Steve Georganas (Hindmarsh, Australian Labor Party) Share this | Link to this | Hansard source

I appreciate the opportunity to continue what I was saying on Monday night about aged care and the importance of the Aged Care Amendment (Residential Care) Bill 2007 to my electorate. On Monday night we talked about the availability of community care packages and the availability of aged-care beds. I gave examples of some of the constituents within the electorate of Hindmarsh who come and see me regularly. We know that the availability of community care packages is questionable at the time people seek them. For example, one of my constituents—a woman aged 99 years who is a few months off her 100th birthday—was quite well and able to look after herself. She contracted a slight illness and had to go into hospital. She was of sound mind and a bit frail but was happy to look after herself in her own home and be in her own community. We tried to get her a community care package, but we could not find anything at the time she needed it—which was when she was due to come out of hospital. There is a waiting list. People do not get the services they require. This woman’s option was to remain in a public hospital bed and stay there, keeping her fingers crossed that something would come up so that she could leave hospital and spend the rest of her life, her twilight years, in dignity at home. The waiting list is so long that the options are not good for her to receive assistance on returning home.

This is the story of a woman aged 99 years, months off her 100th birthday. She has done voluntary work in the electorate for many years. She has worked all her life, paid all her taxes and gone through world wars. This is the way we treat her and other elderly people. It is a sad story of a very proud woman—as I said, she is of sound mind but unfortunately has a frail body—living out her last months in a public hospital bed. She is not alone. I regularly hear of other cases within my electorate of people trying to find aged-care accommodation or care. Every time we talk about aged-care beds the government is quick to say that we want people to stay in their community—and rightly so; we all want people to stay in their community, amongst their loved ones and in a setting that they are familiar with—but there are not enough packages for those people who make the choice to stay home. It is obvious that many public hospital beds are being taken up by people who should not be there. Either they should be in an aged-care facility or they should be receiving some form of aged-care package to assist them at home.

What faith can the community have when, according to the Productivity Commission, the time people wait to access a bed in aged care has doubled in the period from 2000 to 2005? What faith can the community have in this administration reaching its target when, in six months, the shortfall has ballooned out by as much as 10 per cent? That was in my electorate of Hindmarsh. How can any concerned observer or future service recipient have any faith in a government or take any comfort from its record of turning a national surplus of 800 aged-care beds in 1996 into a 4,613 shortfall by June 2006? With the ageing of the population and the increasing levels of frailty that go along with ageing, when someone needs a bed or an aged-care package they need it straightaway, not in a month or three months or six months or 12 months. The likelihood of those people getting packages straightaway is very slim. As I said, we hear of these cases every day. I am sure many other members of the House would see examples of what I see in my electorate.

The objectives of this legislation look to facilitate the independence of, and choice available to, those recipients and carers. The treatment of our elderly is not such that it can be classed as respecting independence. The example of my constituent who chose to stay at home but was unable to do so because the waiting list for the package was far too long is a prime example of this. My constituents face constant difficulties in getting into residential care within their community or getting into places which are close to relatives or the community in which they have lived for decades. If they need to be looked after in an aged-care facility because they need support, they cannot get an aged-care bed in the western suburbs or the south-western suburbs of Adelaide. It is impossible to do so. Some homes have a list of 300 people waiting to get in. There may be beds available 100 kilometres away, but these people want to remain in their communities. Sometimes they have only one remaining relative—it could be a daughter, a son or a sister—and they want to remain close to them. Those people themselves are ageing and find it difficult to travel to visit relatives. So what happens? We put them 80 kilometres, 40 kilometres or 50 kilometres away and they become isolated. They have no contact with their remaining family and, therefore, their condition deteriorates. We need to facilitate independence. The only real way of doing this is to give them the care that they need within their communities, whether it be an aged-care bed in the community where their loved ones live or a care package in their home. This will give them independence. This will give them sound mind and good health.

The residents of Hindmarsh and all Australians in their golden years deserve much better support from the government. They should not be made to wait extended periods for the urgent care they need. This care is not something that can wait; they need care immediately. We should be able to put the packages in place to assist people to find the accommodation they require in their community, if they have high needs. I believe we owe it to our senior Australians to do all we can, as legislators, to assist them to enjoy their later life in satisfactory surroundings, with appropriate support.

We are constantly seeing the effects of this government’s policies on ageing constituents and their families—the grief on their faces when they come to see me. As recently as Friday I had a call from a constituent about their mother-in-law, who was in the Queen Elizabeth Hospital because there was no option of respite care or an aged-care facility.

People make much of the baby boomer generation, whose retirement is rapidly approaching in the near future. The problem is going to be exaggerated. Governments need to grapple with this issue. Elderly and frail people look to the future with approaching dread, but also with something akin to a sense of inevitability, especially concerning failing financial security. This government should do something— (Time expired)

Gary Hardgrave (Moreton, Liberal Party) Share this | Link to this | Hansard source

I am very pleased to speak on the Aged Care Amendment (Residential Care) Bill 2007. Should the day ever come when a doctor decides that I have lost the physical or mental capacity to look after myself and that I should be in a nursing home—people go to nursing homes when a doctor decides. It is not a choice; it is not as the member for Hindmarsh and others in the Labor opposition would suppose—that when people reach a benchmark age they are automatically institutionalised. It is not the case that families can suddenly decide that mum or dad should now be parked somewhere else. I forecast to the House that in the future it will be the music of the Eagles, the Beatles and the Rolling Stones blaring out of that aged-care facility and no longer the music of Vera Lynn.

Talk about the baby boomers: I was born on 5 January 1960—if you want to send me a card, Parliamentary Secretary to the Prime Minister and member for Casey. I make the point that facilities for the aged are provided by the taxpayer, subsidising hundreds of dollars per patient per bed per day, deliberately for when a person reaches a point not of their choosing but of their mental or physical incapacity to look after themselves. That point is constantly forgotten in presentations from those opposite.

I despair when I hear this whole victim analogy, which I have heard yet again this morning. I heard it from the member for Reid the other day and I heard it from the poor old member for Hindmarsh, who basically is saying to anyone over a certain age, ‘You’re going to be up the creek without a bed because that’s just the way life is.’ I do not know what is going wrong in their part of the world, but in my electorate of Moreton in the last 10 years the number of aged-care beds available has tripled. I like to think I have done something special about advocating for that.

When we came to office, we inherited a problem where Queensland was way below the national benchmarks and we as a government have done something about it. One particular set of aged-care packages was basically frozen in the hands of one organisation and the Labor Party did nothing about it—dozens of beds were not being put to use. Forget the fact that state governments are in charge of licensing the facilities; forget the fact that state governments and local councils are responsible for the planning permission needed to build buildings. This organisation had done nothing about fulfilling their obligation to the Commonwealth, and the Labor Party did nothing about it. So we took from them the right to have those beds and we redistributed those beds to other people. We now have a variety of very innovative places as well as a long-term traditional service to our local frail and aged community. You do not just have to be aged to be in these sorts of places.

I also remember a statistic from the great debates we had where those opposite fought us tooth and nail over the question of a financial contribution from people with a capacity to make one towards the physical environment of their nursing home. The people opposite fought us all the way. They ran this lousy argument everywhere that it was suddenly the right of every person to demand of government that absolutely everything about their aged care had to be taken from the Australian taxpayer when they reached a certain age, forgetting that people with a capacity to make a contribution can, and do, do so. They fought us tooth and nail when we said that the maximum stay in a nursing home should be up to five years and that during that period each nursing home would demand a contribution towards the general upkeep and maintenance of what were, when we came to office, facilities falling down about us. They fought us every last inch on that.

The people of Australia rightly routed the Labor campaign against this kind of family involvement and personal contribution towards the maintenance of aged-care facilities. So when they come in here and argue about the lamentable circumstances of individual Australians, such as the member for Hindmarsh talking about this poor woman of 99 years of age who could not find care when she needed it—which I am awfully sad about, I abhor and am shocked to hear—I can also tell you plenty of stories about the way the aged-care sector has met its responsibilities far better than it did years ago. Had we followed Labor’s pre-1996 practice, much worse circumstances would exist in Australia. Had we followed Labor’s practice, we would not have the requirement on accreditation that we now have where providers, to date and over the years ahead, are going to have to further improve what they do and what they provide.

I want to pay tribute to the staff involved in aged-care services throughout my electorate. I have spoken to nurses and other caregivers, and my great fear in looking at these equations is that they are the last people to be properly resourced. The patient-caregiver equation should be the first place that you resource, just as teacher-student equations should be the first place you place your education funding. If it were not for the very special character of nurses and caregivers in aged-care facilities, so much of what we come to rely upon would not occur. As I have said before, they do not get paid enough for the dedication they bring to their job, and I do not think that they are appreciated by the aged-care system—not the sector, but the system—in the way it organises itself. I worry when people have wood lined offices and flash cars ahead of paying good rates to the caregivers that we as family rely upon in our aged-care centres.

Without wanting to name them all, but not wanting to miss any either, the variety of aged-care centres in my electorate is enormous. The resident classification scale, which we are aiming to replace with a new aged-care funding instrument, relies on these aged-care professionals to be good at filling out paperwork and to be good caregivers. We put a lot of pressure on the nurses and caregivers and I would like to pay tribute to them. I do so in no particular order. I know that TriCare Annerley and the Church of Christ Hillcrest Centre at Annerley have served our community for an enormous amount of time. I have met so many people there over the years, including, unfortunately, people who have since passed away whilst in care. The facilities at those places have been in service for a long time. My grandparents—Perce and Rita Hardgrave of Sunnybank Hills, who are sadly long gone—stayed at the Carramar centre at Hellawell Road, Sunnybank Hills while waiting to be placed in other centres. That service is provided by the Uniting Church. My grandfather passed away at the Cazna Gardens centre, which is provided by RSL Care.

Interstate members would be wise to look at the work that the Queensland RSL has pioneered in aged care through their war service homes, which particularly target veterans. The RSL Care people have provided exemplary service and a great standard of care. To the nurses and caregivers there I say thank you for what you do and repeat publicly my thanks for what you did for my own family. RSL Care, to their great credit, also work with a new group of people—the Chinese and Buddhist communities, the Buddha’s Light International Association as well as others in Queensland. Whilst it is just outside of my electorate—I think you will find it in my good friend the member for Forde’s seat—the Jeta Gardens complex is now making itself available with high care, low care and residential facilities for people who want to retire, if you like, in the Buddhist and Chinese traditions. That could be an attractive thing—the Beatles wafting out of that environment might be something that I could be happy about in 50 years time. It is that sort of innovation that this government has presided over and encouraged from community and private organisations—to target the diversity of groups in our community. I am surprised when I see the member for Reid saying, as he did the other day, that these other communities cannot get access to care when I know that what is happening in my electorate is that there is innovation and support coming from the government.

Likewise, the Russian Orthodox community has had a long tradition of aged care. Serge Voloschenko and others involved with the Pine Lodge facilities at Rocklea have been there so long—since the late Sir James Killen opened the facility in about 1969. In fact I think his name is also on the opening block for the renovations after about 15 feet of water went through it during the 1974 floods. And they are expanding their facilities further. If you go there you will hear the Russian language spoken and you will see lots of very good parties and lots of active good fun taking place. But there is also a serious amount of care being given, and they are responding in every possible way to the demands placed upon them by this government to improve the care they give.

Likewise, the Sisters of St Paul de Chartres—who are in the member for Rankin’s electorate—are a very ancient Catholic order that started their work in Hong Kong 311 years ago, and they have been providing support to many Chinese people. My grandmother, Rita, stayed there for a little while many years ago. Beth Eden at Graceville and the Salvation Army at Warrina Village, Chelmer are inspired by their sense of service and by the churches and religious organisations that they represent. All these facilities are providing care, including Bethany Care in more recent times—the most recent of three new aged-care facilities that I have seen in my electorate in the last few years. Minister Bronwyn Bishop opened the White House, and I like the synergy of having the member for Mackellar opening the White House at Warrigal Road, Eight Mile Plains. Minister Andrews opened the Regis facility at Salisbury in Lillian Avenue, where local people are now able to age in a place close to where they have always lived. That is a facility that was not there until we came to government. Regis had the confidence to do that. Former Minister Santoro opened the Bethany facility at Underwood Road, Kuraby. Each of these new facilities is providing benchmark services for the future and for the long term.

Unlike Labor’s pro-institutionalised approach, which seems to suggest that you reach a certain age and then this is where you have to go, we are providing a range of options for people as they age. The concept of ageing in place, which those opposite have continued to criticise through their contributions today, has been an important part of the element of dignity that we have reintroduced into aged care in the past 10 or 11 years. Work is done through the Home and Community Care program, which is 60 per cent funded by the Commonwealth but 100 per cent claimed by state governments—except that when the Labor Party want to complain that they cannot get enough HACC funding in their area then they blame us completely. The contradiction of state governments claiming HACC is all theirs—we fund 60 per cent and yet Labor is saying it is all our fault—is just breathtaking.

The Home and Community Care program needs to constantly test itself, as some on the other side have suggested, with regard to flexible delivery. It needs to make sure that those who are involved in providing ageing in place have the language and cultural skills necessary to meet everybody’s needs. So why would I be anything but delighted when I see the fantastic people from the Islamic Women’s Association of Queensland providing respite care, providing home and community care programs funded by us. This is not about them being funded to just look after Muslims, because the exciting news is that the first person into the respite care centre they operate at Calum Road in Sunnybank Hills was in fact a Jewish woman. It is just like the Country Women’s Association, just like various women’s groups in all sorts of good organisations that have been in our community for generations. The Islamic Women’s Association of Queensland are putting their hand up and saying, ‘We’re motivated by our belief. We’re motivated by our culture and our care. We’re motivated because we are women. The government is backing us and we are doing our work.’ I say well done to them.

The Aged Care Amendment (Residential Care) Bill is about simplifying and streamlining further the already impressive set of circumstances that we now have in aged care in Australia. It is about reducing the number of funding levels for basic care. It is about introducing two new payments: one for residents with complex health and nursing needs, including palliative care; and one for residents who have mental or behavioural conditions including dementia. It has come as a result of former Minister for Ageing Andrews’ response to industry concerns back in 2002. It has taken time because it has needed full consultation.

The aged-care funding instrument which is now going to be used was tested through 2005, and just under a quarter of all residential services around Australia participated. The trial results were very positive and indicated that there were major time-saving benefits for staff, a greater level of agreement between aged-care providers and external checkers, and that on average assessors took less than an hour to complete the ACFI approval process.

The government have said, ‘We’re listening; we understand the importance of backing the patient-caregiver equation, understand the diversity of the range of work that is before them, understand the dedication that nurses and caregivers want to bring to the equation and recognise that one of the real pains in their posteriors is the paperwork associated with all of this.’ The government are responding to these sentiments, which I have expressed in my contribution today. No-one from the other side is complaining about it, and we are very pleased about that.

We are very determined as a government to continue to be innovative. As the Treasurer’s Intergenerational report of five years ago states very clearly, the ageing of Australia’s population is going to bring real costs to Australia unless we invest in this area. The Treasurer’s Intergenerational report highlights the statistics which underpin the need for us to get this right. It is a simple fact that Australia is a nation built on migrants. Australia’s population is now reaching the stage where, in the decades to come, its only growth will be because of migrants. We do indeed need to recognise—and on this I guess I share a platform with the member for Reid but I will express it differently—the cultural and linguistic diversity of our community and make sure that there is the agility and flexibility in our aged-care sector to properly respond to it.

I am sure that the House would agree with the issues that I have raised and the examples I have given from the electorate of Moreton, the most culturally diverse electorate in Queensland. Work is being done on the ground today right throughout my electorate.

One in four Australians was born in another place—that is the figure for Australia’s population today. Almost one in four—certainly one in five—has at least one parent who was born in another place. That means that there is a very real issue in making sure that the system demands standards, as well as flexibility and agility, when it comes to dealing with our linguistically diverse people. No matter the English skills they may have achieved after they came to Australia, the reality is that one of the signs of a dementia patient is that they may take on the tendencies they had as a child. One of the things they may do is revert to the language that they had as a child—they will forget the language that they learned as an adult. You may well see the circumstance where, after 50 years in Australia, someone is suddenly back to speaking Greek, Macedonian, Italian, Polish, German or indeed maybe Gaelic or something exciting like that. The member for Gorton, who is in the chamber, would appreciate that, being an O’Connor.

It is important that we do not then do as the Labor Party often seems to suggest and ‘over-ethno’ our response. What we have to do is demand that our aged-care providers see them not as suddenly now separate but as different strands in the same fabric, and have on their staff people with the language and cultural skills that will fit the particular background that a patient might have. You do not necessarily need to have a Polish aged-care facility or a Dutch, German, Italian or Greek one. It is terrific if you have one; I have a Russian facility and a few others that are doing things. What is important is that you make your facilities available to everyone but that you also have staff with those skills on board—not just the caregiving skills but also the language and cultural skills. That is going to be part of the challenge of the years ahead.

I believe that the framework that we are amending today will make it more possible for the caregivers to focus on those kinds of quality assurance issues to make sure that, when a patient’s doctor has decided they have reached a physical or mental circumstance that means they require care in a care facility, that care is there for them. I commend the bill to the House.

Brendan O'Connor (Gorton, Australian Labor Party, Shadow Parliamentary Secretary for Industrial Relations) Share this | Link to this | Hansard source

I rise to support the amendments to be proposed by the shadow minister for ageing, disabilities and carers to the Aged Care Amendment (Residential Care) Bill 2007. I would like to associate myself with some of the comments made by the member for Hindmarsh. I saw at close quarters how important the aged-care issue is to him: when he was a candidate, prior to the last election, he was very involved in discussing concerns with residents, staff and operators of aged-care centres in his electorate. Following his election, after his third effort, he has shown that he has not forgotten those concerns and is continuing to raise those matters now that he is the member for Hindmarsh.

I indicate to the House that the Labor Party supports in principle the thrust of the bill, but a number of amendments could be made that would improve the policy if the bill were to be enacted. The Senate Standing Committee on Community Affairs, having considered the matter on 7 May this year, made a number of recommendations to the parliament which I believe the government should consider adopting. Some or all of those recommendations were incorporated into the amendments proposed by the shadow minister.

We would argue that the bill would be improved if it were amended to omit item 27, repealing subsection 42-1 of the Aged Care Act 1007, and that the Department of Health and Ageing should monitor the use of this subsection by aged-care facilities to ensure that it is used appropriately. That is why we propose to move to reinstate the term ‘high dependency care leave’. There is a concern that the repeal of that provision would provide problems for a small but important number of applicants. Indeed, the department’s own evidence suggested that some applications, upon review, may have been inappropriate. It would be more useful for the government to accede to the amendment and incorporate that into the bill.

The bill should also be amended to ensure that determinations made by the minister under items 28, 29 and 31 are reasonable and that a safeguard similar to that in section 44-4, which item 32 repeals, be implemented under the new ACFI to determine a minimum lower basic subsidy level.

In the move from the residential classification scale to the ACFI, the provision to downgrade the basic subsidy level by two levels cannot be transferred due to the changed funding methodology. The bill proposes that the minister can determine the lower basic subsidy when a resident is receiving extended care in hospital. The residential aged-care sector is nervous that the determination could result in a significant loss of funds. Labor therefore propose an amendment that requires the minister to determine a reasonable level of reduced subsidy.

The Senate community affairs committee recommended that a review of the new aged-care funding instrument—that is, the ACFI—be undertaken 18 months after implementation to assess the implications for all aged-care service providers and ensure that the stated benefits are achieved. Such an amendment would provide for a formal review within 18 months of implementation.

The amendments proposed by the shadow minister would improve the quality of the bill, the policy of the government of the day and the way in which matters are implemented in residential care across the country. We do not see any reason why the government would refute those assertions or not accept the proposed amendments.

We say the bill is deficient; we would no doubt support it if the amendments were lost, but we are looking to find improvements in an area of public policy that has been ignored by this government for 11 years. The fact is that residential aged care has been neglected by this government for 11 years. It is an area that has not been well attended to by the government. Indeed, I think the government assumes that it receives a high degree of support amongst older Australians, and that assumption has led to its negligence of and contempt for older Australians in the main.

That is exemplified by the government’s approach to residential aged care—and, indeed, aged care in general. Before I was elected to the parliament, I was involved in the area of home and community care. It is certainly an area that needs continued real funding increases because of the demographics of this country. The member for Moreton was correct when he said we will have to rely increasingly upon immigration intakes to sustain a productive society. Our population is in decline and the ratio of producers to those who have already put their shoulder to the wheel for this country is reducing. There are fewer people in work now—as opposed to those not involved in either paid or unpaid productive work—than was the case only 20 years ago. So this has happened quite rapidly, Mr Deputy Speaker Quick, as you would concede. Indeed, that shift is now occurring more rapidly. So I accept the view that we will have to rely more upon immigration.

Indeed, this government, despite some of the dog-whistle comments it makes to the community, has a very high immigration intake. It is a trend which has been consistent since the time of recent Labor governments, which had relatively high immigration intakes. The immigration intake by this government has been very high—which is not always understood by the community—despite some of the pronouncements made by members opposite, including ministers.

As I said, it is clear that, because the government has assumed it has high levels of support from older Australians, it has neglected to attend to their concerns. This is one area in which there have been signs of neglect and failure. That is exemplified by the high level of change in the aged-care ministerial portfolio area.

I do not know how many ministers we have had in the last six years presiding over the portfolio of ageing, but it is a very high number. We do recall that one minister, still in this place but no longer a minister, presided over the kerosene bath scandal. Only last year there was an awful sexual abuse scandal, which I do not think was properly considered by the government, and the government has to take some responsibility in relation to that matter. Subsequent to that, we had a minister who had to resign because of a conflict of interest between his responsibilities as a minister and his share portfolio: he was investing in areas in which he was making ministerial decisions. Now we have a minister who, though he may say he has been misrepresented, certainly gave every indication that he is not particularly happy with his Ageing portfolio. He says it is because he is not old enough, or something like that—or he does not act old enough.

The matters I have just raised, the performance of Ageing ministers and the scandals in the sector, are indications of a government that really does treat older Australians with contempt or, at the very least, acts in a negligent manner in relation to the residential care sector and other areas that impact upon older Australians.

It is true to say, as the member for Moreton indicated, that it is not just about older Australians. It is also about people who are infirm and people who are disabled and require constant care but should not be taking up hospital beds. It is not good for them and indeed it is not economically sound. I think there has to be a better way. I do not think the government has really attended to that. I do believe that the Hogan report has sought to improve the way in which the aged-care residential sector operates—and I can go to some of the comments in that report which were picked up by the government and incorporated into this bill.

This bill is as much about the new funding model, which draws partly on the work undertaken by the resident classification scale review in 2002-03, as it is about projects arising from that review, such as the reduced RCS questions project. The new system will have fewer basic funding categories than the current scale and will include two new supplements. The new supplements are intended to better target available funding towards the highest care needs—in particular, residents with dementia and challenging behaviours, and residents who have complex health and care needs, including palliative care. The new supplements are to be implemented from within the basic subsidy funding which is currently allocated by the RCS.

Following the 2004 budget, the department commissioned Applied Aged Care Solutions to undertake a major study to identify and analyse structural options for the new funding model. The consultancy tested options for their impact upon the industry at service provider and state-territory level, and by rural and remote status. The study was completed at the end of 2004. In the following year, the ACFI was tested by those consultants in an Australia-wide national trial. All government funded aged-care facilities were invited to participate, and 678 homes participated in the data collection phase which concluded at the end of October 2005. The ACFI appraisals were conducted on aged-care residents and prospective residents by staff from aged-care assessment teams, nominated clinical staff from aged-care homes and Department of Health and Ageing RCS review officers. In New South Wales and Victoria, there was a small pilot of community and employment agency nurses also undertaking appraisals.

Those matters have been addressed in this bill. The amendments that we seek will, I think, improve the legislation if enacted.

The resident classification scale is effectively the basic tool used to fund residential aged care. How aged-care residents are classified is important because the amount of basic Commonwealth subsidy paid to residential care providers depends on the classification that residents are given. The scale goes from $22.27 per day, the lowest, to $122.77; so, clearly, it is a means-tested scale. The average subsidy paid to approved providers per utilised aged-care place in 2006 was $34,000. We do not have any problems with that scale. We certainly do not have any problems with seeking to reduce the number of classifications, subject to our proposed amendments being accepted by the government.

For as long as I can remember—probably since early in the first term of the Howard government but certainly for many years—Labor have been raising concerns that aged-care centres had about the amount of paperwork they had to undertake. There is a tension between, on the one hand, ensuring that aged-care operators provide sufficient information so we can monitor their performance and accountability in the sector and, on the other, congesting the administrative workload of operators so that they are focusing on paper rather than on the residents in their centres.

There have been some efforts to reduce the paperwork. We support any efforts to reduce unnecessary administrative work if it means staff can provide more care directly to residents in the homes. That would be far easier for the staff, who in the main do a magnificent job across the country in what I think is one of the hardest and least recognised jobs in this country. The fact is we are hoping to continue to attract people to look after our elderly, our infirm and, often, our disabled in residential care. If you were to look at these people’s employment conditions, compared to those of others with comparable skills but fewer responsibilities and higher pay, you would have to say that many of the staff do it because of a commitment to looking after people who desperately need care. We do not see that in every workplace. We certainly see that commitment by staff in the residential aged-care area, given that they know they can make more money in other areas while probably putting themselves through less stress and working fewer hours—but they do it.

Every time I visit a residential care home, I am amazed by the constant commitment to the residents. We know that the funding levels are not very high in terms of ensuring that the staff of such centres receive decent employment conditions. That has to be addressed in a fundamental way at some point. I am not suggesting it is an easy thing to address in any immediate sense, but there is a real need to review the way in which staff in aged-care centres are treated. We are going to lose too many good people if we do not ensure that they are properly remunerated. We must not rely upon their sense of responsibility for the care of residents. Instead, we must treat them like any other worker and pay them what they are worth—and currently they are not in receipt of that. I think child care is in a similar vein: people who have enormous responsibility and a significant array of skills are not properly remunerated for the work they undertake. That has to be addressed by both sides of politics in a bipartisan way very soon, otherwise we are going to have difficulty keeping the people that continue to work in centres and cope with the difficulties on a day-to-day basis.

I return to the issue of removing unnecessary administrative work. Of course we need to ensure that there is accountability, but staff in aged-care centres are asked to do some things that are not necessary. We have to weed out those unnecessary matters and ensure that the staff are able to focus on looking after the residents who need the care and daily attention of the hardworking staff.

Luke Hartsuyker (Cowper, National Party) Share this | Link to this | Hansard source

I welcome the opportunity to speak before the House today on the Aged Care Amendment (Residential Care) Bill 2007. This legislative amendment is a further example of the coalition government’s commitment to aged care and improving the standard of service delivery across the nation. This particular amendment will streamline the amount of paperwork required and allow aged-care providers to concentrate on the delivery of services to older Australians.

The debate on this legislation provides an opportunity to reflect on the substantial investment in aged care over the past decade and to detail the coalition’s commitment to the sector in the future. The Minister for Ageing, Mr Pyne, has released further details of the coalition’s $1.5 billion Securing the Future of Aged Care for Australians reform package, which was previously announced by the Prime Minister. The minister’s announcement highlights what can be delivered in such a vital sector as aged care when you have strong economic management and the commitment to invest in the future.

But before I elaborate on the minister’s announcement, I would like to note the importance of this legislation and of the aged-care sector in general to my electorate of Cowper. As members would be aware, the electorate of Cowper is located on the North Coast of New South Wales, a region which is very popular with retirees. In Cowper alone, the percentage of people who are aged over 65 is almost double the New South Wales average. Such a statistic reflects the increasing number of people who are relocating from major metropolitan centres and seeking a lifestyle and retirement in what I class as the most beautiful part of the country.

Of course, the seachange phenomenon is not something that has just happened overnight. For years Australians have been migrating to coastal areas to enjoy their retirement. However, in regions such as the Cowper electorate the real difference over the past 10 to 15 years has been the volume of people who have been moving to the coast from the cities or our western country areas. This demographic’s migration has naturally led to an increase in the demand for aged-care services.

This is where the coalition government sets itself apart from members on the other side of the chamber. In 1996, when the coalition was elected, recurrent aged-care spending in my electorate was just $13½ million per annum. Local aged-care facilities were struggling to find the beds to meet the need and the demand for their services. There were virtually no community aged-care packages which provided elderly people with the choice of remaining in their own home. Similarly, there were no Extended Aged Care at Home—EACH—packages. Aged care, under the 13 years of Labor, had been put on the backburner and many older Australians struggled to access appropriate aged care in their retiring years. This is an important point, because the legislation which is before the House today is an extension of the coalition government’s commitment to providing peace of mind for older Australians as well as excellent quality care.

I am delighted to say that the problems which resulted from Labor’s neglect and lack of compassion for the aged-care sector are well on the way to being addressed. If members on the other side of the House would like evidence of this fact then I invite them to visit my electorate, where I will guide them through some of the great achievements which have been delivered in aged care as a result of the coalition government working closely with the aged-care sector. Given that we inherited from the Labor Party an aged-care sector in the Cowper electorate which, as I said, only attracted $13½ million per annum in funding, I am delighted to say that in the 11 years that the coalition has been in power we have increased that commitment to $53 million per annum. That is almost a 400 per cent increase. It includes the funding which will come online once the 2006 round of aged-care places is operational.

The additional investment which the coalition has made to aged care is evident right across our region. For example, in Yamba we have seen the Caroona Hostel and aged-care facility expanded to cope with the increased allocation of beds. A million-dollar extension was recently completed, with a further $5 million expansion announced after the allocation of additional places last year. In Maclean, the Mareeba Nursing Home is also planning extensions and the Clarence Valley Council is providing an unprecedented number of aged-care services in the homes of local residents.

This expansion has been mirrored in Coffs Harbour. Since I was privileged to be elected to the parliament in 2001, extensions have been completed at the Woolgoolga retirement facility, Bellingen’s Bellorana and the Coffs Harbour Nursing Home. We have also seen new facilities opened by Churches of Christ and the Masons, plus the expansion of aged-care services in the home—where Mid North Coast Community Care Options is doing a fine job. A new aged-care facility is also proposed for construction near Urunga. In Nambucca the good news also continues. Plans are now well advanced to construct a $6.5 million facility at Nambucca Heads following the announcement of 60 low-care beds in that town. This follows the completion last year of Riverside Gardens aged-care centre, also at Nambucca Heads.

In February last year I highlighted to the House that, whilst the Cowper electorate had received a substantial increase in aged-care places, there still remained some areas where there was a need to be targeted. Without doubt, the most pressing need was in the township of South West Rocks. As I highlighted at that time, South West Rocks has experienced huge growth over the past five to 10 years with many new residents, many of them retirees. Despite this growth, the town still did not have an aged-care facility. South West Rocks is approximately 30 minutes drive from the nearest aged-care facility in Kempsey, and this places great strain on the spouses of those aged-care residents. With little public transport available, many elderly residents found it difficult to visit their partners on a daily basis.

I was very disappointed when an application to establish a facility at South West Rocks was unsuccessful in 2005. However, 12 months later, I was delighted to be able to inform the community that we were successful in gaining much-needed beds which would provide for a facility at South West Rocks. More than $2.1 million in annual funding has been committed to the South West Rocks facility, which will be operated by Profke Holdings, and an initial allocation of some 40 high-care and 20 low-care places has been committed, with Profke Holdings proposing to construct a facility on the current site of the South West Rocks Motel. Once completed, this facility will employ in the order of 60 people, so not only is it providing excellent aged care for the community but it is going to provide much-needed jobs as well.

The approval of aged-care places specifically for South West Rocks followed a coordinated campaign involving many people in the local community. With the community’s support, I lobbied very hard for the allocation of these places and I was delighted when this lobbying bore fruit and we were able to successfully receive those places. I would like to thank the local community and, in particular, the South West Rocks Aged Care Committee for their support. We were all disappointed with the unsuccessful round in 2005 but delighted with our success in the 2006 round.

Aged care is set to provide many employment opportunities in the Kempsey shire, with a proposed 130-bed facility to be constructed in Frederickton. Once complete, these two facilities together, in South West Rocks and Frederickton, will create up to 180 new jobs. Many more jobs will be created during the construction phase.

So a quick snapshot of the Cowper electorate highlights what aged-care achievements are being delivered on the ground in areas of need across Australia. However, despite this expansion the coalition government continues to recognise the challenges of providing for our ageing population. As all members of the House would remember, the Intergenerational report released by the Treasurer in 2002 estimated that by 2042 the number of Australians over the age of 65 will double, bringing into clear focus the need for quality aged-care services into the future. I was therefore delighted to see the Minister for Ageing release details of further investments in aged care over the next three years. The minister announced that more than 32,000 new places will be provided over the next three years to help meet the needs of older Australians seeking fair and affordable access to high-quality aged-care services.

Once operational, these places would be worth in the order of $1 billion a year in Australian government funding. The minister indicated that a total of 10,734 places would be made available for allocation in the 2007-08 round. This will be welcomed right across the nation, but it will be very welcome in areas such as my electorate of Cowper, which has quite an old demographic. The importance of this commitment was summarised in the minister’s press release. He said:

We have raised the bar. As part of this package, the Government’s planning benchmark has been increased from 108 to 113 places for every 1,000 people aged 70 years or over. The adjustment also increases the community care component of this from 20 to 25 places.

These increased ratios are very welcome. When you consider that the previous Labor government was never once able to meet its target of 100 places for every 1,000 people over the age of 70, it is clear that the coalition has delivered for older Australians.

I know the community care component will be welcomed by many seniors in the community who require aged care but choose to remain in their own homes. The provision of Community Aged Care Packages and Extended Aged Care at Home packages has been a key priority of the coalition government. When the coalition government was elected in 1996, there were just 4,441 CAC Packages nationwide. The latest figures available show that that number has grown to some 32,588—that is, a 634 per cent increase. It reflects two things: firstly, the commitment of this government to deliver in quality aged care at home and, secondly, the desire of many older Australians to receive care not in a formal setting but in their own home.

This legislation now before the House complements the additional aged-care places which have been delivered by the coalition over the past 11 years. The purpose of this bill is to amend the Aged Care Act 1997 to introduce a new arrangement for allocating subsidies in residential aged care. The bill proposes to replace the Resident Classification Scale, RCS, with the Aged Care Funding Instrument, ACFI, as a means of allocating a subsidy to providers of residential aged care.

It is proposed that the ACFI will reduce the number of funding levels in residential aged care and provide subsidies for the care of residents with complex health and nursing needs, including palliative care, and mental or behavioural conditions, such as dementia. The ACFI has been designed to reduce the amount of documentation and record-keeping which aged-care staff generate and maintain in order to justify the funding classification for each resident. I think it is a very important point that our aged-care professionals are able to concentrate on delivery of care rather than on paperwork.

The bill also changes the current arrangements in which classifications expire after 12 months. This extends the period during which a resident’s classification has effect and it removes the requirement for providers to submit unnecessary reappraisals but gives them the option to reappraise a resident after 12 months. Also, the bill streamlines the audit process so that single questions or specific groups of questions can be targeted by review officers rather than every aspect of the appraisal. The amendments allow an approved provider to choose to accept a resident’s current classification when a resident moves from one aged-care home to another rather than being required to submit a new appraisal. I endorse this amendment. I know that many aged-care providers will welcome the streamlining of processes which can sometimes distract staff from focusing, as I said, on what they do best: caring for residents.

As I have detailed today, the Cowper electorate is a major beneficiary of the commitment of the coalition government to improve aged-care services. The growth in the sector has been in evidence over the past five years and is set to continue. This bill will certainly serve to improve the quality of residential care delivered in Australia. It provides evidence of the commitment by the coalition government to improve aged-care services. I commend this legislation to the House.

Daryl Melham (Banks, Australian Labor Party) Share this | Link to this | Hansard source

I am pleased to take part in the debate today which focuses attention on a vital issue for our ageing population. The Aged Care Amendment (Residential Care) Bill 2007 proposes to amend the Aged Care Act 1997. Specifically, it proposes changes to the resident classification scale for those in residential aged care. This will be replaced with the Aged Care Funding Instrument. This is the actual means of allocating a subsidy to providers of residential aged care. Several other provisions were outlined by the Minister for Ageing in his second reading speech, in which he indicated:

The bill will introduce changes necessary to reduce the number of funding levels for basic care, as well as provide payments for residents with complex healthcare needs, including palliative care, and for residents who have mental or behavioural conditions, including dementia.

A funding model was established between the industry and the government, and a national trial was undertaken in 2005. All Australian government funded homes were invited to participate. Six hundred and seventy-eight homes chose to participate. Since then, some modification has been made to the model as a result of that trial. There is no doubt that this legislation, in a broad context, will prove positive for the industry.

Significant comment has been made about the amount of paperwork that staff, particularly nursing staff, are required to complete as part of the appraisal and reappraisal processes in aged-care facilities. The obvious benefit of this change is that it will release staff to complete the duties for which they were trained: caring for the elderly. In relation to that issue, the Australian Nursing Federation, in its submission to the Senate Standing Committee on Community Affairs inquiry into this bill, said:

The complexity of the RCS—

that is, the resident classification scale—

meant that registered nurses employed by aged care facilities spent more time documenting than providing care or supervising care provided by other less qualified staff.

The amendment bill provides fewer basic funding categories than the current system and will include two new supplements. These supplements are intended to better target funding towards the highest care areas, such as residents with dementia and complex care needs, including palliative care.

Currently the act requires that residential care classifications expire after 12 months and that providers submit reappraisals. Under the proposed changes incorporated in this bill, providers will have the option of reappraisal. Amendments will also allow a provider to accept a resident’s current classification when a resident moves from one facility to another rather than requiring them to submit a new appraisal. Finally, the bill will provide for the secretary of the department to stay a suspension of a provider where the provider has repeatedly failed to conduct appraisals or reappraisals in a proper manner. The suspension may be stayed if the provider meets specific obligations.

I commend the government on introducing this bill. The Labor Party has already indicated its intention to support it, subject to consideration of a number of recommendations in the Senate committee report tabled on 16 May this year. I have no need to remind the House of our ageing population—the Treasurer regularly does so. What the House must consider is how we as legislators are able to positively impact on this national issue. This legislation is one step in the right direction. Needless to say, it is only a first step. There is so much more to do.

In 1996 there were 92 residential care beds for every 1,000 people aged 70 years and over; today there are just 86. In 1996 there were 37,323 nurses working in residential aged care; in 2004 there were 33,794. This is despite the growing numbers of residents in aged-care facilities. Measure that against the fact that around 75 per cent of aged care is not provided by the government but by family and friends. I have spoken in previous debates of my concerns for those carers. With the changing demography of the Australian community, the number of carers will decrease, not increase. A report released on Friday, 15 June 2007 showed that the number of aged-care residents needing high-level care has jumped by almost 19 per cent. The report was released by the Australian Institute of Health and Welfare. The report revealed that 69 per cent of permanent residents required high levels of care in June 2006.

In the seat of Banks, there are 17 aged-care facilities. These range from traditional hostel style accommodation to the more up-market retirement villages. I am aware of the lack of high-level care facilities in my immediate area. Only recently, a gentleman came to my office seeking assistance for his wife, who is suffering from dementia. There were no appropriate facilities immediately available and the lady had to go onto a waiting list. During that period she was in hospital. The next available place was at Croydon, some 16 kilometres away. That is not the only example. Families have to accept places where they can get them. If a family member does not drive or public transport is not handy, there is considerable difficulty involved for family and friends to regularly visit. This, of course, adds to the guilt when the relative progresses to the stage where they need high-level care, particularly with illnesses such as dementia.

In the seat of Banks, I can say quite categorically that we need more high-level care places in our aged-care facilities. This is consistent with the information provided by Senator McLucas, the shadow minister for ageing, disabilities and carers. In her media release on 15 June 2007, she stated:

According to the Government’s own stocktake of aged care beds, in 11 years they have turned a surplus of 800 aged care beds in 1996 to a 2735 shortfall by December 2006.

In New South Wales alone there is a shortfall of 1,637 beds. Another area of concern is the lack of appropriately trained staff. As the population ages, this is only going to worsen. It is critical that we have adequate minimum staffing levels for aged-care facilities. We must ensure that wages and conditions are at a level such that we can recruit and retain nurses in an area that is struggling to keep them. This is in the interest of not only nurses and care workers but also providers—so they can attract and retain quality staff.

The Senate Community Affairs References Committee report Quality and equity in aged care, released in 2005, noted that delivery of quality care was under threat from the retreat of qualified nurses, both registered and enrolled nurses, from the aged-care sector. We must ensure that there are sufficient trained staff to service the needs of the ageing. Part of the reason for the lack of staff is the lack of attention given to skills training by this government. It is incumbent on this government to take appropriate steps to ensure that there is sufficient infrastructure for the training of aged-care nurses and other support staff. The service sector will continue to grow. We have a responsibility as a nation to equip ourselves for the future via some form of training for as many young Australians as we can, be it through a trade training opportunity or a university opportunity. A focus on training for people entering the aged-care sector is a win-win scenario.

This government must be serious about the provision of quality care for older Australians. The government must commit to seriously increasing the numbers of undergraduate nursing places and closing the wages gap between nurses working in aged care and those working in the public sector. The changes that this legislation proposes are significant in the impact they will have on how the industry operates. For that reason, it is important that the government considers taking steps to ensure that training in those changes occurs. The Australian Nursing Federation made the following recommendation in its submission to the Senate inquiry into this bill:

The ANF would like to see a commitment by the Australian Government and the Department of Health and Ageing to the provision of ongoing training in the ACFI. There is a high turnover of staff in residential aged care facilities and a high proportion of part time staff. The change from the RCS to the ACFI is a very big change, not just in assessment tools, but also in underpinning philosophy. It is anticipated by the ANF that a four year commitment to funded training in the ACFI will be essential for a smooth transition from one tool to another.

I note the minister tabled a policy paper with the second reading of this bill. The policy paper outlines associated changes to the Aged Care Principles 1997. It is important to the aged-care industry that detail is provided as soon as possible. These principles are critical to the function of aged-care providers. The impact these changes will have on the day-to-day operation of aged-care facilities is considerable. For that reason, and for certainty, the details are vitally important to providers. The classification principles will provide information about the level of funding that each classification level will attract. Providers need to be in a position to assess the impact of the changes on their operations. The explanatory memorandum makes it clear that there are no negative financial consequences in this bill for existing residents. On page 2 it is stated:

These costs will:

• ensure that the level of funding for an existing resident will not decrease when they are reassessed under the new Aged Care Funding Instrument;
• provide additional funding for the top levels of the two new supplements; and
• establish a panel of advisers to assist homes manage the transition to the ACFI.

I congratulate the government on its approach to the process involved in establishing this bill. The level of trial and of consultation does appear appropriate. I commend the bill to the House.

Stuart Henry (Hasluck, Liberal Party) Share this | Link to this | Hansard source

There is no doubt that one of the biggest and greatest challenges facing us is how we prepare for our ageing population. There is no doubt that our population is ageing. Mr Deputy Speaker, I am sure you share that with me. Baby boomers are reaching their early 60s. I am right there; I am a 1946er at the leading edge of the baby boom population. I have no fears about the future for aged care in this country. Since 1996, the policies of the Howard government have established a great foundation for the future development and care of ageing Australians.

As baby boomers reach their early 60s, we face a challenge to ensure that the largest demographic is properly catered for, not just by ensuring financial certainty with support in age pensions but through health care, aged accommodation and quality of life. Our population is ageing. We need to ensure that we can respond properly and promptly to the challenges that occur in the area of aged care. Last year there were over 312,000 Australians aged 85 and over. Over the next 20 years, the number of Australians aged 70 and over will grow 3.3 times faster than the growth of the total population. It is a very interesting statistic when we look at the needs of our aged. Our population of people aged 80 will double over the next 20 years and triple over the next 50 years.

However, as I mentioned, I feel very optimistic about the future of our ageing population. Importantly, the type of accommodation provided for them will be an essential part of that. The requirement for supported accommodation is a huge concern that needs to be addressed. According to the latest data on aged care in the Productivity Commission’s Report on government services 2007, there were, as at June 2006, a total of 163,468 residential aged-care places across Australia. At that time there were just under 3,000 residential services providing these places. The Commonwealth’s contribution to the funding of these residential aged-care places, including the funding for aged-care packages in 2005-06, was about $5 billion.

The Howard government for years has been working to ensure that older Australians have a secure future. In 1996, the Treasurer, the Hon. Peter Costello, released a white paper which highlighted the requirement for major structural reform within the aged-care sector to prepare to meet the challenges being posed by the ageing population. The Aged Care Act was passed by parliament in 1997. The act provided for the establishment of a single residential care program, the improvement of service standards and the improvement of building standards. Previous to the Aged Care Act, Australia had two distinct and separate residential aged-care programs: the hostel system and the nursing home system. That act merged these into a single residential care system and introduced the resident classification scale, or RSC, to provide a means for assessing resident care needs and allocating funding.

The 1997 act improved service standards through the introduction of the accreditation system and the formation of an independent Aged Care Standards and Accreditation Agency. The accreditation system is built around 44 outcomes across four standards: management systems, staffing and organisational development; health and personal care; resident lifestyle; and physical environment and safe systems. These accredited standards provide both government and consumers with confidence in the quality and standard of Commonwealth funded aged-care services. The act also provided for a certification system, which has seen a vast improvement in building standards. The certification system requires all buildings to be independently assessed against rigorous criteria, which include safety, security and resident privacy. From 2008, new space and privacy requirements will become part of the certification regime ensuring that residents can move from their family home to an aged-care facility without a loss in accommodation standards.

In May 2002, the Treasurer, the Hon. Peter Costello, released Australia’s first Intergenerational report, which identified emerging issues associated with an ageing population. As a response to that Intergenerational report, the 2002-03 budget allocated $7 million for a review of Australia’s residential aged-care system. This review, headed by Professor Warren Hogan, was asked to examine the current and alternative funding arrangements for residential aged care; examine the long-term financing options for residential aged care; recommend the appropriate future public and private funding arrangements, including appropriate future indexation arrangements for the industry; and examine performance improvement in the industry, including the appropriate use of performance indicators and long-term financing of the aged-care industry. The Hogan review was delivered to then Minister for Ageing, the Hon. Santo Santoro, in February 2004. It set out 15 recommendations for immediate change and five medium-term recommendations for a sustainable industry, and posed six options for further consideration.

The resident classification scale is a tool used to fund residential aged care. In his report, Hogan recommended that the number of resident classification scales be reduced. He stated:

... main disadvantages identified in the current funding delivery mechanism are the administrative burden inherent in the RCS and the adequacy of the current funding arrangements to approximately compensate for the care needs of particular groups of care recipients.

Key among the recommendations for immediate change were recommendations 5 and 6. Recommendation 5 dealt with basic subsidies and how they should be paid, recommending three levels—high care, medium care and low care—to replace the existing resident classification scales categories in the following way: (a) low care to consolidate current RCS levels 5 to 7, (b) medium care to replace RCS levels 3 and 4, and (c) high care to replace RCS levels 1 and 2.

Recommendation 6 dealt with arrangements through which supplements are paid. The Aged Care Funding Instrument, ACFI, gives effect to these recommendations. Aged-care residents’ classification is important because the amount of Commonwealth subsidy paid to residential providers depends on the classification level that residents are placed in. For example, a resident classified on the scale at level 7 receives a daily basic subsidy of $26.27, whilst those patients classified at level 1 receive a basic daily rate of $122.77. The average subsidy paid to approved providers per occupied aged-care place in 2005-06 was $34,000. That is an average of $34,000 per person in aged-care beds.

Amendments in this bill aim to replace the resident classification scale with a new Aged Care Funding Instrument. This new Aged Care Funding Instrument has been designed to target funding towards the care of residents with higher needs. At the same time, it is expected to reduce the amount of paperwork required for funding purposes. The amendments will vary provisions in the Aged Care Act 1997. The intention is to reduce the number of funding categories for basic care, introduce new payments to target residents with complex nursing or behavioural needs and reduce the administrative burden on aged-care staff. The details of these new funding arrangements and the manner in which specific levels of funding are calculated for residents with different care needs will be included in amendments to the Residential Care Subsidy Principles 1997 and the Classification Principles 1997.

In 2005, a national trial involving almost a quarter of all residential services was held. The results of this trial showed a large reduction in the time staff spent filling in forms. Less time filling in forms certainly means more time that staff can devote to residents and their care. Another important factor was the outcomes of these new resident agreements. The level of agreement between the providers’ assessments of residents and those of the external assessors was much greater. Assessors took less than an hour to complete an ACFI appraisal. Once classified, a resident’s classification expires after 12 months and aged-care providers are required to reappraise a resident’s care needs to obtain further funding. Over 60,000 of those annual reappraisals completed and submitted by providers resulted in no change in the amount of funding received by the approved providers.

This is a massive amount of paperwork being undertaken for nil effect. It is proposed that a standard ACFI classification will not expire. Instead providers will be given the option to reappraise a resident after 12 months. It is intended that the Classification Principles 1997 be amended so that residents who move into aged-care homes from hospital be reappraised after six months. This takes into consideration the likelihood that these particular residents’ level of care can change quite quickly. Each year, approximately 12,000 residents move from one aged-care home to another. Currently, when the resident moves, their classification for funding expires. It is proposed that, when a resident leaves one aged-care home to live in another, from commencement the new aged-care home may choose to accept the existing classification, rather than being required to submit a new classification application.

A provision of the Aged Care Act 1997 allows more than one aged-care home to be paid a subsidy for the same resident when the person is on what is commonly known as high-dependency care leave. Very few residents can qualify for this provision and it is now rarely used, following the changes introduced in 1997 to allow residents to ‘age in place’—that is, to move from low care to high care within the same home. It is proposed to repeal this provision. The ACFI Industry Reference Group supported the removal of this leave type due to its very low take-up rate—fewer than 50 residents were eligible last financial year.

If providers repeatedly fail to conduct appraisals or reappraisals in a proper manner, the Aged Care Act 1997 allows the secretary of the department to suspend an approved provider from appraising residents for funding purposes. It is proposed to allow the secretary to stay the suspension, subject to the provider meeting certain obligations, which may include appointing an adviser at the provider’s cost and/or providing training for its officers, employees or agents. The secretary will have greater flexibility to encourage providers to conduct appraisals and reappraisals properly to avoid a suspension coming into effect. The bill will also include an additional power for the secretary to require a provider to appraise or reappraise some or all of their residents.

In consultation with the industry, the ACFI has been designed to streamline accountability requirements and reduce the uncertainty that arises when departmental audits of residential classification scale classifications lead to a subsequent downgrading leading to a reduction in an aged-care home’s income.

Apart from the key initiatives dealing with recommendations 5 and 6, the government announced a number of new measures aimed at improving the aged-care industry. In May 2004 the government responded to the findings and recommendations of the Hogan review with the $2.2 billion Investing in Australia’s Aged Care: More Places, Better Care package. Investing in better care to enhance staff education and training provided funding to increase education and development opportunities for aged-care staff, including new university places, and strengthened financial accountability standards for providers. There was an increase in the number of funded places from 100 to 108 per 1,000 people over the age of 70 years—the first such increase since ratios were introduced back in 1985.

My electorate of Hasluck has benefited from the increased allocation of new aged-care places by the government. Aged-care operators in Hasluck who have recently received new allocations of aged-care places are now planning major aged-care infrastructure projects which will bring significant improvements to the level of aged-care services in the electorate as well as create new employment opportunities. I have been very pleased to represent the ageing community in the electorate of Hasluck on their aged care needs.

Improvements to capital funding arrangements include the one-off payment of $3,500 per bed to all residential care providers for the purposes of improving building standards and, in particular, fire safety standards. Funds were made available to providers to update or improve fire safety standards, including existing fire safety equipment, to meet state and local government regulatory requirements, to improve the level of staff fire safety training or to engage the services of professional fire safety consultants to advise on possible improvements. This measure cost over $513 million in Australian government funding.

It is important that people seeking placement in an aged-care facility have access to services and information on placements and their standard of care. Additional funding to improve the way older people access residential aged-care services, as well as new funding to improve the Aged Care Standards and Accreditation Agency’s ability to monitor the performance of aged-care providers and care standards, has been provided by the government.

In June 2005 my colleague the then Minister for Ageing, the Hon. Julie Bishop MP, announced that aged-care homes across Australia would receive an extra $1,000 per resident in a one-off payment to target specific issues and help ensure they remain sustainable in the long term. The Howard government provided $152 million for the one-off payment, which will help aged-care providers take advantage of new technology, improve their business practices and efficiency, and increase staff training, particularly in dementia care. In announcing the funding Minister Bishop said:

This funding will also enable aged care providers to improve their efficiency in management and administration. The Hogan Review identified the need for aged care providers to adopt more sophisticated and contemporary business practices to ensure the sector was on a sustainable footing for the future.

The funding enabled operators to invest in new information and communications technology to support their services. Within my own electorate of Hasluck I am aware of private sector providers who have used this funding, in partnership with major software and technology vendors, to commence a major new program of new systems development. This significant investment by those providers will ultimately lead to greater service and system efficiency, improved outcomes for residents and for staff, and the creation of new knowledge which will support the aged-care sector into the future.

The Aged Care Funding Instrument, ACFI, is part of the $1.5 billion Securing the Future of Aged Care for Australians package announced by the Prime Minister, the Hon. John Howard, in February this year. This package comprehensively addresses the remaining recommendations from the Hogan review and will see Australian government expenditure on aged care grow to an estimated $9.9 billion by 2010-11. This represents an increase of 219 per cent over the $3.1 billion in Commonwealth aged-care expenditure in 1995-96. That is a fantastic increase in anyone’s language, for a very important issue.

Preparation for the introduction of the new funding system has been a lengthy process involving a review of care assessment and clinical practices, the development and trialling of a number of assessment and funding options and extensive consultation with industry participants to ensure that the new system is a workable one which meets the objective of reducing the administrative burden on aged-care staff.

The Prime Minister noted in his press release in February this year:

A new Aged Care Funding Instrument (ACFI) will be introduced from 20 March 2008 that will, over time, see payments for those with the highest care needs rise from $123 per day currently to more than $160 per day in 2011.

The government has provided an additional $393.5 million over four years to assist homes in managing the change to the ACFI. This includes an additional $96 million for the new supplements on top of substantial existing funding for residents with complex care needs. The government wants to make sure that aged-care services are available and accessible to all Australians.

This is further evident in the additional funding of $42.6 million over five years to provide support to aged-care services that care for people in difficult circumstances. This funding will help make aged care more available to Indigenous communities, homeless people and people living in remote and very remote Australia by helping providers deliver care. Some $25.5 million will be provided over five years—as recommended by Professor Hogan—to enable the government to pay full subsidy rates to residential aged-care places that are no longer operated by state governments. Through these initiatives the Howard government is realising its vision for a world-class system of aged care that provides high-quality, affordable and accessible services to meet the individual needs and choices of older Australians.

Over the past 10 years the government has identified the areas that need addressing and has worked in consultation with aged-care providers to ensure that, as the needs arise, it is prepared to meet them. The Prime Minister, the Hon. John Howard, stated in February 2007:

It is imperative that we secure the future of aged care to ensure that older people continue to have access to high quality aged care in their own homes wherever possible, and also in high quality aged care homes when they choose.

It is clear that the future of aged care is in safe hands. Older Australians can be confident of receiving the best possible aged care now and into the future. I am very pleased to commend the bill to the House.

Kim Wilkie (Swan, Australian Labor Party) Share this | Link to this | Hansard source

I rise today to speak on the Aged Care Amendment (Residential Care) Bill 2007. The purpose of this bill is to amend the Aged Care Act 1997 to introduce a new subsidy-allocating arrangement for residential aged care called the Aged Care Funding Instrument, or the ACFI. The ACFI has been developed in response to recommendations made in the Hogan report of 2004 and is designed to establish a new funding model for the aged-care sector, in addition to reducing the amount of documentation required by the Commonwealth that is generated in aged-care facilities.

Reducing the amount of administrative paperwork for workers in the aged-care sector will come as a welcome relief, as the federal government’s aged-care reforms in 1997 greatly increased the regulatory burden on the industry. In making Commonwealth funding contingent upon the completion of excessive amounts of documentation, the government’s reforms are wasting the valuable time of registered nurses working in aged-care facilities. Of course, the government have been quite aware of the problem but, acting in their usual haste, have taken 10 long years to get around to doing something about it. I am sure that we all agree that nurses’ time is much better spent attending to the needs of their residents and patients instead of filling out forms X, Y and Z.

Providing care for our ageing population represents one of the growing challenges for Australia in the 21st century. According to the Australian Bureau of Statistics, over the next 50 years the proportion of people aged 65 years or more will double from 12 per cent to around 27 per cent, while the proportion of people aged 85 years or more will increase from 1.3 per cent to around five per cent. Ensuring that our ageing community has adequate access to the quality care that they deserve is of vital importance, yet under the Howard government it has simply not happened. In fact, the state of aged-care services in Australia under this government is a disgrace. Around the country, critical shortages in aged-care staff and beds have resulted in an estimated 2,000 older Australians being stranded in hospital wards waiting for a place to become available in a nursing home.

The story of a 90-year-old grandmother, Ann Duim, reported last week in the West Australian newspaper, is an example. Mrs Duim was admitted to Royal Perth Hospital about three weeks ago due to kidney problems. After being admitted, Mrs Duim and her family decided that she would no longer be capable of living in a house alone and that, upon being discharged, she would need to be moved into a nursing home. However, to their great surprise, when Mrs Duim was discharged from hospital earlier this week, they found there was not one nursing home bed available for her. So, at a cost of almost $1,600 a day, Mrs Duim will be forced to wait in Royal Perth Hospital until a nursing home bed finally becomes available for her somewhere in Perth.

Mrs Duim’s predicament is hardly unique. Around the country there are thousands of older Australians waiting in hospital wards for a nursing home bed to become available. Not only is it a disgraceful dereliction of care for our elderly citizens; it is also unduly costing Australian taxpayers hundreds of millions of dollars a year. The average cost of a hospital bed in Australia is $957 a night. That is roughly nine times the cost of an aged-care bed, so in a year the cost to the health system of leaving our elderly residents waiting in hospital beds is about $700 million. As a recent figure from the WA health department confirms, this government’s failure to adequately fund aged-care services is making it much more difficult for people in urgent need to get access to a hospital bed.

In my home state of Western Australia, last year, on average, 100 elderly residents a week were waiting in hospital beds for an aged-care bed. Not only did this cost Australian taxpayers around $24.9 million; it also used up 38,000 public hospital bed days. In its failure to provide the necessary funding for the aged care of our elderly residents, the government is also compromising the level of care in our public hospitals.

Mr Deputy Speaker Quick, you may think that this appalling example of the outright neglect of aged care by this government would serve as a bit of a wake-up reminder to the Minister for Ageing to get his house in order. But no—according to the minister, there is no problem of aged-care bed shortages. In fact, according to the minister, there is a glut of places available. I would like to see him come to Western Australia and find the glut; there is such a shortage in Western Australia that it is totally unacceptable.

I am sure that this must come as a shock to Mrs Duim as she sits there waiting in Royal Perth Hospital for a nursing home bed to finally become available. In fact, I am sure that the minister’s comments must come as a total surprise to the thousands of elderly Australians around the nation waiting for a nursing home bed. The truth is that in my home state of Western Australia alone there is a total shortfall of 497 nursing home beds. I do not know exactly where the minister is getting his information from, but let us take a look at what the peak bodies representing the aged-care industry have to say about the matter. I quote the Chief Executive of Aged and Community Services Australia:

But we are not happy with the quality of life that we are able to give people because of the continual squeeze on funding and we think governments should do better.

And what of aged-care nurses? What do they think about the current state of aged-care services here in Australia? To put it mildly, they are disgusted. Day in, day out, our nurses witness firsthand the appalling state that aged-care services are now in. According to the secretary of the Queensland Nurses Union, aged-care services require an extra $250 million a year in funding.

The minister can go on about the supposed glut in aged-care places, but I am sure that if the minister put down his copy of the Australian Journal of International Affairs for a minute—we all know that the minister does not want to be in the aged-care portfolio, because he thinks that he is too young for it and really thinks that he should be doing the foreign affairs job—and concentrated on his portfolio and listened to what aged-care workers and industry representatives have being trying to tell him, he would quickly come to realise the disgraceful state that aged-care services are now in. In 1995, there were 92 aged-care beds for every 1,000 people aged 70 years and over. By December last year, that figure had dropped to 86.6 beds for every 1,000 people aged 70 years and over. Considering the fact that we live in an ageing society in which there is nothing short of an army of future retirees marching towards aged-care services, this is a worrying trend indeed. If the government is failing the aged-care sector today, I can only imagine how bad things will be when people aged 65 years and over make up one full quarter of the Australian population in the year 2057.

Last month, I had the opportunity to attend an aged-care forum in my electorate of Swan to listen firsthand to some of the concerns from people working within the aged-care industry. As representatives from the peak council of Australia’s aged-care providers, the Aged Care Industry Council, told me, this government is failing our elderly community. They said that the Australian aged-care industry is in a state of crisis and that the government’s failure to make a serious and long-term commitment to fund aged care adequately was straining the system to the point of collapse. In addition to government funding not keeping pace with the costs of care, they also told me that aged-care providers are being continually asked to do more with less. The previous speaker talked about some of the additional funding that the government has made available to the aged-care sector. But, while the government say that they are putting in more money, the reality is that what they are additionally putting in is a fraction of what is actually needed to do something serious about the actual problems.

Staff are doing the best they possibly can with what limited resources they have, but it simply is not enough to provide the quality of aged care that residents expect and are in fact entitled to. Due to this government’s funding squeeze, the aged-care sector is now in the grips of a nursing crisis.

Joel Fitzgibbon (Hunter, Australian Labor Party, Shadow Minister for Defence) Share this | Link to this | Hansard source

They have plenty of money for political advertising.

Kim Wilkie (Swan, Australian Labor Party) Share this | Link to this | Hansard source

As has just been said by the shadow minister at the table, the reality is that the government are quite happy to spend $200 million on advertising to tell us how wonderful they are. What could happen in the aged-care industry if they put that $200 million into dealing with some of the problems that are being faced? It is high time that they woke up to the fact that there is a growing need. In many aged-care facilities around the nation, there are simply not enough staff to provide an adequate level of care. As a recent audit of aged-care facilities in Queensland found, nearly half failed to meet accreditation standards. In one facility, where there were 93 residents, over 50 of whom were classified as high care, there was not a single registered nurse on night duty. In other facilities, the ratio of care staff to patients is as much as one to 125.

We really need to ask why exactly we face this dire shortage in nursing staff, which so badly compromises the level of care in our aged-care facilities. If you want to get to the heart of the aged-care nursing crisis in this country, you do not really have to look much further than the government’s industrial relations policy. The sad truth of the matter is that under this government’s extreme industrial relations policies, it is precisely people like aged-care nurses who stand to lose the most. As research from the New South Wales Nurses Association has revealed, aged-care workers are much worse off under Australian workplace agreements. Like hundreds of thousands of other workers, many aged-care nurses in Australia have had to accept AWAs that slash their conditions and their pay. Work Choices: I do not think that the government is allowed to use that phrase anymore. Work what? Work Choices, the name that dare not be mentioned in this place by coalition members. For many aged-care nurses, the changes brought in under Work Choices translate into a loss of up to $150 in pay a week. With nurses working in other areas earning up to $20,000 per annum more than those in aged care, it is little wonder why nurses are leaving the industry en masse.

Yet, as a study conducted by the University of Melbourne last year found, the current predicament in which aged-care nurses now find themselves is not only hurting them financially; it is also causing emotional exhaustion. One interview respondent in the study explained:

I have worked in aged care nursing all of my nursing career of 27 years. We claim to care for our residents but everyday we go home feeling emotionally drained and wrecked because we are run off our feet and receive not much support ... we are not providing emotional support for residents or are able to care for them properly because we don’t have the time ... the health care system is chewing up nurses and residents alike.

Coming from someone who has worked in the aged-care industry for 27 years, that is a shocking indictment of the state of aged care in this country. The fact that these unfair and unbalanced laws are detrimentally affecting the ability of the aged-care industry to recruit and retain the staff levels necessary for a quality aged-care system does not seem to worry this arrogant government one little bit. This government is out of touch with the needs of our community. This government is out of touch with the standards of care that Australians expect for their elderly residents, and it has lost sight altogether of the political mainstream.

This government is a government of numbers. And we all know that you cannot translate quality care and compassion into numbers. This government does not care that our elderly residents are forced to sit in hospital wards for weeks at a time waiting for a nursing home bed to finally become available. It does not care that elderly residents of aged-care facilities are exposed to substandard levels of care. And it certainly does not care about a fair and equitable deal for aged-care nurses. No, like all true ideologues, this government cares only for its ideological agenda.

To ensure that elderly Australians like Mrs Duim receive the level of care that they are rightfully entitled to, there needs to be substantial funding planned for the future. The Labor Party supports these amendments to the Aged Care Act, but they will not fix the shortages in aged-care beds and they will do little to improve the quality of aged care. Only a Labor government can rescue the state of aged-care services in Australia and ensure that our elderly residents are treated with the care and respect they deserve. Senior Australians deserve better.

Kay Hull (Riverina, National Party) Share this | Link to this | Hansard source

It is a pleasure to rise to speak on aged-care issues, as I do on frequent occasions in this House. That is because I have an intense interest in the people who have contributed to this nation. My interest in the issue of aged care was really sparked when I came to this House and saw, over many years, the enormous run-down of services by the previous Labor government in relation to aged care and the need to constantly raise the issues of aged people in my community in order to escalate our plans to support, assist and rebuild those facilities which provide aged care.

Aged care is ever-evolving. When I came to this House, nine years ago, due to the previous Labor government there was an overlap of shortage of beds and there was limited choice in different styles of care. Some people are very able-bodied and are unable to consider going into an aged-care facility. But that was the choice: you either went into hostel care or you went into a high-care aged-care unit. If you wanted to stay in your own home, there was very rarely an opportunity for you to access an ageing in place package. That was introduced by this government to assist those people who were capable, were able-bodied, were very involved in their local communities, who loved their own homes and their gardens and who wanted to stay in their own homes but did need seem some form of care and assistance. But at that time you could not get the ageing in place packages which this government so rightly introduced.

When I look at the Aged Care Amendment (Residential Care) Bill 2007, it stands out to me that the aged-care funding instrument that we are introducing will reduce the number of funding levels in residential aged care and will provide subsidies—and this is the more important thing—for the care of residents with complex health and nursing needs, including for palliative care and for residents who have mental or behavioural conditions, including dementia. Picture this: I am an aged person. I have had a mental condition all of my life. I now have no carer and I go into an aged-care facility. My dementia is setting in but they are not quite sure whether I have a mental health problem or a dementia problem. So I have no specific place to go. I then become aggressive, but there is a determination that I may be aggressive due to mental illness and not dementia.

I lash out frequently at a fellow resident, and I hit that resident on a number of occasions. I know not what I am doing, but I am in a position in which I have no other choices. I am a mentally ill, ageing person who has the onset of dementia, and I have no specific way in which to deal with the process that has put me in this place. Then I see two burly policemen come in the door. They walk towards me and I am unsure, unstable and insecure. They hand me an AVO and they order me to court in the next week to answer charges of unknowingly hitting another resident in my frustration of hovering between mental illness and dementia. I am absolutely terrified, because the sight of these policemen is something that I am not used to. I do not know what I have done wrong, and nobody seems to be able to explain it to me. Those are the circumstances that are happening in our nursing homes and our aged-care facilities because there has not been flexibility in the past.

I was absolutely consumed with rage when I was contacted about the circumstances of a gentleman with a mental illness who had lived with his sister all of his life and, on her death, was left alone to fend for himself with no real specific place for him to go. This bill gives us hope and opportunity that people like the gentlemen whom I spoke of, who is here in an Australian Capital Territory nursing home, will finally be able to be dealt with and treated in the way, and with the respect, that he deserves and that there will finally be the flexibility in these programs to understand that there is a difference with a person who has had a mental illness all of their life who has the onset of ageing. So it is with great pleasure today that I find included in this bill the flexibility to ensure that the needs of mentally ill ageing people will be met.

There are other issues in this funding instrument that have been designed to reduce the amount of documentation and record keeping which aged-care staff generate and maintain in order to justify the funding classification for each resident. Across my electorate I have achieved some amazing results in aged-care funding. I have found that the flexible arrangements that have been put in place as a result of lobbying in the House to enable the people of the Riverina to have a variety of care in which to see out their elderly years have been nothing short of extraordinary. Just recently, in December last year, I was able to announce another grant in my electorate of $2.5 million from the 2006 aged-care approvals round for our Mary Potter Nursing Home and our Ethel Forrest Day Care Centre.

David Hawker (Speaker) Share this | Link to this | Hansard source

Order! It being 2 pm, the debate is interrupted in accordance with standing order 97. The debate may be resumed at a later hour and the member will have leave to continue speaking when the debate is resumed.