bn.
The Alliance chief executive, Susi Tegen, says many communities have resorted to raising funds on their own.
She described the failure of governments to adequately fund aged care in the regions as 'geographic narcissism'.
'Some communities are coming up with models that are much better and allow for support from the local community,' Tegen says. 'However, they are often not funded. They rely on volunteers and they are often not considered by government funding to be good enough. And yet, we seem to see a population that is being told by the lack of funding that they're not as important as urban people.'
In New South Wales, the Snowy Mountains community of Bombala shot a nude calendar to raise funds to keep the Currawarna assisted living facility open after it closed due to staff shortages in 2022.
Tegen says rural communities need a commitment from state and federal governments to ensure they receive equitable funding to keep pace with the ageing population. The number of Australians aged over 65 years is projected to almost double from 3.8m in 2017 to 6.4m in 2042, according to the Australian Bureau of Statistics.
Tegen says it is difficult to attract healthcare workers to move to regional areas because they 'feel they're not being supported'.
'They're having to beg and scrape, and they're having to jump through hoops to get the money that everyone else seems to be getting in the city,' she says.
The federal government in March said it would invest $600m in in-home care in regional Australia and for people with diverse backgrounds and life experiences. There is also almost $1bn in the federal budget for the Aged Care Capital Assistance Program, which provides grants to build, extend or upgrade aged care services or to build staff accommodation where older Australians have limited or no access.
But Cardillo says it seems as though that money never filters down to his community, and the people at the top do not understand the reality of those in regional communities. He says the community will keep doing what they need to do to cater for their ageing population.
'They get things done themselves and they do it themselves,' he says.
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