Julie Collins (Franklin, Australian Labor Party, Shadow Minister for Ageing and Seniors) Share this | Link to this | Hansard source

I want to say, at the outset, that Labor will be supporting this bill. As outlined by the minister in the explanatory memorandum, this bill enables a new procedure to do a shadow classification of recipients of residential aged care and some kinds of flexible care in Australia. This has been necessary, of course, because we know that the current funding model is broken—the Aged Care Funding Instrument. Indeed, we have known that for some time, and we have been calling on the government to do more about that. In fact, we have had the University of Wollongong commission a report about the funding model. This has been going on for some time. Indeed, the government has had this report since August 2017, so it has taken a very long time to get to this point.

I want to put on record that the Department of Health has estimated that there will be around 250 independent assessors that will do the shadow classification, and that they are required to hold a qualification of a registered nurse, an occupational therapist or a physiotherapist. I've also been reassured by the government that these assessors will not replace the current ACATs and, indeed, the current ACATs could actually do this work.

I'm also advised by the government that there will be no change to the funding currently allocated to the Aged Care Funding Instrument to providers without any further legislation coming to this place. Indeed, this legislation will only enable the shadow classification ready for any reform that may be recommended by the royal commission into aged care for this new classification system to be introduced, so we want to make sure that the government does the right thing here by current aged-care recipients. We understand that the government wants the 220,000 current recipients of residential aged care and some flexible care to be reclassified in the first year of operation with the shadow classification and that the government wants to start doing that from April.

But we do have some concerns about this bill, and I want to take time to put them on the record. We are concerned that the 250 full-time assessors will not be regulated by the Aged Care Quality and Safety Commission. We understand that the regulation of the assessors will be the responsibility of the Department of Health. We would like to see that fixed. We also understand that the government is seeking to move a substantive amendment to this legislation in relation to improved privacy so that people's personal information is not published. Obviously we want to support the bill, but, as I said at the outset, we are concerned that the government has been very slow to do the reform that is necessary in aged care.

We know that aged care in Australia is in crisis. We also know that the current government and the current Prime Minister, when he was Treasurer, cut funding from the Aged Care Funding Instrument. Indeed, $1.7 billion was cut. And we know that this has had an impact on the care being provided. We know from providers, we know from families and we know from workers in the aged-care facilities around Australia that the current Prime Minister's cut when he was Treasurer to residential aged-care funding has had a substantial impact, particularly on those residents with very high needs. Everybody has seen that the cuts that were made by the current Prime Minister when he was Treasurer have had a significant impact on the delivery and quality of care in facilities right around the country. It got to the point where it was so bad that this government had to call a royal commission, essentially into itself and its management of aged-care reform in Australia. It has been very, very slow. To that end, I move:

That all words after 'That' be omitted with a view to substituting the following words:

'whilst not declining to give the bill a second reading, the House notes the Government's slow approach to reforming aged care'.

Andrew Wallace (Fisher, Liberal Party) Share this | Link to this | Hansard source

Is the amendment seconded?

Mark Butler (Hindmarsh, Australian Labor Party, Shadow Minister for Climate Change and Energy) Share this | Link to this | Hansard source

I second the amendment and reserve my right to speak.

Andrew Wallace (Fisher, Liberal Party) Share this | Link to this | Hansard source

The original question was that this bill be now read a second time. To this the honourable member for Franklin has moved as an amendment that all words after 'That' be omitted with a view to substituting other words. If it suits the House, I'll state the question in the form: 'That the words proposed to be omitted stand part of the question.'

Ged Kearney (Cooper, Australian Labor Party, Shadow Assistant Minister for Skills) Share this | Link to this | Hansard source

I rise to speak on the amendment to the Aged Care Amendment (Aged Care Recipient Classification) Bill 2020, as moved by my good colleague the member for Franklin. As she has pointed out, the bill enables a new procedure to classify recipients of residential aged care. The member for Franklin has very thoroughly outlined our concerns and everything about this particular bill, notwithstanding the fact that we will ultimately support it.

Everybody agrees, as the member said, that the Aged Care Funding Instrument is no longer fit for purpose. When residents enter an aged-care facility, they are assessed using the ACFI—the Aged Care Funding Instrument. This assessment is usually undertaken by a nurse employed by the provider, and many nurses tell us that that is their sole duty—they spend pretty much their entire job doing the figures so that they can maximise the income from the ACFI—instead of using their nursing expertise where it should be used: actually being out on the floor looking after the aged-care residents. Many residential aged-care facilities have admitted that this is necessary because the instrument is very, very time consuming and complex, and they need to maximise the outcome.

It's interesting that we are moving to a new instrument, which has been trialled—the RUCS trial. I'm old enough to remember the old CAM-SAM funding, which was around a long time ago! I see that my colleagues here are also old enough to remember that! But the CAM-SAM funding gave a specific amount for standard care, which everybody got, and then there was an amount added to that for care, depending on the needs of the resident. It's with some amusement that I see, following the RUCS trial, that there is actually broad support returning to a model that is quite similar to the CAM-SAM funding model. It's almost gone the full circle—what goes around comes around. As I said, we will support this bill because this is all about quality, and we are supporting anything that will improve quality for our aged-care residents. As the member for Franklin noted, we on this side are incredibly frustrated with the lack of commitment to reforming our aged-care system and returning quality of care to the residents. I can't tell you how tired I am to stand in this place and keep saying the same things over and over. We keep repeating the words of the advocates, the unions, the workers, the residents, their families—all the things that they've been telling us for years about how broken the system is.

I just want to acknowledge the great work that the member for Franklin has done for all of those stakeholders and all of the people in the aged-care system. I repeat—ad nauseam—the aged-care system is broken. It was broken before COVID, but the pandemic has, of course, shone a light through the cracks. The royal commission detailed the shocking failures in individual aged-care homes. It outlined the structural weaknesses in our system and, to quote the commission itself:

… the aged care system fails to meet the needs of our older, often very vulnerable, citizens. It does not deliver uniformly safe and quality care for older people. It is unkind and uncaring towards them.

Imagine that—to have to give up your loved one into a system that is unkind and uncaring. The royal commission says, 'In too many instances, it simply neglects them.'

I don't know how members of the government can sit there and listen to those words from the royal commission over and over again like we have and not hang their heads in shame. The commission says there was:

…serious substandard care and unsafe practice, an underpaid, undervalued and insufficiently trained workforce—

And that was before the pandemic hit. When we get to COVID, we know that the Prime Minister's plan was nothing more than guidelines offered up by an incompetent minister who never acts with the urgency the sector needs. The plan failed. It's a nonsense to say otherwise; it's an insult to say otherwise.

As a former nurse and head of the nurses' union, I spent a large part of my career actually fighting for a better aged-care system. We've been saying for decades that we need regulated staffing levels, a good skill mix of professionals, better pay and training, and we need to make aged-care providers accountable for the government funding they receive so we know it's spent on quality care. That is why it's so frustrating that amendments put by Senator Griff were defeated by the government—teaming up with One Nation—who voted against transparency in aged-care funding so that aged-care providers can spend or pocket the money they get from the government for their residents.

It's hard to understand how anyone could oppose Australians having more information about the new $20 billion that is actually spent in the aged-care system. We're saying, 'Enough is enough'. We have actually announced what we think is a plan that is necessary to fix aged care—which includes minimum staffing levels, reducing the Home Care Package list, and ensuring transparency and accountability of funding—because we know that Australians are angry. We know that Australians care very deeply about this and that we can no longer neglect the older generations of this country. We can't let them down, we can't let their carers down and we can't let their families down. In their final years of life, when they're sick and vulnerable, they should not be left in beds hungry. They should not be left in beds with maggots crawling through their wounds and without the care they need. It's a great shame. The Morrison government should hang its head in shame.

Katie Allen (Higgins, Liberal Party) Share this | Link to this | Hansard source

Just like the rest of the developed world, the Australian population is steadily getting older. In 1977, nine per cent of our population was over 65 years. In 2017, that proportion grew to 15 per cent. In another 40 years, it's predicted to be 22 per cent. That is something that I learnt about in medical school and it is something that we've been preparing for as a community and as a society. The demographic of those people entering residential care has substantially changed and, as a result, so too has the aged-care sector. Advances in medicine, high-quality diets and lifestyles, and the success of the home-care packages introduced by our government, the Morrison government, has meant, paradoxically, that the aged-care residential population is getting older and frailer so it is more difficult to care for those people in these situations. In fact, half of those entering care will only be there for two years. The Morrison government recognises the complexities associated with the changing profile of those in residential aged care and we are committed to delivering quality care for our senior Australians.

This bill is an important additional step towards the delivery of an improved residential aged-care sector now and into the future. The existing model for funding aged-care residential services using the Aged Care Funding Instrument, ACFI, has been in place for over a decade. Substantial changes in the demographic of those in residential aged care, as I've explained in this time, has meant that the Department of Health and care providers have experienced funding uncertainty and inequity in recent years. Studies have concluded that the ACFI no longer satisfactorily discriminates between residents in terms of what drives the cost of delivering care. We, therefore, need to improve our system to be better tailored to the needs and wellbeing of our ageing population, and this bill does just that.

I know firsthand the journey many Australians and their families have through the aged-care sector. My father—a doctor himself—suffered a heartbreaking deterioration in his later years at the hands of Alzheimer's. He started off with in-home care, then aged care, then a high-care residential facility and, finally, high-acuity care in a residential setting. It was a long and torturous journey but one that was supported by the system. In line with my father's condition, each of these stages involved varying degrees of care, medical attention and personnel, and, ultimately, costs.

This bill establishes a more efficient, stable and contemporary procedure to classify residents of residential aged care. The bill empowers the secretary of the Department of Health to assess care recipients using a new assessment tool called the Australian National Aged Care Classification and to process assessment results to assign new classification levels. This will allow the option to independently assess the relative care needs of individuals in residential aged care.

This bill follows the successful assessment tool trial, which was conducted in 2019 and early 2020, involving over 150 aged-care homes around the country. This is a very important component of the development of this bill. It's about engaging with the sector and ensuring that, as a trial, this has worked.

This assessment tool was developed by the University of Wollongong as part of the resource utilisation and classification study. The overall aims of this study were to identify the clinical needs and characteristics of aged-care residents that influenced the cost of care; identify the proportion of care costs that on average are shared across residents, relative to the costs associated with the individual needs; develop, importantly, a case mix classification based on identified cost drivers that underpin a funding model that recognises both shared and individual costs; and test the feasibility of implementing the recommended classification and funding model across the Australian residential aged-care sector.

The RUCS reported that the ANACC is designed to capture the core attributes that drive the care costs in residential aged care, so we're hearing from the sector on this. The ANACC comprises of 13 classes and explains 50 per cent of the variance in costs of individual residential care. There's a fivefold variation in cost between the least and the most expensive ANACC classes. This change to this bill will better inform funding arrangements and ultimately care for our senior Australians.

The clinical assessment tool that underpins this ANACC can be readily understood and administered by an external clinical assessor. These assessors will have to meet strict professional qualification and additional training criteria. Funding for the assessors was announced by the Treasurer in the Morrison government's budget earlier this year.

This bill now actively responds to criticisms from care providers, statutory authorities and academic researchers of how care recipients are currently classified, which is now considered outdated. It is also an essential step in preparing to respond to the findings of the Royal Commission into Aged Care Quality and Safety.

I would like to take this opportunity to thank our important aged-care sector workers. They've had a tough year on the front line, and particularly in my home state of Victoria, with the COVID pandemic. Within my own electorate of Higgins there are 21 aged-care facilities, and I'm very proud of the hard work and dedication from employees and the teams, administrators and CEOs of these facilities, with which I've been in regular contact throughout the COVID pandemic. Their work does not go unnoticed, and it is very important to acknowledge that many dedicated individuals have made an enormous difference to loved ones in their twilight years through their comfort and care.

I'm thoroughly looking forward to visiting these facilities in person again. I've got a whole lot of visits lined up next week, now that we're finally lifting our restrictions. Last year I took shortbreads around to my local residents in aged-care facilities, and I've been asked whether I will be doing the same thing again. Yes, I am—but with a COVID-safe approach. It lights up their eyes to have a visit with some shortbread and some Christmas cheer. A big shout-out to the residents of the aged-care facilities in Higgins.

In closing: the Morrison government has delivered, throughout a very difficult COVID pandemic. As a doctor myself, I am very passionate about delivering the best health care and outcomes for all Australians but, more importantly, for our ageing citizens, who've done so much to build this great country. I'd like to thank them for the work they have done through the years and tell them that we are continuing to support them in their twilight years. This is an incredibly important bill to support.

Ben Morton (Tangney, Liberal Party, Assistant Minister to the Prime Minister and Cabinet) Share this | Link to this | Hansard source

The Aged Care Amendment (Aged Care Recipient Classification) Bill 2020 amends the Aged Care Act 1997 to enable a new procedure to classify recipients of residential aged care and some kinds of flexible care from 1 March 2021. The bill introduces the option to independently assess the relative care needs of individuals in residential aged care by empowering the secretary of the Department of Health—a very good fellow—to assess care recipients by using a new assessment tool and to process assessment results to assign new classification levels. The bill responds to sustained criticism from care providers, statutory authorities and academic researchers about how care recipients are currently classified, with residential aged-care providers being required to regularly assess residents by using the outdated Aged Care Funding Instrument.

Since the 2016 budget the government has committed to developing and testing a lasting alternative to the Aged Care Funding Instrument. Resulting from previous measures realised under this commitment, a potential replacement for the Aged Care Funding Instrument now exists, called the Australian National Aged Care Classification. This bill builds on the successful Australian National Aged Care Classification trial, conducted in 2019 and early 2020, and will allow a new classification using the Australian National Aged Care Classification tool to be determined for the entire residential aged-care population without affecting how the subsidy for providers is calculated. This is an essential step in preparing to respond to the findings of the Royal Commission into Aged Care Quality and Safety. Classification data obtained from these assessments will ensure that individuals, care workers, providers and the government all have the information they need to fully understand the new funding model. During the information-gathering period that the bill allows, providers will continue to use the existing Aged Care Funding Instrument to assess their residents, in parallel with the new procedure established by this bill.

I thank members for their contributions to the debate on this bill. This bill enables the next phase of residential aged-care funding reform, a phase of preparation that will enable the government, in the context of a response to the finding of the Royal Commission into Aged Care Quality and Safety, to quickly and seamlessly transition funding from the outdated ACFI. It sets the stage for a more contemporary, efficient, effective and stable funding approach—one that will promote investment in residential aged-care refurbishment and expansion and will support providers to better deliver the individualised care that residents need. I table an amended explanatory memorandum to the bill in response to matters raised by the Scrutiny of Bills Committee and the Senate Community Affairs Legislation Committee. I commend the bill to the House.

Andrew Wallace (Fisher, Liberal Party) Share this | Link to this | Hansard source

The original question was that this bill be now read a second time. To this the honourable member for Franklin has moved as an amendment that all words after 'That' be omitted, with a view to substituting other words. The immediate question is that the words proposed to be omitted stand part of the question.

Question agreed to.

Original question agreed to.

Bill read a second time.