Lessons over loss – what a small town’s facility closure can teach government and sector about pragmatic reform

Pyramid Hill is three hours drive from Melbourne. It falls within the Loddon Shire which has a population of 7,750 people and its median age is 52, far higher than the upper 30s of the State’s capital. When Pyramid Hill’s only residential aged care facility closed its doors in 2019, shock and sadness swept through the community. But in the years since the community has started to rally to open up the facility themselves. Within their continuing journey, grounded lessons have been learnt that are vital for government, providers and community members to recognise. Pragmatics and personal conviction, community strength and willingness, alongside provider humility, has moved the re-commencement of residential aged care forward in Pyramid Hill. And when it comes to compliance and regulation, what is raised to government is what could happen if aged care was built up from the local level, with regulation supporting, rather than impeding, aged care offerings by the community for the community.

Regional community strength

John and Jeanette Carroll have called Pyramid Hill home all their lives. The 600 population strong town has seen them go through all their milestones, from first job, first love, marriage, kids, grandkids and more. When the aged care facility shut down, it was a blow. They wondered where they would end up if they ever needed more care.

Carroll spoke to the ABC about how entrenched the community in regional Australia can be, even a few towns over is a sizable change, “it would take a bit to fit in [somewhere else] the likes of Bendigo or something.”

Their five sons all got stuck into the football club, now proud members of the town’s seniors football club. Carroll shares how he is proud of his career at the butter factory in Cohuna, and how he lost count of the cherished hours looking after Pyramid Hill Brigade’s fire equipment.

It is what being in and committing to one place, without the flashy lights, that is a first lesson for government and providers in aged care planning for regional areas. Community members will show up, locals will commit because it matters to them. Their town matters to them, and when things get tough, there’s no one quite like a regional local to have in your corner. The Carrolls directly share that through the decades what’s organically happened is a powerful network of people who regularly checked in on them to offer help as they aged.

This is a critical component of strategy that must be recognised in regional aged care. Advocates call for the government to acknowledge and shape aged care policy around it. The conviction to help, to pitch in is already there. The hardest bit of strategy is done, with a willing workforce to enter into preventative, relational, holistic aged care. The funding should come to that organic network, not trying to take out seniors and staff out of that to largely-metropolitan bureaucratic systems.

Mrs Carroll shares, “it’s just so friendly here, you wouldn’t get that attention in a big place, I don’t believe”.

Proactive

The Carrolls pinpoint an element of fear that is shared by many seniors in their town, if they ever decline health-wise, however much yearning to stay in place, the current resources aren’t there, “we want to stay in our home, but know if we become non-ambulant we will have to move away from Pyramid Hill.”

It is what happened post facility closure that is another lesson for government reform and provider strategy. The community, from its close relationships with its seniors, knew what was at stake, all higher needs seniors required to move away from Pyramid Hill, so they showed their substance. When the aged care provider ceased operations, the community decided they’d get to work to find a better way. There was no need to cajole or ask for initiative, there was no apathy or ‘that is someone else’s problem’. The community started to own it and work towards changes.

Advocates and experts are increasingly weighing in on this very phenomenon. Far from the Commonwealth attempting to patch-work aged care for local regions, particularly regional and rural Australia, they are advocating for the government to operate and plan aged care through regional networks. Aged care expert Hal Swerissen highlights that the primary health networks are already established and a systemically strategic local place to start.

The appetite and stamina the community has already shown in working towards owning and operating the aged care facility is a monumental step. If government policy and reform was run at a local level, advocates and experts see community initiative being supercharged in practical aged care management and excellence. This, many say, would be bringing rights-based to the local reality.

Practical leadership – humility and partnership

The metal of the community was shown practically, with what they have so far achieved alone. While there was a time to grieve for the 30 people that lost their jobs, and the elderly residents that had to be relocated, the community pivoted, they decided they had work to do.

Drew Chislett also spoke to the ABC about the community’s journey with residential aged care. He shares, “losing our aged-care facility was an absolute blow.” And yet, seeing the vacant building doing nothing was not something they could accept. They organised and planned, they got together proposals and crossed their t’s and dotted their i’s. They educated themselves to become effective lobbyists and were able to persuade the facilities operational provider, Respect Aged Care, to hand over the keys to the site, without cost.

And herein lies another lesson, one of humility. For sincere and earnest provider leadership, being painted only with the same brush as others, whereby mismanagement, maliciousness and disregard was the only reason for failure did not coincide with the very real difficulties of trying to manage excellence with razor thin funding from government, rising costs and year on year losses.

Pyramid’s facility operator, Respect Aged Care, has shared that they had $1.1 million in losses over five years. Government figures too, show a macro problem, with 60% of providers operating at a loss. This is a monumental reality that providers are asking government to contend with. Particularly as compliance burdens and the cost of meeting regulatory frameworks increase, providers are clear that heartfelt passion to see excellence in care delivered may not be enough when battling systemically overwhelming bureaucracy, paperwork and compliance.

The reality that small providers, particularly in regional areas, are doing it tough, executives at the helm are repeatedly calling for government to balance regulatory compliance measures with allowing sincere, smart and innovative sector leadership to get on with the job.

Respect Aged Care chief operating officer Jason Binder praises the attitude, conduct and conviction of the Pyramid Hill community, “the Pyramid Hill Progress Association was excellent to deal with, and it was a pleasure to hand the facility back to such an embedded and focused community organisation.”

In a relationship and willingness to directly engage with a community lobby group, Respect Aged Care’s leadership highlight a very different picture to the un-engaging-corporate leadership traits many times painted of aged care executives. The Respect Aged Care’s team were not able to make operations work in Pyramid hill, they acknowledged that with the community and came to the table to partner with those that would be willing to take on the responsibility.

For aged care advocates, they continue to call on the government to acknowledge that national level management of aged care is simply not working. Local networks, local relationships and local relationships are critical to moving through the very real complexity of supplying aged care resources precisely where they are needed.

A resource

Chislett of the Pyramid Hill Progress Association articulates the strategy that aged care experts with decades of experience are touting, leverage the strength of the community to support aged care, therein lies sustainability of operation, finance and future.

He says, “if we can keep our people in our community as an independent living space, then they’ve got their own space, but they’ve got the support of the community around them.”

Mayor Dan Straub, of the Loddon Shire, echoes this pitch to government, give locals the resources and support to make it work for themselves. He notes the small town’s “let’s get it done” mentality as a resource that sets the Pyramid Hill community up for success.

“They do get in and drive the projects that are important to them.”

He says, “It’s a community that rolls their sleeves up.”

Relationships over rules

Advocates and provider heads see Pyramid Hill, and the community’s challenge to find a way to wrap their heads around hundreds of pieces of standards, legislation and compliance, as a key example of bureaucracy impeding excellence in care.

The Pyramid Hill Progress Association has the keys and is cleaning up the facility but still has to figure out how to operate the facility to rigid accreditation standards. And now also, to ever evolving rules that even veteran aged care executives call opaque and confusing.

Swerissen, an expert of over thirty years, directly comments on this. Far from national rules handed down from Canberra, if the management of aged care was disseminated by primary health networks, Pyramid hill would have local government personnel to contact, strategise and plan with. From many in the community like the Carrolls contemplating residential aged care, to those figuring out how to open and run the facility, local aged care planning with substance by those that care could mean cost-effective and sustainable sector moves. No “maze-like” conditions, trying to find answers through My Aged Care or on hold for a government official in Canberra who has never heard of Pyramid Hill.

Chislett and others in the Association know the Carrolls, they know the current empty building, they know the community, they know the people willing to work in the facility, they know the businesses willing to get involved. This is the resource, they have accurate insight. What advocates and countless provider executives are asking for, is that the Commonwealth pivots to bring aged care reform, resource-management and resources to the locally passionate and in-it-for-the-long-game community.

Advocates and provider leaders recognise proactive and locally led aged care as a strategy and model to bring aged care from a reactive scrambling situation to an effective and sustainable sector.