Julia Gillard (Lalor, Australian Labor Party, Shadow Minister for Health and Manager of Opposition Business in the House) Share this | Hansard source

The minister at the table, the Minister for Community Services, is correct in saying that the purposes of this bill are twofold. Firstly, the Aged Care Amendment (Residential Care) Bill 2006 is to amend the Aged Care Act 1997 to harmonise aged-care and pension assets tests in relation to income streams and asset disposals through gifts. Secondly, the purpose of the bill is to amend the act to allow the secretary to delegate to specific members of aged-care assessment teams—ACATS, as they are called—the powers under the Residential Care Subsidy Principles 1997 to increase the maximum number of days allowed for a care recipient to receive residential respite care.

As we know, when someone enters into residential aged care, an aged-care assets assessment is undertaken to determine whether that person is eligible for subsidised accommodation costs. The assessment also helps people to work out the maximum of an accommodation bond or the maximum daily accommodation charge they may be charged for entry to a residential aged-care service. Under current arrangements, the total amount of gifts—assets given away prior to entry to residential aged care—are excluded when calculating the value of assets under the aged-care assets assessment. Schedule 1 of this bill enables gifts and income streams to be treated in the same way they are treated under the Social Security Act 1991 and the Veterans’ Entitlements Act 1996 for the pension assets test.

Given that the intent of this amendment is to treat gifted assets the same way as those included under the pension assets test, this bill improves equity. Consequently, Labor supports this provision. Obviously it is a better arrangement to have consistency across federal legislation about the way in which gifts are to be treated. The issue of the treatment of gifts is that there ought not to be a scheme of arrangements where people can, by way of gifts, deliberately divest themselves of valuable assets in order to qualify for subsidies that they would not otherwise have qualified for. That is the purpose of the way in which gifts and income streams are treated under the Social Security Act and the Veterans’ Entitlements Act. Now the Aged Care Act 1997 will be harmonised with those tests.

Schedule 2 of the bill amends the act to allow the Secretary of the Department of Health and Ageing to delegate to members of the aged-care assessment teams the ability to extend the maximum numbers of days of respite for families who are in need. I think there would not be a member in this place who does not have issues related to respite care raised with them frequently and, obviously, an extension of the maximum number of days of respite for families in need is something that ought to be supported. But in introducing the bill the minister at the table asserted that the Howard government has an excellent record when it comes to aged care. I regret to advise the House that, of course, this simply is not true. There are currently just over 160,000 people in nearly 3,000 aged-care facilities across Australia, and the frailty levels of those going into residential aged care are increasing significantly, with 67 per cent of permanent residents in 2005 requiring high-level care, compared with 58 per cent in 1998.

I think that this is something that people have personal experience of or may know about through friends and family. Indeed, I started my working career in an aged-care institution. That is of course some years ago now, and there is no doubt that the levels of frailty of people who then admitted themselves to residential aged care was much different from the level of frailty now. It is conceivable now for people to remain at home for a lot longer, and obviously community expectations have changed about when it is appropriate to go into residential aged care. So we see that the statistics verify what I would have thought we intuitively knew: the level of frailty of residential aged-care residents is increasing over time.

In addition to those with increasing levels of frailty who are in residential aged-care places, we know that every day there are hundreds of frail older Australians in acute hospital beds because the Howard government has failed to provide sufficient aged-care places. It is possible, in fact, for acute hospital beds to be taken for a long period of time by people who are in need of residential aged care. This is a dreadful result for the patient involved—the frail aged person—because I think all of us know that there is nothing worse than being in an acute hospital bed if you do not need to be there. If you do need acute care, of course, you want timely access to an acute hospital bed but, if you are not in need of acute care, an acute hospital bed is not a pleasant place to be—and frail Australians are left with no choice if they are not in that acute hospital bed. Because of insufficient supply of residential aged care, they will not be in a circumstance where they can be cared for.

On my travels I remember meeting an older gentleman at Wangaratta hospital who had been in an acute hospital bed for 14 months because of problems accessing a residential aged-care bed. I do not seek to suggest that is the norm; that obviously is an extraordinary case. But the fact that there is any case like that is something that we ought to be concerned about. Apart from being bad for the frail elderly Australian involved, it is a dreadful thing for our health system. There is nothing more expensive in our health system than an acute hospital bed, and there is nothing more prized than an acute hospital bed. A lack of availability of acute hospital beds causes blockages in emergency departments, where people end up for unacceptable periods on trolleys. They cannot be admitted to an acute hospital bed on a ward because no such bed is available. Also, a shortage of acute hospital beds means that people can be on elective surgery waiting lists for unacceptably long periods.

We are all familiar with the stories of people who have waited a long period in the public system for so-called elective surgery. It is elective surgery in the sense that, by definition, the conditions they have are not life-threatening, but the surgery they require would make a very big difference to the quality of their life. If you are largely immobile because you are waiting for a hip or a knee operation, then that is really causing a major problem to the quality of your life and to wait in that state for many months, perhaps years, is a very difficult problem. Of course, people also wait for other things—they wait for stent operations to alleviate heart conditions and the like, and the waiting is a very worrying period.

The Howard government would have us believe that this is all to do with state administered public hospitals and, consequently, it is all to do with the performance of state governments. But a pressure comes on our public hospitals as a result of the Howard government undersupplying aged-care beds. That pressure arises because people who should be in residential aged care cannot get there. They are stuck in acute hospital beds, which is bad for them, and those acute hospital beds cannot be used to assist in alleviating pressures on other parts of the system, particularly in emergency departments and elective surgery waiting lists.

A lack of residential aged-care beds is bad for aged Australians, but it is actually bad for our whole health system. Consequently, all Australians should be concerned about it. Even if you are nowhere near the age where you personally would be concerned about residential aged care, even if no-one in your family is in the age range where they should be concerned about residential aged care, you ought to be concerned about it. It is putting pressure on our public hospital system and no-one in this country, given the unpredictability of life’s circumstances, knows when they will need attention in a public hospital and need it in a timely fashion.

The recently released June 2006 stocktake of residential aged-care beds in Australia shows that the provision of aged-care beds continues to fall. At the December 2005 stocktake, there was an undersupply of 3,209 beds across the country. This undersupply has now risen to 4,613 beds. So, far from the grand assertion by the Minister for Community Services—who is at the table—that the Howard government has an excellent record in aged care, when you have an undersupply of aged-care beds and the dimension of that undersupply compared with demand is growing, that is not something one should be crowing about. It is a problem that one should be directing the government’s attention to and seeking to fix.

In the 10 long years that the Howard government has been in office, it has managed to turn a surplus of 800 aged-care beds in 1996 into a shortfall of 4,613 beds in June 2006. The stark picture painted by those statistics is that we are going backwards on the provision of residential aged-care beds. That simply is not good enough when we are talking about the pressures on older Australians when they need residential aged care and the knock-on pressures on our public hospital system.

The government will no doubt argue that it has increased the number of community packages. Labor supports and welcomes the provision of community care, but this should not be at the expense of the provision of aged-care beds. With the ageing population, and the increasing levels of frailty that go along with it, when someone needs a bed, they need it quickly and suggesting to people that they can wait in those circumstances obviously poses all sorts of difficulties.

Indeed, according to the Productivity Commission the time people wait to access a bed in aged care doubled from 2000 to 2005. Not only do we have a growing undersupply of aged-care beds as compared with demand but in five years of this government’s administration we have a doubling of the amount of time that people are waiting for aged-care beds. They are not statistics to be proud of and not statistics that support a grand boast by this government that it has an excellent record in aged care. As I said, that is simply not true.

Then we have the issue of the quality of care that is provided when people are in a residential aged-care institution. Too many of our aged-care facilities fail to reach the 44 quality outcomes of the Aged Care Standards and Accreditation Agency. We know that, as a result of the failure to reach these 44 quality outcomes, there can be risks for residents at aged-care facilities—risks such as what would happen in a fire? That can be a problem. One can imagine what would happen in a fire in a residential aged-care institution, with frail elderly people needing to be evacuated on an emergency basis. Obviously, maximising the ability to so evacuate those people is critical.

In June, in an embarrassing admission of incompetence, the Howard government was forced to reveal that more than 400 aged-care homes still have not complied with fire safety standards even though the deadline was 31 December 2005, and 20 of those homes had not even met the most basic local and state requirements such as organising an inspection of fire extinguishers. I think it would shock many people listening to this debate that we could be in a situation where 20 aged-care homes have not even done the most basic thing of ensuring that fire extinguishers have been inspected so that one can be confident that they are going to work in case of emergency.

We know the Howard government has handed out over $500 million to aged-care providers to meet the 1999 fire safety standards. The deadline to meet those standards was last December, as I indicated, but now some aged-care providers will have until the end of 2007 to comply. So there is a real issue here about quality and safety for the residents in residential aged-care facilities, and that is something this government ought to be concerned about.

There has also been the question of abuse of elderly Australians in aged-care institutions. We know that there have been horror stories. There have been horror stories about kerosene baths, which was something that was very comprehensively discussed in this parliament—as it should have been. There have been concerns raised about sexual abuse, which of course would shock and appal all Australians who hear about it. There have been concerns about poor and inadequate food, and there have been concerns about physical abuse such as beatings. The thought that any elderly Australian in a residential aged-care institution would be at risk of these things—of not being fed properly, of being physically or sexually abused—I think would horrify all right-thinking people. Everyone has heard the stories and read them in the media. This is an issue of quality that needs to be addressed. We need to do more to protect these frail aged Australians. That is our job as the national parliament.

The unanimous report of the Senate inquiry into aged care handed down in August 2005 recommended changes to the operation of the complaints system. The Hon. Rob Knowles, the current Commissioner for Complaints, has himself requested broader investigative powers. The Senate inquiry also recommended the protection of whistleblowers, but it was not until July that the government finally announced a package of measures aimed at combating abuse in aged-care homes. We need to be clear about that time line. We had a Senate inquiry that recommended changes in August 2005. The voice of that Senate inquiry was joined by the voice of the current Commissioner for Complaints, the Hon. Rob Knowles—who would be known to those Victorians listening as a former minister for health in the Kennett government.

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