Shayne Neumann (Blair, Australian Labor Party, Shadow Minister for Veterans' Affairs and Defence Personnel) Share this | Link to this | Hansard source

Last week in the Federation Chamber I mentioned a number of instances in relation to constituents of mine in respect of aged care. I have a 96-year-old hard-of-hearing woman who is legally blind—a widow in Ipswich—who can't get an ACAT assessment. I had a 91-year-old man who was eligible for a level 3 home-care package and eventually got it. He then became eligible for a level 4 package, but died waiting for that package. I have a 92-year-old stroke survivor and widow who languishes on a level 2 package, and has done so for two years while waiting for a level 3 package. These are just three of the stories, from my electorate, of a system that's failing. I speak today to the amendment moved by the shadow assistant minister, the member for Cooper. The system that we have in aged care in this country is abysmal. It's cruel. It's unfair to frail, older citizens in this country and it's inadequate. The government's response to the royal commission is a squandered opportunity.

This legislation that we have before the House today, the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021, deals with three issues only in relation to that royal commission, which handed down an interim report titled Neglect and a detailed report providing a pathway forward, which the government has not taken up. These amendments that are before the House are to strengthen legislation on the use of restrictive practices—which were commented upon and condemned heartily and wholly by the royal commission. Again and again they found the excessive use of restrictive practices. There is some alignment here with the Aged Care Act and the definition under the NDIS that's necessary. There's also an expansion of the Aged Care Quality and Safety Commission's ability to respond to breaches of approved aged-care providers responsibilities in relation to restrictive practices.

Women massively outnumber men in residential aged care by almost two to one. Close to two-thirds of the people living in residential aged care—up from just 50 per cent a few years ago—are living with dementia. Indeed, dementia is the biggest killer of women and the second-biggest killer of men, yet this government has failed in relation to aged care and dementia. They've had a consistent minister for aged care but not a minister for ageing. There is nothing about an age-friendly Australia or dementia-friendly communities across this country that this government has taken up.

The royal commission, that's the subject of this bill, found extraordinary themes: neglect, maggots in the wounds of residents, about two-thirds of residents being malnourished or at risk of being malnourished. This government has been warned by report after report after report. But the government has done almost nothing in respect of workforce development. Indeed, you'd have thought they'd have had a workforce strategy across eight years of being in government. But I pay tribute to those people who are dealing with the Commonwealth Home Support Program; Home Care Packages; Meals on Wheels; those men and women working as nurses, enrolled or registered; and the personal carers, administrators and financiers. These are the people, in both the for-profit and not-for-profit sectors, who are working hard to care for older Australians, so many of whom are incapable of caring for themselves.

In its infinite wisdom, this government has decided to give about $3.2 billion, with no strings attached, to residential aged-care providers. There are no linkages in terms of better nourishment, better care, better accountability or better transparency. This is simply ignoring recommendations of the royal commission. Where is the requirement by this government to clear Home Care Packages? We have tens of thousands of Australians who have died while waiting for Home Care Packages, and I mentioned a constituent of mine before. We've had tens of thousands people going into residential aged care prematurely because they can't get Home Care Packages. There are 100,000 Home Care Packages needed, and this government has failed to deliver them. What about the recommendations ensuring that we have nurses on duty in residential aged care 24/7? There is nothing from this government.

But I think it's important to know that the substandard care we're seeing now is not a recent phenomenon—not by any means. When it came to the election in 2013, we saw that the government had seven pages in their aged-care policy. Does anyone remember that blue book they used to hang onto all the time in the 2013 election? It only had seven pages on aged care—that's what they had. They must have realised, surely, that more than 80 per cent of the funding for aged care in this country comes from the federal government, and that 100 per cent of the responsibility for quality and safeguards in the system is the federal government's. Whether it's in vaccine rollout, quarantine, the NBN, the NDIS or robodebt, aged care is up there on the podium of failure for this government. I'm not sure whether it gets the bronze, the silver or the gold medal, but it's really up there on the podium. According to the latest population trends, 38 per cent of Australian men and 55 per cent of Australian women end up in permanent residential aged care, and their average stay is about two to three years. This means that so many of our fellow citizens, including many people in this chamber who were here in question time, will go into residential aged care.

But this government has failed. We only have to read the 12-page foreword of Neglect to get a sense of the rage, heartbreak and failure in the aged-care system in this country. Let's look back at the history of the failure of this government. We have a government which came to power in November 2013. What did they do? They scrapped the Advisory Panel on Positive Ageing—they scrapped it straightaway. What did they do then? They decided that they would get rid of the $1.2 billion that was designed to help workforce development. They haven't got a workforce strategy at all. There was an aged-care workforce supplement given to providers, with strings attached, to make sure that there was training, development and growth in the aged-care workforce. We need to treble the aged-care workforce by 2050. So what did this government do? They got rid of the supplement—they canned the $1.2 billion. Then, a few months later, in June 2014, they axed the dementia supplement. That was just fantastic, getting rid of the dementia supplement—and the veterans supplement, I might add—that was being provided to help people who were living in need to be cared for. It was there because the Aged Care Funding Instrument, or ACFI, doesn't cover severe behavioural issues and issues for people who are suffering from dementia. It doesn't cover those, but the government decided to cut that funding. Again and again we've barely seen a budget or MYEFO where this particular government hasn't decided to cut funding for residential aged care or home care. Even when they said they were going to provide assistance, it was usually a sleight of hand.

I'll give a couple of instances of why we're where we are today. Think about this. In September 2017, they decided they were going to provide 6,000 home-care packages. That was in response to the first release of the Home Care Packages data. It was because it was a political problem, and they had to try to do something. The HCPs were a result of a change in the ratio, and they were fully exhausted by December 2017. They announced it in September, and it was fully exhausted by December 2017. There was no new funding at all. In the 2017-18 budget, they decided that they would create 14,000 new home-care packages. It was entirely funded by a reduction in more than 26,000 projected residential aged-care places from 2017-18 to 2020-21. There was no new funding. They took money from residential aged care and put it into home-care packages and then patted themselves on the back.

In the MYEFO, in 2018, just a few years ago, they decided they would provide another 10,000 packages. What they really did was not provide any new funding; they just brought forward funding they'd previously allocated in the budget—$287.3 million. They brought it forward by one year and they released 5,000 level 3 packages and 5,000 level 4 packages. There was no new money. They just brought it forward a year. In February 2019, they announced another 10,000 packages on the eve of the beginning of the hearings of the royal commission into aged care. Just before the hearings started they decided, 'We'd better do something to show we're doing something,' so they announced $282.4 million over five years for the next level 4 packages. There was effectively no new money, and it was actually re-announced in the budget in May. They announced it once, and they announced it again. Then, in November 2019, they announced another 10,000 home-care packages. They were announced prior to MYEFO in response to the royal commission recommendations from 1 December. There were 5,500 in the first year. But it was almost impossible to know, when you looked at it, where they got the money from and whether it was or wasn't new money.

So, there were a number of years when this government shuffled money around from residential care to home-care packages, when they provided no new money at all, but they wanted to pat themselves on the back and say: 'We've done a good job. We're responding.' But it was always in response to a political problem, whether it was the release of home-care data, a hearing that was coming up, or a royal commission that was about to commence. This is simply not good enough. You can barely find a budget or a MYEFO where they didn't cut funding. An amount $1.7 billion was cut when this Prime Minister, the current Prime Minister of Australia, was Treasurer. They kept cutting and shuffling money everywhere, and then they wonder why a royal commission found there's neglect, no workforce strategy, people living in terrible conditions, one in three people malnourished and substandard care. They wonder why we've got a problem. How about you actually fund the system properly? Where's the $10 billion per annum that's required, as was submitted to the royal commission? Where's that? Where's that in the budget? They give a bit of money, no strings attached, ignore the requirement that you have to have transparency and better supervision, and then think they've solved the problem.

Aged care is in crisis in this country. We need to treble the workforce. We need to deal with the idea that it's not an aged-care issue; it's an ageing issue. We should be proud of longevity in this country, but we should deal with the challenges that come with aged care and with longevity. The median time for older Australians waiting to get into residential aged care has grown by more than 100 days under the Liberals and Nationals. It's gone from a month to about five months. This government is not serious about this issue. They find a supplement anywhere, whether it's a dementia supplement, a veterans supplement or a workforce supplement, and they get rid of it—and then they wonder why there are consequences.

This particular legislation that we have before the chamber today deals with just three issues—three issues only. They need to do much, much better. You can't say you're going to deal with the challenges of ageing if you don't improve quality and safety. You can't say you're going to improve transparency if you have no strings attached to funding. It's a bit like when Campbell Newman came to power in my home state of Queensland; they rolled out money—and this government did the same thing—on education without any transparency or accountability. You've got a $3.2 billion budget allocation to supplement the basic daily fee by $10 per day per resident. The royal commission recommended that; yes, that's true—that there should be an increase in the daily fee. But there are no strict reporting requirements, and the government didn't follow it as required.

We need to do things differently in this country. We need to make sure that aged-care providers can do what they need to do. We need to make sure that residents, whether in residential aged care or living in community and getting home-care packages, or just getting meals on wheels, are funded properly, that the services are funded properly and are accountable. The government need to do much, much better than they're doing currently with respect to aged care and ageing, and they should hang their heads in shame if they can't do better.

Pat Conaghan (Cowper, National Party) Share this | Link to this | Hansard source

I rise to speak on the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021. On 24 July 2019 I stood in this place and, in my maiden speech, said that my father, a country doctor:

… despaired at times at man's inhumanity to man, particularly the aged, who he believed should be treated with dignity in their final years, not discarded as a burden on society. In this regard, he was right … the aged-care system is bowing under the weight of demand, and residents are all too often treated as a number on a ledger to be measured in profit and loss. The need for a royal commission only validates his decades-old fear. I am pleased, however, that this government has taken steps in recent times to address aged care with record funding. However, more needs to be done. With 27 per cent of residents over 65 in Port Macquarie alone, with similar figures throughout Cowper, we must prepare now for their future.

So, two years on, it is imperative that we as the government look to continue to make change within the aged-care industry for the best interests of the residents, their families, the staff and the future of our ageing population.

This government understands that the royal commission into aged care is a once-in-a-generation opportunity to confront the inadequacies within aged care whilst bringing real change to the system. I am pleased to say that this government has responded to the challenge and is providing a first set of responses that can help meet the future needs of our residents. As a nation we must look to improve our level of respect for our senior Australians, and it must be a national priority. From this respect comes all that we value in the care of our ageing loved ones—dignity, safety and wellbeing. We should all strive to ensure the oldest and the most vulnerable within our society receive the levels of care that support and respect that dignity. We must recognise the contribution our older residents have made to the foundations of our society, and this must be reflected in our care and understanding of their needs in their later years.

There are 148 recommendations from the royal commission into aged care. This government understood this royal commission as a call to action, a call for fundamental and ambitious reform. So this bill and the government's response to the royal commission is an acknowledgement that we will embrace this generational change and provide the necessary framework for the industry into the future.

The 2021 federal budget is another example of how this government is responding to that final report of the royal commission. The proposed $17.7 billion aged-care reform package is designed to deliver sustainable quality and safety in home and residential aged-care services. These proposed changes in this bill will continue this government's ambitious drive to protect our older residents.

We've seen on our TV screens and heard on the radio in recent times that there have been a number of terrible incidents where residents in aged-care facilities have been mistreated. This bill provides the necessary framework and changes to protect aged-care residents into the future. This has been achieved through the use of, and the definition of, restrictive practices and behaviour support, which are highlighted in this bill. This government is strongly committed to providing safe and quality care to all senior Australians, including in residential aged-care settings. These amendments will strengthen protections for aged-care recipients from abuse associated with unregulated use of restrictive practices. This will be achieved by strengthening and clarifying provider responsibilities concerning the use of restrictive practices. This includes strengthening the emphasis on aged-care recipients' rights and the delivery of person centred care, and requiring providers to only use restrictive practices as a last resort, and it must be a last resort following the employment of alternate behaviour support interventions. We do not want to see any more vision of elderly, frail or vulnerable residents being subjected to degrading practices.

While the protection of our most vulnerable is key, the bill also acknowledges that there are some limited circumstances in which restrictive practices may be required around the safety of care of recipients and staff. The bill seeks to clarify that this is a safety measure of last resort where all other interventions have been employed and excluded. Restrictive practices must only be used in a way that supports good clinical practice and provides safe and improved care for care recipients. It can never be used as a method of punishment or as a substitute for inadequate resources.

In my electorate, the electorate of Cowper, we boast around 80 aged-care facilities that receive government funding and offer a range of services, including residential, transitional and short-term restorative care. Some are leaders in their field and have provided exceptional care and support for their residents while providing employment opportunities for many of our residents. I expect to see a continued expansion of facilities within this industry in the coming years, along with a rising number of residents looking to take up opportunities of home-care packages to help them stay in their homes longer. A similar number of providers offer home-care packages across the electorate.

Given the ageing population of the Cowper electorate and a strong desire by these residents to remain in their own homes longer, we have strong demand for home-care packages. The Mid North Coast has almost 5½ thousand home-care packages across all four levels. The new number of entries into home-care packages in the last quarter was almost 600. Pleasingly, the number of packages released into the system in the last quarter was 1,314. This effort and the decision made in the 2021 budget show the intent of this government to provide and match the services people need in our area and across Australia.

When we consider the number of aging residents in Cowper and across the country, it is important also to note Australia's population is aging. A detailed look at the government document Australia to 2050: future challenges shows that between now and 2050 the number of older people 65 to 84 is expected to more than double. People over 85 are expected to more than quadruple, from 400,000 people to 1.8 million in 2050. In contrast, the number of children is expected to increase by only 45 per cent, and the number of prime aged-care working people is expected to increase by only 44 per cent. This means that the proportion of people aged 65 years or over is projected to increase from 13 per cent in 2010 to 23 per cent by June 2050. With an aging population in mind, these amendments become imperative because they provide the necessary security for those residents considering their aged-care options going forward.

This government is taking positive action. One of the measures in this bill that will gain plenty of traction in the wider community is the assurance reviews. This measure is in response to growing community concerns about some providers charging unfairly high administration charges. The government has committed $6.5 billion over four years from 2021 to release an additional 80,000 home-care packages. This record-breaking investment will support more senior Australians to age comfortably in their own homes. We all want to see this level of support focused primarily on the care and assistance for the recipient. Home-care assurance reviews are designed to protect the integrity of this investment by allowing further oversight of arrangements for the delivery and administration of home care to ensure they are effective and efficient. Some of the issues that will be covered by the assurance review process include how approved providers are using the home-care subsidy and charging for home care, including justifications for amounts charged to care recipients; how approved providers are structuring their financial accounting for home-care services; and the nature and time of home care provided by providers. Whilst it is acknowledged that home-care providers need to cover business costs and overheads, it's imperative that senior Australians are getting the best value for money in the use of their package funds by providers.

The implications of this bill, specifically the proposed amendments in the bill, relate to restrictive practices, home-care assurance reviews and aged-care financing. This bill defines the term 'restrictive practices' in the Aged Care Act in alignment with the definition applied under the National Disability Insurance Scheme, bringing practice into line with the disability sector. The new definition strengthens protections for care recipients from abuse associated with the unregulated use of restrictive practices. The bill also expands the Aged Care Quality and Safety Commissioner's ability to respond to breaches of approved providers' responsibilities in relation to restrictive practices. Assurance reviews will inform the continuous improvement of home-care policy and the education of approved providers in relation to home care and home-care services.

I'm pleased to note that the government is investing over $135 million over two years to support the payment of bonuses to registered nurses who remain employed in the aged-care system for 12 months. This is part of the $652.1 million commitment by the government to retain and grow a professional and compassionate workforce within the aged-care industry. In addition, the Aged Care Workforce Industry Council is funded by the government to implement the Aged Care Workforce Strategy. Through this, contract funding is being provided to drive workforce reforms.

In conclusion, these proposed changes will emphasise person-centred care in relation to the use of restrictive practices through a new definition of restricted practice. The bill also provides legislative detail on the requirement for providers to comply prior to, during and after the use of restrictive practices. With regard to home care: this government also believes that assurance reviews will have a positive impact on the delivery and administration of home care, ensuring that they are both effective and efficient. Program assurance will deliver on the government's commitment to provide senior Australians with affordable and value-for-money home care, and will directly support senior Australians to remain in their homes for as long as possible.

The health, safety and wellbeing of senior Australians is of the utmost importance to this government. This is driving our plan for generational change in the aged-care system. These initial amendments form the first step of the government's five-year reform agenda across these five pillars: home care; residential aged-care services and sustainability; residential aged-care quality and safety; workforce; and governance. I commend the bill to the House.

Matt Thistlethwaite (Kingsford Smith, Australian Labor Party, Shadow Assistant Minister for the Republic) Share this | Link to this | Hansard source

It's often said that the measure of a nation is how well it treats its vulnerable citizens, particularly the elderly—those who helped to build the nation that we live in. Many of them lived through world conflicts and economic upheavals. Many of them were migrants who left their homeland to come to Australia and help build the prosperous nation that we all enjoy today. But, unfortunately, under the Morrison government we have forgotten that adage about how important it is to look after the elderly and those who helped to build our nation.

When the royal commission was instituted, we knew that it would uncover a series of shocking incidents that had been reported in our constituencies. When the title of the interim report into the management by those over there of the aged-care sector was one word—Neglectwe knew that there was a problem with their management and stewardship of Australia's aged-care sector. That's exactly what occurred under this government. Because of the coalition-conservative philosophy of cutting services, be they healthcare services, education services, training services or aged-care services, Australians are worse off, and no group is more worse off than our aged Australians. These are the people who helped to build this nation and who have served our country.

This Aged Care and Other Legislation Amendment (Royal Commission Response No. one) Bill 2021 makes amendments to the Aged Care Act and the Aged Care Quality and Safety Commission Act to implement three measures in response to the recommendations of the Royal Commission into Aged Care Quality and Safety, and, in the case of restrictive practices, in response to the independent review of legislative provisions governing the use of restraint in residential aged care. While the changes are urgent, the fact is that it has been eight long years, and many Australian families have suffered enough through this government's neglect of our aged-care system. Unfortunately, it's a system which is in crisis. This is a crisis which has emerged on this government's watch, and it was aggravated by the cuts to aged-care funding that have been undertaken by this government. This ensured that funding failed to keep pace with the facts that we have an ageing population and a growing population, and that we weren't providing the necessary support to ensure that aged Australians who either had to enter into home care or residential care did so with dignity and got the care and respect they deserve.

The royal commission contained some shocking details of the neglect—horror stories of maggots in wounds and that 68 per cent of aged-care residents were malnourished or at risk of malnourishment. The royal commission's comprehensive road map for reform was built around 148 recommendations and the government's aged-care package falls short of those royal commission recommendations.

This bill deals with three of those recommendations. But the government has ignored the principal problem in this particular industry, and that is the wages and conditions of those that work in the sector—better professional development, a nutrition-contingent funding boost, minimum staffing levels, guaranteed nurses on duty 24/7 and civil penalties for duty breaches. And there are many more of those royal commission recommendations that still go unanswered, that have not been adopted by this government. I think that the government's approach is, 'We'll do these three and hope that Australia forgets about the other ones.' But Australians won't forget, because this won't fix the neglect that exists in our aged-care sector that was identified by the royal commission.

Why has the Morrison government refused to accept the recommendation that requires a registered nurse to be on duty at all times in nursing homes? They're taking the nurses out of nursing homes. It doesn't make sense at all. When this change was introduced—predominantly by Liberal state governments—we warned that there would be consequences for the level of care that aged-care residents received, and that has been the result. There have been cases where the level of care hasn't been up to the standard that Australians would expect.

Why has the government refused to even countenance the recommendation to increase the wages of nurses and carers? Unfortunately, we all know that people who are working in our aged-care sector, particularly in residential care, are underpaid and overworked. But I doubt that those opposites know that. I very much doubt that they have ever sat down with a group of aged-care workers and asked them to tell their story and asked them to explain the daily challenges they face just to do their job and care for older Australians. All of them are underpaid, with many of them unable to make ends meet, and therefore have second and third jobs. We've seen through the COVID period the danger that this has caused through transmission between nursing homes. Those that are working in them simply can't earn enough to make ends meet, so they have to have a job in another residential aged-care facility just to pay their bills. That of course ended up with COVID transmission going between those nursing homes.

We have workers in nursing homes being employed by labour hire companies—not even employed directly by the nursing home company that they're working for—as a distinct tactic to lower their wages and conditions. So they're working for base-level wages and having to have two or three jobs just to make ends meet. We're talking about an occupation in which you do need quite a level of training. There's a fair degree of skill and competence involved. But, more importantly, there's an emotional element that many Australians are simply unqualified to deliver and which would challenge a lot of us—the emotional element of having to deal on a daily basis with people who have dementia, with people whose faculties are going, with people who wander off on a regular basis, with people who can't remember your name from the day before and with people who, unfortunately, you create a bond with and then they pass away.

The emotional element involved in this job has, sadly, been ignored by this government and by governments in the past for too long. That is something that the royal commission recognised and it is something that the Fair Work Commission, on numerous occasions in fair work cases and pay equity cases, has recognised as an issue that needs to be dealt with if we're going to provide the necessary care and support for people who are in our aged-care facilities. But this government completely ignores it. As a result, the Australians that are living in these facilities aren't getting the care and support that they deserve.

The Morrison government also needs to explain how 80,000 additional home-care packages will go to clearing a list that has been stuck at over 100,000 for years. We welcome the additional funding for aged-care packages in homes. It's important in ensuring that people get the care that they deserve so that they can stay in their homes for as long as possible and avoid the need to go prematurely into residential care, because residential care costs more, you tend to get a decay in the quality of life of people when they move into residential aged care earlier than would otherwise be the case, and, of course, there is a quality-of-life element associated with it. Yet this government has refused for years to countenance the fact that we've had over 100,000 people in Australia waiting for aged-care packages. Many of them are at level 4—the highest level of care—and are waiting for support from this government. Unfortunately, many of them die whilst they're waiting for an aged-care package. That shouldn't happen in a nation like Australia, where we have relative wealth and high living standards.

The other point is that thousands more will seek home-care packages over the budget forward estimates, because we've got an ageing population. It's a demographic characteristic of Australia that we can't ignore—that we have an ageing population—and we're about to have another Intergenerational report released by the government that will demonstrate once again that the number of Australians who are of working age and who are working and paying taxes is diminishing compared to those who are retiring from the workforce and ageing and requiring additional health services and aged-care services that we simply don't have the ability to fund under this government. Nothing in this package does anything to look to the future and to the growth that you're going to find in the waiting list for those aged-care packages. The Prime Minister hasn't shown an ounce of contrition or acknowledged that it was on his watch that there were cuts made to the aged-care budget that have worsened the crisis. The fact is that, when it comes to aged care, it is the Commonwealth that is responsible. It is the Commonwealth that has the responsibility for making sure that we have standards of quality and for giving an assurance to people that there will be adequate funding at a national level to ensure that not only people living in their homes but also those living in residential care get the quality of support that they need.

I was speaking to a provider in my electorate some weeks ago, as a result of having received an email from a concerned son who had a parent living in residential aged care. The son had asked me why that particular facility had cut out support services that were there to ensure a quality of life for the residents, such as services that assist with, and reduce the onset of, dementia—cognitive skills development and services like that. He was asking why those services were being cut from this particular aged-care facility. When I phoned the provider, the answer they gave me was quite a simple one. They said: 'We don't get any increases in funding that would allow us to continue to provide these services. We're under the pump, and we can't continue to provide these services because we can't fund them.' That was a not-for-profit provider that couldn't continue to fund those services because they hadn't got the necessary funding per bed to keep pace with changes in the cost of living and population growth—what's known as growth funding—and to ensure that those services could continue to be provided. Hopefully, some of the additional funding that's been announced by the government in the budget will go to ensuring that those services that are important to people's quality of life in residential aged care can be restored.

The fact is it should never have got to this. The Australian public have been warning this government for the past eight years that there has been a problem, that the aged-care waiting list has been ballooning—despite the fact we've had Intergenerational reportsand this government has refused to countenance a way to provide that growth funding. It is always on about cutting services and cutting back on that necessary expenditure to provide that support for people.

The other point to make about the government's additional commitments is they haven't announced how they're going to fund them. No details have been announced about how they're going to fund these additional home-care packages and the additional funding that is to be provided per bed in residential facilities. And that's important, because if you're going to make sure that the funding is sustainable into the future, those details need to be released.

In summation, this government have dropped the ball when it comes to aged care. They're finally getting on with implementing some of the recommendations, but they need to look at the other ones as well. And before I finish, Mr Deputy Speaker, I draw your attention to the state of the House.

(Quorum formed)

David Gillespie (Lyne, National Party) Share this | Link to this | Hansard source

I rise to speak on the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021. Aged care is a huge part of the annual budget of this nation, and there are many constituents in my electorate who are in residential aged-care facilities. The royal commission has uncovered gaps in the standard and some very distressing practices in some nursing homes. But, I must say, the quality of care in the Lyne electorate in the facilities that I've visited over the last 30 years has been second to none. These amendments amend the Aged Care Act 1997 and the Aged Care Quality and Safety Commission Act 2018. It introduces three main measures.

The first regards the use of what are called restrictive practices. There were some egregious abuses of physical restraint and chemical restraint uncovered, as they should have been, documented by family members and friends who visited nursing homes. That's why the royal commission was there. There always has to be consent for these sorts of measures, either from family or guardians or the patients themselves. It is a fact of life that in aged-care facilities some aged-care residents get quite agitated and distressed and can be quite confused and violent, particularly around sundown—the so-called sundowning effect. While they need care, love and attention, that agitation and confusion may require physical restraint. But this bill now sets a much higher bar to establish consent and all other measures before the use of either physical restraint or chemical restraint. The other major change that this amending legislation makes is to the Aged Care Financing Authority, such that an advisory body will be created in its stead to advise the minister on aged-care funding matters.

The other big response in this bill is to set up a quality assurance program for the ever-expanding home-care system. As you know, there has been a huge backlog in constituents who have been approved for a home-care package but there hasn't been the workforce for it, but one thing that there has been no shortage of is the increased funding over the last three to four years. It's absolutely expanded exponentially. But a quality assurance review will monitor the delivery and administration to ensure that it is effective and efficient. It will support continuous improvement and policy development in relation to home care. It will inform further education of approved providers in relation to their responsibilities. It does empower the Department of Health to require approved providers and their employees to provide information about their quality assurance program. It also empowers the health department to name those providers who do not comply with notices to produce such information and publish reports on the assurance reviews. It is a very important issue, and these three things will be a significant improvement.

As you understand, we have committed $17.7 billion to improving aged care because Australia's senior citizens in some cases unfortunately weren't getting the quality of care that is demanded. Increased funding will definitely fix some of those problems. But there is a phenomenon happening in aged care in that it is very difficult to get aged-care staff. Not every person working in a nursing home or an aged-care facility needs to be a registered nurse. There can be assistants in nursing, enrolled nurses and personal-care workers. The main thing is it's an old person's home; it's not a hospital like an intensive care or a surgical ward. So you need registered nurses in some of the situations but not all. I think it would be a real tragedy if we tried to turn nursing homes into hospitals.

The other problem is that, with the NDIS funding expanding and the NDIS expanding, a lot of healthcare workers in aged care are moving over to NDIS work because the payment is far higher. A lot of staff are being cannibalised from the aged-care system and going into unskilled, higher-paid work.

(Quorum formed) I was just about to complete my speech. These three reforms are an important response to the aged-care royal commission, and I commend this bill to the House.

Andrew Giles (Scullin, Australian Labor Party, Shadow Minister for Cities and Urban Infrastructure) Share this | Link to this | Hansard source

I'm pleased to make a few very brief remarks on this important bill, the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021, which gives effect to recommendations of the royal commission—a royal commission that was called much later than it should have been and in respect of which its interim report titled Neglect serves as a condemnation of too many governments, over too long, who failed to do the right thing for older Australians at their time of need. I'm pleased to support this bill, but I will yield now to the member for Grayndler.

Anthony Albanese (Grayndler, Australian Labor Party, Leader of the Opposition) Share this | Link to this | Hansard source

Scott Morrison has neglected older Australians and the aged-care system for eight long years, bringing it to the point where it is a national disgrace. When it comes to older Australians, this government has just two settings: carelessness and callousness. This is a generation that has given so much. They deserve our gratitude and our respect, but what they've got from this Prime Minister and his government is contempt and neglect—a government that has turned its back on them, a government that produced, finally, support for a royal commission after years of campaigning from this side of the House. And, when that royal commission produced its interim report in 2019, it had a one-word title that summed up the state of aged care in this country, and that title was Neglect. In one word they summed up this government's attitude towards aged care and towards older Australians, older Australians who built this nation; older Australians who've worked, who have paid their taxes, who have raised children and grandchildren; older Australians who are entitled, in their later years, to live with dignity and respect. We saw last week an attack on the retirement incomes of future older Australians with the government's attacks on superannuation. The government want to reduce the living standards of older Australians in the future, and, when it comes to those who may need aged care either in the home or in aged-care homes, they neglect them.

The Royal Commission into Aged Care Quality and Safety's final report and its 148 recommendations make it absolutely clear Australia's aged-care system is one that is in crisis. Royal commissioner Lynelle Briggs summed it up. This is a royal commissioner who is an esteemed Australian, a former public service commissioner, someone who has had great experience in the public service here in Canberra and has served governments of all persuasions over a long period of time, someone whose appointment by this government signalled that this government respected her views, and this is what she had to say in her statement:

At times in this inquiry, it has felt like the government's main consideration was what was the minimum commitment it could get away with, rather than what should be done to sustain the aged care system so that it is enabled to deliver high quality and safe care. This must change.

That is a damning indictment by the government's own royal commissioner Lynelle Briggs.

The Prime Minister is responsible for this debacle. It is the Prime Minister who was personally responsible for the funding cuts. It is the Prime Minister who was responsible for the terrible neglect that has been identified in this royal commission. Our most vulnerable citizens, those who require care in their later years, are being neglected—maggots crawling from underneath bandages! There was the damning indictment of half of the residents of aged-care facilities being malnourished, half literally starving, and we know that some of that is a direct result of coalition ideology put into practice, coalition ideology that was all for the for-profit sector coming into aged care. We know that some people have done very well out of it, with their his and her Lamborghinis, driving around the suburbs of our capital cities. At the same time those older Australians in their care are literally not being given enough to eat. The coalition have had eight years in government, and over those eight years it has got worse, and giving them another three years won't fix aged care. Older Australians can't afford another three years of this government. The only thing that will fix aged care is a change of government, a government committed to caring for Australians throughout their lives from child care in their early years to Medicare in their middle years through to aged care in their later years. We, on this side of the House, care. It is a great divide in Australian politics with those on this side of the House who care about those people we represent, whether they live in our cities or our regions, whether they're men or women, whether they're young or old, whether they're wealthy or not. We care about them.

Those opposite just care about themselves, and we've seen that today, in the middle of a pandemic, when they focused, just as they did during the bushfire crisis, on themselves with the replacement of a Deputy Prime Minister and the failed and flawed Barnaby Joyce coming back into the position of Deputy Prime Minister. Even though this scandal-ridden former Deputy Prime Minister had to resign in shame as a result of things that he was directly responsible for, they would have us believe, and the Australian people believe, that all of that will just be forgotten. A thoroughly decent man, the current Deputy Prime Minister, Mr McCormack, has been driven out—hounded out—of office, just showing once again their priority. Instead of concentrating on fixing aged care, fixing that crisis and fixing the rollout of the vaccine, what is their priority? Rolling the Deputy Prime Minister. We on this side say to Australians that we are on your side. Those opposite, we know, are on their own side, as seen in their actions. And now they're going to bring back the person responsible for sports rorts, who had to resign for using taxpayer funds inappropriately. But all's forgiven there as well. What a farce.

The truth is that in 2019, when that interim report titled Neglect came down, the government could have acted. They could have put extra money into aged care, could have reduced the home-care waiting list, could have addressed the malnourishment that was happening, could have addressed issues such as regulation of aged care. But they did absolutely nothing. They waited until just before a federal election to say: 'We'd better put a few dollars back in. We've got a trillion dollars of debt, so let's not worry about the fiscal measures here.' But we know that after the next election, if they're successful, the cuts will come. We know the deferrals of increased funding will come. We know that the excuses will be there. They'll say, 'We've got to change,' just as they did in 2014. But when they had the opportunity, they slashed and burned the budget, and they would do the same thing again. The fact is this Prime Minister has selective hearing. His hearing fails whenever experts are speaking to him. His hearing fails whenever people with experience are speaking to him. He failed to listen to Australians in aged care, to their families and to the workers in the system. He failed to listen to the findings in 22 expert reports, and now he's even failed to listen to his own royal commission. When the Prime Minister talks about quiet Australians, they're not actually quiet; it's just that he doesn't want to listen to them. He doesn't want to hear what they're saying. Now they can't be trusted, with the spectre of an election, to respond appropriately.

The government's response to the royal commission and the aged-care crisis through this legislation falls short—massively short. It fails to deliver lasting improvements and reforms and it simply ignores many key recommendations. The Prime Minister must explain why he has rejected those key recommendations. For example, he must explain why he has rejected the call to have a nurse on duty in residential care 24/7, a key recommendation to improve care. It shouldn't be beyond the comprehension of the Prime Minister and those opposite, given the royal commission, to get the idea that nursing homes, as we used to call them, should have nurses. But, apparently, that's beyond their comprehension because this legislation before us today doesn't respond to that. There is nothing in this legislation either that will deal with the issue of the underpayment and overwork which aged-care workers have to suffer, nothing at all; there's no improvement there. We on this side of the House have said very clearly that we would support a case before the Fair Work Commission for an equal value case, as we did with other feminised industries—as we did with the social and community services award in 2012, in the Gillard government. How is it the case that an aged-care worker doing heavy physical work as well as mentally stressful work can be paid more for stacking shelves than for looking after vulnerable Australians? How is that the case? I have met with those workers, many of them largely from migrant backgrounds and overwhelmingly female, who are in it because of their compassion. They say that the people they look after are their friends. The idea that they're unable to look after them is just extraordinary.

The government also hasn't fully implemented the recommendations around transparency and accountability. The royal commission made a recommendation to increase the basic daily fee to providers of $10 per bed per day, to address widespread malnourishment. Just think about that—$10 per bed per day, to feed people. Maybe there is someone on the other side who thinks that they can feed a loved one for $10 per bed per day, but it just says it all. The royal commission recommended that strict reporting requirements be attached to this condition. Are any reporting requirements part of this legislation to make sure that the money actually goes into care and better food? Not at all.

The contempt for the aged-care sector has been brought home by the current pandemic as well. Aged-care residents and aged-care workers were supposed to be in category 1a, right at the front of that queue—and we know the queue was supposed to be at the front of the world. But we find that now, in late June, aged-care residents still haven't been fully vaccinated, and the government has no idea how many aged-care workers have been vaccinated, because they told them, 'Just go and see your GP.' There are no records. What could go wrong? They also removed the requirement limiting aged-care workers to one residence during the pandemic and then wondered why the virus spread, when we know that overwhelmingly the deaths here in Australia from COVID-19 were of aged-care residents, and that a large part of that was from workers working in multiple facilities in order to put food on the table for their families. Yet this government lifted the restriction there. They said there would be 13 vaccine clinics for aged-care and disability workers set up by the end of May. There are three, and they're all in Sydney. They just don't care.

The fact is that this government have failed when it comes to aged care. They have presided over eight years of neglect. This legislation doesn't fix the problem. It doesn't even respond to the recommendations of their own royal commission. It is very clear that this legislation won't fix it, but a Labor government will.

Julian Simmonds (Ryan, Liberal National Party) Share this | Link to this | Hansard source

I am pleased to rise today in support of this vital bill, the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021, and to inform members on both sides of the House of the tangible steps the Morrison government is taking to improve the viability and efficiency of our aged-care system, something near and dear to the hearts of all members on this side of the chamber.

When the Morrison government announced the Royal Commission into Aged Care Quality and Safety, we knew this comprehensive review would uncover some hard truths. Australians have the right to expect that all aged-care residents are treated with respect and dignity. Unfortunately, the royal commission has discovered some sobering realities about aged-care delivery in Australia. Unlike previous governments, however, we are acting decisively to get on with the job of implementing these substantial reforms that will shape our aged-care system for many generations to come.

Before I elaborate on the immediate benefits of this bill, I want to unreservedly thank all former and current aged-care workers, particularly in our electorate of Ryan. At no time have the findings of the royal commission been used to cast blame or dishonour on the vital work that you do, and I, along with all the members on this side of the chamber thank you for all that you are doing in the aged-care sector. Families across Australia place a significant amount of trust in aged-care workers to care for and nurture their loved ones in their senior years, and our government is committing to providing the legislative frameworks to better facilitate this trust. Particularly during the COVID pandemic, the important role that these workers played on our front line was evident. They have done a tremendous job in tough circumstances, and I congratulate them again.

This bill directly addresses the findings of the royal commission, which, as I said, told the nation some hard truths about our current sector. The Prime Minister, when he announced it, warned exactly that that would be the case. The bill will bolster our aged-care legislation to ensure all residents receive safe and effective care. This bill clarifies the parameters that aged-care providers must meet, particularly when it comes to restrictive practices. These important clarifications will ensure that aged-care providers meet robust requirements and operate within strict guidelines in administering this practice in order to guarantee that this practice is delivered safely and effectively.

This bill takes tangible steps to address recommendation 17 of the royal commission and supports recommendations 27 and 118 of the royal commission's final report. Although this bill is an essential step in addressing the findings of the royal commission, we recognise that it will not be the only legislative reform to aged care. This is not a 'set and forget' area of policy for this government. We are continually looking at how we can better support the aged-care sector, its workers and its residents. Our history as a government in addressing aged care is substantive and does not involve some of the superficial and bandaid solutions that we saw from those opposite during their time in government. This bill helps underpin this swift and decisive action to address some of the shortcomings of the aged-care sector. We're committed to implementing more meaningful reforms that will dramatically improve aged care for generations to come.

Although the Labor Party talk a big game on aged care, at no stage have they provided anything that remotely constitutes a costed plan to tackle this critical issue. Although the Morrison government would appreciate bipartisan support on aged care, which affects all of us, as you saw from the speech that preceded mine, the Labor Party are simply interested in scoring cheap political points. That is underscored by the speech we just heard from the Leader of the Opposition in which he spoke more about the Nationals leadership than he did about aged care and the challenges facing the sector. When the Prime Minister, as one of his first steps in office, announced the Royal Commission into Aged Care Quality and Safety, again, the Labor Party were nowhere to be found. Rather than supporting this difficult but necessary royal commission, they were instead plotting to address the issue the same way they address any issue of importance, and that is by increasing taxes. The Labor Party have never seen a problem that they didn't think they could solve by reaching into your pocket to take more taxes. This is a bandaid solution. Labor members say: 'Trust us, we're the party that knows how to operate aged care,' but they never thought to call a royal commission when they were in government, and they continue to offer very little in the way of measures to address the findings of the final report. We on this side of the House will not forget—and Australians won't forget—that the Labor Party's answer to supporting senior Australians in the 2019 election was $387 billion in taxes, including the retiree tax. The Australian people know better than to believe the convoluted claims of the Labor Party when it comes to aged care.

The COVID-19 pandemic has challenged every Australian, especially aged-care residents and workers. The Morrison government acted decisively in the interests of the aged-care sector to provide economic and health support to ensure that they had the resources they needed to help us deal with the pandemic. I remain actively engaged with local aged-care facilities in my electorate of Ryan, such as the Cairns centre at Chapel Hill, which have risen to the challenge of COVID-19 in trying circumstances. And they were very trying circumstances—particularly the lockdowns during which friends and families could not get in to see their relatives in aged care.

The Cairns centre in Chapel Hill in particular has a sizeable dementia ward. Those in care at the dementia ward often rely on their partners who are not living in that care facility to visit them on a daily basis for the support, particularly emotional support, that they require. Some of the toughest circumstances that I was confronted with during the COVID-19 pandemic included helping these families navigate their way back into aged care to support their loved ones, but that we did. The Cairns centre themselves reached out to the Prime Minister and to myself to offer feedback on the support offered by the Morrison government during this time. The Cairns centre said: 'We feel safe in your hands knowing that you have our best interests at heart. The direction has been a great help in clarity to help us plan our lives, enabling us to put what is necessary into practice effectively, and was of great assistance in reducing the risk and promoting excellence in care.' This is from the aged-care providers at the Cairns home.

Over 360,000 aged-care workers across Australia continue to care for some of our most vulnerable members of our society and they know the Morrison government is committed to supporting them through this difficult time. Upon medical expert advice our vaccine rollout was tailored to prioritise aged-care workers and residents and to ensure that they receive targeted support to successfully administer the vaccine.

Senior Australians have contributed so much to our society. We owe them a tremendous debt. They've helped foster the values and ethos of our nation and continue to act as role models for much of our younger generation. All Australians have the right to rest assured that older members of their family who are residing in aged care are treated with the utmost dignity and respect. This bill is an important step in the reform of the aged-care sector that is so desperately needed.

The Morrison government continues to deliver record investments in aged care across the country not only to improve aged-care services but to retain and attract more aged-care workers to continue the vital work that they do caring for our senior Australians. Following the final report of the royal commission, the Morrison government will deliver $17.7 billion of funding to reform the sector and ensure that Australians in aged care are treated with respect and dignity. This is the largest investment in aged-care history and is bolstered by tangible and pragmatic steps to increase the viability of the sector. This includes 33,800 subsidies for the vocational education and training places through the Morrison government's JobTrainer initiative that encourage Australians to contribute and participate in the aged-care sector.

This side of the House is not posturing when it comes to aged care. We have a record investment that includes more home-care packages, new Aged Care Quality Standards and a more streamlined assessment process, creating a better overall experience for aged-care residents. The 2021-22 budget has delivered a record investment in aged care to help the 20,394 senior Australians living in the electorate of Ryan. This investment will deliver additional home-care places, more funding for residential aged care and increase the amount of time residents are cared for, while strengthening regulators to monitor and enforce the important standards of care that this government has put in place.

Despite the significance of this investment we're not increasing taxes or shifting the burden on to future Australians. Unlike those opposite, this government will continue to invoke meaningful reforms and investment in aged care and we will do it through a strong and well-managed economy. Following the Royal Commission into Aged Care Quality and Safety, the Morrison government will continue to fully support this comprehensive and thorough process. While this is the first bill—as I said, it addresses the findings of the royal commission—there is a long way to go in meeting and facing up to those hard truths that the royal commission has outlined. But as I said, this is not a set-and-forget policy area for us. This bill is simply a step along a path of meaningful reform for all Australians.

The Australian people know that for real action on aged care those opposite will result only in higher taxes and bandaid solutions. In contrast, this government will continue to act swiftly and decisively to ensure that aged-care residents and aged-care workers are supported and treated with dignity and respect. I am very proud to be part of the Morrison government, that has committed this record amount in the measures in this bill, in supporting and building a strong aged-care workforce and delivering the highest possible standards of care to our senior Australians. I wholeheartedly commend this bill to the House.

Kate Thwaites (Jagajaga, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021 because the Australian aged-care system is in crisis. The coalition government has neglected older Australians for the past eight years, and we now have a royal commission that sets out for us just how damning that neglect is. Their record on aged care speaks volumes. Under this government there's been a $1.7 billion cut from the sector; nearly 11,000 deaths of people who were waiting for home care in the past year; 685 deaths from coronavirus during the pandemic; and chronic understaffing, malnutrition and neglect in facilities. The royal commission into aged care set all of this out. It highlighted graphically the tragic outcomes of a system of neglect and failures all round—and the government have had eight years to do something about it.

The coalition government have neglected older Australians and neglected aged-care residents and aged-care workers for eight years. These are the people who built our country. These are our parents, our family members and our community members. What does it say about all of us, what does it say about the community we want, that we are prepared to put up with these conditions? What does it say when this government is still failing to act on the recommendations of that damning royal commission? It is a cliche to use the phrase 'damning reading', but it does describe the experience of reading the report of the Royal Commission into Aged Care Quality and Safety. Commissioner Lynelle Briggs found that an 'absence of government leadership and stewardship of the system has meant that obvious and longstanding problems have not been dealt with'. That absence created a system that left Commissioner Briggs wondering whether as a community we had lost our moral compass, so poor is the system now.

The royal commission was the government's chance—it is the government's chance—after eight years of leadership failure, to reset and to build a system that respects older Australians. The royal commission made 148 recommendations, and the government's response to those recommendations is nothing short of disappointing. The government have delayed and rejected key recommendations. Some of the problems with the government's response include not reforming workforce issues, this huge issue that is sitting there. There is nothing in the government's response to improve wages for overstretched and undervalued aged-care workers—the bedrock of our system. On funding commitments, they are gifting $3.2 billion to providers with no strings attached to ensure that this goes to actual care and better food and not into the pockets of unscrupulous providers. They have failed to clear the home-care package waiting list of 100,000 people, yet I know that so many people in my community want to age at home. They've ignored the recommendation to require a nurse to be on duty 24/7 in residential care—something that's core to improving care. And they haven't implemented the main increase to mandatory care minutes in residential aged care.

We know that staffing levels are central to so many of the quality problems in residential aged care, yet this government's response ignores the fact that the workforce we rely on to care for people in residential aged care is underpaid. They're not supported to have a long-term career. They're not supported to have a job that pays them decent conditions. We see the results of this all round. During the pandemic we have seen what that means for workers having to work across multiple facilities when they are not vaccinated and when they're having to go between facilities and the risk that creates for both these workers and for people in those facilities.

In my own community I know that one of the things that people were most concerned about at the start of this winter, as Melbourne was in its fourth lockdown, was the fact that aged-care workers were not vaccinated and that aged-care workers were left without supplementary payments that meant that they were able to work at just one facility instead of having to work across facilities. After what we endured last year in Melbourne, after all the deaths we saw in aged care, after all the workers we saw who were put at risk, this government failed to vaccinate them and failed to put in place the plans that would allow them to just work in one facility. That goes to this government's whole attitude towards the aged-care system: it's a hands-off, not-my-responsibility, nothing-to-see-here and nothing-to-fix-here attitude. Well, that's not good enough. This government is leaving aged-care workers and aged-care residents out of the supports they need and out of the types of support and system that we should have in a country that truly values our older Australians.

We should not be scared about a future where we enter aged care, and yet that is where most members of our community are. I know this because they come and tell me. They tell me, 'I don't want my mum and dad to go in there; I've seen what happens.' They're scared, and the people who are entering those facilities are scared. They should not be, and yet this government is failing to respond to the recommendations of the royal commission. It is failing to put in place the wholesale change—the real change—that will fix this system and will value this system going forward.

Labor knows that our aged-care system needs fixing. We know that it's broken and we know it needs fixing, and we will do the work to fix it. We will make sure that aged-care residents are valued. We will make sure that aged-care workers are paid as they should be. We will make sure that this is a system that works for people, not for providers and their profits. We will make sure that this royal commission does not go to waste and that older Australians are treated with the dignity and respect that they should be.

While it's positive that there are amendments relating to restrictive practices in this bill and while it's positive that we have some amendments relating to home-care assurance reviews, and also amendments relating to the Aged Care Financing Authority, they're not enough: we deserve better. From the beginning of this year, I have known how hard and difficult it has been for people in my community in looking at the situation in aged care and the vaccine rollout. We have the situation of unvaccinated workers, residents at risk and a system that isn't getting the fix that it needs. This government cannot drag the chain anymore. It cannot fail to respond as it should—it must respond to all the recommendations and it must fix our aged-care system.

Angie Bell (Moncrieff, Liberal National Party) Share this | Link to this | Hansard source

The royal commission has made the clear case for reform in aged care in Australia, and the government is determined to ensure that senior Australians receive safe aged-care services of good quality through record funding of $17.7 billion over the next five years. Today I am speaking on the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021, because aged care is one of the most important and urgent reform priorities for the government.

I emphasise 'reform' because simply increasing funding will not automatically deliver the care and safety improvements required in the sector. The government committed to these reforms in March, following the release of the royal commission's final report. The first stage of reform will address three key areas. The first area is strengthening legislative requirements on the use of restrictive practices. The second area introduces home-care assurance reviews and the third repeals the legislative requirement to have the Aged Care Financing Authority.

This bill amends two acts: the Aged Care Act 1997 and the Aged Care Quality and Safety Commission Act 2018. As an overview, these changes will achieve the following: the terminology will be brought into line with the disability sector, so the term 'restraint' will be replaced with 'restrictive practices'. Restrictive practices will be governed by requirements that are both stricter and clearer, and must be met by approved providers. This will provide better protection for aged-care recipients. The Quality of Care Principles 2014 will be used to proscribe new requirements on approved providers when using restrictive practices. Noncompliance with the new requirements for restrictive practices will be dealt with by the expanded powers of the Aged Care Quality and Safety Commissioner. That will include the ability to issue a written notice, and a civil penalty will apply for failure by a provider to comply with a written notice.

Home care will be subject to greater scrutiny, including the implementation of an annual program of assurance reviews for approved providers. This will improve the integrity of home care and increase oversight of home-care charges. The intent is that the oversight promotes better value for money for the government and of course for care recipients. Home-care assurance reviews will support improvements in three key areas: they will monitor home-care delivery and administration to ensure they're effective and, indeed efficient; continuous improvement and policy development; and informed further education of approved providers in relation to their responsibilities.

Greater transparency will be an important tool of reform under this bill, which should improve both the outcomes of and confidence in the aged-care system. The Secretary of the Department of Health will now have the power to do the following: require approved providers and their employees to provide information for the purpose of program assurance; publish information about providers who do not comply with notices to produce information; and prepare and publish reports on the assurance reviews.

We know that many Australians wish to live in their own homes for as long as possible, and that is happening. The government is committed to affordable, value-for-money home care and extra home-care packages. The combination of program assurance and funding will support that very objective.

This bill provides for a new non-legislative advisory group to replace the Aged Care Financing Authority, known as ACFA. The new advisory group will commence from 1 July 2021 and provide advice to government on aged-care financing issues. To facilitate that change, the ACFA requirement is removed from the act.

The government is pursuing generational change of the aged-care system. This bill is part of the more comprehensive five-year reform process, with five key pillars. I'll outline what they are for those listening at home who want to know what the five key pillars of reform are. They are: home care; residential aged-care services and sustainability; residential aged care quality and safety; workforce; and, of course, governance. Many people in Moncrieff and across Australia will be interested in further details on the reform process and the bill that I just outlined. I'll now delve into some of those details.

The time frames for the reforms are as follows. On 1 July this year, new restrictive practices regulations will commence. That's straight away. That's in couple of weeks. On 1 November 2021, this year again, the home-care assurance reviews will be implemented. The Aged Care Financing Authority will be abolished by the assent of the bill itself.

The royal commission identified abuse associated with the unregulated use of restrictive practices. The reforms delivered by this bill in relation to restrictive practices are therefore one of the very important ways that this government is acting to protect aged-care recipients. The bill will deliver reforms in the following ways: it will strengthen and clarify provider responsibilities concerning the use of restrictive practices; it will strengthen the emphasis on aged-care recipient rights and the delivery of person centred care, which is so important; and it will require providers to only use restrictive practices as a very last resort following the employment of alternative behaviour-support interventions.

It is important to point out that, whilst the terminology of restrictive practices is being harmonised across aged care and the NDIS, which means it will be the same, the authorisation processes remain different, for good reason. Under the NDIS arrangements, each state and territory is responsible for the authorisation of restrictive practices in accordance with relevant state and territory legislative and/or policy requirements. The different authorisation processes reflect differences in the likely care needs. In disability care, for example, the care recipient is more likely to have stable needs. In an aged-care setting, fluctuations in care needs and deterioration of various conditions are far more likely.

The arrangements for informed consent will be clarified and strengthened by this bill. The legislation also recognises that state and territory legislation specifies who can consent to the use of restrictive practices for a care recipient and who cannot consent because of physical or mental incapacity. The government is not seeking to harmonise consent arrangements across states and territories with this bill. This will be considered in the longer term and with consideration given to harmonising consent arrangements across care and support sectors, including the disability sector.

The bill doesn't prohibit restrictive practices. It makes them a last resort for the safety of staff and especially for care recipients. In relation to restrictive practices, this is what the bill will deliver: clarity that other interventions must first have been utilised or excluded as not suitable before resorting to restrictive practices; the requirement that restrictive practices only be used in a way that supports good clinical practice and provides safe and improved care for care recipients; and the prohibition of the use of restrictive practices as a method of punishment or as a substitute for inadequate resources.

Further, this bill also makes the use of restrictive practices outside the circumstances permitted by legislation reportable under the serious incident reporting scheme. It does not expand or authorise the use of restrictive practices where it is otherwise unlawful. They are very important points. It provides the Aged Care Quality and Safety Commissioner with the power to issue a written notice if a provider does not comply with its responsibilities relating to the use of those restrictive practices. It provides a civil penalty for breach of compliance with a written notice. This tough, but fair, measure is the first time a penalty has been implemented for those particular circumstances, should they arise. It is not overregulation, because we're preventing abuse. This bill is helping to prevent abuse. Approved providers of residential aged care are already required to minimise the use of physical and chemical restraint in accordance with part 4A of the Quality of Care Principles 2014. The government is clarifying the legislation to avoid confusion and to strengthen compliance.

As I've outlined, the bill will improve aged-care quality and safety in direct response to recommendations of the royal commission. The government will go further by appointing a senior practitioner to the Aged Care Quality and Safety Commission in 2021 this year. That appointment will lead an education campaign for the aged-care sector and general practitioners to minimise the use of restrictive practices, and provide senior Australians and their families with an independent review mechanism to ensure aged-care providers are complying with their legislative obligations.

As I mentioned earlier, the Morrison government is extremely supportive of the desire of many Australians to remain in their homes for as long as possible as they age. The government is cognisant of the quality and safety of home care and the value that care recipients and the government obtain from investing in that home care. Home-care assurance reviews are therefore very important. There has been understandable community concern that some providers charge unreasonable admin fees. To address these community concerns and to protect the integrity of this significant government investment—as I said, $17.7 billion over five years—the government is implementing further oversight through home-care assurance reviews.

This bill is part of a comprehensive reform process that is focused on respect, care and dignity for older Australians. The Morrison government is investing an additional $17.7 billion of funding into the sector—I've said it again for a third time—in response to the Royal Commission into Aged Care Quality and Safety. We are determined that this reform will deliver the high quality of care that Australians deserve. It will ensure the safety of those care services. It will ensure more control and choice for Australians regarding their care arrangements and that those care recipients are treated with dignity and respect.

Even if this issue related to the care of one Australian, how we treat one aged person, it would be a test of our decency as a society. The scale of the aged-care system underscores the importance of that test and quantifies the significant resources needed to address the dramatic improvements required. Just consider that around 1.3 million Australians access aged-care services today. There will be more than seven million Australians over 65 by the middle of the century. The Morrison government's investment of $17.7 billion over the forward estimates will include an annual figure that will reach $5.5 billion by 2023-24. Whilst these large figures demonstrate that the investment by the Morrison government is commensurate with the scale of this challenge, it's important to understand that we're also moving with urgency, as is appropriate. In calling for and responding to the royal commission, at each step the Morrison government has sought to address the immediate priorities to improve the aged-care system, investing $552 million when the royal commission was first established, $537 million at the time of the interim report, $132.2 million in direct response to the COVID-19 special report and $452 million for immediate priority actions in response to the final report, Care, dignity and respect.

Of course, this is not just a government response. Providers and the workforce will be our partners in reform of our aged-care system, as they must be. As I mentioned previously, the reform responding to the commission will be shaped by five pillars, with significant funding for the improvement of each of them. I'll outline them quickly.

Pillar 1 is $7.5 billion in home care, with $6.5 billion for an additional 80,000 home-care packages. This is good news for older Australians. With these additional 80,000 home-care packages, 40,000 will be released in 2021-22 and 40,000 in 2022-23, which will make a total of 275,598 packages available to senior Australians by June 2023. Key pillar 2 is $7.8 billion for residential aged-care services and sustainability, which is also a very important pillar. I won't go through all the dot points I've got here because I see I'm always running out of time speaking on these bills. Pillar No. 3 is $942 million for residential aged-care quality and safety, which is a very important part of the reform. Pillar 4 is $652.1 million going to workforce, those important training places, with $228.2 million to create a single assessment workforce to undertake all assessments that will improve and simplify the assessment experience for senior Australians as they enter or progress within the aged-care system. An additional $135.6 million is to provide eligible registered nurses with financial support of $3,700 for full-time workers and $2,700 for part-time workers. Pillar 5 is $698.3 million that's going into governance to ensure that there is good governance for the National Aged Care Advisory Council, a Council of Elders, and work towards the establishment of a new Inspector-General of Aged Care. Going forward, the drafting of a new Aged Care Act over the next two years will seek to embed the Morrison government reforms that I've just outlined for the House into the aged-care sector.

Patrick Gorman (Perth, Australian Labor Party, Shadow Assistant Minister for Western Australia) Share this | Link to this | Hansard source

There are many lessons to be learnt from the royal commission into aged care. We had a royal commission which reminded some in Australia that aged care matters, that it is a fundamental part of our society and that if we fail on aged care it hurts all Australians. Older Australians have spent their lives working for Australia. We in this place owe it to them to ensure we have the highest quality aged-care system we can have, one that doesn't deprive them of dignity but celebrates them in their old age, and one that does not punish them. The numbers in the aged-care system are significant. In 2020 some 335,889 Australians were using some form of aged care. The federal government last year spent some $21.2 billion on aged care. This should be a source of pride for the government, spending a large amount of money supporting many hundreds of thousands of Australians. But, as the royal commission told us, what is currently happening in our aged-care system is a source of shame.

This bill is needed, and the Labor Party supports it. But, as the royal commission made clear, there is much more that needs to be done. There is much more that needs to be done although this government has had eight years in charge of this system. They have had eight years when it's been under their watch and, after almost eight years, we did see a plan put forward on budget night to spend $17.7 billion on aged care. But, as is customary with this government, the plan is lacking the transparency that the public would expect about where that money goes and how it actually improves the quality of aged care. What we've seen is a $3.2 billion cheque to supplement the basic daily fee, with $10 per resident. But we've had no assurance on whether that goes to food, cleaning, health care, wages—we just don't know. When you hear a story like that and the government's approach is 'money in, no reform', you start to get a picture of how we've ended up with a trillion dollars of government debt in this country. The royal commission did provide the road map and it did provide findings that were horrifying. While this bill addresses some of those problems, it is only a very small step in the right direction.

The royal commission outlined 148 recommendations—some straightforward and sensible, some heartbreaking even to admit that we need to do. It took almost three years to get the final report of the Royal Commission into Aged Care Quality and Safety, a bit longer than expected. It was a pretty shocking report. In it's own words, the royal commission's said it was a 'woefully inadequate' system. It is a system in which Australians 'have their basic human rights denied'. The royal commission said that when it comes to Australians living in aged care:

Their dignity is not respected and their identity is ignored. It is most certainly not a full life. It is a shocking tale of neglect.

One in three Australians using the current system experience some form of substandard care. What we saw in the royal commission was not a mystery, but the commission made very clear what causes these issues and what needs to be done to address them. Our aged-care system is poorly funded, poorly governed and poorly led, and Australians are the poorer for it. When we come to the question of physical or chemical restraints, these rob Australians of their dignity and of their autonomy. In just a few months in 2020, the instances of restraint numbered in the tens of thousands. Stories like this, at that scale, do not belong in Australia.

We also need to acknowledge that, while we have a large number of residents in aged care, we have a huge chunk of our neighbours, family and friends working in aged care. This bill fails when it comes to the urgent and pressing needs of workforce for aged care in Australia. The last census estimated that some 366,000 Australians worked in aged care, two-thirds in direct care roles. Most of these workers are women. In budget week we had a number of those women here talking to us about what they need to be able to keep doing jobs that they love. As they are always forced to point out, love doesn't pay the bills.

I met with one worker, Jude, who's a proud Western Australian. She came all the way here to parliament in budget week to share her story. She said that she gets out of bed every day because she wants to care for people. She's worked in aged care for a long time. She's seen this government's record on aged care. She was disappointed in what she saw in the budget and its complete lack of support for workers. She's worked in aged care for decades. She's seen workers pushed out of the system, burnt out, underpaid and underappreciated. The royal commission confirmed this. It said that many of the workers in aged care are overwhelmed, underfunded or out of their depth. And, again, we have a lack of investment in proper training when it comes to aged care. By the time we get to 2050 it's estimated we'll need a million direct care workers. That is a huge part of our economy. We need workers like Jude, and Jude is not going to be there. She's close to retirement. She told me that it's estimated that, within the next two years, some 15,000 of the workers in aged care will be over the age of 60. This is not sustainable. People who work in aged care do a fantastic job, but they're doing too much of it—for love, not for money.

Also, I want to acknowledge there are a lot of people who volunteer in the aged-care sector, whether it be providing friendship or some level of assistance in the NGO charity-led aged-care sector. I acknowledge Mike Farrell, who works for me part time and has volunteered in aged care, something that I know many young Australians do as a way to connect with older Australians and gain their wisdom and experiences. Again, that's why we need to make sure, when we're talking about how we look after those older Australians, that we have the capacity to learn from them and that we have the capacity for them to have the comfort to be able to share experiences in the last years of their life and not be scared, worried or indeed mistreated when they are in aged care.

The scale of the royal commission is also something that I think should not be lost on this place. The royal commission received 10,500 public submissions, many of which drew on the 22 expert reports that came before. And now we've got a Prime Minister who fails to listen to his own royal commission. We know that the royal commission response was sort of dropped out when the Prime Minister was having a couple of politically difficult days. There wasn't time for the media to properly analyse the report before it was released and the Prime Minister stood up to take questions. But, as we've seen as we start to dissect this report, as we start to pull it apart, not only does it not have anything for the aged-care workforce; it expects aged-care workers to deliver more for less, hoping that somehow this will improve the system.

We had a recommendation from the royal commission that nurses be on duty 24/7 in residential care. We still don't have a comprehensive response from the government about that problem. We still have, despite the announcements in the budget, 100,000 Australians on the home-care waitlist, waiting for their chance to get the care and support they need in their homes, and they live in our communities across Australia. We should also make sure that where we can, where it's effective for the individuals, where it's effective for the government, people can stay in their own home, can stay living in their community, because that also means they contribute so much more to their community.

Before I conclude my remarks, I just want to say that Australia does have a proud record on health. It's not surprising that Australia, with a universal public health system, ranks very high in life expectancy. An Australian can expect to live to 82.8 years, well above the OECD average. But, if we fail to invest in aged care, where people need it most, if we fail to listen to the royal commission and, at the same time, if we start dismantling the proper universality of that public health system, we're actually just going to compound these problems for the future, leaving people with worse health outcomes at retirement, worse health outcomes when they do enter the aged-care system. That will put more pressure on our hospitals and leave older Australians financially worse off in the last years of their life. I will conclude my remarks there.

Anika Wells (Lilley, Australian Labor Party) Share this | Link to this | Hansard source

One hundred and twelve days after the Royal Commission into Aged Care Quality and Safety report was handed down this is the first—and small—step that we have seen from the Morrison government towards fixing our broken private aged-care system. The Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021 implements an urgent recommendation made by the royal commission to prevent the use of restraints and restrictive practices in aged care except for in the most extreme cases and only as a last resort. But you wouldn't know that this recommendation and its implementation were urgent based on how the Morrison government has prioritised it. Since this bill was first tabled on 27 May, it has been pushed back seven times. This bill has sat there collecting dust while older Australians continue to be abused and neglected every single day in our private aged-care system. What could be more urgent than protecting the health and wellbeing of older Australians?

Too many people experience the aged-care system as uncaring, unkind and even inhumane in its response to their basic needs. As I mentioned, this bill seeks to prevent the use of restraints and restrictive practices in aged care except for in the most extreme cases, because the royal commission specifically heard about the excessive use of physical and chemical restraints in residential aged care, which robs older Australians of their dignity and of their autonomy in their final months. Older people with mental health issues, particularly those suffering from the later stages of dementia, are often heavily medicated or physically restrained. In the final three months of 2019-20, residential aged-care services made 24,681 reports of intent to restrain and 62,800 reports of physical restraint devices. Frail older Australians whose hard work created the country that we love are being treated inhumanely. They are being neglected and they are being malnourished in a widespread scale across the country. And, when they turn to this federal government for help, they are being told to wait years and years for the services that they desperately need. It isn't good enough, and I will not stand by and watch this Morrison government pat itself on the back for doing the absolute arguable bear minimum after eight long years of doing absolutely nothing.

The aged-care crisis has not been created in a vacuum and it hasn't appeared out of nowhere; it has taken eight long years of policy decisions that prioritise profits over people. The Treasurer announced $3.5 billion a year for aged care, and, as a flashy headline, that sounds good; but, as always, the devil is in the detail, and this falls desperately short of what senior Australians actually need. It's just one-third. That funding commitment is only one-third of what the royal commission into aged care found had been cut by this government over the last five years. It's less than half of the funding boost that was recommended by the royal commission. Why have a royal commission if you aren't going to implement the recommendations? We've had 19 reports commissioned since 1997 to investigate the problems in our aged-care system, 11 of which have been commissioned while Scott Morrison was the Treasurer or has been the PM. Apparently this latest report is the once-in-a-lifetime opportunity to effect change, and yet somehow they've managed to provide only the bare minimum—and they've pushed back the bare minimum seven times.

The royal commission report recommendations have not been actioned. This budget doesn't include any immediate funding to solve the malnutrition crisis. It does not guarantee a nurse in every facility around the clock. It does not clear the home-care package waitlist, despite the fact that 26,000 people have died while on that aged-care waitlist over the past two years. They died waiting for a home-care package. Australia still lacks a detailed plan to value and to pay aged-care workers or a plan to deal with the huge recruitment and retention challenges that this sector has ahead of it. There are no strong accountability or transparency safeguards to stop price gouging or money being wasted on management fees.

In the last federal budget, the Morrison government handed over $3 billion to private aged-care providers with no strings attached. There is no requirement that this money is tied to improving care, or even to providing food. There is no guarantee that these funds will even be used to implement the recommendations put forward by the royal commission. We need to demand that providers prove that the $13 billion they receive every year from taxpayers isn't just going to shareholders, isn't just going to management bonuses, but is actually going to the older Australians that they are duty-bound to provide for. We should start by stipulating that public funds given to private aged-care providers are conditional upon minimum staffing ratios being introduced to all facilities. Or we could demand that providers prove public funds are being spent to improve the wages of the overstretched, undervalued aged-care workers in our country. We could demand that the private aged-care facilities prove that public funds are being used to improve care or to provide better food. I'm not plucking these ideas out of thin air; these are recommendations that I have heard from aged-care workers who work in my community on the north side of Brisbane. They are also recommendations that were provided by the commissioners of the royal commission itself.

The simple fact of the matter is that you cannot fix a private aged-care system whilst aged-care workers are underpaid and overworked. It is impossible to argue that the work aged-care workers undertake—caring for our most vulnerable, bathing them, assisting them with movement, helping keep them up with their hygiene needs—is even remotely commensurate with the wages that they receive at the moment. An entry-level aged-care worker is paid $21.09 an hour under the award, less than someone stacking shelves at a supermarket. But the real outrage is further up the skills scale. If we look at aged-care workers who have reached classification 4, the award provides roughly $15 an hour less than their equivalent in disability—and disability workers aren't exactly on the best wicket either. Even a nurse with the exact same qualifications is paid less to work in aged care than they would get in a hospital setting.

I recently spoke to an aged-care worker from Queensland who told me she thinks she has had one pay rise in the last seven years, and that pay rise was 25c an hour. What an insult! Aged-care jobs should be good jobs. They should be properly paid. Aged-care jobs should give workers financial independence. Their conditions shouldn't just be tolerable; they should be desirable. Aged-care workers love their residents, our family members; they just want to care for people. But providers depend on that compassion, and some of them exploit it. Love doesn't pay the rent.

I recently spoke to another aged-care worker who works for a major home-care provider. Her workday starts at 6 am and finishes at 10 pm. She is expected to pay for her own work travel costs because her boss refuses to pay. She doesn't get paid for travel time, but can be expected to drive up to an hour to see a client. She's not paid for that time spent on the road. And when she clocks off, she goes back to her office to do paperwork. And possibly the biggest kick in the guts is that she has a minimum of 15 contact hours per week. How can anyone expect to pay their bills based on 15 hours of work per week? When I asked her what she thought of this Morrison government federal budget response, she said, 'Too little, too late.' The budget increased care hours, but we have to wait over two years for care hours to come in. We can't wait that long. The sector is in crisis now, and 'crisis' means it's a problem that needs to be fixed now, not in two years time.

Aged care is a bigger employer than mining in Australia. When we put aged care in with health, disability and social services, it is the biggest employing sector in Australia without question. It is only going to get bigger. The Productivity Commission has told us that we need roughly 7,000 more aged-care workers in the sector in the next 30 years. We need to properly invest in the aged-care workforce now, because our reliance on these workers is only going to grow as our population continues to age.

We have three days left of parliament before we begin the winter break and go back to our electorates to work in our communities. I challenge the Minister for Senior Australians and Aged Care Services, the Prime Minister, the Deputy Prime Minister and the Treasurer to use this time to reflect on their priorities and to create a real plan to actually fix this mess.

Joanne Ryan (Lalor, Australian Labor Party) Share this | Link to this | Hansard source

When you stand for office in this country you have to stand for office on the assumption in this place, if you're one of the major parties of government, that you might win government. Well, those opposite did. Eight long years ago, they won government. I came into this parliament in 2013 on their win, and one of the first things I did as the member for Lalor was visit one of my local aged-care facilities after the 2014 budget to hear about the cuts that this government made to the aged-care sector, cuts that meant that a local facility in my area was incredibly concerned that people with severe dementia were not going to get the quality of care that they required, their neighbouring residents required or the staff required, and that has been the story of this government. Their first act in aged care was a cut to the most vulnerable, our elderly, and, more precisely, it was a cut to our most vulnerable, those who are suffering from severe dementia. That's an extraordinary thing for those opposite to choose to do when they gained the privilege of government, and nothing has changed.

We're here tonight debating a piece of legislation that provides too little too late, that is supposedly in response to a royal commission called by those opposite after 22 other reports said that our aged-care system in this country was in crisis. There are 148 recommendations from the royal commission. But let's not forget the title of the interim report that came down during the COVID pandemic. The title was Neglect. The story of our aged-care system was neglect, and tonight we're here talking about a piece of legislation that does the bare minimum to improve that state of affairs.

We're looking at money going into aged care, but the biggest thing, the most distinct thing, that came out of the royal commission was the notion that we needed transparency about the spend, the notion that accountability would be built in if we had transparency. But what does this government do? This government then makes a monetary commitment with no accountability, with no transparency. That's $3.2 billion with no strings attached to ensure this goes to actual care or better food rather than management bonuses or a new office fit-out.

It takes me back to the middle of the pandemic, and, as we heard the member for Lilley say, aged-care workers work on $21.09 an hour. In light of this government's original cut in that budget, I went and met with aged-care workers in Victoria. It was one of the most compelling things I've ever attended. I listened to the aged-care workers who were sitting beside me, telling me, in tears, what the election of this government had meant for their workplaces. They said it had meant they couldn't sit with someone when they delivered a cup of tea anymore and that it was breaking their hearts because they had known some of these residents for years. They said it was a pattern of behaviour that was no longer afforded in the aged-care centres where they were working, and so they had to say to our elderly citizens, people's parents: 'Here's your cup of tea. Sorry; there's no time to chat. I've got to go and deliver the next cup of tea.'

These are the stories that the royal commission heard, and worse—we've heard ad infinitum the references to maggots—but it's not just those graphic stories that speak of the neglect. It's the bedsores and the other things when families find out about the living conditions of their aged parents in aged care—things that are completely and utterly avoidable and that this government has an opportunity to fix right now, as I stand here tonight. But it chooses not to. It chooses not to build in accountability and transparency. It chooses not to ensure that staffing ratios work to support residents and provide care. It chooses not to insist upon a resident nurse 24 hours a day, as recommended by the royal commission. Nothing should surprise us in this space. Really, seriously, nothing should surprise us. The reason it shouldn't surprise us is that during the pandemic we saw this government's attitude to aged care writ large. Everything that happened in aged care last winter is indicative of where we are now with a government not prepared to embrace transparency in this space.

Let's just go through that a little. This government and the minister responsible for aged care last winter failed to protect our elderly during the pandemic, and they are still failing. There were a litany of errors. Funding was provided for PPE but without an audit to see if it was spent. Even after the tragedies in New South Wales, I couldn't be told whether or not each facility in my electorate of Lalor had purchased the required PPE, because there was no audit, no closing of the loop so the government had assurance that the money provided by it was used appropriately for PPE. So we entered the winter in Melbourne, and in my community absolute disaster followed. When we asked Minister Colbeck, he claimed that the staff had all been trained. Well, if they'd all been trained, you would have thought that the infection rate would be under control fairly quickly, and that wasn't the case. That wasn't the case in every aged-care centre in my community.

Last winter in the electorate of Lalor there were 472 confirmed COVID cases linked directly to aged care. Of those, there were 220 staff members infected. There were 192 residents infected. There were 60 in a bracket called 'other', whom I assume were the families of aged-care workers who took COVID home. Last winter I watched aged-care workers change their clothes behind their car in a public street before they went home. That was in Australia in 2020. Most sadly, there were 67 deaths in aged care in my electorate last winter. They were 67 deaths that could have been avoided if this government had taken the pandemic seriously enough to ensure that the aged-care sector was prepared, trained and provided with the appropriate equipment; if it had ensured that people weren't working in more than one facility.

Despite all that has happened, we had to walk into this place in the last sitting week and remind the government that they had lifted the requirement that aged-care workers not work in more than one facility. There has been a litany of failures from the government, and tonight's legislation just adds to those failures, because the government refuse to understand that transparency is the key to improvement. They've absolutely refused to understand that and it was with tragic circumstances in my electorate. What happened in my electorate is indicative of the way this government sees aged care and their refusal to accept the federal responsibility, because let's not forget last winter they didn't want to accept responsibility for aged care. They kept suggesting that it was somebody else's fault. We had over 680 residents die in aged care. We had a minister who didn't know the number of cases and deaths in aged care at Senate estimates in August. He said he didn't feel personally responsible for the deaths. He said he didn't know how many aged-care workers were vaccinated in June this year. They haven't learnt any lessons about what the pandemic should have taught us about aged care, but they haven't learnt any lessons from the royal commission either. They're coming into this place to bring in legislation that does not do enough.

This one's personal for most of us in the House. I can stand here and tell you that my mum's 93 and she's still living at home. Fortunately she's still independent. She recovered from a broken hip last year in the middle of the pandemic and is back to her bright self at home. She has seven surviving children but the highlight of her week is the visit from her home-care support because that person has become a real friend to my mum. Outside of the family that's probably the person she relies on the most to walk through the door. I'm telling you that person is not paid enough to look after my mum. My mum deserves better and so does the carer who comes and so diligently and carefully, with affection and love, showers her and assists her to dress three times a week. That is gold. That is so much more than 21 bucks an hour. You've got to be kidding in this place.

Susan Templeman (Macquarie, Australian Labor Party) Share this | Link to this | Hansard source

It's right that we're here again talking about aged care, because this has been one of the signature issues that has faced the government. At every turn they have failed to take adequate steps to address the real challenges that are facing residents in aged care and the staff who work in aged care. I talked to my community about this because they know that there is a crisis. The workers are telling me how hard their jobs are, the family members with someone in aged care are telling me and when I go into aged-care facilities often it's the residents who are telling me that things just aren't good enough. But they haven't felt that they had a voice. It was only thanks to a royal commission that anyone felt they had a voice to use in this situation.

People in the broader community often say to me: 'But this is a problem caused by governments over multiple decades. This has been building up.' I say, 'No. I was around in 2010 as a candidate and I vividly remember running aged-care forums in my community in 2010 and then 2013 in the lead-up to the 2013 election. Mark Butler was the minister of aged care then. He came out and spoke to people. There was no sense of crisis. There was absolutely a sense that things needed to evolve and things needed to change, but I didn't have family members telling me how much they worry about the food that their family member is being given or the lack of attention and care that they're receiving in a particular facility, anywhere near the scale that I've been hearing since being a member of parliament for the last five years and for the years since 2013.' There's clearly been a decline, a really significant decline, and it sits squarely at the feet of this government, of successive Liberal governments. Every time there's an opportunity to take action that isn't embraced by the other side. It's an incremental response. 'Let's just do a little bit and see if we can get away with doing a little bit,' and that's how this legislation feels to me. The neglect that older Australians and the aged-care system have suffered is not being addressed by this piece of legislation. This is not fundamentally going to change. I note that this bill is called 'royal commission response No. 1'. Well, I want to know where No. 2 is. And, if they're as small as this, we're going to need No. 3, No. 4, No. 5 and No. 6; we will need a lot of these for this to be considered any sort of meaningful response.

The Prime Minister somehow tries to make out that aged care is really not something he needs to worry about. We saw that during COVID at its height last year, with the onslaught aged-care facilities were facing, the fear that was around and the absolute failure by the government to take responsibility for keeping residents in aged-care facilities safe and keeping staff safe. We eventually managed to get the government to bring in some rules around staff being able to work in only one facility due to COVID. I have to say, I was shocked that that rule was quietly dropped; it just disappeared. We only found that out when we had another serious outbreak. It is just extraordinary behaviour. It's kind of like the people who slow down on the roads when the policeman's watching but speed up again as soon as the policeman's attention is diverted elsewhere. In both those situations, that costs lives.

The delay in responding to the royal commission is one thing, but in the lead-up to the royal commission there were 22 other reports about aged care which pretty much mapped the sorts of things that could be done. At every step this government failed to put forward a plan. Even this is not a plan to reform the sector. This is not what people were expecting to see. It is absolutely tiny steps.

I'd like to highlight some of the gaps that I see that remain. One of the No. 1 gaps is workforce. Nothing is going to change without fundamental reform to the workforce. Some people are earning less than they would earn if they were feeding animals at the zoo. Their base pay is so low, and that says everything about what those opposite think in terms of the quality of workers and the importance of the care that they're delivering. The workers I know—and I know them because I go into aged care; sometimes it's to visit my father—are run off their feet, but they're incredibly caring. I often see people just about to leave a shift—they've probably worked longer than their shift was meant to be, anyway—and, as they're walking out with their coat on one arm and a bag of supplies they had for the day, they hear a voice from a room saying: 'Can someone help? I need to go to the toilet', or they hear a call out from someone in a bed. Do you know what they do? They just drop their stuff, put it on the ground, and go and see what they can do to make that person more comfortable. These are the sorts of people we are talking about—incredible people.

The fact that the government has failed to do anything to improve the wages for those overstretched and undervalued workers is something else that says everything about what those opposite are like. They're very happy to give $3.2 billion of funds to providers with no strings attached—no genuine transparency about how it's going to be spent, just hoping that it's going to go to actual care or better food. The accountability built into this bill is so broad and loose. It's one of the big failings in this piece of legislation.

The home-care waitlist is more than an embarrassment; it's a shame. It's a shame on this whole nation that people are at home waiting for a home-care package that they have been approved for. They have been assessed and someone has talked to them. Do you know how hard those conversations are when you've got a husband and a wife who have to sit there and say, 'We can't do this on our own anymore'? These are people who live in their home and are married. In my parents' case, they have been married for decades, yet my mother has to say, 'I can't look after my husband anymore on my own.'

Do those opposite ever think about what that feels like, even to get to that point of asking for help in the home? Then you may be assessed and told you're eligible for a high-level care package but there's a catch: there isn't one available and there'll only be one available when someone dies and frees it up. These are the people who we should be treating with the utmost respect and dignity, but we humiliate them unnecessarily. That's one of the things that we should be trying to change fundamentally with these reforms. When there's a royal commission which just says 'neglect', underneath that is a lack of respect and a lack of dignity. Those are the sorts of things that we should be absolutely busting a gut to improve. The Home Care Package waiting list is going to continue to be a real stain on this nation because we're letting people be in their homes without the appropriate supports that they need.

The failure to put a nurse on duty 24/7 in a residential facility is also unbelievable—how can people not see how vital that is? It's a core thing to improving the quality of care. And then there's not looking seriously at more generous hours for carers and nurses to spend with residents. COVID has been hard and there are so many lonely people in aged care. I'm locked out at the moment because I've had COVID shots and so I have to wait to get my flu shot, which I will be able to do, but I just have that feeling that I can't even pop in and see my dad and help to alleviate the boredom of his day. It has been hard.

I think we have incredible staff. We need to keep them in the system and we need to upskill them. We need to make them feel proud of what they do because they're not feeling overstretched and overworked—that they can actually have a balance in their life and that maybe they only need to work at one facility because they get paid appropriately. These are the things that Labor wants to fix. I've looked at this government and at the way it has treated aged care for the last eight years and I know that Labor can do better.

Peter Khalil (Wills, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021. It was Scott Morrison, the current Prime Minister, who cut aged care by $1.7 billion when he was Treasurer. And in this recent budget the government spent, spent and spent to paper over their political problems ahead of the upcoming election. They spent to cover their political tracks, not to invest in aged care or to enact fully the much-needed reforms and recommendations from the royal commission. This is an aged-care crisis which we see playing out before us. It's a system that's in crisis. It has been let down by years of coalition cuts and mismanagement.

We've seen again in recent weeks that, due to the embarrassingly low wages and number of hours on offer, workers are compelled to work in multiple care homes. In November last year, the Morrison government returned to a position of allowing workers to work in multiple homes. They made that decision after it was suspended for a period of time because of the pandemic. Once again, they were shirking their responsibilities and not thinking through the consequences. From the very early days of the pandemic last year, we saw the horrifying scenes in countries across the world. In many countries the elderly bore the brunt of the deadly virus. There were horrible pictures from Italy, Spain and other countries. In April last year, in Sydney—in our country—the Newmarch House outbreak took the lives of more than a dozen residents.

We saw this; we saw it play out before us and we can't say that we weren't warned. The government should have learnt from this, yet the coalition government dragged their feet in taking the steps necessary in the aged-care facilities, which are under their jurisdiction. They didn't order enough PPE, they didn't help aged-care facilities to prepare or give them practical advice on infection control. They didn't mandate commonsense controls, like limits on workers working across multiple homes, and they didn't put in mask mandates.

In my electorate of Wills, the St Basil's aged-care facility saw 183 coronavirus cases and 44 deaths—44 deaths in one aged-care facility—and there were more than 650 aged-care deaths in total during Victoria's second wave. Aged care is a federal responsibility—we know that. The majority of the deaths that occurred occurred in private aged-care centres, which are under the responsibility of the federal government. At the height of Victoria's second wave there were 1,923 cases in private facilities; in the public aged-care facilities, the Victorian state government run facilities, there were six.

More than a year on, the federal government have botched the vaccine rollout, and aged-care residents are still at risk. How is this possible? It's been more than three months since our vaccine rollout started, yet only 3.3 per cent of Australians are fully vaccinated against this deadly virus. In the United States they are offering the Pfizer and Moderna vaccines to anyone over the age of 12. In the UK, I think some 59 per cent of UK citizens are fully vaccinated. And here we are struggling to get the vaccine to people who are in their 80s and their 90s. We're still struggling to get the vaccine to people who work within aged care. We're still struggling to get the vaccine to frontline workers in health care.

The minister responsible was forced to admit that he has no idea how many aged-care workers have been vaccinated. He couldn't get that number. With all the power of the government departments under his control he couldn't get that number. Well, it turns out that less than 10 per cent of employees have been fully vaccinated—and it was actually left to Victoria to do a five-day blitz to vaccinate healthcare workers. Yet the minister says that he's comfortable about how the rollout is going. That is what he said in Senate estimates—he's comfortable about how the rollout is going. Where there is no comfort for the families who are grieving, the minister is comfortable—because this government and its ministers won't take responsibility. They won't show leadership. They can't demonstrate real leadership, when the country so desperately needs them to do so.

It's is easy to be distracted by numbers and statistics, but it's important that we remember that in each aged-care facility across this country there are people that we have a responsibility to look after. They are our friends, our mothers, our fathers and our grandparents. One of my constituents, Patrick, contacted my office just last week. His mother resides in a private aged-care facility regulated by the federal government. His mother has dementia and, despite her agreeing to receive the vaccine, on the actual day when they came to give her the vaccine she was confused and, in her confusion, declined the jab. She didn't understand what she was being told. When Patrick found out, he was told that she would be given her first dose when vaccine administrators came back in a few weeks with the second dose. Yet on that day they didn't even try to give her the first dose. Patrick is now having to go through this bureaucratic nightmare just to get his elderly mother vaccinated, and it's been an uphill battle. The government's advice to Patrick was that he try to get her to a GP or get a GP to come out to the facility or for her to go to one of the hubs at the Exhibition Centre to get the shot. Can you imagine an elderly woman with dementia trying to navigate the Exhibition Centre in Melbourne? Is that really the best we can do?

A future Labor government will actually deliver the care that is worthy of elderly Australians—the people who built this country; the people whose shoulders we stand on. We'll do this by ensuring that every dollar spent in aged care goes towards employing a guaranteed minimum level of nurses, assistants and carers and towards daily needs like decent food, rather than lining the pockets of the more unscrupulous providers. We will also take the steps necessary to make sure that the aged-care sector is properly funded and is investing for the long term as our population ages.

Providing the best care possible to our elderly shouldn't be controversial, yet it is. On this side of House we believe in properly funding our aged-care system. On this side of the House we believe in keeping our elderly Australians and most vulnerable people safe. On this side of the House we believe in investing in the long term to ensure all Australians know that they will be able to retire and grow old safely, comfortably and with dignity. Based on all the evidence that we have seen over the past 14 months, as we look past all the PR spin and bluster from the Morrison government and his ministers, I don't think I can say the same for the coalition.

Emma McBride (Dobell, Australian Labor Party, Shadow Assistant Minister for Mental Health) Share this | Link to this | Hansard source

I rise to support the amendment moved by the member for Cooper, noting the systemic, ongoing failures in Australia's aged-care system, as evidenced by the Royal Commission into Aged Care Quality and Safety, including, but not limited to, the use of restrictive practices and restraints in aged care; the inadequacy of the government's response to the Royal Commission into Aged Care Quality and Safety, including delayed and diminished legislative action on key issues and recommendations; and the government's failures in protecting aged-care residents and workers due to their poor management of COVID-19 outbreaks in residential aged care.

Labor supports the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021, but the truth is that this government has neglected older Australians, and the aged-care system meant to support them, for eight long years. The reality is that this Prime Minister doesn't want to take responsibility for a problem largely of his own making—from cuts he made as Treasurer. Remember this is the Prime Minister who failed to listen to Australians living in residential aged care and their concerned families, who failed to listen to workers traumatised by systemic failures, who failed to listen to 22 expert reports and who only announced the royal commission just before an ABC Four Corners investigation, which used hidden cameras to reveal abuse and harm to older Australians in aged care, was screened.

The government's response to the royal commission and the crisis in aged care is just not good enough. They've dodged, delayed or outright rejected key recommendations. Nothing will change without reforms to the workforce. There was nothing to improve wages for overstretched, undervalued aged-care workers. The government is failing to collaborate with employee organisations, despite the royal commission's recommendation to do so. At the same time, they're gifting $3.2 billion to providers, with no conditions to make sure this goes to actual care or better food, not just improving their bottom line.

In the time I have today, I'd like to turn to schedule 1, an amendment to the Aged Care Act and the Aged Care Quality and Safety Commission Act to further strengthen legislation on the use of restrictive practices, including chemical restraint. Some of the most alarming evidence to the royal commission related to the widespread sedation or chemical restraint of aged-care residents, often with dementia. Evidence from Associate Professor Juanita Breen from Wicking Dementia Research and Education Centre at the University of Tasmania, in a study of 11,500 residents in 139 aged-care homes, found that 22 per cent of aged-care residents were taking antipsychotics, 41 per cent were taking antidepressants and 22 per cent were taking benzodiazepines on a regular basis, largely daily. As a pharmacist who worked in mental health and psychogeriatrics, and having lost my father to younger-onset Alzheimer's dementia, this is of concern to me and to countless individuals and families across Australia.

The royal commission's interim report titled Neglect found that the use of antipsychotics was not clearly justified in 90 per cent of cases in which they were prescribed and that polypharmacy and chemical restraint have been the norm. Sadly, this robs people of time, like the case of a beloved wife who spent the last month of her husband's life trying to wean him off drugs, who felt the sedating effects of these drugs robbed her of precious time with her husband. As the PSA's Medicine safety: aged care report found, more than 95 per cent of aged-care residents had at least one problem with their medicines, and most had three, including dangerous drug interactions and overdosing; 50 per cent of people with dementia were taking medicines with anticholinergic properties, which can worsen symptoms such as confusion; and one-fifth were on antipsychotics, with more than half using the medicine for too long.

In the final three months of 2019-20, residential aged-care services made 24,681 reports of intent to restrain. As Associate Professor Chris Freeman said, 'Inappropriate chemical restraint and polypharmacy leading to sedation, falls and avoidable hospitalisation are some of the biggest problems in aged care.' Yet the government has failed to act properly, leaving vulnerable older Australians at risk. On this I'll finish with the words of Dr Andrew Stafford, an aged-care and dementia specialist pharmacist and academic at Curtin University. He said: 'While welcoming the budget measures, it doesn't go far enough to reduce the risk of preventable medicines related harm for people living in residential care, particularly those with dementia.'

In the time I have left I'd like to share the experiences of some local people in my community. In a community where one in five people are aged over 65, aged care is something that matters. It matters to everybody, like Frank who writes to me: 'Every baby boomer we know dreads the thought of having to go into a nursing home. Just look back at the issues uncovered by the royal commission and, more recently, the shocking handling of infection control with COVID-19.' He goes on: 'We have all had experience with parents and relatives experiencing substandard care in nursing homes, so absolutely everyone plans to stay home as long as possible. Of course, this means that the current problems with privately owned nursing homes will only continue to worsen as we all age.' He says: 'What all this is leading to is that it seems to me that ageing at home with support is the best and most logical solution. It's the option we plan to take, if we can.' As of December 2020 there were 1,057 people living on the Central Coast waiting for a home-care package. Across Australia there were some 97,000 people waiting for a package, and I'm aware of people who've been waiting for 18 months for a home-care package. The government has announced 40,000 additional packages this financial year and the next, and this is of course welcome. But it won't clear the waiting list while more people join the end of the queue. Older Australians shouldn't have to wait for the care they so desperately need, leaving them and their loved ones at risk and vulnerable.

I'm often contacted by people at the end of their tether waiting for packages for themselves or loved ones. Dianne of Tumbi Umbi wrote to me: 'I've been waiting quite a few months now. I've been granted a level 3 package and in the interim I've been granted a level 2 package, but I've not received either. My husband has deteriorated immensely over the last couple of months, and I'm needing further help as I am slowly going crazy. At present I receive three hours a week.' Jennifer of Long Jetty told me she's the carer of her 94-year-old mother. She's 68 herself, and her mum's on a level 1 package. She's been waiting since February to be upgraded, and Jennifer is concerned that the level 1 package will not give her mother enough support while she herself is in hospital having surgery. Roger, who is 84, was assessed for a level 3 package 18 months ago, which he has not received. He's been paying for the services he needs out of his own pocket and now has a debt to his provider. Carol, who is 82, applied for a package in late 2019 and was assessed the following year. She was assessed at a level 2 package but was told there'd be a nine- to 12-month wait. In May of this year she was advised that she was still looking at a nine- to 12-month wait. Then there's Margaret, 77, of Wyoming. Margaret and her husband were assessed for a level 2 package 18 months to two years ago and haven't had any service since then. Older Australians and those who love them deserve better. The government has to do more. It's urgent and they have to act now.

Meryl Swanson (Paterson, Australian Labor Party, Shadow Assistant Minister for Defence) Share this | Link to this | Hansard source

I rise to speak on the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021 and I want to speak today about Beryl and Quentin. Beryl wrote to me just last month. She lives in my electorate of Paterson along with her husband, Quentin. She wrote outlining her long list of concerns about the lack of care her husband, Quentin, was receiving during his stay in aged care. Sadly, Quentin has been diagnosed with early-onset dementia. This has resulted in him losing most of his cognitive functions in communicating and comprehending conversation. He struggles to understand what's being said to him and around him and he struggles to let others know what he needs and what he has to do himself. Beryl has said that her husband has experienced a significant lack of care regarding showering and general hygiene. Quentin wasn't even being provided with hot water when being showered. Can you imagine someone who's confused and not sure what's happening being showered with cold water? The mind just boggles. At times he was left to sleep in soiled sheets. How distressing for him and for Beryl, who has found him in this situation more than once. Quentin has multiple health checks that have been neglected and therefore his cholesterol has risen dramatically over the last six months.

The sad reality is that stories like Quentin's and Beryl's are all too familiar, because some aged-care facilities aren't being adequately funded or properly and competently managed. Beryl has shared her story and Quentin's story with me in the hope that our Prime Minister will actually hear what is being said and will act on stories like these. I don't think that this is a failure to listen by those opposite. I think they're hearing what's happening—how can they not?—but the issue is they're not acting. They are not acting, and these people need action from their government. That is one of the principles of winning government, of having the privilege of governing. People vote for you. They vote for you under the assumption that you will act once you are the government, not turn a blind eye or a deaf ear to their plight. And that's why we need action from this government.

The inadequacies of the Morrison government in responding to the royal commission into aged care—look, they really are quite appalling. There's no sensible-thinking Australian who would say: 'There's nothing more to be done for this. We're thinking about what we can do, but we're just not there at the moment.' Surely we have heard enough horror stories. Surely we don't have to hear any more before this government will take appropriate action.

It has been three months since the final report from the royal commission was handed down. The sector is no better off; there has been no road map to suggest how we are going to improve this really diabolical situation. And consider this: we live in a First World country, where ageing should be something that is celebrated, where people should be confident that the people they love will be competently cared for. God forbid you could consider increasing staff or wages for hardworking carers! The figure of $21 an hour really is an insult to those people who are far more than just carers. They are pseudo nurses; they are often pseudo doctors; they are certainly pseudo psychologists; pharmacists—they are doing everything that is being asked of them in these aged-care facilities.

And it's not just about not being paid adequately; this is also about respect. These people are often the salt of the earth, and they're the people with the biggest hearts in our community. They don't do their job because it pays $21 an hour, let me assure you of that. They do it because they have an overarching sense of purpose. Of course they need to put food on their tables, but they do it because someone has to, and they want to. They want to be there when that frail hand reaches out. They want to be there to give that touch and give that love back to that person. At least that's what most of the people who work in aged care have described to me. It's far bigger than just a job.

I would say to this Prime Minister: action speaks louder than any other thing that you can do. We know that the royal commission graphically highlighted the tragic outcomes for and neglect of older Australians. Two-thirds of residents were found to be malnourished or at the risk of malnourishment. And, as my colleague the member for Dobell, a qualified pharmacist, has outlined most graphically today, the use of medication as a chemical restraint is shocking and abhorrent. It cannot be the case that we are just doping up our elderly Australians to keep them sedated and quiet in homes. That cannot be their existence in the latter years of their lives. We cannot accept this for any Australians, let alone those who—we rightly say—have paid their taxes and paid their dues to their country. Surely we are better than this here in Australia. This government has failed to listen. It has failed to listen to 22 experts, and now even its own royal commission. It's like we are in some sort of twilight zone here. I have to pinch myself when I think about it.

The hardest decision a family member can make is to move a loved one into permanent residential care. I know that there are many people across Australia who battle with that decision. We all want to die peacefully in our sleep in our own home at a ripe old age, surrounded by people who love us. That's the dream. But so few people in Australia get to have that dream. Many more should be able to, but we know that, if they're in a nursing home where there's not adequate staff and that's not being managed properly and they're being medically and chemically restrained—what sort of an existence is that for someone?

As I said, the hardest decision a family member will make is to put someone into care, and I know that personally. Just this last weekend I've had to have the conversation with my sisters and my mother about her leaving our family home, a place where my family has resided for generations, and going to a home, and it is absolutely devastating. People don't want it to happen, but it does happen, so we have to make sure that, if your life, after a well-lived life, is about to be reduced to a room about the size of a cupboard in a nursing home, those final years are the richest, safest, most social and best that you can have. If that's what has to happen for you or if you choose to do that, it should be a terrific experience—for all Australians. We here in this place have been charged with that, and I again appeal to the Prime Minister, to this government, to the aged-care minister: liven up, become active about this, get actions into place, give our elderly Australians the absolute best twilight years of their lives so that we can proudly know that we have done our utmost for them.

Justine Elliot (Richmond, Australian Labor Party) Share this | Link to this | Hansard source

Our aged-care system is in crisis because of this Liberal-National government, and its response to the aged care royal commission is far, far from enough. In fact, it really is a complete disgrace. In fact, the government itself is in crisis. We've seen this today, and, instead of focusing on the really big issues across the country, like its bungled vaccine rollout or its lack of quarantine facilities, its completely consumed with itself. We're seeing crisis after crisis from this government, particularly when it comes to aged care. The government's response to aged care really falls well short of what was required and fails to deliver on the long-term reforms that are needed in the sector.

They created this crisis through their ongoing funding cuts and their lack of will and capacity to address problems within the sector. This crisis, when it comes to our senior Australians, is part of the government's overall failure, whether it's their pension cuts or their failure to invest in aged care. Time and time again, our senior Australians know they just cannot trust this government when it comes to accessing the services or the health care or the aged care that they might need.

We were all equally horrified by some of the reports that we saw in the royal commission. Some of those stories of maltreatment and substandard care were truly distressing. Some of the really graphic stories we heard, very tragic ones, include things like neglect, including maggots in the wounds of residents. This is disgusting! We heard that two-thirds of residents were malnourished or at risk of malnourishment. It is appalling that these older Australians in our nursing homes are being treated this way or are at risk of such horrific treatment. The stories were incredibly distressing right across the board. But make no mistake: this situation is a direct result of the Morrison government's severe funding cuts to aged care. That's why the situation is so bad. They have chronically underfunded aged care; they cut billions from aged care over the past eight years. The Liberal-National government, with the various prime ministers and deputy prime ministers throughout that time, have consistently cut funding to aged care.

We also see a lack of funding when it comes to home care as well. We know there are over 100,000 Australians waiting for home-care packages. With the very large proportion of seniors in my electorate, every day I hear from locals who are unable to access home-care packages or the sufficient package that they require to stay in their homes. Of course our older Australians, like everybody else, want to remain in their home for as long as they can, but they can't do that unless they've got a home-care package tailored to their needs, and so many of them are waiting sometimes up to two or three years. This is just appalling—the situations we hear about day by day of older people who are unable to stay in their homes because of this government's funding cuts—and it keeps getting worse and worse.

In terms of the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021, I totally support the amendment moved by the member for Cooper which notes the systemic ongoing failures in Australia's aged-care system as evidenced by the royal commission, including, but not limited to, the use of restrictive practices and restraints in aged care, the inadequacy of the government's response to the royal commission, and the government's failures in protecting residents and workers due to their poor management during the pandemic and the COVID-19 outbreak. The amendment also calls on the government to explain, as a matter of urgency, its plan to fully vaccinate aged-care residents and workers. What an ongoing debacle that has been! Right throughout the country, we have seen the failure of the vaccine rollout and the constant bungling by this government, but, in terms of the residents and the workers in aged care, it has been horrendous. These people should have been prioritised and vaccinated first. We've seen so many situations where particular nursing homes have had to be locked down because these people are not vaccinated. This government has completely bungled it. When it came to this pandemic, they had two major responsibilities: to roll out the vaccine and have fit-for-purpose quarantine facilities. They've completely failed their government responsibilities. The Prime Minister's responsibility—totally failed it. Of course this Prime Minister is responsible for the aged-care system. He's responsible for the funding cuts, and he is responsible for that terrible neglect that's been identified in the royal commission, yet he fails to take responsibility for that and fix it.

This bill does fail to tackle some of the major issues in aged care. The problem is that the government has failed to put forward a comprehensive, overall plan for reform of the sector. They've fobbed off or delayed or outright rejected many of the key recommendations, and there is nothing in this bill that will address desperately needed workplace reform. The people who work in the aged-care sector are incredible people, but they are underpaid, overstretched and overworked. They are not properly paid for the incredible work that they do, and there is nothing in this bill at all to address that. The government has also failed, in this bill, to make sure there's adequate transparency and accountability linked to funding given to aged-care providers. Also, in terms of the introduction of the assurance review, it's disappointing that the government hasn't followed more closely the recommendations from the royal commission to increase transparency and accountability measures. They've failed to clear the home-care package waitlist of over 100,000 people, and they've also ignored the recommendation to require a nurse to be on duty 24/7 in residential care. This is absolutely imperative and is at the heart of improving care. They have ignored that. We know that staffing levels are central to the quality care issues that we've seen in aged care. The government has also failed to do enough in terms of ensuring that there is enough support for those at risk due to the use of restraints.

In conclusion, as I have said many times before, we have a duty as a nation to ensure that every Australian is treated with respect and dignity, and we must ensure that they can access public services, health care and aged-care support when they need them. We must always remember that it's our older Australians who built this country, and they need to have better support from this government. It is disgraceful that they've been neglected by the Liberal-National government. We see across the board the government's complete neglect when it comes to our older Australians. Whether it's because of their cuts to pensions, their plans to expand the cashless welfare card or their cuts to aged care, older Australians know this government cannot be trusted at all.

Peta Murphy (Dunkley, Australian Labor Party) Share this | Link to this | Hansard source

I want to dedicate this speech to an amazing family from my community: Edgard Proy; his father, Silvio; his son, Oscar; and their beloved Monica: mother, grandmother and wife. Edgard is someone I've spoken about before in this place. He fought for his mother to be released from the chemical restraints that an aged-care facility put her in when she and Silvio had to make the hard decision—and Edgard had to be part of that—to go into an aged-care facility. Monica had dementia, and Silvio had suffered a stroke. That aged-care facility put her into chemical restraints in order to 'control her and her behaviour'. Edgard fought for his mother, and he fought for her to be released from those chemical constraints. It took two years to wean her off the medication, with the help of loving and dedicated carers. Edgard then, in 2019, fought for the practice of excessive chemical restraints of people in aged care to end. He bravely told his mother's story and his family's story publicly so that it could be part of the consideration of the aged care royal commission so that others didn't have to go through what Monica went through. Sadly, Edgard and Silvio and Oscar lost their beloved Monica recently, but her legacy lives on. This bill, the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021, is proof of that, because this legislation does prevent the overuse of restraints and restrictive practices in aged care, except in the most extreme cases and only as a last resort. That's why I'm very pleased to be supporting this bill put forward by the government and supported by my Labor colleagues.

It's a little bit disappointing that the royal commission's recommendation around the introduction of an independent expert approval for the use of restrictive practices was rejected by the government. I understand their reasons for doing so, but it is a shame. Nonetheless, on behalf of Edgard and his family and everyone who's had a loved one go through what Monica went through, I'm very pleased to support that part of this legislation.

We all know that there are a lot more problems in the aged-care sector. Some of them stem from underfunding, some of them stem from practices that are more about profit than about care, and some of them stem from systemic undervaluing and a lack of support of the workforce. I recently wrote to my entire community proposing that together we should fix the aged-care system, because aged care affects us, our parents, our grandparents, our friends and our community, and more than half of all Australian women and about a third of Australian men will end up in residential aged care. Sadly, we know that it is the case that over the last eight long years Australians and their families have suffered through an aged-care system which has been in crisis, and this crisis was born significantly from budget cuts and from prioritising competition without regulation.

We all know that there was a royal commission with an interim report that was titled Neglect. We've all heard about the maggots in wounds and that two-thirds of aged-care residents have been malnourished or at risk of being malnourished. There are key recommendations of the royal commission that have not been accepted by the Morrison government, and I am deeply disappointed by that on behalf of my community, particularly the failure to accept that a registered nurse should be on duty at all times, to increase the wages of nurses and carers, and to implement a comprehensive workforce plan, because the truly amazing and dedicated people that work in aged care are the soul of that system and we must value them more.

Of course, as many of my colleagues have said, the bungled vaccine rollout put residents and community at risk, and in Victoria we saw the tragic consequences of that and the tragedy of COVID escaping quarantine for so many individuals and families last year. So we do need to fix aged care, we do need to have minimum staffing levels, we do need to have greater transparency about the use of taxpayer funds and we do need to ensure that all residents and staff get the vaccine urgently.

As I said in the letter I sent to my community recently, 'Let’s fix aged care once and for all.' I asked my community to fill in a survey, and I'll just give this chamber, this parliament, a small flavour of some of the comments that have already come back—I think this survey has been in letterboxes for not much more than 24 hours—'There should be enough fully qualified personnel working in aged-care retirement homes to cater to those in need. It's a basic proposition, and it's a shame on our country that people still think the government needs to hear it.' I've got a constituent whose mother went through 'hell' in an aged-care home. His wife had to complain many times and, in fact, burst into meetings of the staff at that facility in order to try and get something done. I have a constituent who saw an elderly woman tied to a chair in an aged-care home. I have a constituent who has worked in aged care for 20 years and is concerned about the lack of referrals to Dementia Support Australia from aged-care facilities in my community. We know that dementia is the No. 1 killer of women in Australia and the No. 2 killer of people overall. Surely there is more need for the free and available services of Dementia Support Australia. Is the government informing aged-care facilities that the Dementia Support Australia service is there?

I have a constituent who worked as a PCA in a facility that had run out of adult nappies, and that short time as a student nurse taught my constituent that one day they or their family might be subject to these basic failures. As they wrote to me: 'Aged care needs to be so much more than just money. It needs money, of course it does, but it needs all of the attention and proper regulation to ensure nothing slips through. The elderly aren't useless. They are Australians who have paid their taxes, served their country and it's up to us to protect them at all costs.' I couldn't put it any better than that member of my community, who took the time to write to me: 'The elderly aren't useless. They are Australians who have paid their taxes, served their country and it's up to us to protect them at all costs.' We must do more. We must do better. The Morrison government must urgently do better, and we're not going to stop asking them to do so.

Alicia Payne (Canberra, Australian Labor Party) Share this | Link to this | Hansard source

I rise tonight to talk about the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021. Of course the Labor Party will support this, but we've moved a second reading amendment because we need to do so much better than this to address the absolute crisis in aged care. This is not just another minor problem, as this government sees it. So often with the government we see that they are just looking for a solution as a political fix. Well, this is a deep, deep crisis. Anyone who has a loved one in aged care knows that, and anyone who has looked at the aged-care royal commission and its recommendations knows that. I want to again acknowledge the people who contributed their stories to the royal commission, because the nation can now clearly see the depth of this crisis—the malnourishment, the neglect, the situations of people with maggots in wounds. People who've had their own experiences with aged care know that these things are not uncommon either. These are not shocking sorts of things that have happened only once in a blue moon. These are very common things. It's not good enough in a country like Australia.

The government's response in this budget commits nowhere near the funding that is needed to address these problems, but also it doesn't go towards tying that funding, through accountability measures, to where it really needs to go. We've seen the government ignore a lot of the recommendations of that royal commission. Why don't we have 24-hour nurses in aged care? This is something that people have been calling for for many years. Anyone who has a loved one in aged care—or, again, anyone who has looked at the recommendations—knows that staffing is key to addressing these issues. The people who work in aged care do it because they have a deep dedication to residents, because they care about the older Australians in their care. When you talk to these workers that is so clear. They front up day after day because they care about these people. What is so devastating is that they can't actually deliver the care in the ways that they would like to because there simply aren't enough people. I saw that firsthand when my grandmother was in aged care. People would come who really, really cared for the elderly people and wanted to spend time making their lives a little bit brighter. But they couldn't even give them the care to ensure that they weren't in these situations of neglect.

We've seen a response from this government that does nothing to address that, and does nothing to ensure that that money goes where it is most needed. It just goes to the providers like a blank cheque. Some of the providers mean very well, and I want to acknowledge that. I've met with them here in Canberra. Some of them are people who want to create a great place for elderly people to go when they need residential care. But we've also seen people making enormous profits out of aged care while the residents don't even have three decent meals a day. That's not good enough. We could see a policy that would do something about that, but we've not seen that here. I think this quote from the royal commissioner Lynelle Briggs sums this up perfectly and quite shockingly. She said:

At times in this inquiry, it has felt like the Government's main consideration was what was the minimum commitment it could get away with, rather than what should be done to sustain the aged care system so that it is enabled to deliver high quality and safe care. This must change.

This must change, and we on this side of the House, as the member for Dunkley has just said, will not stop asking until it does.

This is not a political problem to be fixed. This is a very human crisis that needs genuine commitment and a genuine solution, so that people in Australia aren't absolutely terrified of the day that they or their loved ones will need to go into aged care. And it's not just residential care; it's people on waiting lists for home care, who can't get the most basic of things to ensure they have dignity and some wellbeing in their older years.

We support this bill, and we have moved this amendment to ensure that, for the restrictive practices that we've seen abused—and we have seen widespread abuse of these very serious interventions throughout aged care—an actual independent expert oversees them. We also want to see accountability measures introduced. But so much more needs to be done. After eight years of cuts and neglect from this government, more needs to be done and Labor wants to see it happen. We have a plan that, under a Labor government, would see a decent aged-care system, decent child care for young people and a decent Medicare for people in between. We have a plan that actually cares about people, because we on this side of the House actually do care about people. We don't see this as a political fix, and we will keep asking.

Graham Perrett (Moreton, Australian Labor Party, Shadow Assistant Minister for Education) Share this | Link to this | Hansard source

I speak today on the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021. I note that we will be supporting this legislation but also note the second reading amendment moved by the member for Cooper. Obviously, anyone who has had a relative in residential aged care in the last 10 years or so knows that the aged-care system has problems, and in fact arguably was failing long before the royal commission handed down its report. I don't need to remind you, Deputy Speaker, that the title of the interim report was damning. It was a simple title: Neglect.

We know that the Morrison government are responsible for aged care and we know that they're about to enter their ninth year of government. This broken system is, sadly, one of the Prime Minister's great legacies. As stated by some of the earlier speakers, some of the rot started when he was Treasurer Morrison. We now have an aged-care system that has failed older Australians, those people entrusted to its care, who are some of our most vulnerable Australians. It is a disgrace. I can't understand why that title, Neglect, should not have been motivation for great change instead of incremental distractions. We know the Prime Minister is personally responsible for the devastation in the aged-care system, because, when he was Minister for Social Services and then Treasurer, he was responsible for funding cuts. He is therefore responsible for the neglect identified by the royal commission.

The entire nation was shocked by the neglect uncovered by those royal commission hearings. It was horrific neglect that included leaving wounds in a state that no civilised nation should accept. There were people with maggots in their wounds. Two-thirds of residents were malnourished or at risk of being malnourished. For eight years, the coalition government have failed to listen to our vulnerable Australians in the aged-care sector. They have failed to listen to families who have raised concerns. They have failed to listen, most importantly, to the workers in aged care.

Rather than looking at some of the fine words that have come from those opposite, let's look at what they have actually done, because it amounts to contempt for the workers in the aged-care system. The coalition have failed to listen to 22 expert reports. Now is not the time for kicking the can further down the road. Sadly, now that the royal commission into aged care has handed down its final report, the Morrison government's response shows that it has not listened to the royal commissioners. The facts were horrific, but the coalition's response, at best, aspires to woeful. They have no plan for reform that will improve aged care in the long term, when we have a tsunami of people who will be experiencing dementia and lots of other health issues. They have fobbed off, delayed or outright rejected some of the key recommendations from the commissioners. The aged-care sector will never improve without reform to the workforce. That is a fundamental part of what a good government's response should be.

Let's see what the Morrison government haven't done. They have not committed to improving wages for overstretched, undervalued aged-care workers. Aged-care workers are currently being paid less than someone working at McDonald's. Call me old-fashioned, but I still think that giving people money is a sign that they are valued. It's not complicated. Aged-care workers have an incredibly complex job. It's difficult. I've been to some of the aged-care facilities in my own electorate. I'm currently trying to get my 85-year-old father into the aged-care system. I know it's complicated. I know, just from trying to coordinate things with my siblings, that it's incredibly emotional. It's draining on staff to deal with the people in front of them. They're not statistics and they're not case loads; they are people with real-life stories and real-life families. But, for all of that, aged-care workers are still some of the worst-paid workers in the land.

We know it's an enormous responsibility to care for residents in aged care. One registered nurse in an aged-care facility reportedly said: 'People don't go to residential aged care for no reason. They go there because they can't look after themselves. They have chronic issues.' In some aged-care homes, registered nurses arrive for shifts to face the responsibility of looking after more than 100 residents. Just think of physically moving amongst 100 humans and having some meaningful interaction with 100 people in a row. That's not fair to the workers or to the aged-care residents relying on this care.

Prime Minister Morrison also ignored the recommendation to increase mandatory care minutes in residential aged care. Staffing levels are central to many of the care quality problems in residential aged care. We know that we're going to need an additional 700,000 workers in aged care by 2050 to cope with our ageing population. There is no way that's achievable when these jobs are disrespected and undervalued by the Morrison government.

Labor does support this bill because it will help prevent the overuse of restraints and restrictive practices in aged care except in the most extreme cases and only as a last resort. I'll mention, Mr Deputy Speaker Goodenough, your other capacity as a member of the Parliamentary Joint Committee on Human Rights. We conducted an inquiry into restrictive practices in aged care. We got some great evidence, and I think some good outcomes flowed from that. But the royal commission concluded that 30 per cent of older people in aged care, almost one in three, had experienced some form of substandard care. They specifically heard about the excessive use of physical and chemical restraints in residential aged care. The use of restraints robs older Australians of their dignity and autonomy, often in their final years or final months. Older Australians suffering dementia are often heavily sedated or physically restrained as a simple management tool, rather than as something that's in their best interests. This bill will help prevent the overuse of restraints, but obviously it's nowhere near the whole answer. When carers are overstretched and undervalued, they can't give the care that residents deserve. They just don't have the time.

Older Australians deserve much more than what is contained in this bill. All Australians deserve a Prime Minister who will listen to the experts and not continually ignore their advice. The royal commission made recommendations that, if implemented, would change the lives of older Australians. In some cases they would save their lives. Sadly, older Australians, their families and hardworking carers can't trust Prime Minister Morrison to fix the broken aged-care system that he started the rot in when he was the minister. Eight years of neglect, nudging into nine—that's what older Australians in aged care are experiencing now. It's not going to be fixed by this bill. Older Australians built this country. They and their families deserve much more than the broken system the Morrison government has created. Aged care impacts all of us. We all expect better than neglect.

Zali Steggall (Warringah, Independent) Share this | Link to this | Hansard source

I rise tonight to speak on the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021. This bill takes a welcome first step towards addressing the very serious recommendations of the royal commission and the independent review of provisions governing the use of restraints in residential aged care. The royal commission and the independent review revealed shocking tales of neglect and abuse in this sector. This bill will address the use of restrictive practices in aged care in alignment with the definition applied under the National Disability Insurance Scheme, bringing care practices in line with the NDIS. The bill also introduces additional scrutiny on home-care packages by creating a role for the secretary of the department to conduct assurance reviews into the delivery and administration of home care. The third measure of this bill abolishes the Aged Care Financing Authority, and the new institutional arrangements have been outlined by the government's response to the royal commission. However, submitters to the Senate inquiry into this bill do seek assurances from the government that there will not be a gap in the reporting on financial reporting of the sector performance in the absence of the ACFA without a replacement as yet.

In my electorate of Warringah there are 18 residential aged-care facilities. They have responded remarkably to the COVID pandemic, and I commend the staff for their efforts during a most trying time for them and their residents. The staff of the aged-care facilities bore a huge responsibility for keeping residents safe during the pandemic, and I know it was a huge stress on them and their families. Many facilities went for over 300 days without the presentation of a single flu symptom, and there was no known transmission of COVID-19 in Warringah aged-care facilities. Thank you to the residents, their families and the staff of these facilities for your efforts, patience and understanding of the need to keep one another safe during what has been a very difficult 15 months.

I am pleased that, in this bill, the government has moved relatively quickly to address the issue highlighted by the royal commission's findings. Restrictive practices involve the use of physical or chemical restraints to control the behaviour of residents in aged-care facilities. The tales and stories were harrowing. The royal commission heard stories and the media reported tales of nursing home residents being turned into zombies and of residents being strapped to a chair for 14 hours in one day. It is horrific to think that that was occurring in Australia.

This bill amends the Aged Care Act to make restrictive practices a measure of last resort. Whilst this is good, it is not quite the whole thing that was recommended. Importantly, it requires that the quality-of-care principles limit the circumstances in which a restrictive practice can be used. It should be noted that the Law Council of Australia points out that the definition used in this bill, unlike the definition employed by the royal commission, doesn't define 'restrictive practices' as 'a restriction on a person's ability to make decisions'; rather, it defines it only as 'a restriction on a person's rights'. So there is a concern about that discrepancy. The Law Council is concerned that the definition of the bill may not as clearly apply to the use of chemical restraints as intended by the royal commission, and the explanatory memorandum for the bill doesn't explicitly address the regulation of chemical restraints. I echo the Law Council's call for the bill to be amended and clarified to ensure that 'restrictive practice' is defined to include chemical restraints and to include safeguards specific to the use of such restraints. That was one of the aspects that was most shocking to people—the extent to which chemical restraints have been used. I urge the government and the minister to consider refining the definition of restrictive practices to clarify the responsibility of providers in relation to their use and to require that much greater control be applied to any circumstances of use of restrictive practices.

The bill also creates the ability for the secretary to conduct assurance reviews for the purposes of assuring that arrangements for the delivery and administration of home care are effective and efficient. Home-care accountability audits are very important. The Council on the Ageing supports greater oversight of home-care providers and also the increased transparency for consumers through the publishing of such reports on assurance reviews, including any recommendations and conclusions. We need these assurance reviews. Leading Age Services Australia has expressed concern at this clause in the bill, including the lack of definition of the term 'effective and efficient', and the absence of a clear methodology to be employed by the Department of Health. Again, it's really important that, when these bills are put to the parliament, the government and the minister ensure that appropriate definitions for these very important terms are included in the legislation.

Increasing accountability and transparency of the delivery of home-care packages is a welcome step; however, I urge the government to increase the capacity of the home-care sector to eliminate the waitlist for home-care packages. Whilst the additional 80,000 places over two years announced in the budget are very much welcome, there is still more than 100,000 people on the waitlist, and I can't imagine that list getting any shorter with the aging population that we face in this country. The royal commission recommended that the waitlist be cleared by 31 December 2021. At present, there doesn't appear to be a plan in place to clear that list until beyond July 2023. I don't think that is good enough. This is an urgent issue and one that requires immediate attention. Whilst I will always support greater transparency, I also support action, and auditing the performance of providers, rather than rolling out more packages, and slowing down their rollout is not the action that we need right now. It is really important for both of those actions to be taken on board by the government.

The 148 recommendations of the royal commission into aged care extend from legislative change to governance, establishment of specialised facilities and care models to improving public awareness of aged care and conditions for workers. It was very extensive. Last month I supported the member for Mayo's motion to establish a parliamentary joint select committee to oversee the implementation of the response to the royal commission. The diversity of issues and the dire need for reform demand ongoing parliamentary scrutiny through a joint select committee. Huge amounts of public funds need to be expended in this sector, and there needs to be the right oversight.

I welcome the government's response to the royal commission, but I urge them to take on board the need to implement more of the findings of the commissioners and the recommendations within the final report. In particular, I need to draw the government's attention to recommendation 72, which aimed to achieve equity for people with disability receiving aged care. There is currently discrimination against people over 65. In December 2019, I presented a petition of nearly 20,000 signatures which addressed the issue of age discrimination. It was brought to me by the ever-determined Bobbie English, whose husband, Chris, had had an accident at the age of 69, giving him quadriplegia. Prior to his accident he was a fully active member of society, but, unfortunately, because his accident occurred after the age of 65, he was not able to receive the level of care that really should have been his due. The government's response to recommendation 72 was non-committal, and no further clarity has been provided on this issue.

When someone over the age of 65 has an accident—and everyone in this place should think carefully about how active people over 65 are, like some members of this place or parents of members in this place—they're not eligible for an NDIS package. An aged-care package is worth less than half that of an NDIS package. Sadly, in relation to Chris and Bobbie English, Chris passed away in January this year, but Bobbie continues to fight for equality for people who acquire disability over the age of 65. Recommendation 72 needs to be addressed. This is something that gets passed around between the minister for aged care and the ministers for social services and the NDIS. Something needs to be done in this respect. We need to make sure that age discrimination isn't occurring. Just as you brought the guidance for restrictive practices into line with that employed by NDIS, bringing support and assistance in relation to disabilities into alignment would also be essential.

I welcome the government introducing this legislation and acting on some of the recommendations of the royal commission, but much more needs to be done in this sector.

Helen Haines (Indi, Independent) Share this | Link to this | Hansard source

I am not alone in this place in being someone who has experienced having a parent in residential aged care. My wonderful father, Jack, spent the last couple of weeks of his life receiving beautiful, high-quality palliative care in a residential aged-care facility in the town where he had spent most of his life. High-quality care should not be the exception to the rule; it should just be the rule. The Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021 is a first step in making some rules that will enable higher-quality aged care, because high-quality aged care must extend to everyone. One of my attempts at ensuring that this could happen again in my own community was to take up a position as volunteer director for an aged-care facility, and I did my best to make sure that we could deliver the highest-quality care to people in our facility.

This bill introduces restrictive practices limitations. Restrictive practices include chemical and physical restraint, and environmental restraint such as seclusion. It clarifies the definition of 'restrictive practices' so that this mirrors the much better NDIS definition, and it will expand the Aged Care Quality and Safety Commissioner's ability to respond to breaches, issue written notices and make applications of civil penalty. This is a good place to start in aged-care reform, because we have all seen the heartbreaking testimony of the royal commission and we all have images of what it looks like to see an older person strapped to a chair, either with ties or with a table clicked into place, or, indeed, restricted in their movement due to the use of sedative drugs. It's an awful sight and one that I never welcome seeing. I know it shocks many people when they see it, but the question here is: why would this be happening in the first place? Why would restraint ever be used, and what consent would be required if it were determined to be the only remedy, the last resort, to guarantee a person's safety?

We know that behavioural and psychological symptoms of dementia, known in the trade as BPSD, are a very challenging aspect of aged care. In Australia around 60 to 80 per cent of all residents in aged-care facilities have a cognitive impairment related to dementia. We know that the rates of dementia are rising. The associated behavioural and psychological disorders associated with dementia frequently result in the prescription of antipsychotic drugs and the use of these other forms of restraint. Person-centred care approaches to the management of behavioural and psychological symptoms of dementia has not been widely implemented, despite their reported effectiveness, and the barriers to the use of the non-pharmacological strategies need way more research. We need an evidence base that tells us what's stopping this happening in residential aged care. But what evidence we do have tells us of the positive impact of a person-centred approach, with skilled staff utilising, for example, music therapy, exercise and story work, ensuring that medical issues such as urinary tract infections and unmitigated pain receive rapid diagnosis and treatment and ensuring that issues like polypharmacy are addressed.

But at the core of this are staffing issues that preclude 24-hour access to registered nurses. We need to see all staff, including our personal care assistants, trained in behavioural management and we need to have access to experts in aged care, such as older persons nurse practitioners and mental health clinicians. Nurse practitioners are an incredible resource that could be mobilised across our aged-care sector if the policy levers were shifted to allow them to operate in a way that they could. Their access to Medicare items needs addressing urgently, and I call on the government to work closely with the College of Nurse Practitioners to get this happening. I know the Minister for Health has an interest in this area. So I encourage him to really get going on this.

I have seen the job satisfaction and joy that aged-care workers experience when they are resourced in a way that allows them to give high-quality care and when they are resourced in a way that makes the use of restraint truly one of last resort and only implemented with full and informed consent—the last resort rather than the go-to. We must not see restraint as a default mechanism to compensate for inadequate staffing levels. So many aged-care workers do incredible work, with great love and care, and this bill is one small step to alleviate decisions of desperation—decisions that are made because of constraints, of there not being enough people on the floor. There are roughly 1,650 people living in residential aged care in Indi, and I want this bill to ensure that there should never be an instance when anyone visiting a loved one sees that loved one restrained without full knowledge and consent. Informed consent is key to the contract of trust that a provider enters into with a resident and their family. We need good, functional decision aids to assist staff and carers to give informed consent.

The second part of this bill is around home-care assurance reviews. I have advocated for greater numbers of aged-care packages from the very first day, my very first speech in this House. It's crucial. It's what people want. I have been encouraged by the government's funding of additional aged-care packages in the last budget. And, of course, I call on them to keep going with that and to make sure that they cut that 100,000 people waitlist right back—well, completely, really. When we are paying good taxpayer money for aged-care services in the home, we want to see the highest-quality services that we can get. We want value for money and we want to see the right services delivered at the right time in the right place. We don't want to see packages eaten up by administrative fees or travel. We want to see adequate services in local areas close to where people live. I think the home-care assurance review is one step to making sure that that happens.

In Indi, over the last quarter, in 2020, 167 new people received a package. What I have been concerned about is what kind of packages they receive. We know that some people approved for high-level packages still remain on waitlists and are receiving lower-level packages. Again, I hope this bill goes towards improving the overall efficacy of the rollout of home-care packages, because we know that, when a person does not receive a home-care package at the level they need, it forces their hand to enter residential aged care much earlier than they otherwise would have. If, for example you live somewhere like Bright or Myrtleford, in the beautiful Alpine Valley region, there are very few residential beds available. There is no high-care aged-care facility in Bright at all. So, instead, we have people with high-care needs making the heartbreaking decision to move away from their homes to receive adequate care.

They move into the bigger regional centres such as Wodonga, Wangaratta or Benalla. For some people who have spent their entire life in a beautiful little alpine village, this may as well be another planet. For their relatives, often elderly, having to make the trek to that other town is extremely difficult and heartbreaking. For some people, in winter, travelling from Bright through snow-covered mountains across to Mount Beauty is a trip they simply can't do. This often means that husbands and wives are separated, and that's a decision that no family should ever have to make. No longer can anyone just drop in on their way past to fit in with sports and school. A trip to see grandma or grandpa can be an hour and a half's drive away. For ageing friends with mobility issues, it's even harder to keep close.

The need for a high-care residential facility in Bright isn't new. This issue has been raging since the 1980s. That they are still waiting for a solution 30 years on tells its own story of intergenerational neglect of our older people in regional Australia by this government and successive governments. Bright needs better aged care so that our older community members can age in the place where they've raised their families and lived and contributed their whole lives. Luckily, though, we are united on a solution. We need a new 35- to 40-bed high-care facility run by Alpine Health and co-funded by state and federal governments. Alpine Health is now looking for money to have their master plan for redevelopment funded. This is the first step. The master plan and the feasibility study from 2015 identified the full redevelopment of the hospital, including the provision for aged care, with some extension into the vacant hospital block.

The master plan redevelopment was left out of the federal and state budgets. For the life of me, in an environment in which we are really promoting high-quality aged care, I don't understand why. But, in my conversations with ministers from both governments, they say they're happy to come to the table and work together to find a way forward to support aged care for people in Bright. I had a really constructive meeting with Mr Coulton, the Minister for Regional Health, Regional Communications and Local Government, who is very sympathetic to the situation. Like me, he knows rural communities right to his bones. We do share the experience of parents in aged care in our small rural towns. He sees a pathway forward to work with all parties to get the aged care this community needs, and I will continue to work with him and his office as we move this forward. A few weeks back I met with Mark Barnes and Cathy Eldred from the Bright Hospital redevelopment committee who have worked tirelessly for over a decade to get high-level aged care in Bright. I visited Alpine Health several times and met with residents and the CEO, Nick Shaw, on this proposal. I know that this is possible, and I know they have all the skills they need to make this happen.

Aged-care reform happens on a national level, like this bill, but change happens at the facility level—at the place and at the moment that people decide to enter residential aged care. I want to see state-of-the-art residential aged-care facilities in Bright. I want to see high-quality aged-care practices wherever people are, and that's where reforms in this legislation should play out. So, today, I call on the ministers and those holding the pen. We need more than platitudes. In places like Bright and in the alpine region, the need couldn't be any more clear. Follow up on the broad-reaching reforms in this bill with something we can see on the ground. I really look forward to working with the committee of Alpine Health and the federal and state governments to get this done.

This is a good bill, and I commend it to the House. I do, though, also support the member for Mayo in her call for a parliamentary committee to oversee the recommendations of the royal commission. This is one of the most important and one of the biggest reforms our nation will see. We have to get it right. We will all be judged by this. We must get it right.

Libby Coker (Corangamite, Australian Labor Party) Share this | Link to this | Hansard source

The aged-care royal commission has shone a harsh light on the horrific mistreatment of many older Australians. It has revealed the grave failures of the Morrison government to act on a broken aged-care system, summed up aptly, but tragically, in the title of the interim report, Neglect. The royal commission found that the Morrison government remains focused not on what should be done but on the minimum commitment it could get away with. Those aren't my words; they are the words of the commissioner. So I welcome the Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021, and Labor will support it, with amendments, as an important first step in correcting the mistakes of this government.

These are no small mistakes. These are horrific, systemic mistakes that have resulted in the gross neglect and mistreatment of many of our most vulnerable citizens—our elderly citizens who rely on this government to ensure that they're treated with dignity, respect and compassion. Sadly, it took a royal commission and the words of brave individuals to force this Prime Minister to act and to introduce amendments to further strengthen legislation on the use of restrictive practices in aged care. Six years ago the Australian Law Reform Commission made recommendations to the Liberal government to stop the overuse of physical and chemical restraints, labelling them as a human rights abuse. But these reforms were ignored by the Liberals, leaving our elderly at serious risk of maltreatment. For example, in January 2019, we saw footage of Terry Reeves. Terry had dementia. He was regularly tied to his chair with a lap belt, sometimes for a total of 14 hours a day, and was heavily sedated with antipsychotic drugs. Terry's daughter, Michelle, gave evidence at the royal commission of other residents with dementia being kept in a small room and strapped to their chairs, just like her father. The statistics are damning. In the final three months of 2019-20 residential aged-care services made 24,681 reports of intent to restrain and 62,800 reports of physical restraint devices. The stories were so shocking that the former Liberal aged-care minister announced the government would consider introducing new legislation, and here we are, many, many months later, finally seeing this occur.

The legislation changes will bring the definition of restraint into alignment with the one applied under the National Disability Insurance Scheme. The legislation will provide a clear definition and ensure all restrictive practices are included. It will expand the Aged Care Quality and Safety Commissioner's ability to respond to breaches of approved aged-care providers' responsibilities in relation to restrictive practices, and it will amend the Aged Care Act to empower the health department's secretary to conduct reviews to ensure the arrangements for the delivery of home care are effective and efficient. But this bill is nowhere near what we need to overhaul a broken system, a system that is no longer trusted by Australians due to the inaction of the Morrison government—inaction on malnutrition, inaction on sexual abuse, inaction on maltreatment and inaction on neglect in the aged-care sector. The legislation remains limited and unresponsive to many of the royal commission's recommendations.

The Morrison government has rejected calls for a registered nurse to be on call 24/7 in aged care, and it has not dealt with the underpayment and overwork of aged-care workers. How can it be that workers in this female-dominated profession get paid less than someone stacking shelves at a supermarket? Labor would do so much better because we value workers and we value the tireless dedication of workers in this sector. I personally have experienced this with the care of my mother-in-law, who, sadly, died in aged care during the pandemic. And this bill does nothing to ensure greater transparency in the aged-care sector, with no requirement for the health department secretary to release reports for scrutiny. It is solely discretionary. It does not respond to the unacceptable number of older Australians waiting for home-care packages—it does respond but it will only reduce it, leaving more than 20,000 older Australians languishing on the waiting list.

Then we come to the vaccine rollout. Only three per cent of our population has been fully vaccinated, and the government cannot even tell us how many residents in aged care have been vaccinated. The government only had two jobs during this pandemic: to manage the vaccine rollout and to ensure a safe quarantine process, and they've failed on both accounts.

In closing, older Australians cannot afford another three years of this government. All Australians deserve a government that will treat our older citizens with dignity and respect and not abandon them to a failing system. We need a government that will restore trust in our aged-care system, because one day we may all face the prospect of entering an aged-care home and when that day comes we want to be assured that it will be a safe, caring and respectful place.

Luke Howarth (Petrie, Liberal Party, Assistant Minister for Youth and Employment Services) Share this | Link to this | Hansard source

The Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021 makes three urgent changes to deliver the first stage of aged-care reform developed in response to the royal commission and to ensure senior Australians receive high-quality and safe aged care. From 1 July 2021, this bill introduces important limitations on the ability for approved providers to use restraints and strengthens protections for aged-care recipients from any abuse associated with this practice. The term 'restraint' will be replaced with 'restrictive practices', continuing regulatory harmonisation with the disability sector. Further and more specific details of the strengthened obligations on approved providers will be prescribed by the Quality of Care Principles 2014.

The bill and the amended principles provide a framework to minimise the use of restrictive practices. The amendments do not authorise the use of restrictive practices where they are otherwise unlawful. The Aged Care Quality and Safety Commissioner's powers will be expanded to include the ability to give a written notice if a provider does not comply with its responsibilities relating to the use of restrictive practices and the ability to apply for a civil penalty order if they do not comply with the written notice.

Aged-care providers and their staff are very important. I know from personal observation that the vast majority of providers do a good job in my own electorate of Petrie up in Queensland—that's from talking to staff and residents in that area. But these changes here are to further strengthen what's required. I want to give a bit of a shout out to the staff in my own electorate of Petrie for the work that they do. They do an amazing job. The staff there care for people in aged care who in many ways helped to build this country. I know that many of those residents have had a difficult time as well with COVID-19 over the last 12 to 18 months. They haven't been able to leave the premises and also have not been able to receive visitors.

I would say to young people too, as the Assistant Minister for Youth and Employment Services, to maybe consider a career in caring for our elderly. That's very important. On Friday I visited a resident in my own electorate, Mr John Russell OAM, who is 101—it was his 101st birthday. He's a veteran from the Second World War. He spent seven years overseas and he actually spent time in Antarctica as well. He's also the author of a new book which has just been released. His daughter, Sue Morgan, is the carer for him. But I would say to young people that caring for our elderly Australians is a great career and that you can learn so much from elderly Australians.

This bill establishes an annual program of risk-based assurance reviews of home-care providers. The secretary of the Department of Health will be able to require approved home-care providers and their employees to provide information for the purposes of program assurance and to prepare and publish reports on the assurance reviews. This builds on our existing work to improve transparency of the aged-care sector and fosters community confidence in the costs of the aged care they receive. The bill also repeals a requirement for the minister to establish the Aged Care Financing Authority, the ACFA. An advisory group will be established to replace ACFA from July 2021, to ensure that the government continues to receive advice on financing issues in the aged-care sector.

I thank all members for their contributions to the debate on this bill. The health, safety and wellbeing of senior Australians is of the utmost importance to the Morrison government, and is driving our plan for generational change in the aged-care system.

Tony Smith (Speaker) 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 Cooper 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 amendment be disagreed to.