Zoe Daniel (Goldstein, Independent) Share this | Hansard source

Aged care, its quality and accessibility is one of the key concerns in the Goldstein community. There are 22 aged-care providers in Goldstein, and, in preparation for this legislation, I had face-to-face meetings with six and received detailed submissions from five others. The key concerns expressed by the providers I consulted are as follows.

Because of increased uptake of home-care packages, people are entering aged care at older ages and therefore requiring increased care from the time they're admitted. The indexation of the subsidy doesn't reflect this increased care requirement, and the wage disparity between the public hospital and disability sectors and the aged-care sector is a problem. The providers also expressed concern about their inability to borrow from lenders, as return on investment is too low. There was much discussion of the AN-ACC funding model replacing the ACFI model, with providers providing this feedback: the quarterly reporting by the AN-ACC external assessors places an unreasonable burden on smaller facilities that do not have the advantage of the economies of scale enjoyed by the larger, multi-facility organisations; this may result in the closure of community-run and regional facilities, and, indeed, it already is. These providers are already under stress with staff shortages. And the health department has already revealed, in answer to questions on notice, that, based on the latest data, fully 86 per cent of small providers—46 per cent in the regions and 40 per cent in the major cities—do not have a 24/7 registered nurse. The resulting decrease of providers is worrying and is reflected in the feedback that I have had from providers in Goldstein.

So, while I am broadly supportive of this legislation, the opposition has proposed an amendment calling on the government to reveal the impact of this on small providers in the cities and the country, in rural, regional and remote Australia. It's a sensible amendment that I support. All members of parliament should have the ability to scrutinise the effect of legislation—whether it does what it's intended to do or falls short—and I urge the government to take a look at what I believe is the intent of this amendment. I note that the member for Mayo has also raised other concerns that warrant investigation.

The pre-assessments required with the AN-ACC model have highlighted significant variations on assessment of individuals. A quality standard needs to apply to the assessors, not just to the facility and residents being assessed—a quality standard that reduces subjective assessment variations. There's a lack of transparency as to how the AN-ACC tool works, as the algorithm has not been made public. This is a problem, particularly for small facilities who do not yet understand how this system will work. Reassessments are expensive, and providers cannot check to see if initial assessments were done correctly.

On 1.7 per cent indexation, providers in Goldstein say that the increasing uptake of home-care packages means that people are entering aged care at an older age and entering with increased morbidities due to that increased age, translating to an increased care requirement of that individual by the time they're admitted. The indexation of the subsidy does not reflect this increased care requirement. Resident care is being compromised, due to indexation not being matched to increased award rates, increased superannuation and increased payroll tax for the mental health levy. There is a significant disparity between wages in the aged-care sector and those in public hospitals and the disability sector. This is leading to staff leaving an already contracting aged-care workforce. Staff shortages were previously filled by agency staff; now those agencies cannot supply staff either.

On 24/7 registered nurses: 85 per cent of aged-care facilities in Victoria already have 24/7 registered nurses in place. And there is no argument—RNs should be on staff 24/7. But, as I said, small providers do have concerns. Ahead of an increase to 215 care minutes, it's also almost impossible to fully staff each shift. It's very hard to find personal care assistants, enrolled nurses and registered nurses, and there's also a concern that these changes could force enrolled nurses out of the system. The definition of what is and is not included in care is challenging. Lifestyle and allied health are not included. These areas provide cognitive and physical support beyond basic care.

There needs to be a clear definition of the care minutes. There's been a failure to recognise the import of enrolled nurses as part of the registered nurse component. Enrolled nurses are generally medication endorsed and do a majority of wound care. Many facilities provide a career pathway for personal care assistants to become ENs and some RNs, and there's a fear that those enrolled nurses will be lost from the aged-care sector due to budget constraints, leaving the lowest paid, less experienced, level 1 nurses and PCAs in charge of the ward. The 215 care minutes needs to be a more nuanced schedule.

Personal care assistants are also not eligible for skilled migration through the mainstream visa program for providing skilled and compassionate care. The Committee for Economic Development of Australia, or CEDA, estimates the industry needs an additional 8,000 workers to meet best-practice standards to combat the 65,000 workers leaving the sector each year. There's a need to make aged care more attractive by removing HECS debt and providing tax incentives. I, as well as the providers in my community, strongly support preferential visas and other incentives to attract staff to aged care to meet the requirement of these legislative changes.

Providers have also spoken about needing to refurbish after 25 years. To remain viable, bigger facilities are refurbishing as soon as 15 years after building, and this expense is coming out of depreciation allocations by the bigger providers. New homes are debt funded and run at a loss for 18 months or so. However, to attract investment in lending, the industry needs a consistent and commercial rate of return. The current rate of return is too low to be attractive for investor or bank funding. Solutions suggested include increasing the rental rate or daily accommodation charge, removing exemptions on the homes value on assets and means test or reinstating the bond or retention. Other comments from providers include overzealous and adversarial regulators, which has staff operating under stress and leads to many leaving the sector for better-paid alternatives in the public health and disability area. There is a deep need to make aged care more attractive to school leavers and to adopt recent CEDA recommendations to make training cheaper.

Finally, aged care is a critical sector and this is critical legislation, but we need to do this the right way and not rush with amendments that have been put forward and not fully considered. Looking after valued older members of our community requires care and respect. Aged care also has an image problem. We must change the reputational problem that, along with rostering and wage issues, is a major disincentive for staff to work in aged care.

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