Sam Birrell (Nicholls, National Party) Share this | Hansard source

I support the amendment proposed by the member for Farrer. The concerns the opposition have about the Aged Care Amendment (Implementing Care Reform) Bill 2022 are shared by providers in my electorate of Nicholls. The bill does not contain adequate detail or an acknowledgement of the complexity of the many issues. It fails to outline an exemption framework that would give comfort to small aged-care providers, ensuring that they won't be unfairly impacted by the changes. This is a loose legislative framework, and there are aged-care providers that have tried and failed to find out from this government what their fate will be when the full regulations are finally implemented.

Here's a practical example of the challenges and uncertainty faced by small regional aged-care facilities predominantly in regional Australia. Nathalia is in my electorate of Nicholls, a beautiful township of 2,000 people with a long history of taking care of its own. Barwo Homestead is a community-run aged-care facility reflecting the desire of residents from the district to remain in the district when they can no longer look after themselves at home. I recently visited Barwo Homestead and spoke with Lynda Walker, the CEO.

The Royal Commission into Aged Care Quality and Safety was a landmark commission, and the Morrison government responded to the recommendations in May 2021, announcing a $17.7 billion aged-care reform package to respond to the 148 recommendations and deliver sustainable quality care and safety in the home and in residential aged-care services.

One of the measures recommended by the royal commission was for an Australian National Aged Care Classification—which people are calling AN-ACC—care funding model to replace the aged care funding instrument from 1 October 2022. This measure, AN-ACC, includes a mandatory care-minute standard for residential aged care. The royal commission identified staffing levels as vital to the quality of care that older Australians receive and recommended that the care minutes be introduced to drive increased care time. Consistent with the royal commission recommendations, from 1 October 2023, the initial care-minute requirements will be set at a sector-wide average of 200 minutes per day, including a minimum of 40 minutes of registered nurse time. This will be based on care provided by registered nurses, enrolled nurses and personal care workers. The 200-minute overall target and the 40 minutes of registered nurse time will be an average target across the sector. In practice, each residential aged-care facility will have its own care-minute target reflecting the AN-ACC case mix of residents.

In relation to aged care, the goal of dignity, quality and safety in aged care is one that we in this place should all share. The issues I raise are not a criticism of the response to the royal commission or the goal of providing quality care nationally, but there is, as I will outline, a need for a nuanced response given the specific circumstances we find ourselves in as we emerge from the disruption of the global pandemic, particularly in rural and regional Australia, such as in places like my electorate of Nicholls.

In the case of Barwo Homestead, there are currently 17 residents in a 20-bed facility. All are low care, and the absence of chronic care needs means they are adequately cared for by personal care staff, with the support of two registered nurses. The transition to a formula of minimum care minutes poses a significant challenge for small, low-care facilities, as does the requirement for 24/7 registered nurse cover addressed in this legislation. They will need to provide 40 minutes of registered nurse time from 1 October, but in the current environment a place like that just cannot recruit registered nurses. Nathalia has a wonderful environment; it's a beautiful place. But registered nurses don't grow on trees. For a small facility like Barwo Homestead, currently at less than 70 per cent occupation, there is also a serious issue with affordability of additional registered nurse hours and the additional administrative burden placed on a small number of staff who would otherwise be engaged with residents.

There is also the issue of reporting on care minutes, which will be one of the measurable indicators used to inform a new star rating system on the My Aged Care website, which will be introduced from December 2022. Given the difficulties faced by small, low-care facilities—and Barwo Homestead is just one of these—they are unable to respond as efficiently or as comprehensively as larger facilities, especially those in the big population centres with larger pools of qualified labour. What smaller facilities want is time to adjust and, in particular, to be exempted from the star system in the interim so that they are not tarred with the stigma of a low rating through no fault of their own—one that isn't reflective of the wonderful care that they provide.

The longer-term issue is one of financial viability for small community providers in our rural towns. Mr Paul Sadler, the interim Chief Executive Officer of the Aged & Community Care Providers Association, said the following to the Community Affairs Legislation Committee on 25 August 2022:

… we would say that, until we know the detail of how exemptions are going to operate, we do run a risk that we could end up with unintended consequences, even up to the closure of aged-care services across regional Australia if they cannot obtain the staff that are going to be required.

I'll repeat that line: 'even up to the closure of aged-care services'.

The Nationals understand rural communities and how important it is that residents remain connected and cared for in their twilight years. We don't want to see important community based facilities gobbled up by big operators or, worse, disappearing altogether simply because of the financial burden of minimum requirements. We don't want aged-care residents who are happily being cared for in the communities they love being forced into care in larger towns where they lose that connection to family, friends and the community.

The opposition supports the royal commission's recommendation on the 24/7 RNs in aged-care facilities, where it is possible, by 2024 and in line with the recommendation. This government wants to legislate much earlier but has not been transparent with any of the details of any exemption clause. Significant questions are 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? How long will they be eligible? What will the penalties be for noncompliance?

The Nationals and our coalition partners have a longstanding commitment to aged care. In government, our total investment in response to the final report of the royal commission amounted to $19.1 billion. Our 2022-23 budget responded to 10 recommendations of the royal commission and built on our existing five pillars of aged-care reform. We delivered record investment across the aged-care system over the forward estimates. It went from $13.3 billion in 2012-13, under Labor, to $30.1 billion in 2022-23—growth of 126 per cent under the coalition.

The government must continue our generational reform of the aged-care system for the benefit of all Australians and stop playing political games with older Australians and their families, particularly in small regional communities such as those in my electorate of Nicholls. I urge the government to ensure that places like Barwo Homestead in Nathalia—and there are many of them—whilst still held to account for the quality of their care, are provided the flexibility to continue to operate as they always have and provide the quality of care in small regional communities that is so valued.

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