Sophie Scamps (Mackellar, Independent) Share this | Hansard source

Before I entered parliament, I was a general practitioner. I felt close to all my patients, of course, but I often had a really special relationship with my older patients, and I treasured the opportunity to care for them. Older people are often so beautifully skilled in the arts of conversation and connection, and they were so appreciative of the care they received. They deserve our care, our attention and our respect, so I rise today in support of the Aged Care Bill 2024. Unfortunately, it took a very long time and a royal commission for this country and this place to properly grapple with all the ways in which our aged-care system has been failing older Australians.

The report of the royal commission shocked the nation. The royal commission has described it as 'a sad and shocking system that diminishes Australia as a nation', the story of which is 'a shocking tale of neglect'. Our aged-care system needs an overhaul, not only because of its deficiencies but also to cope with the projected increase in the number of Australians who will need its services in the future. In 2018 and 2019, there were around 515,000 Australians aged 85 and older—two per cent of the population. It is projected that, by 2058, that number will increase to 1.5 million people or 3.7 per cent of the population. The corollary to this, of course, is the diminishing proportion of working-age people in Australia, relative to the retired proportion. In Australia in 2019, there were 4.2 working-age people for every one person aged 65 or over. And by 2058, this will reduce to 3.1. The direct implication is that there will be proportionately fewer Australians both funding the aged-care system and working in the aged-care system.

However, it is hugely important not to think of older Australians as a burden. Ageism, like so many other biases in this country, is real. The Human Rights Commission reports that more than one in three Australians aged between 55 and 64—35 per cent of us—have experienced age discrimination. The most common forms of discrimination reported include being turned down for a job, being ignored or treated rudely and having disparaging jokes made about their age. More than one in four older Australians live in poverty, and we know the situation for Indigenous Australians is even worse, as they are twice as likely to live in poverty than non-Indigenous Australians. For whatever cultural reason, older people do not enjoy the same levels of respect, let alone reverence, that they enjoy in Asian and African countries and in the Mediterranean—respect that they deserve. After all, Australians aged 65 years or over contribute almost $39 billion each year in unpaid caring and voluntary work. If the unpaid contribution of those aged 55 to 64 was also included, that figure rises to $74 billion per year. If employment rates of Australians aged over 55 increased by five per cent, it would add another $48 billion to our economy every year. The contribution they can make in the workplace is immense. Experience and wisdom are powerful assets in any industry.

Older Australians are our mothers, our fathers, our uncles and our grandparents. Walking alongside them in their later years is a privilege. The mark of a civilised society is how it treats its most vulnerable. That's why I applaud the fact that this legislation is centred on the rights of older people. It is based upon the rights that older people in the aged-care system should expect.

What have the government already done? They have instituted 24-hour nurses in residential care and a 15 per cent increase in the pay for aged-care workers. This is a really good start to what must be a dramatic overhaul of the system. Since being elected as the member for Mackellar 2½ years ago, it has been my absolute privilege to run an electorate office that assists elderly constituents and their families with the aged-care system as one of its core functions. It is unfortunate that so many people need to turn to their members of federal parliament for assistance, however. We are usually an avenue of last resort for them on a range of issues. Nevertheless, it has been wonderful to watch my team ease constituents' difficulties navigating the aged-care support system. People seek our assistance in relation to all aspects of the aged-care system: the Commonwealth Home Support Program, home-care packages and residential care. Australians may not appreciate that while most of the national aged-care budget is spent on residential aged care, more than two-thirds of the people using the aged-care services do so from home.

There are clear patterns or themes to the difficulties my constituents have been facing with the aged-care system. These include long wait times for home-care package approvals and upgrades, sometimes up to 12 months; insufficient hours of care provided through the packages; high management fees which then reduce the available care hours; low carer allowances to families compared to the time they invest and compared to rates paid to home-care package workers and providers; quality of care concerns; system inefficiencies and perceived mismanagement; and inflated costs for equipment and services when billed through packages.

Here are a couple of actual stories my constituents have shared with me about their experiences with the aged-care system. I have changed the names of these people, whose stories I am sharing. Joan's father, who has Alzheimer's, recently deteriorated while in respite care after a fall. Despite accessing physiotherapy and dementia support, Joan and her father have been waiting nine months for his home-care package to be upgraded. Joan's mother, who is elderly and struggling with the daily care of her husband, desperately needs the extra support and is putting her own safety at risk.

Cynthia has been caring for her elderly mother on the northern beaches for years. After her mother suffered a fall and began receiving assistance through My Aged Care, Cynthia started noticing inconsistencies in the quality of service. Cleaners sent by agencies were unreliable and often unprofessional, with one alarming incident where two identified cleaners showed up unannounced, leaving her mother feeling unsafe in her own home. Despite having access to government funded care, Cynthia and her siblings found themselves stepping in to maintain the house, take their mother to appointments and manage day-to-day tasks that they knew could be done better by family members. Cynthia now wonders why family members who are already providing care out of love can't be paid through aged-care packages or the Commonwealth Home Support Program to ensure a higher standard of care.

Finally, Cora feels that aged-care providers and service companies are overcharging. She was shocked by the inflated fees for physiotherapy and equipment when she booked them through her My Aged Care package, costing much more than if she had paid for them directly. Cora worries that this is an abuse of taxpayer money, and she is concerned about the long-term sustainability of the system if the overcharging continues.

Moving now to the bill which has been introduced to address all of these issues and more, I applaud the government's adoption of the rights based model for the provision of aged-care services, which has been recommended by the royal commission as the best way to ensure access to quality, safe and timely support; to facilitate social participation and dignity; to allow for self-determination; and to provide freedom from harm, mistreatment and neglect. I completely agree that this is the appropriate framework for the bill, as do the experts.

The other big changes proposed in this bill deal with the funding of the aged-care services. Overall, the changes that the bill introduces will shift the funding model to a means-tested one, with co-contributions from aged-care users and the Commonwealth. The changes will mean that people who can afford to pay more will pay more. I agree with this in principle, because the system has become unsustainable and, with an ever-ageing population, the cost will only keep growing. It should not be contentious for people to pay for their own accommodation where they can afford to do so. If they cannot, the state steps in to assist. That is as it should be.

As to accommodation costs, the maximum amount providers can charge for rooms will increase from $550,000 to $750,000, which will now be indexed. That price can be paid by residents either as a refundable lump sum, as daily payments or as a combination of both. The lump sum payment can be made by way of a refundable accommodation deposit, an RAD. In this new bill, the RAD concept will remain in place, but those deposits will no longer be fully refundable. Providers may retain two per cent of the RAD per year for a maximum of five years. In her second reading speech, the minister explained that this is to ensure that residential aged-care providers can attract the investment they need to keep the current facilities open, to improve quality and to build new homes. With the trend towards an ageing population, new wings and new facilities will need to be built to accommodate greater numbers of people requiring care. Experts including Professor Kathy Eagar from the University of New South Wales noted that there is no corresponding requirement that any of this additional funding that providers will receive or profits they will make be spent on more or better services for residents. This is a missed opportunity. It seems a balance could have been struck between increased profits to aged-care providers and the care and service that those providers are required to provide to their residents.

What I think is absolutely critical to note is the stipulation in the bill that aged-care users will pay no contribution to the cost of their clinical or medical care. This is indeed fundamental to the objective of universal access to medical and health care. This is partly so that individual contributions can be targeted to services that support people's independence and everyday living costs, such as cleaning, gardening and accommodation. It is also welcome that there will be a lifetime contribution cap of $130,000 on non-clinical care contributions or cessation of contributions after four years. Finally, there is a 'no worse off' guarantee so that people already in or assessed as needing home care or already in residential care won't make a greater contribution to their care than they had already planned for.

Unfortunately, what constitutes clinical care, independence support and everyday living support is not included in this bill but will be contained in the rules. At this stage, therefore, it's hard to properly assess the extent to which people soon to enter care will be worse off under the new funding model. Advocacy groups like the Older Persons Advocacy Network are concerned about the lack of detail here. They are sensibly calling for modelling which will enable them to properly understand the real impact on self-funded retirees. This lack of detail and clarity also makes it difficult to decide whether to support the bill at the point when it comes before the House for a vote. It is akin to the government again saying, 'Just trust us.'

In summary, I support the aims of this bill. The system must be made sustainable and our elderly population must get the standard of care they deserve. The aim of universal access is critical. It is not perfect, but it is progress. I will continue to advocate for the government to continue their efforts to improve our aged-care system and support its residents. I commend the bill to the House.

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