Shayne Neumann (Blair, Australian Labor Party, Shadow Minister for Indigenous Affairs) Share this | Hansard source

I rise to speak in support of the Aged Care Legislation Amendment (Increasing Consumer Choice) Bill 2016. Labor is supporting this legislation. It is essentially the next logical step in the reforms of aged care. Labor has a strong record on aged care reform. In government, we introduced the 10-year Living Longer Living Better reform of the nation's aged care system. These reforms are rolling out as I speak and sit here in Parliament House.

Living Longer Living Better was a 10-year plan to build a better, fairer, sustainable and nationally consistent aged care system that would meet the challenges of our ageing population. Living Longer Living Better was developed and delivered with extensive consultation and bipartisan support. We deliberately chose to implement these reforms over 10 years to ensure the sector, consumers and government had time to make the necessary adjustments. Like those in the aged care sector, I am pleased to see the government continue to roll out Living Longer Living Better and a Shorten Labor government will build on our legacy and ensure the aged care system is sustainable, robust, fair and even better.

As we know our nation's profile is changing. Over the next 20 to 30 years, the population aged 65 years and over is projected to increase from over 14 per cent of the population to 25 per cent of Australia's population. Labor recognised these challenges and undertook the Living Longer Living Better reforms to ensure our aged care system kept up and will keep up with the ageing population.

The bill before us is making further changes to the way we allocate home care packages. This measure is in the spirit of Living Longer Living Better. I do note that it precedes the legislated review of Living Longer Living Better, which is required by mid-2017. I trust the minister will have an accountable, transparent and independent process. Certainly that is Labor's intention should the Australian population grant us the Treasury benches. That review is where we look at the impact of the reforms to date and then determine the way forward.

It was always envisioned that over the next five years we would see an increase in consumer choice, along with greater control for and by consumers. But I get it. I understand why the previous Assistant Minister for Social Services announced this measure as part of the 2015 budget. While there was extensive consultation with the sector and the community, while there was bipartisan support, these reforms are and will always be Labor's. These amendments allow the coalition to make their mark and say, 'I was here too.' I suppose that is true. But they are in the spirit of Labor's reforms.

What this measure will do is give the consumers of aged care services—our older Australians and their carers and families—greater choice and control of the services and support they need to remain as independent as possible within their own homes and communities and that is what they desire in increasing numbers. The Commonwealth allocates close to $7.5 billion for Commonwealth funded home care packages across the forward estimates. Given the government's inability to oversee the implementation of Labor's reforms efficiently or effectively, there is good reason for concern.

This bill is the first part of a two-stage plan to change the way home care services are delivered to and for older Australians. The first stage is addressed in this legislation before the House tonight, which would allocate packages directly to the consumers from 27 February 2017. Home care packages would 'follow the consumer', enabling the consumer to choose and change their provider. It would 'follow' them if they moved to another area. The second stage would integrate the Home Care Packages Program and the Commonwealth Home Support Program into a single home care program from July 2018. This will require additional legislation from whomever forms government after the next election.

The legislation before the chamber will make amendments to the Aged Care Act 1997 and Aged Care (Transitional Provisions) Act 1997 in three main areas. First, funding for home care packages would follow the consumer rather than the provider. Consumers would retain their funding arrangements even if they choose to relocate and live in a new area, or if they want to change providers. For example, if a woman is living with dementia in Ruthven Street in Toowoomba and is cared for by her husband and, sadly, her husband passes away, and her daughter living in Bridgeman Downs in Brisbane asks her to come and live with her, she would not have to abandon the package provided by, say, Blue Care in Toowoomba in the Darling Downs. She could take the package with her and move down to Bridgeman Downs to live with her daughter, who could be her carer. She could also choose to change providers and may choose to avail herself of the services of TriCare or Carinity in that particular location, or any other provider of her choice. That is how the reforms will operate.

This measure would remove the Aged Care Approvals Round—ACAR—process for home-care packages. The 2015 ACAR saw the final allocation of home-care packages to providers. Home-care providers currently compete for an allocation of packages through the ACAR, which they then offer to eligible consumers—so the providers have the control. In the 2014 ACAR, which was announced in January 2015, competition for new home care places was extremely high. The department received applications for 108,281 new home-care places with respect to the 6,653 places made available by the department. That means that approximately 17 new places were sought for every place available. That is intense competition and an enormous expense for the providers. This amendment would remove considerable red tape for aged-care providers, who would no longer be required to make these applications, and it would improve the profitability of the providers. Providers would be approved and would meet the accreditation and quality standards. That would not change.

Secondly, the amendments before the chamber tonight would create a nationally consistent approach to prioritising access to home-care packages through My Aged Care, the portal available to all Australians who are engaged with the aged-care sector. This measure would remove the regional ratios as well, with a prioritisation process to take into account an individual's needs, circumstances and waiting time, regardless of their location. Consumers would still be required to undertake a comprehensive assessment by an Aged Care Assessment Team, known in the sector as ACAT. Currently, a limited number of new packages are released within various aged-care planning regions according to the aged-care provision ratio. Approved aged-care providers compete for allocations of home-care packages through ACAR, at great cost to the sector and to them in particular. Much work is done by aged-care providers to ready themselves and make those applications. Those packages are currently then offered to eligible consumers. The number of packages with the changes before the chamber today would still be capped, but packages would be released progressively throughout the year, prioritising the needs of individuals. That would be determined through the My Aged Care portal. One of the benefits of the change will be more accurate data on the demand for home-care packages. Waiting lists are managed by individual providers. This measure would allow My Aged Care to capture just how many are waiting for a package, how long they have been waiting, what part of Australia they reside in and so much more. This has some real benefits for accurate collection of data, which will facilitate better government policy in terms of aged care.

The third change is the reduction of red tape for providers to become approved under the Aged Care Act 1997. The quality standards will remain, as I said before, but the criteria for assessing suitability will be streamlined. This is a very lengthy process that has been based on key personnel rather than capacity. Providers had to have an allocation of places in order to retain their status as approved providers. The legislation will allow providers to retain their status as long as they meet the quality processes and maintain accreditation.

The aged-care reforms are being progressively implemented, as I said before. I just thought that, for the benefit of those who might be listening to this debate, we need to look at just how they have changed. In 2012-13 and 2013-14, years 1 and 2, there were major amendments: new home-care packages and supplements in both home care and residential care; the establishment of My Aged Care and a national contact centre; the establishment of the Australian Aged Care Quality Agency; and the launching of the Aged Care Pricing Commissioner. Years 3 and 4 aim to significantly improve choice for consumers and strengthen system sustainability. In 2015, those things were built on. That included the government, with opposition support, improving consumer choice and flexibility. Now we have a situation where all home-care packages are delivered on a consumer directed basis.

There have been issues in relation to the functionality of the My Aged Care website and the contact centre hotline. There have been issues in relation to those. Changes have been made in relation to the implementation of national voluntary quality indicators for aged care. There has been growth in the sector with the creation of the Commonwealth Home Support Program. There are better regional assessment services. Public and private funding was introduced into the system. More residential aged-care providers are listed on the Stock Exchange. And there is greater productivity in the sector and greater profitability, if we can believe, as I do, the report done by the Aged Care Financing Authority recently and the report done on the Aged Care Act.

In 2016 through to 2022, there will be continuing changes in the sector. The legislation, as I said, mandates a five-year review. I am hoping that whoever gets into government will have—and we certainly will have—an independent, accountable and transparent process. The Abbott-Turnbull government removed Labor's Aged Care Reform Implementation Council and replaced it with the Aged Care Sector Committee. ACRIC was made up of a diverse range of specialist knowledge and expertise, including legal, union, gerontology and government, who were independent from the aged-care sector.

There is the development of a road map, and I am asking the government to release that road map. It is outlining the next stage of aged-care reform, and I think the government should release that and should cooperate with the opposition in relation to that.

According to the vision of Living Longer Living Better, we need a more sustainable and affordable sector, more diversity, more rewarding career options, encouragement for aged-care businesses to grow and invest, and a higher and better skilled workforce. There needs to be greater choice, with control in the hands of consumers, and more support for people to stay at home as part of their communities as long as they wish.

We set a target, as I said, in relation to home care packages of 125 residential and home care places for every 1,000 persons aged 70 years and over by 2021-22. These 125 places comprise a ratio of 80 residential places and 45 home care packages. These changes aim to give consumers greater choice in selecting home care providers, but it relies very much, as I said before, on the My Aged Care website, portal and hotline as a single entry point to access these providers. This is where there have been big problems in the sector. The aged-care sector and consumers are very concerned, as are providers, about the My Aged Care system's capacity to expand even further, and the system currently is inadequate. In addition, it relies on an informed and competent consumer.

The government plans to make further changes, as I say, which will integrate the Commonwealth Home Support Program and the Home Care Packages Program on 1 July 2018. These changes have generally had support across the sector, but we in the opposition are very concerned. The No. 1 concern we have is in relation to My Aged Care. From 27 February 2017, consumers would apply directly through the My Aged Care gateway rather than directly to aged-care providers. The idea of a single gateway is desirable, and Labor supports it, but it has not functioned as it was first designed to. I have met residential aged-care providers who have never got referrals through the My Aged Care website and have had to rely on their own devices and, indeed, their backlog of people waiting to get into their facilities.

The implementation of the Commonwealth Home Support Program in July 2015 has made consumers and providers very, very wary of the functionality of the gateway. Certainly, whether I have been at the ACSA national conference in Perth or talking with providers in Brisbane at the Brisbane North PHN about all these issues, there have been issues raised again and again.

We saw the Commonwealth Home Support Program formed from four programs that were being done: the HACC Program, for home and community care services; the National Respite for Carers Program; the Day Therapy Centre Program; and the Assistance with Care and Housing for the Aged Program, which was for those people who cannot find any housing, are quite financially strapped and have found difficulty with issues of housing and homelessness. According to the government, this was meant to achieve similar outcomes to those proposed in the legislation before the chamber today, including streamlined access to entry-level support services through a regional assessment service, known as a RAS; a standardised national assessment process and entry point, as I say, through My Aged Care; and reducing red tape for service providers through more streamlined funding arrangements.

The subordinate legislation, principles and fee structure were not delivered until September 2015, some months after 1 July 2015. The fee guidelines—which the government completely and utterly botched—became principles while providers were functioning in a new system completely and utterly in the dark. This was the direct result of the delayed implementation, the last-minute consultation with the sector and a complete failure by the government to trial regional assessment services.

The government want to push legislation through the chamber today in order to give them enough time to ensure that the sector is better consulted and prepared for these changes. Having looked at the track record of the government, I say that is a good thing, because they have certainly not designed and implemented the reforms that they inherited from Labor very well at all. The sector, while supporting generally increased consumer choice, is rightly concerned about the government's capacity to implement this major change in the legislation before the chamber by 27 February 2017.

The Department of Human Services Medicare payments to providers and Centrelink means testing remain an issue. In late 2013, the Department of Human Services—Medicare—took over the payment of aged-care supplements and subsidies to aged-care providers. This resulted in a major breakdown of the system, and home care providers experienced major delays and errors in payments. Some providers were not paid from November 2013 through to March 2014 and were owed tens of thousands of dollars. The department had to conduct manual payments through 2014 and into 2015.

Leading Age Services Australia, LASA, has expressed concern about the readiness of the government and the department's systems in relation to the reforms before the chamber. Home care providers in particular have suffered over two years, so their confidence in the government's implementation of the reforms before the chamber is debatable. We need a workable payment system, and the problems have not been fully resolved.

In addition, there is significant delay in reconciling accounts, with Medicare taking up to three to four months to pay for services. This will make the portability of home care packages in the legislation before the chamber very fraught and very difficult. A consumer may want to change providers, but, unless there are changes to Medicare payment systems, providers may not be able to reconcile exactly how much funding actually remains in a package. The Department of Human Services has failed aged-care consumers as well.

Living Longer Living Better saw greater consumer contributions towards aged-care services, but, while older Australians are assured of access to equity in terms of quality aged care, those who can afford it are expected to contribute more. This has seen the introduction of means testing for residential aged-care and home care packages in greater numbers and with greater strengthening from 1 July 2014.

To date, older Australians are waiting a long time for assessments. Many have experienced errors, mistakes and delays in notification of assessments. The delays in receiving notification of their assessment have resulted in aged-care residents owing tens of thousands of dollars in means-tested care fees. Aged-care providers were not charging this, as they had received no notification from Medicare. This remains an ongoing issue in the sector.

The second major challenge is consumer readiness. The pre-baby boomer generation, which I have heard called the silent generation, are living through this period of rapid change in the aged-care system, and the baby boomers are next. According to electorate offices on our side of politics and the media, older Australians are struggling with the pace of these changes, the complexity of the system and the constant errors and misinformation. It could be argued that consumers have not been taken along this journey to greater consumer choice and control. As I said, the government has failed in terms of its implementation.

Not all consumers have the capacity to make informed choices, and safeguards are clearly essential for the most vulnerable and those with complex clinical care needs, especially those who will be required to pay more due to their means-testing arrangements. Elder abuse can occur when unscrupulous family members make decisions based on cost rather than care needs. Consumers will need significant education and information. I ask the government to make sure that the department handles this much better than the examples I gave earlier in this speech. Consumers need to be aware of their own needs, how much they will have to pay for the services on offer, what services are there and what is provided by the providers. They require greater levels of health and financial literacy and support to negotiate packages equitably and effectively.

This comes on top of the government cutting the aged-care workforce supplement in September 2013—$1.1 billion. This comes on top of the government cutting the dementia and severe behaviours supplement—$52 million. This comes on top of the government stupidly getting rid of the panel for positive ageing at the mere cost of $1 million. To the credit of Everald Compton, other organisations and Per Capita, through the Longevity Forum, they delivered their Blueprint for an ageing Australia. This comes on top of the aged-care payroll tax supplement being axed at a cost to the sector of $653 million. This comes on top of this government cutting $21 million when they rebadged ACSIHAG to DACS funding. This comes on top of the government cutting $40.2 million from the aged-care workforce development fund. It comes on top of the government cutting $595.1 million from the middle of this year, in MYEFO last year when streamlining health and aged-care workforce programs. It comes on top of the ACFI revision of $472.4 million they did in MYEFO from the middle of this year.

The government have cost the sector nearly $1.49 billion and they want the sector to be able to handle the changes they want to do. They have taken the sector for granted. They leave consumers in a position where they find it difficult to access the aged-care services that they need. They make the sector far less profitable. That is clear when you look at the reports I referred to earlier. Regional and rural communities are suffering and those residential aged-care providers are suffering.

This legislation comes on top of the government taking nearly 540-odd days to provide a report in relation to their own Commonwealth funded stocktake of Commonwealth funded programs in relation to the aged-care workforce. This was to be, as one of the ministers or assistant ministers for aged care said, the basis for the development of an aged-care workforce strategy. Instead, it was the precursor to nearly $1 billion in cuts in the aged-care sector and health sector combined in terms of workforce development and ACFI revision in MYEFO at the end of last year.

The government said in Senate estimates that they are not intending to undertake an aged-care workforce development strategy. This is contrary to the request not just of the unions—that is, the AWU, the HSU, United Voice and the nurses—but all the other stakeholders, all of whom believe there needs to be an aged-care workforce strategy developed in this country. Every single aged-care provider I have met with—in boardrooms in Sydney, Melbourne, Brisbane or elsewhere—has said we need to work together to develop the workforce we need.

The Productivity Commission in 2011 said that we need to quadruple the aged-care workforce. The average age of a person working in aged care in this country is about 50. About 90 per cent of the workforce are women. About 34 per cent come from CALD backgrounds. They are paid low wages compared to those who work in other sectors. For example, a nurse working in residential aged care is paid hundreds of dollars less than a nurse working in a public hospital. We need an aged-care workforce strategy that brings the sector together to deliver the kind of reform we need.

We have about 350,000 people working in residential aged care, home care and Commonwealth home support programs in the country. We need, according to ACFA, about 900,000 by 2050. We are not going to get it if the government does not show leadership in the development of an aged-care workforce strategy in this country. This government has decided that the market will do the trick. It is wrong. It has failed. It gave back a lot of that money and more so, in terms of the aged-care workforce supplement, after it ripped it out of the hands of workers. It gave it back to the sector and we have seen in the sector no appreciable improvement in salary and wages, career pathways or professional development. There has been no appreciable difference, so the government has a lot to answer for.

The government have failed in this area. Like everything to do with aged care, they think it is just about aged care. It is not just about aged care; it is about ageing and longevity. It is about transitioning Australia to the future to an age-friendly country. Other countries have picked up those concepts, like the UK and Japan. The government's fixation is on aged care alone. They have had so many ministers and so many assistant ministers. One of their ministers, the member for Pearce, thought he was the minister for an hour or two. He had it ripped away and it was given to the current Minister for Health and Minister for Aged Care. Even the title 'aged care' shows that they are not even thinking about what we need to do in the future. We need to think about that and transition our aged-care sector workforce and the aged-care system. We need to think about ageing issues and dementia-friendly communities, which Alzheimer's Australia and so many advocates talk about. All of these things remain outside the understanding and the mindset of the government. They do not seem to understand anything about that, but we need to do it.

This legislation has merit. We support it. It is the next logical step on Labor's Living Longer, Living Better program. We support it and we will back this legislation in the chamber. But I urge the government to cooperate with the opposition and to think bigger than they are thinking. It is not just about aged care; it is about ageing and longevity, and that is what they need to do. They need an aged-care workforce strategy and they need to do far more than this legislation, and I urge them to adopt a bipartisan approach across this area of policy.

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