Allegra Spender (Wentworth, Independent) Share this | Hansard source

Today I rise to speak in support of the Aged Care Bill 2024, a bill that, while no silver bullet, marks a step towards rebuilding the structure, reputation and sustainability of Australia's aged-care system. I congratulate the government for bring this bill forward, and I commend the coalition for their constructive engagement in the process and helping to build a robust piece of legislation.

I was recently invited to visit an aged-care facility in my electorate to mark the awarding of an Order of Australia to a resident, Kalman Bloch. Please indulge me for a moment while I commend Kalman and his family for the contribution he's made in my community over many years. He's been a Lions member for the last 50 years, and that was why he was recommended and awarded the Order of Australia. His commitment to his community, to volunteering and to helping people in times of need was remarkable, and it was wonderful to celebrate that with his daughter, grandchildren and great-grandchild as well. It was a very special event, and it was at an aged-care facility. During that visit I spent about an hour or so with residents and staff, and I was struck by the genuine decency, humanity and connection shared between staff and residents. I witnessed genuine compassion and care, and that is what all of us seek and want for our families.

We all fear ageing, and gradually losing our faculties and the independence we take for granted for so much of our lives. We also fear becoming dependent, whether on a spouse, friends, carers or our children. A well-functioning aged-care sector is a critical part of our social security safety net and provides assurances that the worst of ageing can be managed with dignity, respect and compassion. But I fear in recent years we have lost faith in that safety net.

The need for reform has never been clearer. The Royal Commission into Aged Care Quality and Safety painted a harrowing picture of the failings of our current system. It showed us that too many older Australians have suffered not just from poor service but from neglect and, in some cases, even abuse. The stories that emerged from the royal commission were heartbreaking. We heard of elderly residents left in soiled clothing, of people going days without adequate food. It revealed the human cost of allowing the system to drift away from a model of care concentrated on the rights of individuals, their wishes and their autonomy. COVID-19 further exposed the fragility of this sector to external shocks. It showed us the system was stretched to capacity and unable to adapt to a crisis, leaving both residents and aged-care workers at significant health risk.

When I speak to care providers in my electorate, they talk about the challenges they have to deliver the growing need not only in my community but also in communities around the country; the challenges in building more facilities and providing more beds; and the challenges of getting the right staff in to support this incredibly important work. As a daughter who has recently lost two parents, one of whom was desperately afraid of going into aged-care facilities, that fear that many of our community have—that they will not have the facilities in place and will have to move to other parts of the country where they do not have the same connections to friends and families that they have in their local environment—is a real concern.

Speaking briefly on Wentworth, one thing that startled me the most is that the aged-care provider, who is a provider of many aged-care facilities around the country, said they have as much of a problem getting aged-care workers in Wentworth as they do in some rural electorates because of the enormous cost of living and cost of housing in communities like mine. So there are some really significant challenges in the sector.

However, we need to be honest: the sector has been failing. It has failed residents, it has failed its staff and it has failed its community. But, when I go into aged-care homes and when I talk to other aged-care providers, I think that there's a really important reminder that the majority of the sector is deeply committed to the preservation of dignity and quality of life for elderly Australians. The system has been broken but it is not beyond repair, and I think this bill goes some distance towards doing that.

As I said, I commend the government for working closely with stakeholders and with members across the parliament to produce a bill that has received broad support from the sector and from aged-care community representatives. There are still some areas to strength, and a significant part of this bill is actually in regulation, but stakeholders that I have spoken to have acknowledged the improvements to this bill since the exposure draft. It is clear that the government and others have been listening to the voices of those most affected by these issues—older Australians, their families and workers. Once again, I commend the opposition, the coalition, for their engagement, and I know that my community does appreciate the changes that were made based on the opposition's feedback.

This bill represents a substantial overhaul in the way that aged care is provided in Australia, explicitly legislating a rights based model that acknowledges every Australian's right to age with dignity. It also introduces revised funding arrangements that acknowledge the roles of both home care and residential care in addressing both capacity constraints as well as the wishes and needs of elderly Australians. This new rights based framework is grounded in the principle that older Australians should be able to access quality, safe and timely care and was a key recommendation of the royal commission. However, as a number of organisations have pointed out, these rights are not enforceable under the act and will rely on the Aged Care Quality and Safety Commission and complaints commissioner to ensure that these rights are upheld.

The Aged Care Bill provides civil penalties for infringements on registered provider obligations, and I think this is a really important part of the bill. I know that there is some concern that these don't go far enough but I also recognise that we need to find the right balance here to make sure we are not only working constructively with our aged-care providers to ensure that bad actors always face the full force of the law but also that we recognise there are many people and many in the sector who are working constructively and genuinely to improve quality of care and look after their residents in an effective way. We need to strike the right balance.

The funding arrangements proposed in this legislation appear to be sensible adjustments to the current user-pays system, although I note that the community eagerly awaits the release of rules that will actually determine the individual fees that will be charged. The bill maintains a means-tested co-contribution system based on a service's need with different funding arrangements, subject to whether a required service is considered clinical care, independent support or everyday living. This co-contribution model has caused some concern that the service quality of aged care will become dependent on ability to pay, and, while the government has noted incentives for providers to provide ratios of supported residents, this is not mandated and is an area we do need to closely monitor.

There are provisions that allow for more a sustainable sector, such as allowing services to retain up to two per cent of the refundable accommodation deposits, which the sector has been requesting for some time. This will have an enormous impact on the ability of services in my community to expand, grow and invest.

I want to briefly note why this is important and why the whole legislation is important. Our community is aging. The great joy and the great benefit of this is that Australians have a greater chance of living healthier lives for longer in our country, but we also need to recognise the impact that that has on our tax system and on our ability to fund the services that are most important. Back in the 1970s and eighties, there used to be six younger, working-age Australians for every older Australian over the age of 65. This is now under four, and the expectation is that, in another generation, it will be under three.

We do know that the community is aging, so the burden and the cost of actually providing quality services are going to increase. We do need to face how we're going to pay for that and pay for that in a way that shares the burden appropriately across different generations and across different people's ability to pay. I do acknowledge that this bill goes some way to trying to address that in a way that is fair, particularly for those people who are already in the aged-care system and have made their plans, but that is also thinking forward.

A key part of the legislation which I'm really happy to see is the emphasis on home care. When I talk to people in Wentworth who have had engagement with the aged-care system, one of the things they talk to me the most about is how difficult it is to get home care in a timely way. When you're assessed for a package and you're on a waiting list, by the time you actually get the package you're often significantly more unwell, as you have not been able to get the services you needed right then to support yourself. This can often precipitate having to go into aged care, which, had you got the right services in your home when you needed them, you potentially wouldn't have needed to do. So I think this emphasis on home care is really important.

This bill will introduce greater flexibility, allowing older Australians to receive early interventions and a high level of support, including services like meal preparation, cleaning and personal care, with an easier transition between different levels of care when needed. I also commend the government for expanding the end-of-life care pathways to allow more people to access palliative care in their homes. I have experience of this on a personal level, having seen my father go through palliative care. He had the great benefit of having a wonderful palliative care team that he relied on very much at the end of his life. It is really important that we acknowledge the importance of palliative care for individuals and their families at end of life. It also gives people a chance to die at home, an aspiration that many, many people have but that many fewer reach.

Apart from the integrated assessment pathways, I still hold some concerns about the wait times to receive some of these home-care supports. When an older person, as I said, is deteriorating, receiving timely care is absolutely essential, and I would ask the government to more explicitly address this issue in their work and in their future legislation.

I also would like to acknowledge that a significant amount of the reform will be delivered through delegated legislation. While I understand the need for the bill to pass quickly to implement these much-needed changes by next year, I know that the community eagerly awaits closer scrutiny of the aged-care rules, which include the final quality standards, the code of conduct and how fees will be calculated.

Again, this bill is a positive step towards a better model of aged care in Australia, but the market based model means that the success of this legislation hinges critically on the ability of providers to provide adequate services, not to mention addressing the issue I identified earlier, which is the shortage of aged-care workers. In 2021, the Committee for Economic Development in Australia estimated that we would have an aged-care worker shortage of 110,000 by 2030. Bills that legislate rights and standards are promising, but, unless we have a suitable and sustainable workforce, the standard of care and quality of care for aged-care residents are likely to continue to be unmet.

I mentioned before how much this issue affects my community in Wentworth, where the chronic shortage of aged-care workers means that aged-care providers can't expand in the way that they would like to in my community, and they are really concerned about their ability to continue to attract great aged-care workers. I am concerned—I'll be honest—that the government isn't doing enough in this area. I want to outline that, while they have brought in a migration policy to attract aged-care workers from overseas, my great concern with that model is that it is tied up with, basically, an agreement between the aged-care workers and the unions, which is the only way that those special fast-tracked visas can be accessed. I have real concerns about that because many of the providers I've spoken to do not have those union links at the moment and would like to be able to work with other groups, such as Fair Work or other government institutions, to be able to access these workers without having to necessarily agree to all of the requirements that the unions impose on them, because in some cases they feel that they are unnecessary or onerous. I am concerned that their migration settings are not yet pulling that way.

The other issue I always come back to is that, in this place, we as parliamentarians are very good on imposing obligations on businesses, and in aged care it's absolutely critical, but we should also be constantly thinking about how we make sure that we are rightsizing the burdens that we put on individuals and on care providers. How do we make sure that we can still allow for innovation, growth and productivity in sectors like aged care, because this is an increasing part of our economy? How do we make sure, particularly for our frontline workers, that they're spending time on the care they want to give, rather than on paperwork and bureaucracy?

I used to work in a hospital, and I have worked in education. The consistent feedback I got from the nurses, the doctors, teachers and the principals was that they were spending less and less time on the things that mattered to them most, the things that were the reasons they got into the sector in the first place: their desire to provide care and education to people. They were spending more and more time on bureaucracy. I think every government needs to aspire to constantly rightsize this, to constantly come back to say: 'Here's this regulation. It's there for protection, but are there other ways of providing that protection while still giving people flexibility and unburdening the frontline workers so that they can do what they do best, which is to provide care and education to those who need it?'

In conclusion, while I believe that this bill represents a good reform and a significant step forward, there is still further to go. We must continue to push for greater investment in the workforce, in particular. We must address long wait times for care and ensure that reforms are implemented in a way that truly benefits older Australians but also allows innovation and productivity growth in the sector.

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