Emma McBride (Dobell, Australian Labor Party, Shadow Assistant Minister for Mental Health) Share this | Hansard source

I rise to speak on the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill 2020 and support the amendment by the member for Franklin. The purpose of this bill is to change the payment of home-care subsidy to approved providers from being paid in advance to being paid in arrears. This change is to commence in June of this year. The report from the Aged Care Financing Authority highlighted that this is the first phase of reform for home-care payment arrangements. Phase 2 and 3 are set to commence in April 2021, and are to ensure that the provider is only paid for the service they provide and that subsidy payments to providers would be reduced to a currently unknown portion of the unspent package funds held by the provider for that recipient.

As previous speakers have noted, while we will not oppose this bill we do have some concerns on its impact. The June 2020 time frame for shifting from advanced to arrears payments increases the risk to some smaller providers, who may not have adequate cashflow to cope with this change. As a result, these providers, some of whom will be in regional and remote areas, may be reluctant to take on new clients or be forced to reduce services to existing clients. In all their talk about service providers and consumers, the government seem to have lost sight of the people, of the older Australians, their loved ones and their carers, and their hopes to remain safely in their own homes.

The Royal Commission into Aged Care Quality and Safety will hand down its final report in November. It's interim report made unprecedented recommendations which this government should be acting on now. But what is the government doing? Instead of acting on the recommendations of the commissioners, it's making piecemeal changes which appear to be designed to just save some money or shifts costs. Like the proposal from the government to privatise the assessment of aged-care services, a change described as illogical by the New South Wales Liberal health minister, Brad Hazzard. The government said there were no plans to privatise ACAT, yet there was a tender process scheduled to take place in April 2021. If there were no plans to privatise ACAT, why have a tender process? I'm relieved the government finally came to its senses and withdrew the tender process, following strong opposition from the community, from the unions, from state health ministers, from Labor and from the sector.

It does make you question this government's priorities when, instead of acting on the commissioner's recommendations, it tries to fix the one part of the sector that isn't subject to adverse findings by the commission. The interim report of the royal commission handed down in October last year, a report titled Neglect, put forward three recommendations that required urgent action: first, to ensure older Australians are getting the care at home when they need it most; second, to end the overreliance on chemical restraints in aged care; and, thirdly, to stop the unacceptable number of young people entering residential aged care. The government's response to the interim report has been woefully inadequate, especially in relation to home care packages. The commissioner recommended urgent action to address the home care package waiting list. What has this government done in response? It released 5,000 home care packages before Christmas—5,000 home care packages when there are over 120,000 older Australians waiting for their approved home care package. Labor has consistently highlighted the serious consequences of delays in home care packages to the person, to their family and carers and to our community. The average waiting time for a home care package is five months, with many people, particularly those waiting for high-level packages, waiting for over a year. Sadly, we learnt that 30,000 older Australians have died while waiting for home care and that 25,000 older Australians have ended up in residential care sooner than they needed to. Everyone has been saddened by the aged-care quality and safety report—three volumes, titled Neglectthat sines a light on the state of aged care in this country.

The government must bear some responsibility for this crisis. It was the current Prime Minister who, as Treasurer, took around $1.2 billion from aged-care funding. And how has the government responded to the findings of the commission? By providing $500 million for an additional 10,000 home care packages, of which, as I mentioned, only 5,000 were available before Christmas last year. This doesn't even amount to half of what the Prime Minister cut from aged-care funding during his time as Treasurer. For many, the truth is that these packages are too few and too late, and they don't address the underlying systemic problems plaguing the aged-care system in Australia today. As I mentioned, there are currently over 120,000 Australians on waiting lists for home care packages that they have been approved for—people who have been referred by their GP, who've had an ACAT assessment and who need help and need it now. They are on waiting lists under this government.

On the Central Coast there are over 1,333 older Australians waiting for home care packages right now. These are people like Noel of Long Jetty. Noel was approved for a level 2 package six months ago, a package which would help him to stay safely and independently in his home. But he's still waiting, like so many hundreds of thousands of others. So he's paying out-of-pocket for the services that he needs to stay safely at home. As an age pensioner, this is something that he can't afford. Noel and his circumstances are not an isolated example. According to the 2016 Census, almost one in five people in my electorate of Dobell are aged over 65. This is higher than both the state and national average, yet there hasn't been a hearing of the Royal Commission into Aged Care Quality and Safety held on the Central Coast. I note that on 27 November last year there was a hearing held in Newcastle. People in my electorate, and across the Central Coast, deserve the opportunity to share their stories and to share their experiences close to home, independent of the experiences of people living in other parts of Australia.

In November last year, I hosted an aged-care forum in my electorate on the New South Wales Central Coast, along with the Deputy Leader of the Labor Party. We heard from families, carers, support workers and providers about the challenges and difficulties they have experienced. People spoke often of the difficulties they've had dealing with My Aged Care. My Aged Care is the telephone and internet based national aged-care system which is often a person's first point of contact with aged-care services—a system called by the commissioner 'frightening, confronting and confusing.' So how do people access home care packages or find out about residential aged care? How do they arrange their assessment with an ACAT team? Through a portal that many, particularly in their 80s and 90s, find frightening, confronting, and confusing. Maybe the government could start by addressing My Aged Care.

As a pharmacist, I'd like to turn to the disturbing use of chemical restraint that was exposed in the interim report. The report found:

widespread overprescribing, often without clear consent, of drugs which sedate residents, rendering them drowsy and unresponsive to visiting family and removing their ability to interact with people.

Over 33 per cent of the online submissions to the commission raised issues about medication management, and research presented a survey of 11,368 residents across 139 facilities that found 61 per cent of residents were administered psychotropic agents. Psychotropic medications affect the mind, emotions and behaviour of a person. They're medications that should be used according to clinical guidelines and with informed consent.

As part of its response to the report, the government announced $25.5 million to improve medication management and $10 million for additional dementia training for aged-care providers to reduce chemical restraint. The Pharmaceutical Society of Australia, the PSA, in their submission to the commission when referring to the use of psychotropic medicines said, 'level of inappropriate use in aged care generally required review and action.'

On 26 February, the PSA released its Medicine safety: Aged care report. The report found over 95 per cent of people living in aged-care facilities have at least one problem with their medicines, detected at the time of the medicine's review. Most have three problems. It found that 50 per cent of people with dementia are taking medicines with anticholinergic properties, which can worsen confusion and other symptoms of dementia. One-fifth of people living in aged care are on antipsychotics, and more than half use the medicine for too long.

The Society of Hospital Pharmacists released a public statement following the announcement which noted:

the fact remains most aged care facilities do not have a pharmacist on staff, despite research consistently finding beneficial outcomes from the provision of clinical pharmacy services.

While funding for medication management training is welcome, these figures once again show the government not properly addressing the problem or the recommendations of the interim report.

The royal commission recommended urgent action to stop the flow of younger people with a disability going into aged care and to speed up the process of getting those young people, who are already in aged care, out. The royal commission heard evidence that there are some 6,000 people under the age of 65 living in aged-care facilities. It's just not right that people in their 30s, 40s and 50s should be living in aged-care facilities. I call on the government to act urgently on this recommendation.

The bill updates the payment structures for home care providers, but what is the point if people can't access home care packages when they need them? What is the point if people don't understand how the find a provider online and if the process of finding and researching the right package needs support, which many older people sadly don't have or isn't available to them? What is the point if there is no provider in that area, so they can't stay close to home, be close to friends and family and the community they know and have lived in.

This bill makes changes to the payment arrangements for providers, but what older Australians and their families need is aged care they can trust, where they have confidence that their loved ones are safe and well-cared for. The interim report made recommendations which the government must act on now to stop the neglect of older Australians. Changing the payment arrangements may help the government's bottom line but won't improve the quality of care for older Australians.

I come to this House as a pharmacist, as someone who worked in mental health for much of my life and at our local hospital for 10 years before I came into this place but also as the daughter and the granddaughter of someone who lived with dementia. I made a promise to my mum that I would do everything that I could to make sure that people who care for others will be better supported, and this is what I intend to do. It is something that is important to everybody: everybody should have confidence that they can trust that the person that they love will be cared for, will receive a quality and standard of care that they would hope to receive for their parent or their grandparent or, in future, themselves.

This is urgent. The government must act now. There are unprecedented recommendations from the commissioners in the interim report, and the government must act on them with urgency to make sure that older Australians are treated with dignity, respect and have care that they can trust.

(Quorum formed)

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