Tony Zappia (Makin, Australian Labor Party, Shadow Assistant Minister for Medicare) Share this | Hansard source

The Aged Care (Single Quality Framework) Reform Bill 2018 amends the Aged Care Act 1997 and the Australian Aged Care Quality Agency Act 2013 to make provision for a single set of aged-care quality standards that will apply to all aged-care providers under the Aged Care Act. The bill will also vary the functions of the chief executive officer of the Aged Care Quality Agency to reference the aged-care quality standards.

With respect to those standards, there are currently three different areas. They include residential aged care, where there are four standards; home care, where there are two standards; and the national Aboriginal and Torres Strait Islander Flexible Aged Care Program quality review, where there are two standards. I stress the term 'standards' because none of these standards come into effect until 1 July 2019, which is still over a year away. And while we on this side of the House will be supporting this legislation, it is somewhat concerning that it has taken so long to bring these matters to the parliament and, indeed, that it will take yet another 12 months before the effects of this legislation are felt out there in the community.

There are currently some 235,000 Australians in around 2,700 aged-care facilities around the country. A similar number of employees work in those facilities, which are a combination of for-profit and not-for-profit centres. The reality is that all of them are trying to keep their centres viable, and that means they're all striving to make a profit. Indeed, if they are unable to, it would be only a matter of time before they would have to cease operations.

This legislation arises from a failure of the health department, the Aged Care Quality Agency and the Office of the Aged Care Complaints Commissioner to protect vulnerable people, mainly older Australians, from mistreatment, inadequate care, physical abuse and medical neglect in some residential aged-care facilities. I stress the word 'some' because clearly there are some very good operators out there and there are also very good services and people who provide home care. But it's not always the case and it hasn't been the case for years. Indeed, over the last two decades I can recall regular media reports, scathing media reports, exposing the maltreatment of people within residential care facilities.

In 2015-16, there were 2,862 notifications of assault to the Department of Health. In 2017, there were 4,713 complaints to the age commissioner. This is with respect to residential aged-care facilities. Those numbers, however, do not reveal the true extent of the concerns that would be generated by those facilities; they might not complain because of fear by the residents themselves or by the families of the residents, or fear of retribution towards the resident should they complain. Indeed, there are even allegations that lawyers acting on behalf of the facilities are bullying those people who dare to complain about any service that they are unhappy about.

Perhaps of even greater concern is that they cannot and would not ever represent the true level of concerns we should have about these facilities because, as we know, around 53 per cent of people in residential aged-care facilities have dementia or Alzheimer's disease or an illness that prevents them from being able to communicate or formally lodge a complaint. So the reality is that we're dealing with the tip of the iceberg with respect to the number of concerns that come out of those facilities.

We also have a report that was undertaken over a 15-year period by Professor Joe Ibrahim with respect to deaths that occur in residential aged-care facilities. His report covered a 15-year period where he looked at coroners' reports in respect of the people who died whilst in a facility. He found there were some 3,000 deaths over that 15-year period that were avoidable. He means they were avoidable because they occurred through things such as misdiagnosis, poor care or communication errors. In some cases it was assault of one resident by another, which included choking. Sometimes it was because of medication errors. There were other factors, but those were the kinds of factors that were occurring. These deaths could have been avoided had the care been there in an improved way.

The reality is that the sector has been dogged by negative stories, criticisms, scandals and damning statistics which for too long have been conveniently ignored by many of the operators of those centres and by the government departments we trust to oversee those centres and ensure they comply with the standards and regulations that are set. However, the most damning proof that the system is failing is that in the last two decades we have had numerous inquiries into the aged-care sector or inquiries that relate directly to the aged-care sector. The most recent ones we often talk about are the Productivity Commission report, the Australian Law Reform Commission report, the Carnell-Paterson review and the current ICAC investigation in South Australia into the Oakden facility, which also led to a Senate inquiry. We now also have the Standing Committee on Health, Aged Care and Sport conducting an inquiry into the aged-care sector in this country. The fact that there are, and have been, so many inquiries tells its own story. Inquiries are not held unless there is a problem. In this case, the problem goes back years, and it has been ignored for much, much too long.

Over recent years, I have visited many centres. Indeed, only last week I went to a centre and spoke at length with the manager of that centre. But I've also met with family members who have talked to me about the experiences they have undergone with respect to members of their families who were in centres, and I have met with aged-care workers, including those whom I would describe as whistleblowers who came to see me in confidence and who don't want their names provided publicly. They told me about how they saw the industry from the inside. Indeed, some of the people that I met with were at management level. They were not just personal care workers or nurses; they were people that worked at senior management level. It's clear to me that the aged-care system in this country is in crisis and that we can and should be doing a lot better.

I accept that the government is aware of the concerns that I have raised and has met with and listened to the same kinds of people that I have been speaking with. The government's response to doing a lot better appears to me to be simply moving the deckchairs. It may be necessary to change the rules, change who is responsible for the rules and change the way bureaucracy carries out its responsibilities and functions. Clearly, this legislation does that, and we support it. But it seems to me that that is not going to solve the real problems that we're confronted with. What is required is a cultural change both within government bureaucracies that are entrusted with the responsibility to oversee the aged-care system of this country and within those providers who are not living up to the standards that we set for them. Until we get that culture change, I suspect that no amount of regulation or changing of the rules is going to make enough difference to prevent the kinds of mistreatment that we have seen for too long.

It is not right and it is not acceptable to mistreat any vulnerable person of any age. I suspect that if these were children that we were dealing with there would be much more community outrage about the issue. Yet the reality is that many of the people that either are in need of home care or are in residential care are as vulnerable as the little children that we also strive to protect whenever we can and in the best way we can. I have visited centres in my electorate over many years and I have seen the changes within them myself. Indeed, some time ago I met with a delegation of about 15 or 20 family members of residents of a particular aged-care facility within my electorate who talked about the declining nature of care that was being provided to their family members. It's clear to me that there has been a decline in the level of care that is being provided to people in these facilities. Whether that is because of financial pressures I don't know. Perhaps in some cases it is, but the reality is that there has been a declining level of care.

The level of care has been declining because staffing numbers have dropped. It's been declining because the numbers of registered or enrolled nurses within those facilities have been reduced and replaced by personal care workers or not replaced at all. It's been declining because allied health services to those centres have also been cut. It's been declining because the standard of food provided to those residents has also deteriorated. There are other areas that I could refer to, but what's clear is that the level of care is declining. All of this points to cost-cutting measures carried out by the operators of those centres, who, in many cases, would say, 'That's because there have been cuts to the aged-care sector by government, and we are simply trying to operate within the means we have.' Again, it's not for me to comment on whether or not that is true, but that is the response we are getting.

One of the problems resulting from of all those cuts—and I've already talked about people who died because they were given the wrong medication—is that when patients who can't properly communicate are misdiagnosed within those centres they ultimately end up having to be transferred to public hospitals. Operators will do that, rather than bring in registered nurses or enrolled nurses to care for them, because it is an easy way out for them. That in turn adds to the cost of our public health system. The reality is that the facilities they are in should be able to—and in the past would have been able to—care for them without transferring them to a public hospital. It is something that needs to be factored in every time we look at this issue.

The last issue I want to speak about is the home care packages the government has provided. It claimed in the budget that there will be an extra 14,000 packages over four years, which is 3½ thousand a year. The reality is that in the last six months of last year alone there were applications for another 20,000 home care packages, so 3½ thousand a year will not even pick up the growth in numbers. But, just as importantly, if those people do not get the home care packages that they need then one of the options that they will be forced to consider will be going into a residential aged-care facility. Family members at home without the package will not be able to help them, so they will have no choice but to look at residential aged-care accommodation. If that ends up being the case then, again, it will come at a greater cost. Indeed, sometimes, when families try to look after them at home, it ultimately results in the person going into hospital as well. It's a false saving.

It's time the government acknowledged the problem for what it really is. It's an important problem. It's a serious problem. It will not be fixed by simply moving the deck chairs or by not allocating a single new dollar to the aged-care system, as this government has done—that is, it has not allocated a single new dollar to the system. It has simply said, 'We will change these responsibilities and then that might fix the problem.' It won't. We are an ageing country. We have an ageing population, particularly in South Australia. If we don't address it, the situation is only going to continue to deteriorate.

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