Rebekha Sharkie (Mayo, Centre Alliance) Share this | Hansard source

The Royal Commission into Aged Care Quality and Safety found in 2021 that the treatment of older Australians in the aged-care system was characterised by neglect. It shocked the sector, the community and governments into action. This bill was borne out of that royal commission. So it's somewhat disappointing to know that the majority of the debate on this bill has actually occurred in the Federation Chamber. This isn't an amendment; this is an entirely new act. And I feel incredibly disappointed that this bill has not been debated or heard in the main chamber.

This bill, if passed, will implement 58 of the 148 royal commission recommendations handed down in 2021. It will provide more tailored support for older people, with eight ongoing levels of funding of around $78,000 per year and short-term support for palliative care, which I think is critical and which is something that I've raised directly with the minister in months and years gone by. So I'm pleased to say that that will be in there, and that will allow people in that palliative stage of life to hopefully stay at home for as much as possible. It will provide for home modifications and access to assistive technology, including a new equipment loan scheme.

While organisations which deliver aged-care services will now also be allowed to deliver assessment services, I have received assurances that monitoring will occur to prevent conflicts of interest so that a provider can't use assessments as a make-work scheme for their own business. We have seen that in other sectors.

I'm pleased the bill provisions aim to address serious delays in obtaining aged-care assessments, but I believe it should set out a statutory timeframe for the delivery of assessments and the allocation of packages, as we have seen these blow out so much, depending entirely on how much is allocated in the federal budget, year on year. Waiting lists are now so long that it takes 13 months after assessment for a high-level package to be delivered, and that is utterly shameful.

We don't even know exactly how many people are on the waiting list. The government's own website hasn't updated its figures since the March quarter, which is disgraceful in itself. But it's believed—from questions in the parliament—that there are around 76,000 older Australian that are waiting for care at home. People are dying while waiting for a package, and some people are seeing no other option but to take their own life, with voluntary assisted dying, because they're deteriorating while they're waiting for that elusive package. It's almost like it's a mirage on the horizon.

I thank the Council on the Ageing, National Seniors Australia, the Older Persons Advocacy Network, the Aged & Community Care Providers Association and other advocates for their efforts to improve the experiences of older Australians in the aged-care system.

While I support this bill in principle, I do believe that it misses the mark in some respects. I am disappointed the bill will not create an independent complaints commissioner. An independent complaints commissioner with teeth and a transparent complaints process are needed in order to best protect consumers' rights.

I have funding concerns. I'm concerned about the funding model for the system, going forward. Older Australians will be carrying the burden for the sector's funding shortfall and to deliver savings to the government. The increased user-pays approach to aged care will make life incredibly difficult for many. Even if only one partner needs high-level care, many couples with a family home will likely need to sell the home to cover the significantly increased contributions towards ongoing care fees and higher refundable deposits for residential aged care.

Providers will now be able to charge a maximum refundable deposit of $750,000 that will be indexed over time—that's up from $550,000—without seeking regulatory approval. With compound interest calculated at a conservative six per cent and retaining two per cent per annum of the $750,000 refundable deposit, a provider will be able to obtain up to $328,699 over five years or more, per resident. It is not clear how the government will ensure that the additional funds are spent, as intended, on improving facilities and constructing new aged-care beds as our ageing population continues to grow. Further, the bill provides the operation of the deposits will not be reviewed until 2029. We cannot provide a blank cheque to aged-care providers at the expense of older Australians.

I would like to point out that, in addition to the significantly increased refundable deposits for aged care, residents will also be liable to pay for the following charges, and these, I understand, are not capped over a lifetime: basic daily care fees of tens of thousands of dollars per year; and daily extra services, now 'higher everyday living fees', of thousands of dollars per year, set at the discretion of the provider. I receive feedback that my constituents are often charged these fees even if they don't or are unable to use the services, such as wine and television. There are daily accommodation payments for those who are unable to repay the refundable deposit. These fees will combine to leave some older people, particularly if partnered, with an incredibly high level of cost, and it's my view that this will likely impact women in particular, given that they have a longer life expectancy than men.

Other social schemes, such as Medicare, child care or the NDIS, do not require contributions of this magnitude. After listening to concerns raised, I've asked the minister for more information on how the 'no worse off' principle will apply in practice. There is a grey area with respect to grandfathering and whether that also applies to how people use their current package. Many have raised concerns with me about the limitation of their package regarding cleaning and gardening. If you live in a regional area, you generally have a bigger garden, and many tell me that it is having the garden cared for, having support in the garden, which allows them to stay home. That helps them manage the bushfire risk. What we are saying to people accessing NDIS is, 'You have a choice and control.' What we say to older Australians is: 'We will be prescriptive. We will tell you what you need, and we're going to try to extract from you the very maximum that we possibly think is politically palatable for the privilege.'

National Seniors Australia have shared their view that the bill and the explanatory memorandum contain insufficient detail regarding the Support at Home means test and thresholds to allow people to calculate means testing for all incomes. They posit that the means test regime—with 14 steps, 10 threshold areas and various contributions and supplements—is neither clear nor simplified enough for all consumers to understand. Furthermore, I'm extremely disappointed that the bill doesn't deliver on recommendation 72—that is, that older people on disability support should receive equitable treatment in comparison to those on the NDIS. I've raised this issue many times with ministers of both this government and the previous government, as well as in the media. It is age discrimination, and it should be addressed. The system as it is now means that if you are 65 you can't go on the age pension, but you certainly can't go on NDIS either; it's a great inequity. We need to make sure that we address that.

I've also heard from key stakeholders that the statutory review of the act five years after it commences operation is too late. I'm seeking an amendment to require a review of the operation of the act three years after the commencement of the act with key terms of reference for the review to be set out in the bill.

Much of the detail of the new aged-care regime is devolved into the rules and other instruments, such as service lists, which will not be subject to sufficient parliamentary scrutiny. This includes rules in relation to the list of services for the purpose of means testing to establish consumer contributions. Some peak bodies and several constituents have raised concerns regarding the inclusion of independence services, rather than clinical care services, such as showering, feeding and dispensing medication. Such services are likely to be clinically required and are not optional extras or nice to have. How on earth can we think that being assisted into the shower is a 'nice to have'? That is clinical care. It is ridiculous. They are often essential for older people's health, and I'm concerned that requiring significant contributions for independence versus clinical care services could lead to adverse outcomes if this discourages people from obtaining such essential services with personal care—as I said, showering, feeding and medication. This will have dire consequences for the physical health of people.

My constituent Betty, whose husband is living at home with dementia, shared a common problem with me:

The contribution for personal care is a concern as it makes it sound like a choice. I'm worried that carers may try cutting down on the service, which is essential. My husband, a large man, has collapsed in the shower twice. Fortunately, last time a carer was there to help, and I could call the ambulance while she held him. Showering a person with dementia is surely an essential service. The carer, just by luck, was an experienced nurse the last time my husband collapsed, and she was wonderful. The previous time I was on my own, and it was traumatic.

Current delays in home-care packages and CHSP must be addressed. The promises of support at home in this piece of legislation is purely academic for those who are currently waiting for a home-care package. One hundred per cent of providers who responded to Anglicare Australia's 2024 Life on the waitlist report said they could not meet the demand for CHSP—Commonwealth Home Support Program—in their community due to funding restrictions, workforce issues and regional challenges.

It often takes not months but years to find a CHSP provider in my electorate of Mayo. In those circumstances, giving regional and rural people a CHSP code is just a cruel fiction. I'm heartily disappointed that the government has ignored opportunities to commit sufficient resources to address this in the last two budgets.

The Aged and Community Care Providers Association has advised that 55,000 additional home-care packages are needed to address the now 76,000-strong waitlist in the federal budget. Seventy-three per cent of their members said they could deliver additional home care. While this would come at an approximate cost of $1.8 billion, that does not take into account the anticipated savings to government from increased contributions from people receiving funded services under the new Support at Home program, and nor does it reflect the savings due to the delay in people taking up more costly residential aged-care places because they're able to be supported at home for longer. Also, of course, that does not even address the fact that many people are ending up hospitalised because they're not getting any support at home.

Older Australians can't wait for Support at Home to commence before these egregious wait times of 12 to 15 months are addressed by the government. Support at Home can only be as good as the funding that's committed; otherwise, existing delays will simply be inherited. I again call on the government to urgently address this chronic underfunding of CHSP and home-care packages, and to properly resource Support at Home in the future.

Now, we're talking about numbers here—76,000; a 15-month waiting list—but we are really talking about real people, and I would like to share the story of one of those real people. Cyril is 86 years of age. He weighed 80 kilos when he was assessed as needing a level 4 package in January this year. Cyril is six feet tall; he's a tall man. Nine months later, Cyril was down to 42 kilos. He was then told that the wait for care would be some months more, and he lost hope.

In October, Cyril had yet another fall and he was hospitalised again. He then felt that he was too far gone.

Cyril's a carpenter, a musician, a husband who cared for his wife until she died, and then, at that point, embarked on another career, as a carer. Cyril didn't retire until he was 81 himself. But, when it was time for someone to care for him, he was abandoned.

I met Cyril a few weeks ago. He wants to be remembered as someone who has spoken out about home-care packages. He very much wanted to go to the media and talk about this abominable situation—that is, that a gentleman who lives alone and was assessed in January this year as needing a level 4, by September was still told his package would be months away. He has gone through the process of obtaining the medication to have voluntary assisted dying because, at 42 kilos of weight—again, he started at 80 kilos of weight in January—he doesn't see how he can come back from that. And he is now bedbound after a fall. If he had had the support at home, if he had had a chair in his shower, if he had had aids to better help him, if he'd had someone to come and help him wash, someone to come and help him prepare meals, the story for Cyril would have been very, very different. I'm very sorry that Cyril has had this experience. And we must do so much better.

We talk about this bill, but, until we address home care, it really does mean nothing.

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