Kylea Tink (North Sydney, Independent) Share this | Hansard source

The Royal Commission into Aged Care Quality and Safety revealed an industry rife with neglect and one failing to deliver the services, safety and dignity Australians deserve. Australia's decades-old Aged Care Act has not been fit for purpose for many years and is long overdue for reform. In that context, I welcome the government's commitment to reform the aged-care system, because Australia's population is aging. According to the ABS, 17 per cent of Australians are currently over the age of 65, and, in 40 years, that percentage is expected to double. Given these demographic projections, it's clear the sector needs to evolve, and we need to work towards a sustainable aged-care system that delivers a dignified quality of care, consistent with our aspirations to be a nation that looks after our own.

In reviewing the Aged Care Bill 2024, I can see the time and effort that has gone into it. It is as complex as the system it is aiming to reform, and there is a lot to like in it, including the rights based paradigm, the simplification of the assessment pathways, the focus on aging at home, the improved standards of care in allocated funding to reduce wait times and, finally, the stronger regulatory framework. But there are also areas that my community wants to see strengthened.

Firstly, while the legislation purports to be rights based, I was surprised to find that the International Covenant on Civil and Political Rights is mentioned only in the explanatory memorandum and does not appear in the bill itself. The upholding of human rights is an issue that's really close to my heart and the heart of my community, and I've long advocated for the establishment of a human rights act that will enshrine our basic rights in law. Many of the abuses and injustices of the past in our aged-care system might have been avoided if our most vulnerable had the fundamental protections of a human rights act. Instead, the statement of rights appears to be a selection of rights afforded under international human rights law with many key rights missing, such as the rights to life, liberty and security of person, freedom of movement, freedom of religion, freedom from restraint, the presumption of legal capacity and the prohibition against torture. While an improvement, then, the statement of rights for individuals and the statement of principles to guide service provision included in this bill are a continuation of Australia's piecemeal approach to protecting basic rights. Arguably, a better outcome could have been achieved by introducing a federal human rights act.

Despite the best of intentions to put older Australians at the centre of aged care, the reality is the system is a closed one with an interdependent and shifting balance of power held between government, approved providers and the regulator. Many older Australians have little real choice about whether they enter aged care, particularly if their needs are high, and the availability of services often dictates whether people can stay in their community or who provides their services. While the bill includes a positive duty on providers to uphold the statement of rights, it is severely limited by the fact that it only applies to providers rather than the whole of the aged-care ecosystem, including aged-care advocates and needs assessors. There is also the practical ability for providers to limit rights, for example, to prevent harm. But, concerningly, the bill does not distinguish between permissible limitable rights and absolute rights.

Strengthened aged-care quality standards and additional powers of the Aged Care Quality and Safety Commission will be critical, as they are the sole basis on which those receiving services can enforce their rights. Similarly, an effective compliance mechanism and whistleblower process will be crucial to ensuring older people are heard because these things are not currently protected in our legislation. Under this bill, rights can ultimately only be upheld through the complaints commissioner. Separating the complaints commissioner from the regulator is important in establishing trust. However, as it stands, there is no pathway for review for those unhappy with the decisions of the commission. Some in my community have also expressed their disappointment that the government reneged on the imposition of criminal penalties for bad actors. In removing criminal penalties, the needs of providers have been prioritised ahead of aged-care recipients and is likely part of a deal to get the coalition's support.

A focus on dignity, independence, privacy and control for people as they navigate ageing well should go without saying. This focus is necessary if we are to rebuild trust in the system and establish the new foundations for a robust and fit-for-purpose aged-care sector. This focus on these rights and principles should apply regardless of whether older Australians are accessing government funded services or paying privately. The number of people over 65 in my community of North Sydney is close enough to the national average of around 17 per cent, with most living or renting in private accommodation, including in retirement villages and social housing. Financially, these people live within a range of means. Some are on the full pension, many are Commonwealth seniors health card holders, while nearly 35 per cent are fully self-funded retirees who access non-government funded services rather than join the currently lengthy waitlist. However, despite that relatively high percentage of self-funded retirees, many still live within relatively modest means and should therefore be recognised for taking financial pressure off the aged-care system and rewarded with equal rights under this legislation.

When the superannuation regime was introduced, it promised to be a cornerstone of the government's retirement income policy. The aim was and continues to be, as far as I am aware, to move people towards self-funded retirement and it is working. In the past 20 years, the number of partially or fully self-funded retirees in Australia has more than doubled and now sits at around 43 per cent of those aged 65. But, because these people after accessing aged-care services outside the government's subsidised framework, they will not benefit from the same rights and contribution caps under this legislation, and that hardly seems fair. Ironically, in fact, this may incentivise people to access support within the currently struggling government funded system, which is undoubtably not in anyone's best interest. Ultimately, whether publicly or privately funded, there should be an equivalence of rights, as without equal rights we cannot ensure older people are being universally treated with the same level of care and dignity regardless of the service provider.

Acknowledging and responding to the desire of people to age at home for as long as possible is commendable and is consistent with what I hear from my community, both from older members themselves and from those providing unpaid care and assistance to older relatives and friends and, let's face it, it is what many personally hope for ourselves. By remaining in familiar surroundings, older people preserve their emotional wellbeing and maintain a sense of independence and autonomy, and these factors contribute to overall happiness and quality of life. A well-functioning system for supporting people to stay home is therefore critical and is rightly one of the key ambitions of this legislation. To be clear, the current home-care supports are, quite frankly, a mess.

Since coming to office, my team has heard consistently that wait times between being approved for a home-care package and receiving any funding have been steadily increasing as the availability of the local home-care providers has fallen. Wait times can be as long as nine months, with no indication of when their funding will become available. Obviously, this presents a significant practical challenge for people who need immediate support to live independently at home. Often the burden of this delay is borne by the family. Those with means are turning to privately paid care, not understanding the implications this can have for exacerbating wait times if, for example, they have turned down a lower-level package in order to wait for the one they have been approved for.

The additional funding to be provided to the new Support at Home program to address wait times is therefore welcome but many are actually questioning whether it will be enough. With forecasts suggesting that the funding will only effect the desired improvement by July 2027, we are set for another three years of people waiting excruciatingly long times for the help the government has agreed they need. This doesn't even include the often lengthy time it can take to be assessed in the first place. It wouldn't be alarmist, then, to state that some people will literally die waiting for care.

Along with wait times, another significant issue that has been brought to me by my community is the administrative complexity and difficulty in navigating the aged-care system. This includes navigating the assessment process, understanding the options for residential and home care, meeting the associated costs and interactions of contribution caps and means testing, understanding how to access funding and choose a care provider, accessing the availability of appropriately qualified care providers, navigating wait times and the decision of whether to hold out for the package funding or obtain a private service, and trying to stay close to family and community. The list goes on and on and on. This would be difficult for someone at the top of their game to navigate, let alone someone struggling with health concerns and general worries about ageing, finances and changing circumstances.

Streamlining the assessment process is an important first step, and I look forward to seeing additional detail and timeframes for the implementation of a single assessment workforce. Given the importance of the assessment as a necessary first step in the process for accessing funding services, it's surprising that the assessment workforce will operate outside the act with no obligation to have regard to the statement of rights. Any outcome from the assessment process should have reference to the rights.

Similarly, streamlining various contribution caps and ensuring there is a total cap across both Support at Home and residential costs is a welcome improvement. However, some members of my community have expressed concern that the need for them to contribute more will push them into poverty. Without seeing the modelling, it's impossible to reassure them that they will be left with a living income. One older woman I spoke to queried what will happen to Commonwealth Home Support Program recipients beyond 2027. She literally said to me, 'Does the government assume I will be dead?'

The financial sustainability of the aged-care sector is rightfully a key issue, given our ageing population. This has implications both for the federal budget and for the financial viability of providers, because the government relies on services being provided by private and non-profit institutions. However, the shift to a user-pays aged-care model represents a significant change in how aged care is funded in Australia. While it aims to create a more sustainable system, it also raises important questions about fairness and accessibility. The 'no worse off' principle and the introduction of additional means tested contributions from July 2025 have generally been well accepted by my community, notwithstanding the fact that it's likely that additional means tested contributions will lead to most paying more for aged-care services than otherwise. A critical caveat to that is the implicit guarantee that an increased contribution will result in an improved standard of care—both in the quality of care provided and through a requirement for increased transparency—so people can have confidence that their money is being applied to services they need and that they are in fact receiving. Again, with trust in the current system lacking, this increased transparency and accountability is crucial. I note the government has made inroads here with the dollars-to-care information available via My Aged Care.

Ultimately, this improvement will come down to the definition of 'high-quality care', the detail in the various standards being applied to providers, the ability for providers to attract and retain an appropriately qualified workforce and how the commission monitors and enforces those standards. It's important the government gets these standards and definitions right in the rules as they are a critical expression of the standards older Australians can expect and rely on under their statement of rights and will also determine what is funded as clinical care and what services require a contribution.

Like others, I'm concerned about where the lines might be drawn, particularly in relation to services that maintain independence. Does someone who has a clinical condition that means they cannot feed themselves have feeding included as part of their clinical care, or is it considered a service to assist in independence? Similarly, if someone cannot physically shower themselves, does their right to personal hygiene come down to affordability? The detail in the associated rules is paramount, and I will continue to listen to my community and other key stakeholders to ensure these rules meet community expectations.

Of course, quality care can only be delivered by a well-qualified and experienced workforce. The heartbreaking stories of neglect, pain and distress unveiled by the royal commission identified poor staff ratios, underqualified staff and inadequate training as key contributors to the systemic breakdown of the sector. The government's response to date has included some positive initiatives by way of the aged-care worker pay increases and fee-free TAFE courses. However, there is community concern that this does not go far enough and that the standards must specify carer ratios and qualification standards. I support the recommendations of Dementia Australia on mandating dementia care training. Similar to workers in the NDIS, the aged-care workforce should be registered with the Aged Care Quality and Safety Commission to ensure oversight and minimum skills.

None of this is easy. The government has inherited a silo system of aged care on the one hand with complex practical independences on the other. On balance, my community and I welcome this bill. But, like others, I will be monitoring the rollout to ensure the community's expectations are met and that the promise of increased fairness, transparency and sustainability is being achieved across the board, from those who are most vulnerable to those who we are increasingly relying on to fund themselves.

See this speech in context