Anne Webster (Mallee, National Party, Shadow Assistant Minister for Regional Development) Share this | Hansard source

Australians want and expect that our older Australians are well supported and cared for in a way that brings dignity and respect to them. They want to stay in their communities. That is why the coalition when in government called the Royal Commission into Aged Care Quality and Safety to ensure our senior and most vulnerable Australians receive the care that supports and respects their dignity, which recognises the important contribution they have made to society.

The final report of the royal commission makes 148 recommendations, which the coalition supported and continues to support. Twenty-three public hearings and over 10,000 public submissions produced a report which is the product of wise and compassionate scrutiny of Australia's aged-care system. In response to the royal commission the coalition committed $19.1 billion to a five-year plan to improve aged care, with new home-care packages, respite services, training places, retention bonuses and infrastructure upgrades. We in the opposition remain committed to supporting the health, safety and wellbeing of older Australians and understand the important role that aged-care providers, care workers and nurses play in ensuring this support is provided in residential aged-care settings.

Paragraph 5 of recommendation 86 of the royal commission's final report calls for:

… from 1 July 2024, the minimum staff time standard should require at least one registered nurse on site per residential aged care facility at all times.

That is 24/7 registered nurse, or RN, care. I am regularly contacted by aged-care service providers in Mallee and I meet with them. They tell me how desperate they are for workers and how impossible it is to find nurses. This is called having a thin market. Those of us who live in regional communities are very familiar with what that means. They also talk to me about the issues with the current and proposed funding models—workforce issues, thin markets. I wrote to the Minister for Aged Care raising concerns of the funding shortfalls that will occur because of the government's indexation rate. I have also written to her regarding the challenges aged-care providers in my electorate, some of which are the only ones in a town, have in finding staff to meet their compliance obligations. While I thank the minister for her reply, it does not solve the ongoing crisis occurring in regional Australia.

I've spoken to many aged-care providers in Mallee. This is some of the feedback they have provided:

There are no floating RNs in Mallee ready or able to supply the workforce required. There are simply not enough RNs to fill shifts in smaller regional town settings.

The CEO of Sunnyside Lutheran Retirement Village in Horsham, Denise Hooper, told me that they have an RN on morning and afternoon shifts and have been advertising for four months for an RN and have not been able to attract one. That's four months. Horsham is not a small town. I know Sunnyside. It is a large establishment and employer, and while they have concerns about attracting staff, it is nigh-on impossible for towns such as Nhill, Warracknabeal or Ouyen to find any. As Denise said, it is challenging enough finding RNs for the hospital, let alone for aged care, where conditions and salaries cannot be matched.

Denise told me that aged care is becoming a subacute care facility, as people are entering facilities older and with more complex needs than they did several years ago. Yet they are not funded for that level of care. While the royal commission recommended that a registered nurse must be on site 24 hours a day, seven days a week, by 2024, schedule 1 of this legislation establishes a new time frame for providers to do this by July 2023. Make no mistake: our nurses have worked tirelessly on the frontline through the COVID-19 pandemic, protecting lives and keeping Australians safe. I recognise the amazing support that nurses provide our older Australians, particularly their critical work in aged-care homes since the outbreak of the pandemic. These were not easy times, yet our nurses stood up when it mattered most to protect so many older Australians—and I am grateful for their work. I note today, even speaking with another aged-care provider, that we have yet another COVID outbreak in one of our facilities. However, we've come a long way, and the vaccination rate and the care rate have increased so that the conditions of older people are absolutely so much more improved.

This legislation will seek to ensure that every aged-care home in Australia has a registered nurse on site 24/7 by July 2023. However, this time frame is not consistent with the royal commission's final report, which recommended this occur in 2024, with an accompanied minimum care minutes requirement under recommendation 86. The minimum care must be provided by RNs, not ENs. The royal commission took into account a range of factors when recommending the July 2024 time line, recognising the current workforce shortages and the time required to train or access the necessary additional workforce. Given the government has brought the start date of this recommendation forward by a year, it must specifically outline what support will be provided to regional and rural providers, and to other providers already struggling with viability and workforce challenges.

The opposition notes the unique challenges faced by our aged-care providers in rural and regional Australia, particularly regarding access to the RN workforce. Does the Labor government? The government must outline how they plan to get additional nurses into aged-care homes following their talkfest jobs summit. The opposition supports the royal commission's recommendation on 24/7 RNs, but there are realities that must be faced. Regional and rural communities struggle to get a basic workforce. What is the government planning to do to assist these vital local services? I note that 53 per cent of aged-care providers are based in regional and remote areas, and 86 per cent are small providers. However, the fact that exemptions will be required for rural settings but will not be known until the legislation is passed, and will be a delegated legislation, means that the government can decide, without scrutiny and without any transparency, to make the exemptions as narrow and short lived as they wish. This is concerning. It provides no stability nor security to our small providers.

The other concern I have is that to give exemptions in regional settings while demanding urban aged-care facilities provide that 24/7 RN capability will make a two-tier aged-care system. If the bar is lower in regional and rural settings, what is that saying about the dignity and the quality of care required for aged-care residents in regional settings? I find it troubling.

The opposition calls on the government to provide oversight of the delegated legislation that puts in place the mechanism and details of possible exemptions. The government has not been transparent with any of the details of this exemption clause, with significant questions still to be answered, such as: What is the exemption mechanism that will be contained in the delegated legislation?

Who will be eligible for an exemption? For how long will they be eligible? What will be the penalties for non-compliance with schedule 1? Will there be provisions that seek to prevent providers from using the exemption process as an excuse not to fulfil the royal commission's recommendations to provide high quality care to support its residents? Who is the decision-maker?

This lack of transparency creates uncertainty for providers who are already under stress from the COVID-19 pandemic. This information is particularly critical for rural and regional providers, who will likely be subject to significant difficulties in finding the additional workforce to meet the requirement within the timeframe. I have spoken to other aged-care providers in Mallee who have expressed their thoughts and concerns, Darren Midgley, from Chaffey Aged Care in Merbein, while agreeing that exemptions are warranted, argues that the current legislation fails to endorse current highly trained ENs—enrolled nurses—in the care minutes that are now going to be required. He also states that the modified Monash 4 centres such as his, which are 15 kilometres outside the buffer zone of MM3, which receives more funding, is unfair and does not comprehend the higher costs for delivering quality aged-care services a great distance from urban centres such as Melbourne, 550 kilometres away.

One of the key challenges, he acknowledges, is that regional services have zero access to agency nurses. Even if they managed to find the staff required, when a nurse calls in sick, there is no agency nurse around the corner to replace them, unlike in Melbourne or Sydney—or Bendigo or Ballarat. There are 90 aged-care services in Mallee, with just over 4,000 nurses and midwives in the whole of outer regional and remote Victoria. No-one—not the federal government, not the state government, not the universities, not the aged-care service providers themselves—has been able to explain to me how they will meet the requirement for these extra nurses in the time frame Labor wants.

Labor should stick to the previous government's time line for the implementation of 24-7 nurses as recommended by the royal commission for 2024 and put in place incentives for training the needed RNs for regional settings in a regional setting. Labor should reveal the details of its proposed delegated legislation so it can be scrutinised by parliament and the parliament can determine if it's suitable for aged-care providers, especially rural ones. Labor needs to state its plan to get more nurses into the regions so regional aged-care providers can provide this quality care.

See this speech in context