Zali Steggall (Warringah, Independent) Share this | Hansard source

Today I rise to speak on the Aged Care Bill 2024. Australia's aged-care system is facing a crisis. It's unsustainable and not effectively meeting the needs of our older Australians. With an ageing population, demand for care services is only going to grow, making it crucial that we develop a system that promotes the wellbeing of older people while remaining economically sustainable. In the next 40 years, the number of Australians over the age of 65 is expected to double, and the number of those over 85 is expected to triple. In Warringah, nearly 17 per cent of the population is over 65, with over 25,000 individuals entering their senior years. These numbers highlight the growing demand for aged-care services, particularly the increasing desire for independence and support to age at home.

The Aged Care Bill 2024 is an important piece of legislation aiming to deliver significant reforms that ensure quality of care for older Australians. It also seeks to help seniors maintain their independence, especially through ageing at home. My electorate office in my electorate of Warringah regularly receives calls from constituents who need assistance navigating the complex aged-care system, and it's not just those needing it themselves; it's often family members finding it incredibly complex. The current system is clearly not meeting the needs of the community, and that's why I welcome the reforms. There have been long delays and difficulty in getting the level of care needed by people.

The Royal Commission into Aged Care Quality and Safety revealed hard truths about our system and horrendous stories of neglect. The final report, titled Care, dignity and respect, made 148 recommendations for improving the standard of care. Following the report, there have already been three legislative changes, and now this new bill responds to about 60 of the royal commission's recommendations, alongside those made by the Aged Care Taskforce. This bill will replace the Aged Care Act 1997 and the Aged Care Quality and Safety Commission Act 2018. The new legislation gives the Aged Care Quality and Safety Commission increased regulatory powers as recommended by the royal commission. It introduces a new regulatory model focused on ensuring that registered providers offer high-quality care while being held accountable. Often the most important part of the feedback that we get from the community is: 'How do you know the facility you are proposing to have your loved ones live in is actually going to meet their needs?'

Accountability and oversight are essential in delivering better care, and I support the introduction of a statement of rights for older people in this legislation. Placing the rights of older people at the centre of the law is a necessary step to recognise and protect their dignity. However, I am very concerned. Alongside key stakeholders, I ask: how are those rights going to be enforced? There seems to have been a watering down of the initial intention when it came to that statement of rights. When I visited constituents and discussed this with them, many had concerns that a statement of rights for older people not just be window dressing but that it have some effect on their standard of care and treatment.

The Support at Home program, which would come into effect on 1 July 2025, is also another key change in this legislation. It will replace the current four Commonwealth home support packages. Those four will become eight ongoing classifications and there will be two additional short-term classifications, one for restorative care and one for end-of-life palliative care, and I welcome these changes. They aim to better support older Australians ageing at home, meeting their changing or developing needs and ensuring they maintain their independence. Of course, the additional short-term classification of restorative care will assist people to meet short-term increased needs. The sad aspect of palliative care one is that, of course, it is the end of life, so that assistance can make such a difference to the quality of life and to supporting the person and their family through that difficult time.

However, I would note that while these changes are good they do very little to address age discrimination and the huge gap that remains between services of the NDIS, aged care and other areas. It remains that those over 65 who have an accident or who develop a disability can still not access a similar level of support and assistance on the NDIS as those under 65. There is still a massive difference between the maximum level of support in these eight aged-care classifications, even with the additional restorative care aspect or home improvements, compared to what is available under the NDIS. Keep in mind the age of 65—many in this place are at that age threshold. While 65 has been traditionally thought of as a time of slowing down and maybe retirement, many people are incredibly active at 65 and are still contributing and working. If an event occurs that significantly changes that situation, it is still such an incredible contrast. Just because of that age threshold, the difference in dignity and support the people receive is still incredible. It is still an age discrimination that needs to be addressed.

A central feature of the Support at Home program is the no-worse-off principle designed to provide continuity and certainty for those already in the aged-care system. Of course, these are big changes. People have contacted my office, concerned about what it means for them if they are already in the system. The program also introduces a new assessment tool allowing for more tailored support. I welcome that but, again, the proof will be in the pudding in terms of how that assessment occurs and in making sure it is not just an automated, overly administrative process but that it is genuinely flexible and recognises the individual needs of people.

One of the key aims of the Support at Home program is a reduction in average wait times for care approval and access to services to three months. It is a significant improvement compared to current approval wait times of some 12 months or more. That delay is devastating, because we have had instances where some people have passed away while they are still waiting for their care approval. So I think it is incredibly important, when we look at this type of service, that the administrative side of it is effective, efficient and resourced well enough to make sure there is no delay in wait time.

I welcome the government's intention to reduce these wait times, but I have questions about how they plan to implement the ambitious reductions. If we've got circumstances going from over 12 months to now being done within three months, you have to question how. I hope this is going to be done sensibly and efficiently. I am also concerned about the measures that will be in place to ensure people are not neglected or forgotten during those wait times. Even if they are reduced to three months, a person's condition can significantly deteriorate in that time and a lack of support for their need can make a significant difference.

The new funding model requires older Australians to contribute more to their care cost—I know that's of great concern to some—in both the Support at Home care model and residential care. We know that, for this to remain sustainable with an ageing population, that contribution is necessary. The fees will be based on services used, with full pensioners making low contributions for some aspects of care. Part-pensioners and Commonwealth senior health card holders will contribute depending on their income and assets, and self-funded retirees will face higher contributions. Changes to residential care will include increased contributions to daily living costs and reforms to accommodation contributions. Both residential care and Support at Home care will be categorised into clinical care, independent services and everyday living care. In terms of financial contribution, clinical care will be fully funded by government and funded for everyone.

The second category, the independent services such as personal care, will require contributions. These will range from five per cent for pensioners to some 50 per cent for self-funded retirees. Everyday living services, the third category, which can include things like cooking and cleaning, will require the highest contributions, from 17.5 per cent for full pensioners to 80 per cent for self-funded retirees. I welcome that the contributions will have lifetime caps and aim to create cost parity between home care and residential care. Needless to say, these cost arrangements and contribution arrangements are complex but I commend the minister and her team for their diligence in working this out.

I note the bill has been referred to the Senate Community Affairs Legislation Committee for review; that will hopefully provide a careful analysis of its economic impact and the viability of the structure. For my constituents, I will endeavour to have more information as soon as possible and ensure that people are engaging with these changes and understand how to properly access the services and what these contribution models mean for them.

Our older Australians deserve to live with dignity, and the new aged-care bill represents a positive step in addressing the challenges we face as a nation with an ageing population. However, much more needs to be done to ensure that all Australians receive the care and support they need in their senior years. I recently visited St David's Village in Frenchs Forest to hear concerns from residents there, and the recurring theme was a desire for agency. Older Australians want to maintain control over their lives with autonomy in their services, independence in their living arrangements and choice in end-of-life care. Another key concern was how the government plans to communicate the changes, what transition plan will be in place and how the government plans to support people through these upcoming reforms.

Ensuring older people maintain agency during this transition is crucial. To help seniors, their families and their communities navigate the aged-care system, my office, like those of many other MPs, recently released a seniors guide to assist in organising aged care. What is interesting is that so many of the services are digital—they're online—but for many people that is incredibly complex. They just need a proper hard copy—a road map to using these services. The seniors guide has been an incredible success, demonstrating the importance of providing accessible information for informed decision-making. Much of the key information on aged care is assessed online via an online portal. By making this information available in a simple printed booklet, we've received huge feedback and appreciation from the senior community because it makes it a lot easier to navigate. I encourage the government to be mindful that, whilst we want the efficiencies of everything being online and digital, information remains accessible for all.

Lastly I'd like to mention that, when considering changes to aged care and how to improve that quality of care, we need to consider how these changes will impact First Nations Australians. The National Aboriginal and Torres Strait Islander Aging and Aged Care Council is working to better ensure that aged care policies are culturally safe and trauma aware for elders. It's a massive issue. For older First Nations Australians, the concept or the prospect of residential care brings back huge amounts of trauma, especially if they are part of the stolen generation. We have to make sure that, throughout this system and throughout legislation, we acknowledge the complexity and the challenge that First Nations Australians face. The council has made a submission on the bill to the Senate Community Affairs Legislation Committee and makes key recommendations.

A division having been called in the House of Representatives—

Sitting suspended from 10:25 to 11:01

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