Click here to download Navigating ‘conflict of interest’ issues in thin markets

Published October 2020

The Commonwealth Government perceives a conflict of interest occurring in instances where Aboriginal community controlled organisations (ACCOs) provide aged care assessments to Aboriginal Elders and, subsequently, also provide aged care services to the same Elders. This may include ACCOs directly referring Elders to their own aged care services, and/or Elders choosing the same ACCO to be their service provider as was their assessor.

This perception of a conflict of interest represents a significant roadblock to the provision of culturally safe, trauma informed aged care services and supports for Elders.

This roadblock results from the Commonwealth Government’s lack of a rights-based, equity focused approach to mediating the thin market for Indigenous aged care services. This problem can be solved by Commonwealth aged care system policy incorporating an understanding of how Elders’ rights (including Self-determination and ‘choice’) and equitable access to essential services are inhibited by the current system and its economic and logistical limitations for ACCO health services and aged care providers.

This paper presents an argument and strategy to overcome this roadblock. It outlines why allowing ACCO assessors to directly refer Elders to ACCO service providers, and in some cases even to the same ACCO provider they were assessed by, is not a conflict of interest. Rather, it is:

• the inevitable result of how ‘thin’ the market is for Indigenous aged care, which the government is responsible for mitigating in order to ensure provision of essential services;
• protects and upholds the human rights and indigenous rights of Elders as per the respective UN declarations to which Australia is signatory;
• crucial to providing Self-determination and choice to Elders;
• crucial to providing equitable and adequate aged care assessment and services to Elders.

This paper argues that the Commonwealth government needs to implement policy applying to Indigenous staff and ACCOs that allows ACCO assessors to:

• refer Elders to ACCO service providers,
• refer Elders to the same ACCO provider they were assessed by, if there are no other ACCOs providing the necessary/required aged care services locally.

This policy would enable the ACCO sector to provide more of the culturally safe, trauma informed assessments and
services to Elders that they so desperately need and want.

This policy change should be viewed as one of three necessary actions to enable the established ACCO infrastructure to upscale operations and workforce, so that ACCOs can provide for the aged care assessment and service needs of Elders, along with:

• establishing a stable, economically viable Indigenous aged care workforce, and
• increasing the availability of appropriate, flexible funding models for small-scale service providers to relatively small dispersed Indigenous populations, as the lack thereof currently inhibits ACCO providers of aged care and health care from becoming economically viable and expanding service provision in the current system.