Tony Zappia (Makin, Australian Labor Party) Share this | Hansard source

Nothing highlights the failures and incompetence of the Morrison government more so than its handling, or should I say mishandling, of aged-care services, a sector that has been in crisis for years. The sector has been the subject of some 20 aged-care reviews in the past 20 years, including a review by a committee of this parliament. Indeed, the Standing Committee on Health, Aged Care and Sport held an inquiry into the quality of care in residential aged-care facilities in Australia, and it was only some three years ago that we handed down our report. The report had 14 recommendations, which in turn had many other parts to them. Mr Deputy Speaker Freelander, you would be very familiar with them because you were on the committee, as was I. Many of the issues that have subsequently been raised by the royal commission and others were matters that the committee closely looked at and reported back to government about, yet we saw little from it in terms of any real action from the Morrison government.

The problems with aged care were not only well known because of so many of those reports; in particular, the Oakden inquiry in South Australia lifted the lid on much of the practices that were then subsequently exposed both by our committee inquiry and the royal commission. Indeed, Oakden was not an isolated case. There were so many other examples of similar bad practice. Perhaps we'll never get to them all, because the truth of the matter is I suspect many of them went unreported and were covered up in different ways and were never fully exposed, as they should have been.

Finally, when the Morrison government reluctantly implemented a royal commission, it used the royal commission, in my view, as an excuse to defer action it could have implemented at the time. There were many things that could have been done, as a result of the previous inquiries and what the government was aware of, that would have changed and improved the system, even if it was as interim measures at the time; in other words, allow the royal commission to proceed but carry out interim measures that would have helped people much more than what the government actually did. Instead, we saw not only the royal commission be used to defer any real action from the government; from memory we had about 100,000 people still on waiting lists for appropriate home-care packages, and too many people in aged-care facilities poorly cared for.

The poor care was through no fault of the people who work within the sector. Those staff who work within the sector do an extraordinary job under very difficult conditions. As you would know, Deputy Speaker Freelander, they are underpaid, overworked and under-resourced, and, at times, they have to do work which they are unqualified to do. If they were given the support they need, they would be able to deliver much better services. I know that most of them—in fact, all the ones I've spoken to—are people that are very passionate about their work, love doing the work they do and have a genuine care for the residents they look after. But the reality is they have not been given the support they need. I say to all those workers in the aged-care sector, particularly with the last two or three years when we went through the COVID pandemic, when there were additional restrictions which prevented family members and visitors going into those centres and providing a little bit of extra support as well: the aged-care workforce did a magnificent job in caring for the people under their care.

We have around 277,000 people who work in aged-care facilities. They deserve our gratitude and recognition for what they do, but they also deserve the increased support that this legislation begins the process of delivering for them. The requirement for providers to provide transparency about how much is spent on care, nursing, food, maintenance, cleaning, administration and profits will make providers accountable. As the member for Indi quite rightly pointed out, it will also give families important information when making choices about which facility best suits their needs. The accountability process, I believe, will also add to ensuring providers of aged care lift their own standards in order to be competitive because they know potential residents will look around before they sign up with a particular provider.

With respect to that, I note the member for Indi touched on the star rating system. In 2019 there was a study by the Centre for Health Service Development which used a five-star rating method to define adequacy of staffing care in facilities. That study found that more than half of all Australian aged-care residents are in homes that have, in their view, a one- or two-star rating level for staffing. In a five-star system, that, to me, indicates it's a pretty poor level of service. Twenty-seven per cent of residents were in homes that had a three-star rating, and only 15 per cent were in homes with a four- or five-star rating. In fact, only 1.3 per cent were in homes with a five-star rating. It just shows that, yes, there is a difference, and there are some very good homes out there, but the overwhelming majority of residents within those homes simply were not being provided the care that this study suggests they should have been provided. Transparency will bring competitiveness and accountability back to the system and, in my view, that can only lift the standard of care that is being provided.

The bill will also ensure that a registered nurse will be on site and on duty 24 hours a day, seven days a week at each residential facility. That responsibility will apply from 1 July 2023. It's just under a year away and it provides providers some time to get the additional staff that they need. I accept that that in itself will be a challenge, but I don't believe that the shortage of staff is solely because there are not enough nurses out there. Indeed, referring back to the study from the Centre for Health Service Development, I also note that, when it came to their assessment of registered nurses in aged-care facilities, they found that between 2003 and 2016 the number of registered nurses in residential aged-care facilities fell from 21.4 per cent to 14. 9 per cent—by a third. The number of enrolled nurses fell from 14.4 per cent to 9. 3 per cent—again by about a third. Those reductions in nursing staff over that period didn't result from a shortage of nurses available; they resulted from cost-cutting measures that were implemented by many of the providers.

Again, as others have quite rightly pointed out, enrolled or registered nurses within these facilities actually save communities and governments a lot of money. If you have a nurse on site at all times, it will very likely prevent a hospital admission. It may well prevent even a doctor's attendance, because there might be medical needs that can be provided by a qualified and experienced nurse. As such, not only will the patient benefit, because they will get immediate service; it will mean that there will be a savings at the other end that would otherwise be a cost if the person is admitted to hospital or if a GP has to come out.

Indeed, on the subject of the GPs coming out, Deputy Speaker Freelander, you would be well aware that it was becoming increasingly difficult for GPs to attend aged-care facilities, because the remuneration they were receiving for their service was also becoming inadequate for the time that they were spending out there. That in itself became a problem whereby having an enrolled or registered nurse on deck would have made a difference to the wellbeing and care of the resident.

The bill also caps the amount that home-care providers can charge for administration and management. That is an issue that has been brought to my attention as a member of parliament and perhaps has been brought to other members in this place on many occasions. It seems to me that an issue of providing funds for packages and services to people that require aged-care services is that much of the funds are used up in administration fees. Just as badly, if residents try to switch provider, they are charged a fairly exorbitant exit fee, which makes it almost impossible for them to switch, because they would lose much of the funding that was provided to them. That has to come to an end. Quite frankly, the funds were provided for services, not for admin costs. I believe there were at least some providers who were exploiting the system, making good money out of the admin costs and providing little in the way of services. I'm pleased to see that, again, this matter is being addressed.

All three of the matters I have touched on were recommendations of the royal commission. It is not surprising; they were matters that I think many of us were aware of, should have been addressed and could have been addressed much earlier.

I will wrap up by saying this. Many of the residents who enter aged-care facilities today do so towards the end of their life, when they are in a situation where they need much greater care. Many prefer to stay at home for as long as they can and, with the support of government services, have been able to do so. So they enter these aged-care facilities at a time of very high need. That is the time when the staff in those centres need to be able to spend more time with them in order to support them. And yet, what we're seeing is the reverse. Staff are run off their feet, not having time to look after them in the way that they should, and, in turn, the level of care diminishes. Again, that is not through any fault of the staff, but simply through the pressures that are put on them to provide the services that they would like to otherwise provide. As higher care needs more time and more skills, in my view that also means that we need to appropriately pay and remunerate those people who work in the aged-care system for the services that they are providing, because, if we don't, as we have already seen, many of them will exit that particular sector because the remuneration simply isn't there. And nobody can blame them for that.

This legislation picks up on some of the recommendations of the royal commission. Yes, there is a lot more to do. And, yes, delivering on even the requirements within this legislation can be challenging. But it's a start in the right direction. I'm pleased to see that the government is making it their priority and I'm more than happy to say: 'Let's work through these issues one at a time so that we can ensure that the Australians that ultimately end up in aged-care facilities get the services and the support they need.' In this country, we have over a million people today that are over the age of 80 years. Many of them will end up in one of these facilities and many of them, unless they are given the care that they need, will also spend their last three years living in a way that I don't think any one of us would want for ourselves or for our own parents.

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