The Barriers That The Older Australians May Face When Accessing Health Services

Older Australians aged 65 years and above are one of the fastest growing subgroups of our population. To maintain the health and wellbeing of an estimated 8.8 million people by 2057 (Australian Institute of Health and Welfare [AIHW], 2017), pressing concerns related to increased mortality rates due to loneliness and limited social connections must be addressed. 16.2% of Australians aged 65+ years found themselves not leaving home as frequently as they would have liked, doubling to 46.8% in those living alone with a disability (ACRC, 2017).

Feelings of loneliness and isolation have strong links to psychological distress leading to poor physical and mental wellbeing. When exacerbated to the worst possible case, this can even contribute significantly to premature death, accounting for up to 14% of elderly people affected by extreme loneliness (Aged & Community Services Australia [ACSA], 2015). Those who self-identify as ‘lonely’ are up to 60 times more likely to turn to emergency services to reach out for social contact rather than medical attention, and double their likelihood of self-admitting to residential aged care living arrangements (Bailey, 2017). With an estimated 245,000 older Australians experiencing isolation (Freak-Poli, 2017), social seclusion is a significant concern that will continue to rise without implementing adequate education and intervention.

Barriers that elderly Australians face in an attempt to access health services are centered around issues of accessibility. A vast majority of older Australians remain living independently but their autonomy can often come at the risk of compromised transport to and from appointments. As people age, their dependency on family members, friends and/or public transport can hinder their access to health services.

This can prove difficult if family members no longer live within close proximity and must prioritise their own responsibilities to accommodate for the needs of the elderly (National Aged Care Alliance, 2007). It is common for older people to hesitate for fear of imposing a burden, exacerbating their sense of isolation and preventing them from receiving treatment. Public transport can be unreliable, costly, unfamiliar, seem unsafe and even non-existent in more rural areas, posing yet another barrier to access health care if they are reluctant to travel on their own (ACSA & NRHA, 2004).

Older Australians that drive also have a tendency to prefer shorter distances and only drive at certain times to avoid peak traffic, potentially limiting the range of appointments that can be made available to them (Dent & van Ganns, 2018). Paired with the likelihood of long waiting times and waitlist times, lacking health services at maximum capacity and specialists requiring referrals from GPs before collaborative care can begin – many elderly Australians simply go without appropriate and timely medical attention.

Victoria’s metropolitan and rural public transport service, Public Transport Victoria (PTV) has several concessional benefits that Australian seniors are entitled to. Any holder of a Victorian Seniors Card can access reduced fares on trains, trams, buses, V/Line trains and V/Line coaches on weekdays. This includes complementary travel on weekends in selected travel zones in Melbourne and regional bus lines. Elderly Australians also qualify for two off-peak travel vouchers, posted out to their homes each year. Those living in regional Victoria receive four off-peak travel vouchers annually (Australian Human Rights Commission, 2017). This can make a dramatic financial difference for older Australians who depend on public transport as their only means of travel.

Subsidisation for seniors is indicative of the Australian governments’ awareness and support of this growing need. St John’s Ambulance Victoria is a not-for-profit, volunteer-based organisation that provides First Aid training, education and public service at schools and community events. They have recently initiated the St John Community Transport Service, a program offering older Australians mobile, safe and reliable transport in their local community starting from $17. It is staffed by qualified, trained and friendly St John volunteers during work hours (8am – 5pm) and offers an optional Companion Service, where further assistance of a carer-like nature can be provided at $35 per hour.

It includes a fleet of vehicles fitted out with defibrillators and other standard First Aid medical equipment, space for walking frames and other support apparatus, and no additional charges for accompanying family friends or other companions (St John Ambulance, 2018). It is currently available across metropolitan Melbourne and highlights the increasing demand for specific vehicles that are medically appropriate and anticipate the potential for medical emergencies.

Victoria’s public transport system may not be as equitably accommodating for seniors across all ages, frailty, disability or current health statuses as it needs to be. Elderly Australians suffering from chronic diseases with multi-morbidities often have no choice but to attend regular doctor appointments. People who require dialysis, for example, are obligated to approximately 4-hour treatment blocks three times a week. This can be quite costly even with the senior concessional rate, and can easily add up to an amount that most people cannot manage given their fixed government pension. Even the free transport on weekends and off-peak vouchers will prove impractical if more than two doctor appointments are required per year, while most medical centres operate on weekdays only during standard peak times.

Similarly, while St John’s Ambulance Community Transport Service is medically efficient, it is much too costly to access on a regular basis – an even more expensive option than public transport that still only operates on weekdays during daytime work hours. While it is arguably more private, safer and a more personally catered experience, it is still not available to older Australians living in rural areas who may benefit from this kind of tailored assistance the most.

The Baby Boomer Bus will address concerns of financial hardship, safety and social isolation. It will be a community transport service operating within a fixed route throughout 3 (minimum) to 6 (maximum) post codes adjacent to one another. It will transport older people to doctor and hospital appointments, local shopping centres and other social activities within the route vicinity.

Organised by the local community hub or hall, flyers will be handed out to elderly residents’ home to ensure they are aware of the service and can sign up using their home address and locations they will frequent, such as the local GP’s office. This will create a sense of familiarity as the bus will stop at the same routes every time, only altering slightly to pick up and drop off new users of the service. The list of regular passengers will foster meaningful and frequent social interactions with similar people who live close-by, and bonding can ensue both onboard the bus and as people attend appointments or go shopping together and support one another.

It will be partially government subsidized with a flat rate fee of $5.00 per week from each person. The bus will be specifically fitted with wider seats, support handles, grip mats and ample space for walker frames, wheelchairs and medical equipment. This makes the transport service accessible, affordable and accommodating for people over 65 years of age who are frail and living with an illness or disability who require more apparatus-friendly vehicles. It will be operated three times a week by a First Aid trained driver and nurse, both specialising in geriatric health with extensive knowledge of specialists, doctors and welfare services available in the immediate area.

REFERENCES:

1. Australian Institute of Health and Welfare. (2018). Older Australia at a Glance. Retrieved from https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance/contents/demographics-of-older-australians/australia-s-changing-age-and-gender-profile
2. Aged Care Report Card. (2017). Loneliness and Social Isolation Linked to Early Mortality. Retrieved from https://www.agedcarereportcard.com.au/blog/Loneliness-And-Social-Isolation-Linked-To-Early-Mortality
3. Aged & Community Services Australia. (2015). ACSA Issues Paper No. 1: Social Isolation and Loneliness. Deakin, ACT. Retrieved from https://www.acsa.asn.au/getattachment/Publications-Submissions/Social-Isolation-and-Loneliness/1015-Social-Isolation-and-Loneliness-Paper.pdf.aspx?lang=en-AU
4. Bailey, C. (2017). The Effects of Loneliness and Isolation on the Elderly. Retrieved from https://mylumin.org/the-effects-of-loneliness-and-isolation-to-the-elderly/
5. Freak-Poli, R. (2017). Social isolation and loneliness among older Australians. Retrieved from https://supervisorconnect.med.monash.edu/projects/social-isolation-and-loneliness-among-older-australians
6. National Aged Care Alliance. (2007). Transport and access to health care services for older Australians. Retrieved from http://www.naca.asn.au/Publications/NACA_transport_0507.pdf
7. Aged & Community Services Australia., & National Rural Health Alliance. (2004). Older People and Aged care in Rural, Regional and Remote Australia. Retrieved from https://www.pc.gov.au/inquiries/completed/ageing/submissions/national_rural_health_alliance_inc./sub012.pdf
8. Van Gaans, D., & Dent, E. (2018). Issues of accessibility to health services by older Australians: A Review. Public Health Reviews. https://doi.org/10.1186/s40985-018-0097-4
9. Sydney, NSW. Retrieved from https://www.humanrights.gov.au/publications/your-rights-retirement/11-your-right-transport
10. St John Ambulance (2018). Community Transport Service. Retrieved from https://www.stjohnvic.com.au/community-transport/