Fiona York, Executive Officer of Housing the for the Aged Action Group, gives evidence to The Royal Commission into Aged Care Quality & Safety about the obstacles facing older people who are homeless or at risk of homelessness to accessing Aged Care.
Full video and livestream of the Royal Commission can be found here.
Full Transcript
<FIONA June YORK, AFFIRMED [2.46 pm]
<EXAMINATION BY MS BERGIN
COMMISSIONER BRIGGS: Ms Bergin.
MS BERGIN: Your full name is Fiona June York.
MS YORK: Yes.
MS BERGIN: Have you prepared a statement for the Royal Commission, Ms York?
MS YORK: Yes.
MS BERGIN: Operator, could you please bring up document WIT.0398.0001.0001. Is there a copy of your statement in front of you, Ms York?
MS YORK: Yes.
MS BERGIN: Could you please turn the pages and identify that it’s a true copy.
MS YORK: Yes.
MS BERGIN: Do you have any amendments to your statement?
MS YORK: No.
MS BERGIN: And is it true and correct to the best of your information and belief?
MS YORK: Yes.
MS BERGIN: I tender the statement of Fiona June York dated 23 September 2019.
COMMISSIONER BRIGGS: The witness statement of Fiona June York of 20 September 2019 will be exhibit 10-7.
EXHIBIT #10-7 WITNESS STATEMENT OF FIONA JUNE YORK DATED 20/09/2019
MS BERGIN: Ms York, could you please tell the Commission what Housing for the Aged Action Group does generally?
MS YORK: Okay. Housing for the Aged Action Group is a community group that started about 35 years ago by a group of older women, tenants who wanted to advocate for housing justice. Since that time, we’ve grown quite considerably and are now delivering services. Our main service is the Home at Last Program which is funded partly through the Commonwealth Homes assistance with housing and that program is providing housing information to people aged 50 plus who are experiencing homelessness or at risk of homelessness. Since around 2013 we’ve housed 900-odd people in long-term secure housing and we also provide supports for those people once they’ve moved. So, we’re not actually housing providers ourselves but we do try and link people in with appropriate housing.
The other part of that service is the retirement housing service which is funded through Consumer Affairs Victoria and that provides information and advocacy for people who are living in retirement housing or considering moving into it and we also support around 300 people a year through that as well. We have an early intervention approach and so that involves trying to reach older people through community education and through professional education of different providers to
recognise when people are at risk of homelessness and intervene before they end up at that crisis point. So, we specifically targets culturally diverse communities and we are now moving into the LGBTI space as well. And as a result of our culturally diverse project we now have around 60 per cent of our clients are from a CALD background. Three-quarters of our home support staff are bilingual and we use interpreters every day, so we are very cognisant of what you need to be able to do to access those communities.
The other big part of your work is a partnership with Adelaide University and it’s looking at the data around housing and homelessness and people at risk of homelessness, particularly aged 50 plus and that’s moving around State to State at the moment, producing reports on what the ABS statistics and what the Centrelink data is saying about the housing situation for older people.
MS BERGIN: Ms York, what’s your position at HA?
MS YORK: I’m the executive officer.
MS BERGIN: And has HAAG been involved with the diversity subgroup of the Aged Care Sector Committee in preparing the draft homelessness action plan?
MS YORK: Yes, we were commissioned in around December last year to develop the homelessness action plan and we now sit on that diversity subgroup.
MS BERGIN: And in the market or in the NGO world, is it fair to say that HAAG is in a unique position in that you straddle the aged care sector as well as the homelessness sector?
MS YORK: Yes, there’s not many specialist older people’s housing services and we are the only one of this type. There’s other services like Wintringham that provide housing but for us we are a housing information service, and so what we found is that we sit in a position where we have one foot in the aged care space and one foot in the housing and homelessness space. And housing and homelessness as a sector is generally focused on family violence and younger people and doesn’t necessarily have a big focus on older people. And also, the aged care sector isn’t necessarily across housing and homelessness and understands that it’s not the first thing they think of when they’re interacting with older people. So, yes, we do sit in both spheres.
MS BERGIN: You personally sit on the diversity subcommittee of the Aged Care Sector Committee; is that right?
MS YORK: Yes.
MS BERGIN: Now, I want to turn to the topic firstly of what homelessness and at risk of homelessness means. What would be HAAG definition of at risk of homelessness?
MS YORK: So, for us, when we were developing the homelessness action plan we were using Bureau of Statistics definition which is slightly broader and
MS BERGIN: I’ll just bring that up for you, Ms York.
MS YORK: Sure. Yes.
MS BERGIN: Operator, if you please bring up RCD.9999.0212.0001 and turn to page 7.
MS YORK: Yes. So
MS BERGIN: If you could zoom in please operator under the line in brief the ABS statistical definition is. So, at about point 25 if you could zoom into those first two paragraphs and bring them up. Please continue, Ms York.
MS YORK: So, I guess what springs to mind when people think of homelessness is what is called rough sleepers, which are people living in parks and in their cars and things like that, and that is certainly a definition; any homelessness definition should clue that, but it also includes people that don’t necessarily have adequate or safe or secure housing. So, for us that includes people that may be not only living in their cars but living in temporary housing like hotels or boarding rooms, living in inadequate housing like caravans but also couch surfing, staying with friends and family longer than they need to or want to because they don’t have a choice and also living in poor quality or unaffordable private rental. So for an older person that is perhaps living in a house where they have no control over that environment because they need to ask the landlord permission in order to install ramps and rails or get a stepless bath or the doors are too narrow for them to be able to access if they are using a wheelie-walker, etcetera, these are all issues that are in private rental and if they’re paying 85, 90 per cent income on their rent it’s unaffordable. So, our definition of homelessness and at risk of homelessness encompasses that group of people as well.
MS BERGIN: So, in your explanation, that second dot point when a person has no tenure or if this initial tenure is short and not extendable
MS YORK: Yes.
MS BERGIN: Where does that concept sit in the rental market in say Victoria?
MS YORK: Every State has different legislation that governs residential tenancies. In Victoria there has been some recent reforms to that which – some of which are already in place and some are due to be implemented next year but, really, if someone can be evicted from their home with, you know, six weeks, eight weeks, even, you know, three months’ notice, or they’re on – there needs to be a good reason to evict those people, so no-reason notices to vacate, that’s not secure tenure and unfortunately that’s the case across many jurisdictions in the country. And
we’ve advocated along with a lot of other tenant advocate groups that we get to get rid of no-reason notices to vacate and we need to offer longer term leases and also allow – you know, allow modifications to the home to allow people to age in place.
MS BERGIN: Thank you. I should have mentioned at the start that there’s no definition of homelessness or at risk of homelessness in the Aged Care Act.
MS YORK: Yes.
MS BERGIN: It’s a term that’s used in section 11-3 of the definition of special needs. There is legislative definition both at a Commonwealth level and a State level and I will just bring that up. Operator, if you could please bring up RCD.9999.0216.0002. This is the definition taken from the Supported Accommodation Assistance Act. What comment would you make about this definition, Ms York? Is it consistent with the HAAG definition?
MS YORK: Yes, it’s broadly consistent. I guess, for us it is safe, secure and affordable. If you have safe, secure and affordable housing, then you’re not homeless and not at risk of homelessness. And that definition does mention safe and secure and affordable, so yes, it does encompass. It’s around security of tenure. So, when we say security we are not necessarily talking about dead locks on the door or that type of security; we are talking about security of tenure and that’s a really fundamental thing to acknowledge when we’re talking about older people ageing in place.
MS BERGIN: So, in paragraph (d), for example:
A person is taken to have inadequate access to safe and secure housing and therefore meet the definition cross-referenced from paragraph 1 if the only housing to which the person has access places the person in circumstances which threaten or adversely affect the adequacy, safety, security and affordability of that housing.
So, in the Commonwealth definition, security of tenure is only one element of four, if you like.
MS YORK: Yes.
MS BERGIN: All of which must be met for a person to be classed as homeless.
MS YORK: Yes.
MS BERGIN: Is it your position that that is too broad or not sufficiently broad?
MS YORK: I think it needs to be all of those things. It needs to be affordable, safe and secure. So, if any of those elements don’t exist, then the person is potentially at risk of homelessness, if not homeless.
MS BERGIN: I see. So, you would say if the person is in circumstances where the adequacy or safety or security or affordability of their housing is threatened, then they’re at risk of homelessness; is that right?
MS YORK: Correct.
MS BERGIN: So, you would advocate for a broader definition.
MS YORK: Yes.
MS BERGIN: Thank you, Ms York. Now, why is the definition of homelessness and risk of homelessness important?
MS YORK: I think it’s around perception of what is homeless and it’s partly driven through, I guess, popular media depictions of what homelessness is. And I think that if you’re – a lot of our clientele are older women, in particular, who have worked their whole lives in low paid jobs and are finding themselves struggling to pay the rent when they’re in their late 50s, early 60s and even 70s and those women would probably not see themselves as at risk of homelessness and the service providers wouldn’t either. And so that means if you’re providing a service – if you’re trying to get help for their person and they’re not a self-identifying and you’re identifying as a worker, then that’s an issue in terms of their health and wellbeing in the long-term.
MS BERGIN: What risk to ageing in place does homelessness present?
MS YORK: So, over the last, I don’t know however many years, there has been a focus on being able to provide as much support in the home to allow people to stay in the home as long as they can to prevent premature entry into residential care and these days the percentage of people in residential care is quite small compared to the overall older population. That’s all predicated on an assumption that somebody owns their own home and has safe housing. It’s very difficult to be able to provide home care in the home, whether it’s Commonwealth Home Support or a home care package, if that housing is inappropriate, insecure, unaffordable. So, it really is an underpinning assumption.
It also assumes that older person owns their own home and will be able to sell that home in order to move into residential care. So that’s not necessarily the case either. Over the last 10 years we have seen a real change in the demographics of older people and their housing circumstances. We are seeing people who are retiring without having paid off their mortgages. We are seeing more and more people in private rental and more and more people in private rental paying unaffordable amounts of rent. This is just clearly seen in the statistics that the ABS produces. So, if you have a look at those statistics you can see that things have changed. People are either not achieving home ownership all or falling out of home ownership and this has really big implications for the delivery of home care.
MS BERGIN: Ms York, are you suggesting that provision of home care or Commonwealth Home Support really relies on having a stable home?
MS YORK: Absolutely, and if – it’s not just around service delivery either. It’s about social connection and it’s about health and wellbeing and most of – there has been a recent study through the Benevolent Society that said that the number one factor for an older person’s health and wellbeing is affordable housing. So, if you – in our experience, what we find – and we see it time and time again through all of our clients that come through is that once they’ve got their stable housing and their secure housing, they can afford it, lots of their other health issues drop away. So, they suddenly become socially connected and they suddenly, you know, are able to manage other chronic health conditions. So, we know from our work that secure housing – homelessness isn’t necessarily a life time of complexity. You can fall into homelessness through an event that’s beyond your control and all of a sudden find yourself in this situation, and if you have safe, secure and affordable housing, a lot of the other issues fall away. So, people can age in place with a lower level of services if they have that housing.
MS BERGIN: Ms York, one of the elements of your definition is affordability of housing.
MS YORK: Yes.
MS BERGIN: So, what is unaffordable housing?
MS YORK: So, the definition of affordable housing, or a person being in housing stress is if they’re paying more than 30 per cent of their disposable income on their housing – on rent, and unfortunately with rising rents we’re seeing that there’s not much of that any more, yes.
MS BERGIN: You’ve mentioned that the statistics are alarming, and I want to come to those in a moment, but, firstly, could you describe in broad terms what systemic factors lead to homelessness.
MS YORK: Yes. So, I guess the number one factor that causes homelessness is unaffordable housing. So, it’s not necessarily personal issues. It can be personal issues, of course, it can be family violence, it can be divorce or, you know, losing your job or having to care for your ageing parents or your, you know, sick kids. All of these things can lead to a crisis point that tips people over into homelessness, but the number one factor is affordable housing and the lack of affordable housing.
MS BERGIN: And is that connected with, in paragraph 23 – you mention that one of the factors causing these increases includes an ageing population, decreasing rates of home ownership.
MS YORK: Yes.
MS BERGIN: Is there a connection here?
MS YORK: Yes. I think
MS BERGIN: Affordable housing?
MS YORK: Yes. I think the statistics show that people are not so much getting into home ownership any more. There has been a decrease over time, and as the population ages that’s what the data is showing.
MS BERGIN: More people retiring with mortgages.
MS YORK: Yes.
MS BERGIN: Is that also a factor with homelessness.
MS YORK: Yes. That’s definitely a factor. Yes.
MS BERGIN: And then you point to the significant reductions in public housing supply. Is that a recent factor?
MS YORK: There hasn’t been any real investment in public and social housing for a long time and what investment there has been hasn’t kept up with demand. And so, as the population needs increase and as rents go up, there’s less and less options. Public and social housing used to be able to provide for more people than it does now just because of our – you know, because of the lack of investment and the increasing population.
MS BERGIN: And is your comment about the reduction in public housing supply – is that primarily focused on Victoria?
MS YORK: No. That’s across the whole country. Yes.
MS BERGIN: Now, turning to the statistics, you mention at – in your statement that the number of women aged 65 to 74 using homelessness services over the last five years has increased, and there has been a 75 per cent increase in older women sleeping in their cars.
MS YORK: Yes.
MS BERGIN: Could you explain that statistic.
MS YORK: In terms of explaining where it came from or explaining the reasons behind it?
MS BERGIN: Could you explain the reasons behind it. I think you’ve helpfully given us the source at paragraph – at footnote 3 to paragraph 22. Operator, if you could bring up paragraph 22, please.
MS YORK: Yes. So, in terms of – what we have been seeing through our client work, and I think the data is demonstrating this as well, is that older women use all of their resources before going to help. They may not identify as being at risk, and then once they’ve run out of other options – so they can’t afford the rent any more – they’ve stayed with friends and family as long as they can. We also have people that have been house sitting for a long time or, you know, moving from place to place, then the only option left to them is, you know, rough sleeping, sleeping in their cars. So yes, we are definitely seeing those people as well come through, and that’s why it’s so important to have early intervention.
MS BERGIN: Why is this specifically an issue for women?
MS YORK: I guess it’s around safety, isn’t it? But I also think – I think in terms of why are more women accessing services and why are there increases in the number of women who are experiencing homelessness or at risk of it, it is around a life time of systemic issues and disadvantage. So lower wages, women couldn’t get their own home loans until the late 80s without getting it counter-signed by a man. There wasn’t any superannuation. A lot of people have been in and out of the workforce caring for people. There’s all of this unpaid labour around volunteering. None of it gives you any money in the bank, and you get to an age where, you know, you’re in your late 50s and early 60s and lose your job, and there’s age discrimination in the workforce, and you are paying 80/90 per cent of your income on rent, and then you’re on Newstart, what are you going to do?
MS BERGIN: And then in terms of that second component two-thirds of single older women on the age pension have less than 50,000 in savings and 35 per cent of women aged 60 to 64 have no super.
MS YORK: Yes.
MS BERGIN: Is the – are you referring to single older women – is that women over the age of 60.
MS YORK: Yes.
MS BERGIN: And on the age pension, would you be able to afford market rent, or is rent
MS YORK: No. So – no. That’s the factor that’s really terrifying is that Anglicare did a rental snapshot, and they found if you are a single person on Newstart, there are zero properties in the entire country that are affordable. So less than 30 per cent of your income on rent. And on the aged pension, I think it’s 0.6, around 0.6. So, if you are a single older woman and you are on a fixed income like Newstart or the
pension, and you are living in private rental, the reality is that you are at risk of homelessness, and that’s a very confronting thing for the whole of our society to think about, but that’s the reality.
MS BERGIN: Ms York, that study that you mentioned by Anglicare, that was a national survey that was published earlier this year.
MS YORK: Yes, I think in May. Yes.
MS BERGIN: And did you say that the finding was that no rental properties were affordable for the cohort on the aged pension or any pension.
MS YORK: On the Newstart, there’s zero. On the aged pension, there’s about 0.6.
MS BERGIN: 0.6 on the aged pension. Thank you.
MS YORK: And that’s not making any comment about the appropriateness of the housing. So, as you would know, the lower end of the rental sector isn’t necessarily appropriate for the older people or anyone really, but to aging place – if there’s mould, if there’s narrowed doorways, if there’s steps over baths – all of these things in a rundown private rental is no place for an older person to age.
MS BERGIN: Turning to paragraph 20 please, Operator. You mention the census in 2011 and 2016.
MS YORK: Yes.
MS BERGIN: And say there has been a 42 per cent increase in people aged 65 and over paying unaffordable rents in Australia.
MS YORK: Yes.
MS BERGIN: Numbering more than 132,000, and that’s unpublished ABS census information, published by the University of Adelaide.
MS YORK: Yes.
MS BERGIN: Could you comment on what that means?
MS YORK: So, it’s even worse if you look over the 10 years but – so this is the data that’s come through our Ageing on the Edge National Project. So, we are looking at census data and we’re – the benchmark that we’re using is 30 per cent of your income. If you’re paying more than 30 per cent of your income on rent. So what that means in reality is that there’s a lot of people who are hidden, who are going about their daily business who aren’t going to be captured in rough sleeping counts, but are at risk of homelessness because of these really, really high rents and – yes, their managing people are amazingly resourceful, and they are pulling on the
community resources, but some people don’t have those community resources, and so we need to be able to provide stable and secure housing for people in order for them to survive, and so that’s the data. It’s a lot of people.
MS BERGIN: Operator, could you please turn to paragraph 21. Homelessness has increased by 48 per cent for people aged 55 and over between the 2006 and 2016. Is that the census?
MS YORK: Yes. That is the 10 years.
MS BERGIN: And that’s the 10-year bracket that you’re talking about. And 53 per cent for people aged 65 to 74, the greatest increase for all age cohorts.
MS YORK: Yes.
MS BERGIN: Why is it the greatest increase for all age cohorts?
MS YORK: I think it’s partly around the ageing population. So as people get older, they fall into that age bracket, but I think it’s also about a lifetime of systemic barriers, and although a lot of the focus for housing and homelessness is on youth, the biggest growth area is unfortunately older people.
MS BERGIN: And, Ms York, I want to ask you to explain how this large increase in homelessness is also a health issue and an issue related to aged care.
MS YORK: Yes. Well, like I was saying earlier, housing is the number one factor for people’s health and wellbeing. In terms of aged care provision, it’s very difficult to be able to provide aged care in the home if someone doesn’t have stable housing. So, although there may be a sense that it’s – housing is too hard and too complicated, and we don’t want to deal with it, the reality is we need to deal with it in order to be able to provide aged care. And it also causes – the amount of stress that people are under when they’re at risk of homelessness – it means that they are prematurely ageing as well. So that’s another factor that we need to take into consideration.
MS BERGIN: So, when you say we need to take these factors into consideration in providing aged care, that’s both in the home
MS YORK: Yes.
MS BERGIN: and is it to manage the risk of entry to residential care as well because of the health risk.
MS YORK: Yes, definitely. Yes.
MS BERGIN: Now, you mentioned that there is a significant lack of public and community housing or other affordable housing options to address the short fall.
MS YORK: Yes.
MS BERGIN: What does that mean for aged care services?
MS YORK: Because there’s not as many options as there needs to be for older people. So, in an ideal world an older person doesn’t need to be a home owner to be able to access quality care. Like, you should be able to be a renter in the public and social housing system. You should be able to live in independent living units or different forms of retirement housing and still have safety and security and affordability. That shouldn’t be – it shouldn’t be up for grabs, really. So, I think it is important for the aged care system to recognise that housing and homelessness is a big issue for their clients, and also they need options, and that’s partly why we advocate not only for service navigation for the aged care system, but service navigation for the housing and homelessness system because it is big and complex. People don’t know what options there are, and you do need someone, a specialist service like what we have at Home At Last and what we’d like to see all over the country is a place where people can go, they can find out their housing options tailored to their circumstances and then be assisted to obtain that housing and then hopefully be linked in with aged care services as a result of having stable housing.
MS BERGIN: Ms York, I want to ask you about access and barriers to access in a moment, but, firstly, before we turn away from this topic of the cohort that we’re talking about
MS YORK: Yes.
MS BERGIN: people who are homeless or at risk of homelessness and require aged care services – you mentioned independent living units. Are they an example of community housing that’s affordable?
MS YORK: So independent living units – they are called different things this different places, but they are usually in small clusters dotted around the suburbs often owned by small not for profit and sometimes also owned by residential care providers as well. So, it’s not residential care, and there’s a common misconception that retirement housing and residential care are the same thing, and they’re not. So, retirement housing is independent living. So, it’s just like being able to live in – as a home owner. Often times, it’s – you pay a small in going, and then the rent is fixed – your income as is with community and social – public housing. So those are all set at 25 per cent to 30 per cent of your income regardless of what that income is. So, you are always going to be having affordable housing.
And so, what’s – what we’re seeing is that the independent living unit sector is a thing that people want, a place where they want to live in the community. It’s usually connected in with different services. However, that sector hasn’t really been supported by government for a long time, and it seems that it’s changing, and it’s very opaque and hard to get into, which is what our retirement housing service does. We try to get people into independent living units, and this is usually people that are over the asset limit for public and social housing. So, In Victoria, public and social housing asset limit – it does recognise that there’s a cohort for 55 plus which is great, and there’s also specific 55 plus housing which doesn’t exist in other states that is owned by the government or owned by community housing providers, but that’s different to independent living units.
We need more of everything, basically. We need all options available for older people to make choices about where they want to live, and, unfortunately, those options are narrowing because lack of funding and lack of long-term investment. So, we always advocate for more public housing to be able to provide for the very low income no asset cohort. Then there’s quite a big gap, and that’s for usually women who have a small amount of savings, meaning they’re ineligible for public and social housing, but they can’t afford to buy anywhere else, and there’s really very limited options for those people.
MS BERGIN: So, when your officers at HAAG are looking to assist a client find housing, and that person is, say, over the age of 65, is one of the features you are looking for that their cost of the rent is set at 25 to 30 per cent of their income, whatever that might be?
MS YORK: Yes.
MS BERGIN: And how often do you find that in the current market?
MS YORK: We, if they don’t have any assets, our first point of call is public and community housing. So – and we house about 12 people a month in public and community housing. The biggest issue that we find are the ones that have more than $30,000 in savings and so if you have 50 or 60 thousand dollars you aren’t eligible for public and social housing and you don’t really have many other options, and we find that much more difficult. Unfortunately, the way it is, you deplete your savings until you don’t have anything else and then you’re eligible, and that’s not what superannuation was supposed to be. That’s not what savings are supposed to be. So ideally we would like to see more investment in different types of housing for those people that fall through the gaps but also much more investment in public housing.
MS BERGIN: And do you see that as the responsibility of State Governments or Federal Governments?
MS YORK: Both.
MS BERGIN: Why is that?
MS YORK: Because I think it’s the responsibility of our society to provide safe and affordable housing and that’s what our taxpayer dollars are for. So, it’s about prioritisation as well as investment in housing which everybody thinks is very difficult. It really is about prioritisation and there are some innovative models as
well as public housing, but we do need to be able to provide that base level of housing for people and, yes, and services to help them connect with that.
MS BERGIN: Thank you, Ms York. Now turning to the topic of barriers. Why do homeless people have particular and additional barriers to access aged care and home care as compared to people who aren’t homeless or at risk of homelessness?
MS YORK: Well, what we found, so we have – we’re one of the information hubs for the service navigator pilot project and we are targeting homelessness. What we’ve found is, first of all, under the Commonwealth Home Support guidelines, the eligibility for accessing services so accessing an assessment and then potentially getting services is 50, whereas aged care is 65 and so that is probably one of the biggest barriers that we come across. A person is under a lot of stress so they prematurely age and they need services but they get knocked back at the first door and that is trying to get them registered on My Aged Care. So, our – since we’ve started this
MS BERGIN: Can I just pause you there, Ms York.
MS YORK: Yes.
MS BERGIN: When you say there’s a cut-off of 65 and over, what do you mean by that?
MS YORK: So the eligibility for – even though there’s no age in the Aged Care Act, it’s commonly thought of through the CHSP as well that 65 is the cut-off age for Commonwealth Home Support, and that means that when you try to access an assessment through a regional assessment service or through ACAS, the first thing you need to do when you get on the phone to My Aged Care is to say what your age is and if you are under 65 you just get bumped off. And that’s not the case. So even with strong advocacy, even with our workers sitting on the phone and calling back and calling back and trying to get people registered, we’ve had no success in getting anyone registered who is under 65 even though they are eligible under the guidelines. And there has been communiques go out from government. We’ve been told there’s going to be training but first cab off the rank you can’t get through that door.
Then if by some miracle you do get through the door, then you need to go through assessment and often the assessors aren’t aware of the eligibility. They have really inconsistent information around what they tell each other, what they tell their clients and, yes, and so that’s another barrier. And then if they do actually get assessed then there’s, what happens if you move, where do the letters go to? Do you have 100 points of ID? All of those things are quite difficult for people who are transient, who are couch surfing, who are moving from place to place relying on friends and family. The letter with the number goes missing, or they’re confused about what the letter means. So, there are so many barriers before you get even the most basic of support, so, yes.
MS BERGIN: You make the point in your statement that I think at paragraph 30, as you’ve just said then, that ACAS and RAS assessors are often unaware of the age eligibility for people at risk of homelessness
MS YORK: Yes.
MS BERGIN: for home care packages and there you are talking about I think the approval of care recipient principles.
MS YORK: Yes, but also the Commonwealth Home Support Guidelines, yes.
MS BERGIN: And the guidelines refer to age 65 but there’s no such reference in the guidance for officers assessing eligibility for home care packages; is that your understanding?
MS YORK: No, but – yes. There’s – under the CHSP, particularly the assistance with care and housing program, which is funded through Commonwealth Home Support, and that is the linkages program that’s across the whole country. Unfortunately, it’s not expansive enough; it doesn’t cover all geographies and it certainly is underfunded. But the eligibility for that is 50 plus and that is under the Commonwealth Home Support program. So, it does refer in those guidelines to people who are prematurely aged due to being at risk of homelessness can be 50 plus. And that’s the real lack of – people are aware of Aboriginal and Torres Strait Islanders’ age eligibility to some extent but they’re not for people at risk of homelessness.
MS BERGIN: And that test is a test not only for residential care but also for home care. In clause 7, 1, 2,3 and 4, it includes as part of the eligibility assessment, a person who is not an aged person
MS YORK: Yes.
MS BERGIN: undefined, there are no other care facilities or care services more appropriate to meet the person’s needs. So that gives officers flexibility in assessing eligibility for home care.
MS YORK: Yes.
MS BERGIN: Now, you mentioned the phrase “premature ageing.”
MS YORK: Yes.
MS BERGIN: Is there a definition of that phrase?
MS YORK: No, as far as I’m aware there’s no definition of the phrase. Anecdotally through our day-to-day work we can see the effects of not having safe housing compared to having it because we follow up with our clients after they’ve
been housed and all of a sudden they’re able to contribute, you know, to society again. They’re able to get their chronic illnesses under control, etcetera. So, we can see it but I don’t think it has been defined anywhere. But that’s not to say that it’s not a factor. It’s definitely a factor.
MS BERGIN: Okay. Thank you, Ms York. So, you’re saying, then, that in terms of people who may be at risk of homelessness, so, for example, falling into that category of having insecure tenure.
MS YORK: Yes. Yes.
MS BERGIN: They are missing out, if they’re under the age of 65 and you say there are no other facilities or care services more appropriate than, for example, home care.
MS YORK: Home care package, yes.
MS BERGIN: They’re missing out.
MS YORK: Yes. Yes. They’re definitely missing out and we would like to see a lot more kind of consistency around the training and the guidelines for both the people at the My Aged Care portal end on the phones but also the assessors.
MS BERGIN: And when you talk about the people at the end of the phones and the assessors, do they, in your experience or in what you’ve been told by your clients at HAAG – is there any flexibility applied during assessments?
MS YORK: It really depends. It really depends and it’s very inconsistent. So, we’re doing a project at the moment with the Deakin University and National Ageing Research Institute where we are trying to roll out training around for ACAS and RAS assessors around what to look out for in their clients when they go into the home. So, if a person is on the pension and in private rental and is single and likely to be at risk of homelessness, so make an early referral in and they’re telling us that they find it – they weren’t aware of the age eligibility being 50 and also they find it difficult to even find the assistance with care and housing program in the MAC portal.
So, within the referral pathway it’s quite hard to find and that’s a problem because that’s a well-known, well respected service but it’s very small. And we would be advocating for a significant expansion of that program because we know it works, but the geography of the country means that some people are missing out. There’s around 60 services across the whole country but there’s four in Queensland, There’s only two in Tasmania and it just doesn’t have the reach. And from when we were doing the homelessness action plan, going around from place to place, we were finding workers that were going above and beyond and doing a great job of linking people in with housing but they don’t have any brokerage funding to help with hoarding. They don’t have assistance to help people move and they’re sometimes
having to use their own cars, you know. It’s just a very under-funded program but it’s a very effective one.
MS BERGIN: At paragraph 31 you offer some reasons why My Aged Care might – I withdraw that. You offer the explanation that it’s often difficult for people to have 100 ID points of ID for example if they’re at risk of homelessness.
MS YORK: Yes.
MS BERGIN: Can that affect the outcome of an assessment by My Aged Care?
MS YORK: Yes. Well, all they need to start with is a Medicare card. So that’s the first step. But, yes, what we were hearing when we were doing our consultations was that, for example, if somebody – so people will go to services that they trust, whether it’s an aged care service or homelessness or a GP or community health. People will go to the places that they know, and sometimes because of the delay in registering somebody on My Aged Care and then the assessment might be quite a long time after that, there’s no flexibility around being able to do that assessment right there and then when you have that person. So even that process could be streamlined if we could actually empower people at that front-line level to get people registered and assessed as soon as possible while you have them, then they wouldn’t be having to chase those 100 points of ID and they wouldn’t have to be chasing letters as they move around. You know, someone that is house sitting, for example, where do the letters go? So, this is a barrier and, yes, we would like to see more flexibility around that very initial assessment.
MS BERGIN: Ms York, you say at paragraph 39 that Commonwealth Home Support and home care package services may be denied or withdrawn where the service provider determines the environment to be inadequate or unsafe as a workplace for their staff.
MS YORK: Yes.
MS BERGIN: Is that, for example. with reference to what you said earlier in your evidence about inappropriate rental accommodation where there might be mould.
MS YORK: Yes. So, we’ve had – I mean, we’ve heard about and had clients who have had home care packages in place or Commonwealth Home Support in place and workers have had to be withdrawn because of OH and S issues because the house is too run down, it’s too overcrowded. If somebody is living in a shed or a laundry or whatever at the family’s home, it’s very difficult to be able to provide a safe working environment for the personal care workers or the home care workers to go into the home and that’s obviously illustrative of the broader issue around how difficult it is to provide home care supports if the housing is inadequate.
MS BERGIN: Should home care packages be available to assist tenants to restore the status of a house which meets which meets OH and S as an interim measure or as an emergency measure?
MS YORK: My first thoughts on that is that it’s a landlord’s responsibility to provide a house that has minimum standards and it should be the landlord’s responsibility. I guess in an emergency they could use their package but that seems to me to be a bit of a Band-Aid solution. I think the packages could go to fixing up needs rather than fixing up somebody else’s house where they still have no security of tenure and it still might not be affordable.
MS BERGIN: Sure. And what most commonly would those needs look like?
MS YORK: In terms of?
MS BERGIN: Needs to would be appropriate to be served through a home care package or a Commonwealth Home Support?
MS YORK: Around housing?
MS BERGIN: Yes.
MS YORK: Look, I think it’s the same supports as everybody needs. They need – you know, if they have, need shopping assistance or home care or personal care or whatever, it shouldn’t matter where you’re living. You should be able to get that. But unfortunately, because of the state of the lower end of the private rental market, the cheaper end, it’s difficult for that to actually happen, yes.
MS BERGIN: Now, you note in your statement, I think at paragraph 34, that for those who are homeless and prematurely aged, noting that that is a term that is used a bit loosely at the moment and perhaps might be defined in the future, appropriate residential aged care are often the most suitable form of accommodation.
MS YORK: Yes.
MS BERGIN: What do you mean by that?
MS YORK: I guess this is not – we are not as connected with the residential aged care sector as, say, some of the other providers who get the homelessness supplement. So Wintringham obviously in Victoria but there’s others in New South Wales and South Australia and other places that provide less of an institution and more of a home for people that have experienced chronic homelessness. It tends to be men, I have to say, not so much women. But yes, that allows, you know, if they – a lot of them are very careful about how they select their staff. They allow dignity of risk and they do provide a home environment for people that haven’t had stable housing for a long time and in those cases, then yes, they are most appropriate. For our cohort though we tend to get the more hidden homeless, the people who are struggling in private rental or couch surfing or living with friends and family and our – their care needs are lower. All they really need is stable housing and potentially some home care and they will be fine.
MS BERGIN: I see. So, there are some limits.
COMMISSIONER BRIGGS: Can I ask
MS BERGIN: Sorry.
COMMISSIONER BRIGGS: What’s the relationship between your organisation and the state housing providers? So, the public housing providers?
MS YORK: We’re partially funded through Housing and Homelessness. Yes.
COMMISSIONER BRIGGS: And the people you’re talking about should largely be considered to be in an emergency situation, shouldn’t they?
MS YORK: Yes.
COMMISSIONER BRIGGS: And get some priority on the public housing list?
MS YORK: And they do.
COMMISSIONER BRIGGS: And they do? Okay.
MS YORK: They do get priority, which is why we can house people relatively quickly. So, between three months and 12 months on average, if they only want one bedroom. If they want two bedrooms, then they’re going to wait for a lot longer. But it’s really about supply.
COMMISSIONER BRIGGS: Okay. Thank you.
MS YORK: Yes.
MS BERGIN: And when you say it’s about supply, it’s supply of affordable housing?
MS YORK: Yes. And lack of that.
MS BERGIN: Yes. Now, HAAG has a special role in identifying and advocating for the needs of homeless and risk of homelessness cohort, of course. Is trauma-informed care relevant to people who are part of that cohort?
MS YORK: Yes.
MS BERGIN: And what does that look like?
MS YORK: I think trauma-informed care is probably better established in the housing and homelessness sector. It’s much more, kind of, embedded than in the aged care sectors, from my experience. And I guess what it means is understanding people’s reactions may be different because of the trauma that they’ve experienced. And rather than, kind of, lumping them in with – as a difficult client or whatever, recognising that this is often a lifetime of systemic barriers that have led a person to this point. So, I do think it’s really important. And our – we have all social workers on staff pretty much, and we are encouraging as much as possible for people to take that approach. Yes.
MS BERGIN: Is a client likely – first, presenting at HAAG for assistance, is a client likely to disclose their status as homeless or at risk of homelessness?
MS YORK: By the time they get to us, yes, because we’ve reached out to them. So, what we tend to find when we’re doing that early intervention, community education, particularly in culturally-diverse communities, we’re talking about stories that illustrate when someone’s at risk of homelessness. So, we’re talking about couch surfing, we’re talking about house-sitting, we’re talking about all of those – overcrowding. All of those sorts of pressures on an older person. And then we would say, “This places you at risk. If you need assistance, come to us.” And we really want to get people before they’re sleeping in their cars, so we can have that lag time between, you know – as I was saying, it’s about 12 months to get someone housed. So, we want to get them early, before that happens. And to encourage people as much as possible to put a plan in place about what happens for their housing – consider housing as they get older. Yes.
MS BERGIN: And is that a message you give to younger
MS YORK: Yes.
MS BERGIN: Younger people seeking assistance. Now, do you need a break, Ms York?
MS YORK: I’m fine.
MS BERGIN: Okay.
MS YORK: Yes.
MS BERGIN: And I just want to turn, finally, to the topic of the draft Homelessness Action Plan
MS YORK: Yes.
MS BERGIN: proposed under the diversity framework. How was it developed?
MS YORK: We were commissioned in around December last year to develop the Homelessness Action Plan. So, it was the fourth action plan after the LGBTI, the culturally-diverse and the ATSI ones that came out. And we engaged Dr Sandra South, who – we seconded her from the Australian Association of Gerontology. And herself and our national project development worker conducted the consultations. We had a survey that went out for older people who are at risk of homelessness or had experienced homelessness, and then a survey for service providers. We had around 480-odd service providers complete the first survey and around 120 older people. So, we got a really good spread. Then we did around 45 site visits across every state and territory. And we were specifically targeting people who receive Commonwealth funding for homelessness support.
So, the three funding streams that we were looking at was residential care facilities that are getting the homelessness supplement – that means they need to have 50 per cent of their residents having experienced homelessness, and the Assistance with Care and Housing program, which is that one I mentioned earlier. There’s 60 providers of that across the country. And that’s a linking service that helps people, kind of, get from – you know, provide a support to get housing and then also link them in with aged care supports. And then the third one was Access and Support, which is only a Victorian program, but that has homelessness-specific workers as well. So, they were the funding streams that we looked at. And then, after we’d done those site visits, we did the draft plans and we put them out to a Delphi survey. So that just said, “These are the recommendations that we’re proposing. You can vote them up or vote them down. And put ”
MS BERGIN: Can I pause you there? When you say that you put them out to survey
MS YORK: Yes.
MS BERGIN: are you talking here about the draft
MS YORK: Yes. The recommendations.
MS BERGIN: So, there are three components
MS YORK: Yes.
MS BERGIN: as I understand it, to the Homelessness Action Plan.
MS YORK: Yes.
MS BERGIN: There’s the actions to support older and prematurely-aged people who’ve experienced or been at risk of homelessness, a guide for aged care providers.
MS YORK: Yes.
MS BERGIN: The, secondly, there’s a guide for consumers.
MS YORK: Yes.
MS BERGIN: And, finally, there’s the plan. So
MS YORK: That’s for the government. Yes.
MS BERGIN: That’s the government’s draft plan?
MS YORK: Yes.
MS BERGIN: Were you involved or was HAAG involved in drafting the draft plan
MS YORK: Yes.
MS BERGIN: for the government? So that’s the – those three
MS YORK: Those three
MS BERGIN: components is what you were commissioned for.
MS YORK: That’s right.
MS BERGIN: And were all of them put out to consultation?
MS YORK: Yes. And
MS BERGIN: And how did the consultation go?
MS YORK: We got a good response. And all of the – none of the recommendations were voted out. So, all of the recommendations were endorsed. And that was across – we had a good range of providers from every state and territory vote those in. And because of that level of consultation and because of the layers of, kind of, expectations around what people can do – so it’s not just the responsibility of people who are specialists in this area, it’s also the responsibility of any aged care provider to at least attempt the foundational recommendations – the foundational actions in those recommendations. Yes. So, in terms of what we would like government to do, it’s around, really, having a look at the Assistance with Care and Housing program and elevating that, expanding that and recognising that as a really important component for people who are at risk of homelessness as an early intervention strategy.
MS BERGIN: I asked you a moment ago – I should mention, Commissioner, that all three of those documents have been included in the general tender bundle. And at appendix 3 of CTH.0001.1001.2031, Operator, if you could please turn to native
page 20, which is at .2050. I asked you before about whether a client’s likely to present and let you know that they’re at risk of homelessness or homeless.
MS YORK: Yes.
MS BERGIN: And I should have asked, how does HAAG initiate a conversation about a person’s homeless status?
MS YORK: Yes. I think the three factors that we look at is whether someone is on a fixed income, how much rent they’re paying, if they’re paying rent, and their age. So, when those three factors intersect, particularly for single people, then we can safely assume, because of the rental market and because of the low rates of Newstart and the Age Pension, that they’re at risk of homelessness. But they’re unlikely to identify themselves as being at risk of homelessness. It’s very – you don’t think – you don’t go around saying, “Hey, I’m homeless.” So, I think it’s up to the people who are working with older people, who are interacting with older people, to have that gentle conversation around housing and housing futures and make a plan.
But also, I guess, yes, recognise that people aren’t going to self-identify. And they also might not know what there is. And that’s why it’s really important to have these sorts of, you know – as we have a housing information service or a service navigator where people can actually go through options – and you might just want to have a very gentle conversation around housing, what happens – even with couples. So, you know, we have a couple at the moment and they’re both on the aged care pension. If one of them dies, they won’t be able to afford the rent. And they’ve talked about it; they know about it. This is, sort of, you know, how to have a conversation about what’s going to happen. Yes.
MS BERGIN: Thank you, Operator. It’s native page 20, point zero – thank you. If you could – yes. Appendix 3. So are these – appendix 3 is the – thank you very much.
MS YORK: Yes.
MS BERGIN: We were talking before about possible training of My Aged Care operators.
MS YORK: Yes.
MS BERGIN: Is this a topic that, in your view, should be able to be tackled in appropriate circumstances
MS YORK: Yes.
MS BERGIN: by telephone operators? Or is it too sensitive?
MS YORK: I think – I think relying on a telephone or internet interface for people, older people, particularly people at risk of homelessness, is not an adequate way to – for people to navigate the system. That shouldn’t be the gateway for people. What we found is that face-to-face supports work best and that people come to services that they trust and that they know. And if you’re in a trusted position, you’re much more likely to be able to have that conversation. And I think that will be reflected through all of the diversity discussions that you have this week. It’s all around trust and building up that rapport. And that’s certainly what we found with our Homelessness Action Plan and why we continue to advocate for the need for face-to-face support for people who are vulnerable. And if you’re in housing stress, you are vulnerable.
MS BERGIN: Thank you, Ms York. Now, arising out of the work that was done on these draft action plans, one of the recommendations you mention in your statement is to provide block funding for intensive case management to support people who are at risk of homelessness to access aged care and to make informed choices. How can block funding assist?
MS YORK: We think that block funding assists because it allows – it should exist because it allows a flexibility in the approach, and it’s not reliant upon individual kind of packages or – a service can plan if they have block funding, and then they can provide that flexibility that a person may need to be able to, first of all, access it and then make a choice. So, it’s – we can’t rely on, I guess, the market to help everybody, and there’s going to be people that fall through the gaps, and without that kind of ability to be able to do that short-term case management role where your linking a person into the system, that’s very difficult without block funding.
MS BERGIN: And is the reason block funding assists in this space because one person’s query may be answered quite quickly, but it might take extra time to answer a more complex query.
MS YORK: Yes.
MS BERGIN: And with block funding, you’ve got more flexibility in the case management services.
MS YORK: Yes, and also, you can allow people to come back over time as well. Which is what we often find. Sometimes, we will provide the information, and someone might not act on it for 12 months, and that’s okay. At least they’re acting on it. So that’s one of the things that allows you to have that flexibility as well.
MS BERGIN: I think you mention in your statement that the Home At Last program is partly funded by the Commonwealth home support. So that’s an example of block funding.
MS YORK: Yes. So, all of the Assistance with Care and Housing is that. You still have deliverables that you have to meet, number of hours of service provision.
Unfortunately, it’s just not enough to be able to provide a really long-term kind of case management, and I guess it doesn’t include things like brokerage, which we found in our service to be really important. For example, with hoarding, we often hear, we run a network of assistance with care and housing providers in Victoria and we often hear particularly in rural areas that hoarding is a major issue. There’s no funding to deal with it. So, to get somebody into a safe housing when their house is full of stuff, it is really difficult without specialist support. Also, people who need to move, we provide assistance with removalist costs and packing and things like that to help older people because it’s very difficult for them at that age as well. So yes, all of these flexible approaches require support funders. Yes.
MS BERGIN: How could assistance with care and housing ACH be expanded with additional block funding?
MS YORK: So, our recommendation in the homelessness action plan is that it needs to be expanded ten-fold and that’s based on geography as well as the amount of kind of cross-subsidisation that’s happening. Because it hasn’t actually expanded in real terms for a long time, what it means is that the amount of money is so small it gets absorbed into other services often. So even if they do have ACH funding, it will be subsumed under all of the other funding, and it’s difficult to make referrals. So, what we would like to see is that the program is much better recognised, much better funded and is able to provide that linking between someone that’s about to fall into homelessness and the aged care sector.
MS BERGIN: Now, what’s the current status of the draft Homelessness Action Plan?
MS YORK: It has gone through the diversity subgroup, and it has been presented to government. We did that in – I think it was around end of May, I believe. So, yes.
MS BERGIN: Have you had any formal feedback?
MS YORK: No.
MS BERGIN: HAAG consider that there are a number of changes required to the government’s assistance with Care and Housing subprogram to make it more effective, and you mentioned linkage services, and you’ve mentioned a few times that service navigation and navigating the aged care system is important. What does HAAG consider would make – I withdraw that. What is your view of the current navigator trial?
MS YORK: It’s early days. We’re finding that it has been really difficult for our clients, our cohort to be registered on My Aged Care, and it has been really difficult to – even if they have been registered, it’s not – the idea of the service navigator was to get people who are pre-any aged care at all. So, they have not received an assessment. So, what we’re finding is even if we do get them registered, that’s not the last time we see them.
They will be coming back to us with questions about what’s happening next? What’s happening with the assessment? What does the letter mean? When is the service provision going to happen? And I think that’s just testament to what is actually needed which is a trusted person that can walk you through the process. It’s not just up to that first point of call. We have had, most of our clients are over 80 years old. Lots of them are from refugee backgrounds. They may be experiencing elder abuse; they are in overcrowded unsuitable housing.
They don’t want to sit on the phon. It’s too much for them, and 40 minutes minimum with an interpreter to go through some basic questions before you can even get registered is too much. And obviously we don’t leave them then; if they come back, we’re going to help them. And I think that’s the reality of any service that is working with vulnerable people will find people keep coming back, coming back, and why we always advocate for face-to-face ongoing support for people. And, yes, that’s why we want to have the idea of having these housing information services across the country where people can actually not just navigate aged care but navigate housing.
MS BERGIN: Finally, Ms York, is person-centred care an appropriate part of the solution for this cohort?
MS YORK: Yes, I mean it definitely is but what does that actually mean in reality? And I think that’s the question. So, you can be person-centred in the way you speak to people and talk about their goals and make a care plan. But if there’s no services available, if they can’t even access the service, it’s not really a meaningful concept. Ideally, yes, person-centred care, of course, but what does that mean when you can’t even access anything? So, it’s less about choice and more about access.
MS BERGIN: Thank you very much, Ms York. Commissioner, that concludes my examination.
COMMISSIONER BRIGGS: Thanks, Ms Bergin. I’m wondering, is there any scope to deliver Commonwealth Home Support programs in day centres or community centres to support these people?
MS YORK: Yes, probably, yes.
COMMISSIONER BRIGGS: Okay. And are you aware of it happening or not?
MS YORK: No, I’m not. I think maybe residential care providers or the providers of actual housing would have more to say about that, yes.
COMMISSIONER BRIGGS: And are the groups of women, largely women, that you’re talking about, is this primarily a city phenomenon or are you seeing this right across the country?
MS YORK: Right across the country, and the thing that we have also seen is people moving to the rural areas think that they’re going to have cheaper rent, finding themselves very car-dependent, very socially isolated and the rents aren’t that much cheaper. And then really finding themselves in a lot of trouble.
COMMISSIONER BRIGGS: All right. This issue in the last two to three years has had a lot of public attention. Have the states and territory housing departments begun to get on top of it or what’s happening?
MS YORK: I think people recognise that it’s a problem, and there has been a lot of publicity for older women, and there has been some innovation around different models, which is good to see. But there’s also a lot of, to be frank, buck passing, who’s responsible for it. And I think, as I was saying, it’s everybody’s responsibility from all levels of government to be able to provide housing for its citizens. So, at the moment, there has been a little bit done in various state jurisdictions, and there has been some new models come out, but there hasn’t really been the level of investment that’s needed, and it has not been prioritized.
COMMISSIONER BRIGGS: Right. And the structure of the income or assets testing for public housing, you mentioned $30,000.
MS YORK: Yes.
COMMISSIONER BRIGGS: So presumably, there is some tapering away of access or entitlement after that amount.
MS YORK: Yes, or there’s zero access.
COMMISSIONER BRIGGS: And to what extent are those authorities now understanding that these people are dealing, perhaps, with the savings of a life time and a bit of superannuation? Any recognition of that, or is it just the queues are so long more generally?
MS YORK: Yes. I – in Victoria, and I can probably only speak about Victoria, there has been recognition of the asset limit for older people, and there has been prioritization for people aged 55 plus. In New South Wales, I believe it’s 85 plus, and I don’t think there’s any other age prioritization in any other state, and part of our work in the national project is to engage with government to, first of all, let them know about the demographics and what’s coming and what’s existing now, but also come up with solutions, and one is investment in housing and the other is investment in services for access what housing does exist because a lot of it is very spread across a lot of different jurisdictions, and there’s no real central place where you can go and find out what your housing options are.
COMMISSIONER BRIGGS: Why does that not surprise me. Okay. Certainly, you wouldn’t be looking at My Aged Care for that. Ms York, thank you very much. I found this very, very interesting and, in many ways, quite disturbing.
MS YORK: Yes.
COMMISSIONER BRIGGS: I will think some more about this, or we will think some more about this and what might be done to at least elevate the issue.
MS YORK: That would be great.
COMMISSIONER BRIGGS: And get some attention to it. So, thank you very much and you are excused from giving further evidence.
MS YORK: Thank you very much.
<THE WITNESS WITHDREW [3.50 pm]
"There is nothing like staying at home for real comfort."