Louise Miller-Frost (Boothby, Australian Labor Party) Share this | Hansard source

I rise to speak to the Aged Care Amendment (Implementing Care Reform) Bill 2022. As a society and a community we have a duty and a responsibility to care for those vulnerable amongst us. Over a long period of time we have failed one particular group of vulnerable Australians to an unacceptable degree. Like all Australians, I was shocked and appalled by what I saw in the Four Corners special that aired in 2018 titled 'Who cares?' and I welcomed the announcement of the Royal Commission into Aged Care Quality and Safety. The final report handed down in April 2021 detailed 148 recommendations. I was proud to run as a candidate for a party that made election commitments on aged-care reform designed, in line with the royal commission recommendations, to address the shameful neglect of our older Australians.

This bill implements three of the commitments that were made in response to the royal commission. They are, firstly, to lift care and quality standards and ultimately health outcomes by making it mandatory to have a registered nurse on site at all times in residential aged care. The fact that this is controversial boggles the mind, given that aged-care facilities were once referred to as nursing homes. This commitment, if this bill is passed, will take effect from 1 July 2023 and will introduce a new responsibility for approved providers of residential care and of specified kinds of flexible care to have a registered nurse not only on site but also on duty at each residential facility 24 hours a day seven days a week.

This policy is designed to raise the standard of care to a level that our older Australians deserve and that I think we as a community expect. Having a registered nurse on site and on duty 24/7 is expected to save thousands of unnecessary trips to hospital emergency departments. For instance, a urinary tract infection is extremely distressing and can quickly escalate to delirium, and older people can rapidly become very unwell, deteriorate and become disordered. You wouldn't want to go to hospital for a UTI and you certainly wouldn't want to be hanging around waiting to be seen. You need rapid diagnosis and treatment. A nurse on site can facilitate that. Likewise, a nurse on site would be able to triage residents after a fall or an illness, again preventing unnecessary ambulance trips and hospital visits. These trips can, of course, be extremely unsettling and disruptive for patients, particularly for those with cognitive decline. Any step that can be taken to assist in dealing with minor ailments within the aged-care setting is to be welcomed.

This is also part of the solution to addressing the very serious issue of ambulance ramping and bed block in hospitals that we're seeing across the country. I note that there are going to be some exemptions to that on a case-by-case basis, I understand. Certainly I have heard from local providers who have facilities in rural and remote areas that they will be seeking that. They understand that, while we have to have the right level of care, there are some areas where workforce shortages will be a considerable issue. In particular I'll note one that was mentioned to me: Booleroo Centre, which is in very remote South Australia—and certainly not in Boothby.

Secondly, this bill ensures that government funds going to aged care are directed towards their real purpose: providing a better standard of care for residents. The bill introduces a power that will enable the government to cap the amount that home-care providers can charge in administration and management, as well as remove the ability for providers to charge exit amounts. In practice, this means that the government has committed to capping the amount that can be charged for admin and management to people who receive home-care packages. Given that over 210,000 older residents currently receive home-care packages, this measure ensures that government funds go towards improving quality of care, rather than being chewed up by additional and unnecessary administration fees.

Of course, we recognise that organisations providing home-care services do need funding for administration functions, and most services do the right thing. However, I hear from many older people about their distress at being unable to access or fund the services they need, despite what they consider to be very generous aged-care packages. As a government, we have a responsibility to ensure that our funding goes to the outcomes that we have designed it to reach, and they are the actual services to our residents in the community.

Thirdly, this legislation implements our commitment for greater integrity and accountability in aged care. Specifically, it fulfils the government's election commitment to increase transparency about how much providers spend on care, nursing, food, maintenance, cleaning, administration, and profits. This amounts to much greater transparency and insight into what aged-care providers are spending government money, taxpayer money, on, and this is a crucial step in improving public trust in our aged-care system. Again, many providers are doing the right thing, but, as the royal commission highlighted, some are not, and this has a significant effect on the quality of life and the health of our aged-care residence.

During the campaign I had from a local man, Salvatore, about his mother's, Maddalena, terrible last month in an aged-care facility. Sal had been horrified at the bland, unhealthy, innutritious and inadequate food she was provided—and he actually gave me some photographs, which were pretty horrific—as well as the poor quality of her room. The family ended up helping out with minor maintenance and cleaning, including mould removal. In a nursing home situation, where we have people who are, in many instances, already of poor health, to actually have mould in their rooms is unacceptable. Sal was very distressed that, despite his very best efforts, despite being a frequent visitor, along with other family members, to his mother, he was still not able to ensure that her care was even adequate, let alone what he wanted for her last months. This is for you, Salvatore, and for your mother, Maddalena. I'm so sorry for your experience and your mother's experience.

The electorate I represent, Boothby, is the home of many major aged-care centres. Indeed, my husband is the chair of the advisory committee to one, Alwyndor Aged Care, which was founded by his stepgrandmother. Many of them perform well and provide excellent care that is of the standard that residents and their families rightly expect. I certainly heard some fantastic stories of people finding that what their relatives were being offered was exactly what they had wanted and what they would have wanted to do if they could have kept their relatives at home. But, as with the rest of the country, when you visit aged-care sites or talk to aged-care workers, a core theme of exhaustion and frustration comes through. It's no wonder workers are leaving the sector in droves.

During the campaign, I also welcomed the then shadow minister for aged care, Clare O'Neil, to a forum on aged care held in Marino, in the south of Boothby. We had a large number of local residents come, many of whom had family in aged care, but we also had a lot of workers come and tell us their stories. We heard harrowing stories from aged-care workers from the United Workers Union, who were sick with guilt and worry at not having the time or the resources to provide the care that they wanted to provide to residents. We heard from exasperated and often desperate family members just like Salvatore—relatives of older Australians who could not navigate the system or find practical solutions to the need to find affordable care.

We note that aged care has changed very much over the past decade. A decade or so ago, people would stay in aged care for five or six years, maybe longer, and we're now in a situation where aged care is often more of a palliative service. The average stay is often around the six- to eight-month mark. That's changed things significantly. It does mean that we have a higher need for care. We do need to have a nurse on site so that people are getting the care they need in their final months and so that we can ensure that they're getting the pain relief they need. We need to ensure that when something happens—when there's a fall, when they're deteriorating or when they're ill—they get the care they need, whether that's something that happens in the nursing home or whether they do in fact need to go to hospital via ambulance. Obviously, that's a very important part of palliative care. A very important part of living in a nursing home is that you can access that care when you need it. This aims just to ensure that people are not going unnecessarily to hospital, both because of the trauma and the distress that that causes the residents themselves and because it often results in long waits at the emergency department or in ambulance ramping.

These are some of the first steps in what is going to be a long journey to fixing aged care in this country. We know that older Australians have worked hard all their lives. We know they deserve a better situation than what was found by the royal commission, which was summed up in the title of its interim report as, simply, Neglect. The previous government presided over this neglect of older Australians and the aged-care system. There were multiple reports into aged care before, finally, a royal commission following that Four Corners report. The royal commission's report was handed down in April 2021, and the recommendations have still not been implemented. This government, the Albanese Labor government, is determined, under the fine leadership of our Minister for Aged Care, Anika Wells, to leave no stone unturned in helping implement all possible practical measures to guarantee older Australians get the care that they deserve—the care that we, as their family, as their friends and as a community, expect that they can have.

I don't know anyone who isn't impacted by aged-care at some point in their lives, whether they be residents themselves; those in middle age who are facing the daunting task of figuring out how to get adequate and affordable care for their ageing parents; or those now looking at their own future in aged care, either through home-care services or in residential aged care. The aged-care system and the aged-care services that we provide our community impact us all. Even beyond that, the current situation in aged care that we have inherited should outrage us all.

All Australians deserve to be supported with dignity and humanity in their twilight years. This bill is a strong start towards making that a reality for all older Australians, their friends and their loved ones. We understand that aged care is a system, from home care to residential care, the intensive services provided for dementia and palliative care, but it needs to be a system that can be navigated easily. When people are putting their loved ones either through services at home or into aged-care facilities, they should feel confident they are getting the care they need, they are getting the food they need and that they'll have quality of life in those last years. That is what we all expect for ourselves and our loved ones. I commend this bill.

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