Rural and Remote
In Australia, approximately one third of the population (around 7 million people) live in rural areas. Another half a million people live in remote regions of the country. The term ‘rural and remote Australia’ represents areas outside Australian major cities and includes inner and outer regional areas, remote or very remote areas.
Rural health inequities
Illness and disease risk
People in rural and remote areas often have lower life expectancy, worse outcomes on health indicators, more long-term health conditions, injuries, disease risk factors, occupational accidents and injury, and poorer access to care compared to people in major cities. Risk of suicide and self-harm is much higher (especially for males) in rural and remote areas. Behaviours associated with poorer health, including tobacco smoking and excessive alcohol consumption is higher in rural and remote areas than in metropolitan areas. People in rural or remote locations experience pressures and causes of stress and illness not experienced by their metropolitan counterparts. The National Rural Health Alliance has factsheets on a variety of issues relating to health in rural and remote areas.
There are higher proportions of Aboriginal and Torres Strait Islander Australians living in rural and remote regions than metropolitan areas, and these individuals have poorer health on most measures compared to non-Indigenous people.
Socioeconomic disadvantage
Social disadvantage increases with remoteness. Rural and remote communities in Australia generally exhibit lower socioeconomic status compared to cities.
There is lower access to employment, education and income in rural and remote areas. Financial hardship due to natural disasters or climate change may also affect residents. People from Aboriginal and Torres Strait Islander backgrounds experience increased socioeconomic disadvantage and have limited access to culturally appropriate services. Other groups, including older people and those who identify as LGBTI, may feel discriminated against, and feel as though there is a lack of specialised services.
Living in rural or remote Australia can be both rewarding and challenging. People living in these areas are known for being down-to-earth, practical and resilient, but also often face barriers due to not living in metropolitan areas. Some challenges, including fewer job and education opportunities, and the effects of living and working in isolation are experienced in greater numbers by people living in rural and remote regions. These factors can affect mental health and well-being. A significant proportion of people experiencing homelessness are in regional, rural and remote Australia, where there are fewer services available to assist these individuals to resolve the issues leading to their homelessness.
The Australian Government provides information for payments and services for regional, rural or remote Australians. Specific support for farmers and farming families is available.
Service and access barriers
Rural and remote Australians often feel disconnected from health and human service systems. Inadequate access to, and availability of, appropriate services is a barrier to receiving care and support for many rural and remote Australians and these access issues increase with remoteness. Accessing after hours care can be especially problematic. Lack of access to health and service professionals contributes to poorer health outcomes. Medicare, pharmaceutical and allied health services are underused in rural and remote areas. Another consideration for some rural and remote residents is the location of their nearest pharmacy, which is often far compared to those in urban areas. Additional service barriers in rural and remote areas include a lack of medical equipment, or delays in obtaining appropriate equipment, and unreliable electricity and power issues. Such barriers can impact health and well-being.
Cost of and distance to existing services can be another barrier for some rural and remote residents in accessing general practitioners and other professionals. Not knowing where to go to find help can also contribute to inequitable access. Online and telephone support services (telehealth) can help to close this gap by providing instant access to support. This may be especially helpful for linking rural and remote residents to support where local providers are based some distance away. healthdirect’s service finder and free 24-hour phone line (1800 022 222) provides non-urgent assistance and health advice from a registered nurse.
In some parts of rural Australia, where hospitals and doctors are far away, nursing posts can provide many medical services. A nursing post is a health centre staffed by highly-skilled registered nurses or nurse practitioners who have the training necessary to provide certain medical services, including emergency care. Nursing posts are found in remote areas of Australia, particularly in Western Australia and Queensland. healthdirect provides more information about nursing posts. My Health Record helps improve communication and record-keeping between doctors, health services, specialists and hospitals.
Workforce barriers
Recruitment and retention of an appropriately qualified health workforce continues to present difficulties in many areas, leading to workforce shortages. These contribute to the poor health status of many rural and remote Australians, especially Aboriginal and Torres Strait Islander people. Rural communities often find it very difficult to attract and retain doctors, making local access to even basic medical services challenging. There are less GPs available in rural areas to provide medical input and choice for older adults, especially those being cared for at home.
Transport barriers and social isolation
Distance to services and a lack of transport options are also barriers for rural and remote residents. Many people in isolated areas must travel significant distances to access basic services. In many small communities, there are no public transport options or taxi services. Social isolation and loneliness are often issues which may impact the mental health and well-being of rural and remote residents.
Stigma and cultural factors
Fear of stigma and other cultural factors, including rural stoicism and a culture of self-reliance are barriers to improving awareness, acceptance and use of mental health and support services, especially in small and more insular communities. Many prefer to manage their problems by themselves, or feel embarrassed or afraid to ask for help. Concerns about anonymity are often heightened in smaller communities. Rural residents may be especially worried that people will judge them for seeking help. HeadtoHealth provides mental health support for rural and remote people.
Diverse populations in rural and remote Australia
It is important to acknowledge the diversity of people and communities in rural and remote areas of Australia. There is no one single type of rural or remote community. Communities will be shaped by groups within them and their characteristics and beliefs which will need to be considered in providing appropriate palliative care.
Aged care considerations for rural and remote communities
People in rural and remote areas are less likely to gain timely access to aged care. Options for care in rural and remote areas are more limited and less specialised than in capital cities. People from rural and remote areas can use the Find a provider tool or call My Aged Care on 1800 200 422 for more information about aged care services and providers nearby.
There are aged care homes in many country areas, and a growing range of services, including hospitals, community services, and family support. Residential aged care facilities in outer regional, remote and very remote areas are generally small, and cost per more per patient. It is not possible to replicate traditional metropolitan residential aged care models in rural and remote areas. Some rural residents may consider relocating to a nearby town to access residential care, while others may prefer home care options.
In the absence of residential aged care facilities in small communities, a Multi-Purpose Service (MPS) provides combined health and aged care services. They are generally located in communities where it would not be viable to operate a separate hospital and aged care home. There are Multi-Purpose Services in all states and territories. However, these are generally run more like hospitals, so it is important to learn more about each local site. Aged care beds could be allocated within the main hospital, or as a separate unit. Multi-Purpose Services deliver a flexible mix of services to best meet the community’s health and aged care needs. All Multi-Purpose Services deliver residential care and some services deliver care in the home. Encourage the people you work with to contact their local MPS to find out more about the services and supports provided.
Many people in rural and remote areas are eligible for community care support but there are often long waiting lists. People may find that no new clients are being accepted because available services have been allocated. Those receiving assistance may find it difficult to move through various levels of care as their needs change. MyAgedCare provides information to support rural and remote residents.
Palliative care and advance care planning considerations for rural and remote Australians
Palliative care services and networks have developed mostly in urban areas and are often under-funded and not well distributed across the country, leaving gaps in care provision to rural and remote communities. There can be practical and geographic specific issues to consider in palliative care delivery and advance care planning initiatives for rural and remote residents. There are a range of unmet needs for rural palliative care patients and their families, including access to palliative care services, and accessing information about illness, practical care and support.
Primary healthcare providers are pivotal in palliative care provision in rural and remote Australia. Nurses in rural and remote settings may have limited access to specialist medical and nursing support, and often provide palliative care as part of their generalist role. Sometimes there is no local resident doctor to support health professionals providing palliative care in rural and remote areas. These health professionals can also include allied health professionals, Aboriginal and Torres Strait Islander Health Practitioners or Aboriginal Health Workers. Training and upskilling across the full multidisciplinary palliative care team is important to ensure that rural and remote workforces are equipped to meet people’s current and future needs. ELDAC’s Linkages toolkit and information about HealthPathways may be useful.
Palliative care services in rural areas also have unmet needs in terms of their own support, educational requirements, access to specialist symptom management and ways to facilitate communication between service providers. System-related barriers to palliative care in rural and remote areas include lack of services, funding issues, poor continuity of care, and power provision issues. Rural and remote residents and carers can check if staff are trained in palliative care and whether there is a visiting specialist or palliative care team available to provide assistance. For some rural and remote Australians, the nearest hospital may be several hours away. The National Rural Health Alliance has a factsheet on palliative care in rural and remote areas. This video highlights the benefits and challenges involved in delivering rural and remote palliative care services.
Not all people want to travel away from home to a specialised palliative care centre and to remain there towards the end of their life. Many people, especially those living in rural and remote communities, may prefer to spend their last weeks at home or in a small hospital or aged care facility near to people they know, with the support of local primary care health professionals. It is important that rural health professionals and their patients have ready and timely access to specialised advice, equipment and practical suggestions to support local approaches to palliative care. Obtaining supplies and advice about the use and disposal of medicines for palliative care can be challenging for people in rural and remote areas if there is no pharmacist nearby.
If rural residents are receiving treatment far from their location, arrangements may be made for day trips back home. Rural and remote residents may also want to enquire about visiting hours, and overnight stays by loved ones, especially where families may be far away and may need to travel long distances to see family members when there are changes in their health status. Phone and internet access in residents’ rooms can assist during stays.
Aboriginal and Torres Strait Islander people tend not to use palliative care services in mainstream facilities. The desire to die at home or on traditional homelands is often an important palliative care consideration. Cultural safety is essential when addressing end of life needs with Aboriginal and Torres Strait Islander people. Another important consideration is the inclusion of Aboriginal Health Workers in rural and remote palliative care teams. Evidence-based resources to inform practice are available on Australian Indigenous HealthInfoNet. For more information on Aboriginal and Torres Strait Islander people and aged care and palliative care considerations, visit our webpage.
Uptake of advance care planning and advance care directives remains low in rural and remote Australia. This may contribute to lower quality care for older rural populations. To ensure the end-of-life wishes of people in your care are recognised and acknowledged, encourage rural and remote people to record their preferences. For more information on rural and remote issues, visit CareSearch, palliAGED, Services for Australian Rural and Remote Allied Health (SARRAH), CRANAplus, and Australian Rural Health Education Network.