Margaret May (McPherson, Liberal Party, Shadow Minister for Ageing) Share this | Link to this | Hansard source

I rise today to speak on the Aged Care Amendment (2008 Measures No. 2) Bill 2008. At the outset, let me say that the opposition has a number of reservations about certain aspects of the bill. I shall elaborate on those reservations further in my speech. That being said, the bill is largely uncontroversial. It seeks to ensure that provisions of the Aged Care Act accord with changes in the aged-care industry and addresses gaps in the aged-care framework. Caring for older Australians is a huge challenge. It requires careful planning, appropriate funding and dedicated staff. It requires acknowledgement that the ageing of our population is undoubtedly the biggest social issue that Australia and indeed the developed world faces. The challenges are enormous, but even more challenging, I would argue, is the planning that must begin now in response to our rapidly ageing population.

In September, the Productivity Commission released a research paper titled Trends in aged care services: some implications. It paints an alarming picture of the future of aged care in Australia. According to the paper, there will be a significant increase in demand for aged-care services over the next 40 years. The number of people aged over 85 is expected to increase fourfold by 2047. Today, approximately one in seven Australians is aged 65 years or older. That is 2.8 million people, or 13.4 per cent of our population. By 2050, the percentage of people over the age of 65 is expected to rise to one in four. The impact this will have on the aged-care sector over the coming years should not be underestimated.

We live in a society that demands, and rightly so, that we take care of our older citizens and give them every opportunity and support to live with dignity and with respect. In order to achieve that, we as legislators must provide policies and legislation that give all Australians confidence that our aged-care sector is delivering the optimum level of care for all senior Australians who require it. That optimum level of care will need to become more diverse and deliver a more flexible service that will respond to the changing health needs of the aged.

The former coalition government placed significant emphasis on wide-ranging reforms to deliver a high-quality, affordable and accessible aged-care system that met the needs and preferences of older Australians under the act. In her second reading speech, the Minister for Ageing correctly asserted that the aged-care industry has matured significantly since the Aged Care Act 1997 was first introduced under the former coalition government. With that maturity over the past decade, the sector has evolved from one where the owner of an aged-care facility also provided the day-to-day operation of the facility to one where increasing levels of investment in the sector are coming from larger corporate entities.

There is no doubt that a consistent and modern regulatory framework must support this evolution in the industry. One does not need to be a particularly gifted prophet to predict that the aged-care sector in a decade from now will look vastly different to the aged-care sector delivering services today—and, of course, today’s aged-cared sector looks vastly different to a decade ago when the Aged Care Act was first introduced by the former coalition government.

This bill before the House today will bring about greater consistency between the regulatory framework and contemporary business practices, recognising the change in business models over the last 10 years. The opposition supports the measures in the bill for clarifying and identifying key personnel and the role they perform within an organisation. This measure is about transparency and accountability of those delivering aged-care services to older Australians.

Another measure that the opposition supports is the further protection of accommodation bonds. In recent years, there has been significant growth in the value of accommodation bonds held by aged-care providers. In fact, more than $6 billion is currently held by approved providers in accommodation bonds. I am sure members on this side of the chamber need no reminding that it was the Howard government who introduced the Accommodation Bond Guarantee Scheme in 2006, which guaranteed the repayment of bonds if a provider were to enter into insolvency or become bankrupt.

The introduction of the guarantee scheme was a good thing, both for providers and for residents. Without a doubt it brought about greater confidence in the industry. The measures in this bill will further strengthen the protection of accommodation bonds by extending the scheme to include lump sum payments which are paid by residents to enter a facility that, at the time the payment is made, is not an approved provider but subsequently becomes an approved provider. Under the measures introduced in this bill, should that provider enter into liquidation, residents’ lump sum payments will be guaranteed through the scheme. This is an excellent measure and brings about more confidence for those paying those bonds.

Another excellent measure in this bill is the aim to reduce the number of unnecessary assessments by aged-care assessment teams. There are some assessments, it is fair to say, that are either unnecessary or that are being reviewed too frequently. This includes the need for an annual assessment for residential respite care and approvals for high-level residential care. Given ongoing approvals are generally granted at the time of reassessment, it is unlikely that the person being assessed will no longer require these services. This measure is in fact aimed at streamlining assessments, reducing red tape and, hopefully, reducing waiting times for assessment of older Australians. This can only be a good thing, particularly as I know that in many areas waiting times for ACAT assessments can be weeks and sometimes even months. The minister has indicated in her second reading speech that following these amendments to the ACAT assessment process negotiations will commence with the states and territories to ensure that the greater efficiencies provided for in the bill will result in shorter timeframes for ACAT assessments. I hope the minister will report back to the House on these negotiations, as I can advise the chamber today that lengthy waiting times for ACAT assessments are causing unnecessary stress on our elderly residents.

As I indicated at the beginning of my speech, I do have a number of reservations with regard to this bill, which I would like to outline to the chamber. These reservations and concerns have in fact been raised with me by the aged-care industry. I think that it is important to advise the minister of the issues and encourage her to work with the aged-care industry to seek some positive outcomes to these concerns. There is no doubt that the aged-care industry is at crisis point, and providers around Australia are experiencing low and deteriorating financial returns.

Given the funding constraints that providers are experiencing, it is extremely disappointing that section 22 is not being amended to address inequities in the system where a resident is assessed as being low care when in fact the resident is high care. Stakeholders involved in the consultation process of this bill were led to believe that these inequities would be addressed. Under the new aged-care funding instrument, aged-care providers are frequently finding that an aged-care assessment team’s assessment of a resident’s care needs do not reflect their true care needs—that is, many residents are being assessed as low care when in fact they require high care. The difficulty lies in the delay that a reassessment of a resident’s care needs takes. This reassessment by an aged-care assessment team—an ACAT team—can take a number of months. Hopefully that will be streamlined, but there are cases known to us where it can take weeks and even months for that reassessment to occur. During that time, however, the facility is only being paid a low-care subsidy, even if the resident is found to be high care. Upon reassessment, payment of the subsidy is not retrospective. What this means, in essence, is that providers in many cases are taking care of high-care residents but are only receiving a low-care subsidy until a reassessment has been undertaken. This non-retrospectivity of the level of subsidy paid is having a big impact on the bottom line of providers and needs to be addressed immediately.

Another area which I have real concerns about is items that come under section 65 of the act. The clause introduces an unreasonable degree of subjectivity that I believe undermines the integrity of the act. Clause 65-2(c) widens the power of the department to enable it to impose sanctions on behalf of future aged-care residents. The department already has wide powers to impose sanctions where breaches have been found to have occurred. I am therefore at a loss as to why the bill seeks to insert a new clause which deals with future care recipients. Further, clause 65-2(da) of the bill introduces a new concept, which is the ability of the department to impose sanctions to act as a deterrent against future noncompliance. Again, this is of concern to me, as the amendment widens the secretary’s power to make a judgement about the use of sanctions as a deterrent to future noncompliance. Noncompliance occurs at a point in time. The power to impose sanctions as a deterrent against future noncompliance introduces ambiguity and complexity into the legislation.

The subjectivity of the above two provisions introduces an amount of uncertainty that does nothing to strengthen the act in any way. I respectfully suggest—I ask—that the minister look at these areas of concern and engage in discussion with the aged-care industry to address these issues. Each of these issues has been raised by the aged-care industry itself, and they are issues, I believe, that should be considered as part of the inquiry by the Senate committee to which the bill has been referred.

The safety and protection of elderly residents is of paramount concern to both providers and families of residents. The minister, in her second reading speech, alluded to changes to the aged-care principles under the Aged Care Act which directly address the safety of residents, and this is a measure the opposition supports. In fact, this measure strengthens the principles which were introduced under the former, coalition government. The detail of what is intended has not been provided, but I understand from the minister that these amended principles will be introduced on 30 November. Of course, the safety of residents should never, ever be compromised, and these principles will ensure that unsuitable people are not working with frail older Australians.

For the record, I read a recent report from Aged and Community Care Victoria regarding the current system of police checks. A number of concerns were raised in the article about the current arrangement and the fact that it does not provide for continuous tracking of offences and that police checks only reveal a snapshot of the criminal history and do not give an ongoing, up-to-date record. There were also concerns raised about the variations in spent conviction schemes from state to state and varied definitions in categories of crimes and offences. I would ask the minister to consider the proposal from Aged and Community Care Victoria about whether or not a national system could be administered by one federal government department or agency to replace the current system of police checks.

For the most part this bill is supported by the aged-care industry, but it would be remiss of me today not to highlight some of the concerns we in the coalition hold for the future of the industry and, indeed, concerns the industry itself has for its future. Despite the positive attempts at reform contained within this bill, I still believe there is a long way to go in reforming the aged-care sector to reflect the needs of our ageing population. The industry needs a bipartisan approach to deal with the range of challenges currently on the radar. I do not exaggerate when I say the aged-care industry is in crisis. Without the right approach to policy and legislation, without the right approach to addressing the needs of Australia’s ageing population over the coming years, the viability of the industry will be in extreme jeopardy. Many providers are operating in the red due to funding constraints. Only last month, Grant Thornton’s interim survey was released, and it showed that the return on investment of a high-care bed was 1.1 per cent and, because of the non-viability of the sector, industry is finding it difficult to attract capital.

With regard to this bill, I believe there will be additional financial burdens on approved providers in complying with their new and amended obligations. This will act as a further deterrent of investor confidence in the industry. This is a very real concern, because we need to encourage providers to take up more bed licences, but the opposite is happening. Providers are walking away from the industry. They are returning bed licences and making decisions at a board level not to apply for further licences. There is in fact an undersubscription of those bed licences, and we saw that in the last funding round in Western Australia and Tasmania.

A division having been called in the House of Representatives—

In continuing my remarks on this aged-care legislation, a further factor in the decision is the volume of red tape, paperwork and compliance requirement which is taking the focus away from the care of Australians. I therefore urge the parliament to consider the extent to which the additional and amended obligations proposed in the bill will affect the ability of industry to provide the high level of care that older Australians expect. The Australian community take the care of our most elderly and frail very seriously. We expect older Australians to have access to high-quality and affordable aged-care services, but as staff are weighed down by paperwork the focus is taken away from care. In the coming years, the aged-care industry will need to respond to the changing health needs and longevity of Australians. As a country we will need to respond to the increasing number of Australians suffering from dementia. There will be a growing prevalence of comorbidity—people living with two or more diseases at the same time. The changing patterns of disease will create the need for greater diversity in the care needs of older Australians. But diminishing returns on investment may in fact see providers exit the industry and the needs of caring for older Australians will certainly suffer. Baby boomers will want more choice in the type of facility in which they want to invest or indeed spend the remaining years of their lives.

As I said, the viability of the aged-care industry in this country is under threat. It is under threat at a time when the ageing of our population is growing at an alarming rate. The industry is facing numerous challenges to deliver first class aged care to older Australians. To meet those challenges, the industry needs confidence and assurance from this government that it is listening and will address the funding needs of the aged-care industry. At the end of the day, it is the frail, older Australians who are going to be affected.

In closing, I do commend the minister today for strengthening the Aged Care Act 1997, but I urge her to work cooperatively with industry and indeed the opposition to develop policy that will sustain a healthy, vibrant industry that will meet the needs of our ageing population. It is imperative that a review of our aged-care regulatory and funding arrangements is undertaken as a matter of urgency. The opposition is not opposed to this bill. However, we reserve our opinions on a number of matters pending receipt of further information from the Senate inquiry.

Chris Hayes (Werriwa, Australian Labor Party) Share this | Link to this | Hansard source

I rise today to take the opportunity to support the Aged Care Amendment (2008 Measures No. 2) Bill 2008. This bill provides the most extensive changes to the aged-care regulatory regime in the last 10 years and it is the first broad set of changes for aged care under the Rudd Labor government. Older Australians deserve high-quality care regardless of whether they are in residential care or receiving community care in their own homes. Older Australians are and have always been an incredibly valued asset in our community. They have helped shape this country. They have shaped the composition of modern Australia, and they will continue to make a significant contribution to society with a lifetime of skills, knowledge and experience.

This bill before the chamber today highlights how serious we are about older Australians and how committed we are to one of the major challenges faced by the nation—that is, protecting our aged and frail. I regularly take the opportunity, as I am sure most members do, to recognise the contributions of older Australians in our local communities not only to their families but also within the communities themselves. I encourage the participation by older Australians in various community activities.

Only last month, I had the opportunity of presenting six community service awards to older Australians on behalf of my community of Werriwa. Between them, the six recipients clocked up almost 20 years of service to our community. Such an effort is more than worthy of recognition and appreciation. The award recipients were: Samuel Oliver, who was nominated by the Lurnea Adult Activity Centre; Alf Cooper, Elizabeth Henderson, Gwen Scherer and Dorothy Kerr-Lansom, who were nominated by the Pembroke Lodge in Minto; and Jean Cameron, who was nominated by the Campbelltown City Senior Citizens and Pensioners Welfare Club. Without these amazing people, so many things that we ordinarily take for granted in our communities would simply not take place at all. Whether it is organising the regular bus trips, organising activities and outings or working to assist in various charitable works in our communities, these things, unfortunately, fall to people in some cases who have the time but above all who have the commitment, wherewithal and ability to keep making these contributions. Like other members, I do try to recognise and honour that continued community activity by many of the older Australians in my electorate. By the way, they do not do it to compete for awards or honours. There is no fuss or fanfare about these people. They are very committed and they worked diligently to ensure that our communities are the better for it.

This bill will go a long way to continuing to please and reward older Australians by amending the Aged Care Act 1997 and the Aged Care (Bond Security) Act 2006 to address current legislative inadequacies and maintain effective regulatory safeguards for ensuring high-quality care for our older Australians. In particular, these amendments will link approved provider status to the allocation of aged-care places directly linked to the Commonwealth funding. They will modernise the legislation so that it better aligns with contemporary business practices and applies to all approved providers regardless of their corporate structures. They will streamline the assessment of frail and older Australians to ensure that more timely, consistent and quality assessments are provided. They will ensure that any accommodation bonds or like payments paid by our older Australians for entry into aged care are fully protected under the Commonwealth bonds guarantee scheme, and they will make some minor operational changes to improve the administration of the legislation so that it operates in a more efficient and effective manner.

The Minister for Ageing outlined in her second reading speech that the features of this bill are significantly different to what existed in 1997 when the Aged Care Act came into effect. A bit over a decade later, the sector has, quite frankly, evolved from one which was typically a one-site, one-service type where the owner of the facility was also the operator, to now one—and my electorate is no different to many others here—that is often a multi-site, multi-state and certainly multi-service operation using complex financial and legal arrangements. In other words, there are large business models underpinning these facilities. That is really what has eventuated over the last 10 years or so.

The last decade has also seen a significant increase in the levels of investment in the sector from large corporate entities, where the owner and operator of the facility have distinct roles and distinct responsibilities which are often very separate. They cannot, in other words, be considered one and the same. Therefore, in many instances, the current business model that exists now does not actually lend itself to scrutiny of these complex corporate structures. The changes which are laid out in the bill are now very much intended to ensure that the regulations do keep pace with these changing developments within this industry generally.

The bill is aimed at a range of people who are considered to be the key personnel for the proposed regulatory scrutiny. Currently, as the minister put it in her second reading speech, the existing legislation is aimed at those who pull the financial strings. But they may not necessarily be considered the key personnel. The amendments before us will ensure that an inspection of all of those who pull the financial strings and the relevant provisions apply consistently to all approved providers. The bill will provide better protection for residents and promote public confidence by increasing the capacity for the Department of Health and Ageing to consider the record of the related entity when making decisions about approvals. This is very important. It is not just about whether the entity has the ability to bankroll a development; it also goes to the actual record in service delivery. So it will assist people, not only the frail and the elderly but also their children who are helping to make decisions on their behalf in some instances, to see the company’s record of service delivery and therefore to judge suitability. I think that is also significant. From the department’s position, this will allow them to assess suitability by having regard to the delivery of service record of those who are seeking approval for these developments.

Importantly, the bill also makes changes to the regulatory and administrative framework. The bill will make clear that only aged-care services are regulated under the Aged Care Act, removing uncertainty about which aged-care services are regulated by this legislation. This is necessary given contemporary developments. What we are now seeing—which, again, I think is pretty consistent across all our electorates—is that developers are sometimes developing aged-care retirement villages and disabled care all in the same development. That gives rise to a level of uncertainty as to the regulatory regime that actually applies throughout that total development and particularly how it impacts or does not fully impact under the Aged Care Act.

These reforms all add up to greater confidence for aged-care recipients and their providers about their rights, obligations and protections that apply under this scheme of regulation. As the shadow minister indicated, she understood that these amendments had the support of industry. It is important to note that the changes outlined in the bill have been subject to significant consultation with the aged-care sector, largely undertaken through the Ageing Consultative Committee. In addition to the committee’s activities, there was broad consultation through the distribution of a paper prepared by the Department of Health and Ageing that resulted in substantial written submissions received from stakeholders that informed the development and finetuning of the complex legislative and policy reform process.

I would like to spend a little time talking about some aged-care facilities in my electorate of Werriwa. Like all members, I visit aged-care facilities and these ones in my electorate operate at a very high standard and have a proven record when it comes to aged care. For instance, the Blue Hills Village at Prestons is a market leader in the field. They have a very close cooperation with their local community and provide high-quality service, particularly for veterans. Maurice Tulich is the CEO of the village and is a bloke I have known for many years. He is certainly committed to excellence. It is a family owned and operated business and continues a proud tradition of growth and change to meet community needs and market demand. He has just opened a new facility on the outskirts of Menangle in the electorate of my colleague the member for Macarthur. It is a state-of-the-art facility and one that we can be justly proud of in the south-west of Sydney.

It was not all that long ago that the Minister for Ageing, the Hon. Justine Elliot, paid a visit to the Blue Hills Village to pay tribute to Ian Monro for his voluntary work with members of the community at the Blue Hills Village as well as the wider community of Prestons. The minister also went to the Frank Whiddon Masonic Nursing Home, Easton Park, at Glenfield. She met with residents at two of the facilities and gained a greater understanding about Masonic homes generally throughout New South Wales. Robert Hillier, the CEO, and his staff are highly trained and professional people. The significance of the Frank Whiddon Masonic Nursing Home is that it is the headquarters for all the Masonic homes operating in New South Wales. The minister was able to spend an hour or two with Robert and his staff discussing a broad range of issues applying to the industry. We are very fortunate to have people of that calibre in my electorate. Two other local aged-care facilities I would like to mention are Maple Grove at Casula, which is managed by Barbara Mullen, and Pembroke Lodge at Minto, which is managed by Joseph Zhou and the director is Lorraine Rushbrook. Lorraine only recently visited my office with a number of residents from Pembroke Lodge, ones we specifically recognised for their continued commitment to the community of south-west Sydney.

Many people agonise over decisions to move their parents—or grandparents, in many respects; in my case, my parents—to a retirement community. As the previous speaker—the shadow minister for ageing—has said, a lot of this in terms of community expectations goes back to people seeking to have the standard of care that we want to afford our own parents, and there certainly are changes in expectations in that respect. The retirement community in Werriwa have excellent choices in terms of their retirement community providers. Before I finish talking about my local providers I should say—on behalf of the government but certainly on my own behalf—that there is a genuine appreciation for the time, the effort and the commitment that the wonderful staff of the community providers show and the dignity they provide in looking after the older Australians in my electorate of Werriwa.

I will return now to what this bill is about. This bill comes about in the midst of a global economic crisis but, again, we are taking decisive actions to strengthen the Australian economy. This bill will make a significant amendment that will help protect the accommodation bonds of older Australians. By the way, as at 30 June last year there was $6.3 billion in bonds held under the guarantee scheme. Currently, under the accommodation bond guarantee scheme, repayment of the bonds is made only in the event of the provider becoming insolvent or bankrupt. As we have discussed over the last number of years, there are many business structures operating out there that simply being insolvent or bankrupt may not be the sole protections required in terms of these guarantees. Many have been put in, as I know myself, on behalf of parents and others, so a level of financial security is required. This bill will strengthen the protections of the bonds by ensuring that they are fully protected by the guarantee scheme, not just in instances of insolvency or bankruptcy, and therefore these assets will be protected. And, by the way, these are sometimes the assets of some of those most vulnerable in our society.

The other proposed amendments concern police checks. At the moment, under the existing legislation, police checks are provided only for people who are working as staff with unsupervised access to residents. This government is committed to ensuring that older Australians in nursing homes and hostels receive quality care in a safe and secure environment. As such, the amendment before us will ensure that all persons working in these facilities, regardless of their activities, are obligated to undergo police checks. As I say, this will extend police checking to all staff, regardless of whether they are supervised or unsupervised. The only criterion is that they have access to residents. Further, the waiting time will be reduced for aged-care assessments by streamlining the assessments. During the consultation stage, as I mentioned a little earlier, it was identified that one of the major causes of discontent is the level of time it takes for an individual to be assessed by an aged-care assessment team. This is now going to be streamlined to best meet the needs of the people concerned and to ensure that the services being provided are the most appropriate. Nevertheless, the amendments to the bill will make the assessments more efficient and more effective.

Finally, the bill will also provide for a more formal arrangement in respect of notifications of missing persons and for those notifications to be put through to the Department of Health and Ageing when residents are reported missing to police. This is to ensure that appropriate safeguards are put into a system so that, when a person has gone missing, appropriate action is being taken by the provider to ensure that, where possible, we guard against similar breaches occurring. Again, that is a significant measure of security.

Over the next four years, the Australian government will provide more than $40 billion in funding to aged and community care, including $28.6 billion to nursing homes and hostels. As I said at the outset of the speech, this legislation provides extensive change, which is long overdue, to the Aged Care Act. More importantly, it is about protecting the most vulnerable members of our society: the frail, the aged, and the infirm. I commend the bill to the House.

Debate (on motion by Mr Lindsay) adjourned.