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

The opposition's position on this bill was provided in the House on Tuesday 8 October 2024. I would like to respond to the bill as the shadow assistant minister for regional health from the regional perspective, through the prism of the regional aged-care summit that I convened in July 2023. Before I do so, I want to commend the shadow minister for health, Senator Anne Ruston, for her efforts in negotiating with the government on this bill. She secured many significant changes from the government, one of which was negotiating what was going to be a 17.5 per cent inclusion of assets for contribution towards care costs, which is now down to 7.8 per cent.

For older Australians who have paid their taxes and not had the benefit of superannuation, who have worked hard to ensure they would not be a burden on society in retirement, who made significant sacrifices and volunteered for their country, it sticks in their craw that an arbitrary and immediate date threshold will now see some of them contributing so much of their assets to the cost of their care in later years in a home or a room beside other people who made far less effort for their country, who contribute nothing and who get the same care for free.

Given the chronic obstacles aged-care providers told me about in delivering quality and equitable care in regional areas, I hosted the national regional aged-care summit in Mildura in 2023, bringing together front-line workers, providers and peak bodies from across Australia to consider policy solutions to the many problems they face. Government ministers were invited but did not attend, nor did departmental or Aged Care Quality and Safety Commission representatives but they undertook to receive and respond to a copy of the summit communique. It took some time to get a response, and to say it was underwhelming is being kind. So, to do justice to the 100-plus attendees at the summit, I will review this bill by stepping through that summit communique. It says:

Regional aged care services face similar difficulties to the broader healthcare system in rural and regional Australia. There is a significant shortfall in … workforce leading to under-staffed and under resourced services, which ultimately means older people in regional areas receive a lower standard of care than their metropolitan counterparts.

I will come back to workforce issues a little later. The first topic that we surveyed on that day was 'Regional residential aged care—viability'. Under that heading, the communique says:

There is a cost premium for delivery of regional, rural and remote aged care that needs to be recognised and addressed by government under the equity principle. This is reflected in travel costs for clinical staff and providers to deliver services to rural patients; capital and maintenance costs for regional aged care facilities and increased expense of service delivery compared to urban areas.

Solutions to this cost premium must be adopted to ensure viability of the sector in regional Australia.

The summit proposed:

I'm pleased to say that Senator Ruston managed to negotiate a $300 million fund for regional service providers. It goes on:

The Regional Aged Care Summit held in Mildura in 2023 looked at the Modified Monash Model and considered it:

… ineffective and not for purpose with geographical social and economic framing resulting in clear disadvantages for regional Australians, particularly those living in Modified Monash Model category 3 and 4 (MMM3-4)—

such as Mildura, my own home town—

and fails to acknowledge the costs of workforce attraction in those regions.

Aged-care facilities are paying three times the average nurse wage for agency nurses and, of course, for FIFO locums who come in and out. This creates an intolerable burden on their budget. Yesterday, there was a release of the Medicare reviews, including for workforce, the Modified Monash Model, distribution priority areas and the distribution workforce shortage mechanisms. The government released the Working Better for Medicare Review: final report and the Review of General Practice Incentives: expert advisory panel report to the Australian government, with Minister Butler acknowledging to the Royal Australian College of General Practitioners that morning that he is constantly lobbied on the distribution priority areas and the Modified Monash Model.

From the moment Labor changed the DPA, I've been calling out the negative impacts it has been having on regional Australians. The Working Better for Medicare Review: final report found:

The current method of determining DPA status via automatic application of MMM2-7 blankets means that of the 827 GP catchments across Australia … (85%) now have DPA status. The almost universal view of submissions and consultations suggest DPA in itscurrent format is no longer an effective distribution lever.

It proposed:

… MMM should no longer be used to establish blanket rule exemptions.

It also determined:

… each GP catchment area would individually be accorded DPA/non DPA status.

Thirdly, it held that a similar mechanism, the distribution of workforce shortage, was no longer fit for purpose, saying:

There are too many areas within cities, and heavily populated centres outside these cities, that are classified as DWS.

In short, the review says what I've been saying for years and what the regional aged care summit said and communicated to the government a year ago: the Modified Monash Model is no longer fit for purpose, and Labor have wrecked the DPA workforce lever to shunt far too many international medical graduates into suburban areas of capital cities. Poor primary and preventative care services through a lack of doctors results in people developing poorer health and entering acute-care services—which are far more expensive, and including residential aged care—sooner.

The Regional Aged Care Summit communique stated:

Regional aged care is a poor cousin in the care economy and is a victim of sectoral competition not just with acute care, but now with the National Disability Insurance Scheme. Governments must, to the greatest extent possible, remove perverse incentives which prioritise motivation to practice in other areas of the care economy in preference to aged care, for example wage differentiation between the public hospital system versus the private or public aged care system … Regional private and not for profit providers suffer, in particular, from an administrative burden from regulation—

one could almost say overregulation—

that should be addressed by government and the regulator. A government subsidy system must be established to support not-for-profit aged care providers in a way which balances the advantage state funded public aged care facilities have in 'top-up funding' per bed per day, and a backing for running at a loss, which 70 per cent of not-for-profit facilities currently experience.

That is extraordinary:

Community-led home care services represent a strong model for regional Australia, providing local residents with a sense of community, purpose and assistance from people who know the community.

While there has been a slight improvement, the silent waiting lists for elderly regional Australians—namely access to ACAT (Aged Care Assessment Teams) and the time lag between home care package approval and implementation—remains unfairly delayed in regional Australia.

This brings me to the question of grandfathering arrangements proposed under this bill. The government has signalled that those in the system at the time of the government's announcement of this bill will benefit from existing arrangements and will not have to pay more their for care. Firstly, that is effectively legislation by press release, and that is problematic. Secondly, what if someone applies for an aged-care place before 1 July 2025, or whatever the start date is settled at through this legislative process, and has or has not received a place? Are they both grandfathered? What if someone applies on 30 June 2025?

The communique says:

2022 data shows that more than 50,000 older Australians died while waiting for approved home care since July 2017.

Access to home care packages for older indigenous Australians is a particular issue, and face-to-face information regarding ACAT assessment, provided by indigenous health services and workers, is a preferred model to the current information on the MyAgedCare website and reading materials.

The cost premium for regional services means that home care packages are not fully meeting the needs of recipients.

As one constituent, Rose, pointed out to me in the last couple of weeks, she has an $80,000 package in her home-care funding but what she really needs is cataracts. As she points out, there is little point installing home help if she cannot see because she will not be able to live at home. The wait times in Victoria's public health system are so bad that there could be permanent damage to Rose's eyes by the time she receives cataract replacements. But her package money could be used, and she could save her eyesight and continue to live at home.

The situation highlights the broader problems in the care funding arrangements, the legacy arrangements of different silos of Medicare, aged care, NDIS and other funding streams, and whether we need to look holistically at federal health funding to focus on outcomes, not process. I even had one constituent in his early 60s ask if he could access his superannuation to address his need for cataracts, as he was getting little help from his fund. These are the lengths to which older Australians are trying to go to ensure quality of life in their latter decades or years in the absence of appropriate regional health care. In my view, this is an absolute priority. We know that preventive primary care saves a lot of money for the federal government by keeping people out of tertiary care. This is the same in aged care, and the government needs to focus on how to assist older Australians to stay at home. The Regional Aged Care Summit recommended that a growth funding round for CHSP, the Commonwealth Home Support Program, is required to enable more providers to enter the market in regional areas. Capital funding should be targeted at a needs based approach, and government must acknowledge that smaller providers may not be able to invest the same time and funds in grant applications as larger providers and take this into account when awarding grants. The market cannot always be relied on to provide aged-care services in remote parts of Australia.

I don't have time to go through the rest of the regional aged care summit communique, but I just want to say that regional Australia needs to have a priority place in whatever funding, proposals and mechanisms are put in place by this government, and I urge the government to look at this more seriously.

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