Sussan Ley (Farrer, Liberal Party, Shadow Minister for Women) Share this | Link to this | Hansard source

I rise to speak on the Aged Care Amendment (Implementing Care Reform) Bill 2022, and I move:

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

"whilst not declining to give the bill a second reading, the House:

(1) notes that, of the aged care providers who do not currently have a registered nurse on site, and on duty, at all times, 53% are based in regional and remote areas and 86% are small providers; and

(2) calls on the Government to ensure that:

(a) when amending the Quality of Care Principles to make provision for an exemption to the new responsibility relating to registered nurses, the disproportionate impact on providers in regional and remote areas, especially small providers, is taken into account; and

(b) further consideration of the bill is deferred until two sitting days after a draft of legislative instruments relating to the following matters are made available:

(i) exemption from the responsibility related to registered nurses as proposed in section 54-1A of the bill; and

(ii) information about aged care services that must be publicly available as proposed in section 86-10 of the bill".

The coalition supports the implementation of the recommendations of the Royal Commission into Aged Care Quality and Safety, and we want to make that very clear. In response to the recommendations of the royal commission, the previous coalition government invested $19.1 billion to improve aged care and to fund new homecare packages, respite services, training places, retention bonuses and infrastructure upgrades. This bill continues our work on the fundamental and generational reform of the aged-care system to ensure that it meets the needs of senior Australians both now and into the future.

This bill, the Aged Care Amendment (Implementing Care Reform) Bill, further responds to the recommendations of the royal commission which are contained in three schedules that amend the Aged Care Act 1997. The opposition is disappointed, however, that this legislation lacks any details on how the schedules will be implemented. It also dismisses the full details of one of the key recommendations of the royal commission. Schedule 1 of this legislation seeks to deliver on a Labor Party election commitment to have a registered nurse on site at all aged-care homes, 24/7, by 1 July 2023. Recommendation 86. 5 of the Royal Commission into Aged Care Quality and Safety states:

… from 1 July 2024, the minimum staff time standard should require at least one registered nurse on site per residential aged care facility at all times.

The opposition supports the implementation of the requirement for a registered nurse on site 24/7 at every aged-care facility, in line with the royal commission's recommendations.

The royal commission took into account a range of factors when recommending their time line, recognising workforce shortages, the pressure placed on aged-care homes throughout the pandemic and the time required to train or access this additional workforce. Despite these undeniable factors the government has brought the time line forward by a year, in conflict with the royal commission's recommendations. The opposition has genuine concerns regarding the impact this will have on the aged-care sector, particularly on small aged-care homes and those in rural, regional and remote Australia. And everyone would acknowledge that on this side of the House we have more representatives of rural, regional and remote Australia. The bill fails to demonstrate where the additional workforce will come from and how this workforce can be accessed in the short time frame set by this bill, and whether this will have significant impacts on other care sectors which are competing for the limited number of registered nurses available.

I note the testimonies from the Community Affairs Committee's hearing into this bill, where many witnesses, including aged-care peak bodies, providers and unions, anticipated that accessing additional registered nurse will be difficult and, in some cases, not even possible in the foreseeable future. The written submission from the National Aboriginal Community Controlled Health Organisation stated, 'There is a risk that many services may need to close or that providers will leave aged care, especially in areas where there are no other services available. There is a known undersupply of health and care staff across the sector. In aged care, this includes registered nurses, and the aged-care industry needs adequate time to recruit and train additional staff.' Without access to the details that will be contained in the delegated legislation, it is unclear how providers, including Aboriginal and Torres Strait Islander providers and those in rural and regional Australia, will be supported to ensure that their aged-care services will not be closed due to this requirement.

These concerns are heightened by the lack of detail surrounding the exemption clause for schedule 1, which will create uncertainty for many providers. The lack of transparency surrounding this subordinate legislation also avoids parliamentary scrutiny and has been highlighted as a key issue for aged-care providers and other key stakeholders. The government must provide answers to the significant questions surrounding this exemption clause. Providers deserve to know the details of the exemption mechanism: who will be eligible, the length of the exemptions, the penalties of noncompliance and who the decision-maker will be. The opposition is particularly concerned about the impact on regional and rural providers of the uncertainty that exists until these questions are answered and the delegated legislation is seen.

We note the unique circumstances of rural and regional providers due to their geographic locations and the challenges they face in finding the additional workforce to meet the requirement, exacerbated by the time frames set out in this bill.

These concerns were also shared by the National Aboriginal Community Controlled Health Organisation, as I announced earlier. They said, in order to meet the recommendations of the royal commission and the national agreement and ensure Aboriginal and Torres Strait Islander people receive aged care from the most appropriate organisations, consideration must be given to alternative staffing models for services in urban, regional, rural, remote and very remote locations. So the opposition believes it is essential the delegated legislation outlining the details of the exemption mechanism should be tabled before this bill is further considered.

In recognition of our concerns, the opposition will seek to move an amendment, which I have circulated, to ensure that the draft subordinate legislation is presented to parliament prior to the passage of this legislation. The cost to providers of a poorly drafted exemption clause has the potential to be significant, especially for providers already facing difficulties accessing adequate workforce and whose viability is already under pressure.

It is also unclear whether the subordinate legislation will consider the acuity of care required by individual facilities in the implementation of the requirement for a registered nurse to be on site 24/7. I note testimony from Dr Brooke, the Chief Executive Officer of the Australian Community Care Alliance, who said the other problem is, if you have one registered nurse for a whole facility, you're not defining the level of experience suitable to the level of acuity in those residents. You can have one registered nurse who's a new graduate who's been out for two weeks and that will fulfil that requirement, but the level of acuity with palliative, dementia and delirium isn't going to be supported by an inexperienced nurse or a nurse who's not familiar with the residential aged-care facilities.

Schedule 2 of the bill enables the government to cap charges that approved home-care providers can charge care recipients, and it removes home-care providers' ability to charge exit amounts. In government, the coalition implemented for the first time a requirement for information to be published relating to the median prices charged for home-care services to support older Australians and their families make more informed decisions on home care and the associated costs. The coalition government began the process of providing greater accessibility of information to assist with informed decision-making on home-care services and to put downward pressure on home-care prices. We support the government's continuation of our reforms to support older Australians access important home-care services, allowing them to remain independent in their homes for longer.

Schedule 3 of the bill requires the Secretary of the Department of Health and Aged Care to publish information in relation to aged-care providers with the aim of further increasing transparency on aged-care services and allowing Australians to make more informed decisions on aged care. The publication of additional information to increase sector transparency and increase consumer understanding of the sector is supported by the opposition. We absolutely agree on the importance of increasing transparency in the aged-care sector, and we're happy to see the government continue our reform work in this area. However, we note that, like schedule 1, the details of this schedule are subject to delegated legislation that has not been released by the government. There are still questions regarding exactly what will be published.

So, in conclusion, and to speak to my amendment, the opposition strongly supports improving the aged-care sector and the care provided to our older Australians. However, the extreme reliance of this bill on delegated legislation, the details of which have not been released by the government, denies the parliament the opportunity to scrutinise the impact of this legislation. That's why our amendment has been introduced—to ensure the government, who was elected on a platform of transparency, provides the necessary information to allow for adequate parliamentary scrutiny of this bill. We propose that further consideration of this bill be postponed until such time as the draft legislative instruments relating to schedule 1 and schedule 3 of the bill are tabled in parliament.

We also note that 53 per cent of all aged-care homes who currently do not have a registered nurse on site at all times are based in regional and remote areas, and, of this, 86 per cent are small providers. Considering this, we're calling on the government to ensure that, when amending the quality of care principles to make provision for an exemption to the new responsibility relating to registered nurses, the disproportionate impact on providers in regional and remote areas, especially small providers, is properly taken into account. So the opposition calls on the government to provide greater transparency on the details that will inform the implementations of the schedules of this bill.

Nothing in the introduction of our amendment should detract from our real and genuine passion for reform of the aged-care system. This is something that the royal commission picked up on, that we ran with, that we funded and that we want to see done incredibly well and properly. Failures in that system have brought members of this House to tears on many occasions, both within this chamber and outside it, when they've looked at the circumstances of their own families and when they've seen the struggles of the providers in their own, often rural and regional, communities. The level of care and concern is very high. And in no way do we want to politicise what should not be a political debate.

But what we are saying is that the government must stick with this promise of being transparent—of demonstrating the detail of the legislation. Where they have changed the royal commission's recommendations, and where that change could have a deleterious effect on rural and regional and remote providers, as demonstrated by the committee hearing, then we must see the detail, because uncertainty only adds to insecurity—insecurity of our wonderful community based providers. The member for Forrest, who's at the table, has many in her own electorate that she has spoken about on many occasions. Personal examples have been brought forward on many occasions. We need to see that detail so that we can reassure our community based providers, who work under incredible pressure and do what they do incredibly well, and also reassure our older Australians and their families. I thank the House.

Scott Buchholz (Wright, Liberal Party) Share this | Link to this | Hansard source

I thank the honourable member for her contribution. Is the amendment seconded?

Nola Marino (Forrest, Liberal Party, Shadow Assistant Minister for Education) Share this | Link to this | Hansard source

I second the amendment and reserve my right to speak.

Ged Kearney (Cooper, Australian Labor Party, Assistant Minister for Health and Aged Care) Share this | Link to this | Hansard source

I rise to address the House on the Aged Care Amendment (Implementing Care Reform) Bill 2022. This bill implements a number of our government's important election commitments that will improve integrity and accountability for aged-care facilities. The bill puts nurses back into nursing homes and caps home-care administration and management charges. This will ensure that older Australians receive the aged care they deserve, and that security, dignity and humanity are put back in the system.

These reforms must be done urgently. This is because hundreds of thousands of families have seen the aged-care system in crisis and they need to know that the system is changing for the better—that it will be fixed. It is reforms like these that only happen under Labor governments, and it is reforms like these that are precisely why I am standing here where I am. I am so honoured, as a registered nurse who's worked in aged care, to be here today, speaking in the chamber about the importance of these reforms. These are reforms that I have worked on with my colleagues and have played a role in nurturing, from the idea stage through to legislation, and that those in the mighty union movement—in the ANMF, the UWU and the HSU, with other unions—have worked on collectively, along with their members, the hard-workers in aged care, and with providers and consumer advocacy groups, because when we do things together we get things done.

This bill also responds to recommendations of the Royal Commission into Aged Care Quality and Safety and demonstrates another step this government is taking to address these shortcomings in the care provided to older Australians. In the history of aged-care facilities in Australia, there will be a 'before this legislation' and an 'after this legislation'. The 'before' is a terrible national tale of neglect, where older Australians—mums and dads, grandmothers, grandfathers, neighbours, friends and community members—were left to languish in a system that was not geared to protect them. Under the previous government, we saw COVID rip through these facilities. Under the previous government, aged-care facilities didn't have an adequate supply of personal protective equipment or enough RATs. There was a failed delivery of booster shots. There was a cynical cash bonus incentive for poorly-paid workers. But they would not commit to any real wage increases. We saw facilities struggling to fill shifts, with a stampede of workers leaving the sector for less stressful and better-paid work elsewhere. There was a failure to act decisively on the royal commission's recommendations, including in making sure that workers had enough time and resources to care for residents appropriately.

I want to paint this 'before' picture, which is a bleak portrait of the sector that was almost on its knees. While there are many great examples within the sector, by and large, it was one that had been failed by the government and was failing Australians. The picture we are working to paint, with these reforms as a significant part of that, will be very different. These reforms will shift the way aged-care facilities fundamentally run and operate and the way people are supported to age in the community and residential care settings.

Schedule 1 of this bill will introduce a new responsibility for approved providers of residential care. From 1 July 2023, aged-care providers will need to have a registered nurse on site and on duty at each residential facility, 24 hours a day, seven days a week. Put differently, we are putting nurses back into nursing homes. Nurses offer so much. They're a highly skilled set of hands. They offer expertise. They're a steady and measured presence that many other staff often look to for guidance and support.

The royal commission found unacceptable staffing levels in over half of all nursing homes. For too long staff have been stretched too thin, and the consequence of this has been that our older Australians are not guaranteed the care they deserve. By putting nurses back into nursing homes, we are implementing a crucial election commitment. This will save thousands of unnecessary trips to hospital emergency departments and will ensure that older Australians living in residential aged care have access to the nursing care they deserve. It will lift care and quality standards and improve health outcomes. Crucially, this will put expertise in house.

The dedicated women and men who work in aged care are so critical to getting the settings right for this sector. These workers, the personal care workers, cleaners, cooks, nurses and administrators, are such exceptional people who've had to work in incredibly difficult circumstances. After enduring the pandemic and its massive implications for the sector, they are bone tired. They've worked around the clock to care for their elderly residents. They've often taken on additional responsibilities to keep residents cared for and safe. They've been spread so thin, looking after way too many residents, and these workers have had to make extremely difficult decisions about how to prioritise care. They've worked double shifts covering colleagues out sick with COVID. They've taken yet more shifts as colleagues have left the sector for less stressful and better paid work.

The ANMF released a survey of nearly 1,000 aged-care workers in March this year. Thirty-seven per cent of these workers said they planned to quit the sector within the next one to five years, with another 21 per cent planning to leave within the next 12 months. These workers said they were feeling hopeless and abandoned, exhausted, demoralised and resigned. Being both overworked and underpaid is not only a terrible position to put workers in but it's potentially dangerous for the residents, as it leads to a rapid exodus of workers.

The previous government must be held accountable. The sector has been haemorrhaging staff and we need to stem the flow. We need to get these people back and encourage a pipeline of the next generation of aged-care workers. One of the ways we plan to do that is also a part of these reforms. We need to give aged-care workers the time and resources to provide appropriate care for residents. This is why we will be mandating care minutes for aged-care residents.

Everyone who works in aged care is there because they want to be there, they want to provide care to our older Australians, and they must be given the time to do that. That is why the government will mandate that everyone living in residential aged-care facilities will receive an average of 200 minutes of care per day by October 2023, and this will increase to an average of 215 minutes of care per day by October 2024. This, crucially, includes 40 minutes with a registered nurse. This will fulfil our election commitment and is in line with recommendation 86 from the Royal Commission into Aged Care Quality and Safety.

By mandating these care minutes, workers will be able to dedicate an appropriate amount of time to look after each person in their care. It will make sure that residents get an average of 35 additional minutes of care above current levels. It will mean that workers don't need to make a difficult decision about whether to feed someone or follow a resident who is wandering and keep them safe, because they will be able to look after everyone in their care. It will mean residents aren't put to bed at 4.30 in the afternoon because there are not enough staff on an evening shift. It will mean they can spend the time talking to the residents and assessing their mental health, their cognitive awareness and their wellbeing and give them some much-craved company. It will mean more care for every resident every day and not just for essential medical treatment. It will mean they can help a resident have a shower, get dressed or even phone a loved one. We know this will improve the lives and wellbeing of residents immeasurably. It will improve not only their health but also their mental health.

Another part of this suite of reforms is capping administration and management charges for people receiving home care. When charges are capped it means that more of the funding will go directly to care. Too many older Australians who are living in their homes have crippling high management and admin charges. Currently approaches to charging vary significantly across providers. While they are required to publish prices for care and package management, there is little transparency about how these prices are set and there is no cap on the amount that may be charged. Our government is reducing the high levels of administration and management charges and will remove the ability of providers to charge care recipients for ceasing care.

Evidence to the aged care royal commission demonstrated some organisations gouge as much as 50 per cent from people's packages. These historically high charges have had a significant impact on the amount of funding that can actually be spent on care while people are living at home. This has meant older Australians are missing out on care. Ultimately we want to be keeping people in their homes as they age as long as it's safe and they are comfortable. We've listened to older Australians and we will keep listening to them and their families. So many older people want to stay at home as long as they can. They want to stay in their communities, stay where their family and friends can drop in, stay where they can make tea and coffee in their own kitchen and sleep in their own bed, and live on a familiar street with neighbours who know and love them. When someone is well enough to stay at home it encourages their independence. Light physical activity is important and it supports general wellbeing and connectedness. It's so important to have the support systems and services in place so that people can stay in their homes.

A Labor government is not afraid to put the quality and safety of home care first by reining in unscrupulous providers who are charging exorbitant management and admin fees. These reforms put transparency, integrity and accountability into aged care. For too long under the previous government the aged-care sector was encouraged and rewarded for opaque, greedy and even deceptive fees. This has to change. We were very clear that a Labor government will stop this. We'll ensure that older Australians and their families have access to more comprehensive information about aged-care services and providers, including how money is spent on care. The Labor government have long said that we will improve transparency, integrity and accountability in this sector. We'll shine a light in the dark corners in areas where poor behaviours and practices have flourished.

The amendments in schedule 3 of the bill will ensure that older Australians have access to more and better information. These amendments will ensure information is published in a format that is clear and able to be understood. This will empower older Australians and their families to make better decisions about their care and will strengthen the integrity and accountability of providers and incentivise best practice. This will deliver improved nursing care and provide for improved pricing and transparency. It demonstrates this government's commitment to putting security, dignity, quality and humanity back into our aged-care system.

This bill takes several important steps towards fixing the aged-care crisis. Change takes time, and we don't believe things will be fixed immediately, but change means fixing many things, monitoring them and continuing to talk to workers, residents and other people in this sector to understand how the reforms are progressing. However, at its heart it is all about dignity; it's about restoring humanity and respect to the sector; it's about standing up for workers and their conditions; it's about enshrining integrity and transparency; it's about improving people's lives as they age, both in their homes and in aged-care facilities; and it's about reforming the aged-care sector to do what it is meant to do—care for people.

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

I rise to speak on the Aged Care Amendment (Implementing Care Reform) Bill 2022. I support the aims of this bill and believe that it shows the crossbench continues to be an engine room for key reforms. That is because the measures in this bill mirror two private members' bills which I introduced in the previous parliament and another measure for which I strongly advocated. However, unlike my bills, this bill places an overreliance on subordinate legislation with key—indeed, almost all—details of the measures not yet known because they will be comprised in subordinate principles under the Aged Care Act.

Based on the bill before us, members will be denied any opportunity to debate the devil in this detail. I know very well that many of these provisions could be included in the primary legislation, because I have previously introduced private members' bills that did precisely that. That is why I will move a second reading amendment, which has been circulated in my name, to the amendment moved by the member for Farrer. I move:

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

"the House:

(1) has concerns that the bulk of the substantive measures comprising the bill are to be detailed in subordinate rather than in primary legislation; and

(2) calls on the Government to

(a) provide an opportunity to review the Quality of Care Principles, User Rights Principles and Information Principles proposed to be made under the Aged Care Act 1997;

(b) include in the Quality of Care Principles under Schedule 2 criteria for the exercise of exemption powers which provide for smaller and regional providers taking into account critical workforce shortages among other considerations; and

(c) specify in Information Principles under Schedule 3 financial and non-financial information of value to older Australians, their families and the community that must be published by the Secretary, including:

(i) expenditure on care, nursing, food, maintenance, cleaning and administration;

(ii) profits;

(iii) payments such as rent to third parties; and

(iv) expenditure on executive salaries".

I call on the government to provide parliamentarians with an opportunity to review these subordinate principles. It is my view that I deserve, and that every other member in this place deserves, the opportunity to properly represent our constituents and ensure that changes to the age-care system are to the benefit of all older Australians.

My second reading amendment also calls on the government to take into account in those subordinate principles that smaller and regional residential aged-care providers which are experiencing critical workforce shortages have flexibility. Many terrific smaller regional providers are already reporting struggles with workforce shortages and, indeed, just to break even. They are really struggling due to the ongoing management of COVID. So I would like to see some recognition by the government that additional funding and support are needed to ensure the regional facilities where older Australians live and where they want to go into care in their communities so that they can continue to age in place.

My second reading amendment also sets out to be inclusive, not exclusive: a list of matters which I believe should be published by the secretary, including executive salaries and such as payments to third parties. This is so that we can avoid, for example, a provider paying well above the market rent to an affiliated third party, and we have seen instances of that. In addition, my substantive amendment to the bill, again, that has been circulated in my name, addresses the risk that the imposition of a cap on administration and management fees for home services doesn't result in gold plating of fees and services or of equipment in other areas—essentially, cost- or profit-shifting.

My constituents tell me that providers have required them to obtain costly occupational therapist reports to secure equipment such as a basic shower chair and, in one case, a hanging basket for the shower, just to contain soap bottles. While such assessments are probably advisable for high-value items, they can cost up to $700 out of a package in a month, only for people to be told that, really, they just need a very simple piece of equipment. Other constituents have been forced to use expensive third-party providers, paying a 10 per cent premium to their aged-care provider for the privilege, or prevented from purchasing identical items, such as hospital beds or showering chairs, which are available more cheaply elsewhere.

When contacting the Aged Care Quality and Safety Commission, my team has been told that these are matters for providers. So anything that we can do in this place to prevent rorting and to prevent gold plating should be pursued here. I therefore urge members—the government, the opposition and of course my fellow crossbenchers—to support these amendments.

To the bill itself: schedule 1 amends the Aged Care Act to require approved residential and flexible-care providers to have at least one registered nurse on duty in residential aged-care facilities at all times. This is consistent with aged-care amendments secured by former senators Stirling Griff and Rex Patrick, for South Australia, in the other place in the last parliament. I advocated for the amended bill in question to be brought back to this place on budget reply day, and I was disappointed that it lapsed with the proroguing of the parliament and wasn't brought on for debate, unlike other amendments that tend to come down from the Senate.

While it's pleasing to see that this measure progressed, I'm concerned that the details of exemptions with respect to the quality-of-care principles made under the act will be absent from parliamentary scrutiny and debate in this place because it's all going to sit in subordinate legislation. These examples will be of immense importance to smaller regional providers in electorates such as mine which are already reporting huge challenges with respect to critical workforce shortages. The risk we run is: if appropriate exemption criteria is not set, smaller regional providers may be forced to close. This could leave regional residents unable to access care in their communities close to friends, close to family, close to where they know and where they grow up—their homes.

The idea that the exemption provisions will be buried in subordinate legislation really does concern me. As the Law Council has pointed out, the primary legislation should identify the decision-maker, prescribe the circumstances in which exemptions should be granted and provide that exemptions can only be granted if safe, quality care can otherwise be ensured. The Law Council also submitted that the bill should set out a mechanism for merits review of exemption provisions. I therefore urge the minister and the department to listen to older people, particularly those in the regions, and to their families, providers and advocates, including their elected representatives, when establishing these exemption provisions.

Schedule 2 of the bill introduces a cap for home-care administration and management charges from 1 January and to ban exit fees for people wishing to change home-care providers. This is an excellent measure but we need to make sure that we get it right. On 25 October last year I introduced my Aged Care Amendment (Making Aged Care Fees Fairer) Bill. My aim was to improve transparency for charges for aged care at home to ensure that home-care fees would be spent on home care rather than on administration management fees, and, I also put in that bill, to ban exit fees. I really do welcome this move by the government. The genesis of my bill was through surveying more than 15,000 residents in Mayo aged over 75. We had more than 1,200 people respond, half of whom said they were really unhappy with their administration and management fees. We saw that respondents were reported paying administration management fees of up to 48 per cent of their package; that would be month on month, even when there was absolutely no change at all to their package. Capping these fees, I think, will make a real difference. We need to make sure, though, that profits and charges are not then transferred to other areas.

At the time when I introduced my bill, it set a cap of 25 per cent on lower-value packages and 20 per cent on higher-value packages which could be charged for administration or care or package management, clearly defined to prevent fees being hidden elsewhere. Following the introduction of that bill I was overwhelmed by the number of older Australians from right across Australia who made contact with me, expressing their support. We know capping fee provisions can be imposed through primary legislation because that's what I did in my private member's bill, so I don't understand why we are not seeing this in this bill here before the House.

Schedule 3 of the bill amends the Aged Care Act to allow for subordinate information principles to specify information about providers and their services that the secretary must publish. The government states that information to be published may include certain financial information, profits, expenditure on care, nursing, food, maintenance, cleaning, administration and non-financial information. But the bill does not provide this detail at all, and I would prefer to see the publication requirements included in the primary legislation and extended beyond the information proposed by the government to include executive salaries and rents. We know that there have been cases where more than double the commercial rent has been charged to an aged-care facility that sits on land owned by other parties. We need to make sure that that sort of gouging stops.

My Aged Care Legislation Amendment (Financial Transparency) Bill 2020, introduced on 19 October 2020, also required residential aged-care providers to disclose their income, food costs, medication, staff, staff training, accommodation and administration moneys paid to parent bodies each year, and to include financial information in annual financial statements. Aged-care providers have this information; it's just a case of disclosing it to the public. That needs to be as transparent as possible for families and for those who are entering aged care. The fact that these requirements were specified in my private member's bill means that the government, with its considerably greater resources than what a crossbencher has—including departmental resources—could specify these requirements in primary legislation if it chose to do so.

So, while I do feel a sense of relief that older members of our community will finally benefit from these practical measures to improve aged care, my gratitude is tempered by the lack of transparency provided in the legislative process, through over-reliance on the use of subordinate legislation. This is my third parliament, and I have heard other members in this place complain bitterly when we saw huge swathes of decision-making put in subordinate legislation, essentially at the discretion of the minister. I am always of the view that there is much to be decided on through debate in this chamber by all of us, not through the pen of the minister.

I thank the government for processing these long-awaited reforms. I do commend this bill, and I seek support for my substantive amendment to the bill and for my second reading amendment, which I have already detailed. We need to ensure that there is prompt implementation in order to make a difference for older Australians living in residential aged care and older Australians who are in receipt of, or desperately seeking, a home-care package.

Scott Buchholz (Wright, Liberal Party) Share this | Link to this | Hansard source

Is the amendment seconded?

Dai Le (Fowler, Independent) Share this | Link to this | Hansard source

I second the amendment put forward by the member for Mayo—a strong voice for regional Australia and an incredible advocate for the elderly and their wellbeing, and for her constituents and the broader Australian community. Like regional Australia, my electorate of Fowler in Western Sydney is often neglected for key services relating to aged care and health—

Scott Buchholz (Wright, Liberal Party) Share this | Link to this | Hansard source

Member for Fowler, are you just seconding the amendment at this stage and reserving your right to speak, or do you want to speak to the amendment now?

Dai Le (Fowler, Independent) Share this | Link to this | Hansard source

Yes. Like regional Australia, my electorate of Fowler in Western Sydney is often neglected for key services relating to aged care and health in favour of the cities and electorates more politically favourable for the major parties. Every Australian deserves dignity and the right to access affordable and high-quality aged care, regardless—

Scott Buchholz (Wright, Liberal Party) Share this | Link to this | Hansard source

Order! Sorry, Member for Fowler, if I can interject for a moment, the convention of the House is normally that, once the mover of an amendment has spoken, the next speaker would come from the other side of the House. If you would bear with me so we can observe convention, I'll do some housekeeping. The amendment is now seconded. The original question was that this bill be now read a second time. To this the honourable member for Farrer moved as an amendment that all words after 'That' be omitted with a view to substituting other words. The honourable member for Mayo has now moved an amendment to that amendment—that all words after 'whilst' be omitted with a view to substituting other words. The question now is that the amendment moved by the honourable member for Mayo to the amendment moved by the honourable member for Farrer be disagreed to.

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

I rise today to speak in support of this bill, the Aged Care Amendment (Implementing Care Reform) Bill 2022, which will stop the neglect and return security, dignity, quality and humanity to aged care.

For too long older Australians have been forgotten and neglected, and for too long they have suffered. All of us in this place have heard too many heartbreaking stories of a system that has let down many of the most vulnerable Australians. The royal commission found that 30 per cent of people in aged care have experienced substandard care. That's one in three of our parents and grandparents who have been robbed of their dignity in the final years of their lives. Australians in aged care are not a burden, and they deserve the proper care and support that they need in their later years. Aged care affects us all—our parents, grandparents, partners and friends—and many of us most likely will rely on it at some point. These are our loved ones. These people are Australians, and they deserve to be treated as we would want to be treated. That's why we need to get this right.

Over the last decade we saw 23 reports, inquiries, studies, committee reports and a royal commission, and they all told us the same story—that the aged-care sector was in crisis; that older Australians were being robbed of their security, dignity and quality of life in their later years; that aged-care workers were underpaid and overworked, and the system was being pushed to breaking point. The Royal Commission into Aged Care Quality and Safety challenged us to be better and do better. I want to say, again, thank you to those people who shared their stories through the royal commission, because they shone a spotlight on the true depth of the crisis. They told stories of malnourishment, of maggots in wounds and of older Australians being physically restrained for hours on end. I've spoken before in this place about my own family's experiences with aged care and the fact that, while the stories that were brought to light by the royal commission were completely unacceptable and shocking, for anyone who had had an experience with aged care they were, devastatingly, all too commonplace. They were not that surprising for people who'd had firsthand experience with the sector.

But Labor has heard these stories, and I am proud to be part of a government that has listened to those findings and is now taking action to fix this crisis. I'm proud to be part of a government that has a plan and will deliver on those commitments. I really want to acknowledge the work of the shadow minister for aged care in the last term, the member for Hotham, and acknowledge our Minister for Aged Care for the incredible work she has done in hitting the ground running. I know that she will give her all to fixing this crisis. Labor's plan will put nurses back into nursing homes, lift wages for workers in the sector and give carers more time to care. It will deliver better care, it will improve transparency and accountability, and it will cap the fees paid for home care.

I also want to acknowledge again in this place the incredible work of aged-care workers, the true heroes of the pandemic, who fronted up day after day to care for older Australians in spite of being underpaid and, in many cases, not properly protected with the things that they needed for their own safety as the pandemic hit. These people have been brave and strong, and they got us through. I also want to thank them for their advocacy over all the years that finally bring us to addressing these problems.

From 1 July next year, providers of residential care and of specified kinds of flexible care will be required to have a registered nurse on site and on duty at each residential facility, 24 hours a day, seven days a week. This is something that people—unions and others—have called for over many years. This will give older Australians living in residential aged care access to the nursing care that they deserve. It will also have flow-on benefits to our health system, which has been struggling with the pandemic, because this proactive care will prevent thousands of stressful, expensive and ultimately unnecessary trips to hospital emergency departments. Labor understands facilities in rural and remote areas face a tougher time in attracting and retaining staff, so there is an exemption framework within the legislation for specific circumstances. However, all exemptions will be time limited to ensure that providers do not use an exemption as an excuse to stop seeking staff or to circumvent the need to deliver quality care.

The Department of Health and Aged Care and the Aged Care Quality and Safety Commission will work with exempted providers to help them work towards meeting their new responsibility. But the Labor government recognises that older Australians living in rural and remote areas deserve the same quality of care as those living in metropolitan areas. Importantly, rural and remote providers are still required to meet a standard of care and, if subject to an exception, would still need to demonstrate that they have appropriate arrangements in place to ensure quality and safety of residents.

We recognise the difficulties that some facilities have in attracting their workforce so have established a wide range of programs to attract staff and support retention. These include initiatives such as 1,900 scholarships, support for 5,250 clinical placements and the nurses retention payment of up to $6,000 annually.

Labor wants to make aged care a place where people want to work, where they will be respected and valued for the important work that they do, and wants their pay to reflect that. That's why we are also backing a real pay rise for aged-care workers and have made a submission to the Fair Work Commission in support of increased wages for aged-care workers. We are committed to funding the outcome of the case. Increased wages for registered nurses are expected to close the gap between supply and demand. These improvements are long overdue for these incredible workers in the aged-care sector.

This bill also reflects the government's commitment to fixing home-care charges. That's why this bill will cap the amount that can be charged for administration and management to people receiving home-care packages and remove exit charges altogether. The royal commission heard of astronomical fees, that up to 50 per cent of some home-care packages were being eaten up in administration and management fees, charges that reduce care rather than improve it. That's money that should be going into care. These unacceptably high fees lead to older Australians missing out on the care that they need to keep independence and continue living at home.

This legislation will enable the government to cap these charges and maximise funding available to address the care needs of more than 210,000 older Australians currently receiving home-care packages. These proposed changes are intended to provide all-important pricing transparency for consumers and providers and greater clarity about direct and indirect costs.

We are totally committed to improving integrity and accountability in the aged-care sector. The royal commission found that a lack of transparency is a pervasive feature of the current aged-care system. We want to provide greater transparency on what aged-care providers are spending money on and other valuable information about providers' operations. The royal commission found that there is a lack of transparency and accountability about approved providers and that good quality comparative information about aged-care services is not publicly available.

The bill requires the secretary and the department to make publicly available information on residential aged-care services and provider expenditure, including information on labour, care, food and nutrition, cleaning, administration, maintenance and profit or loss. This information will be published online, empowering older Australians and their families to make better informed decisions about their care. It will also strengthen integrity and accountability of providers and incentivise good practice. These important measures respond to public concerns about the aged-care system and ensure that older Australians are receiving the care that they deserve.

I also want to acknowledge the providers in the sector that are really doing their best to deliver for their residents and the people that they care for, including those in my electorate that I have spoken to, throughout the last term, about these issues.

Significant consultation is underway to inform robust and evidence based policy that will be set out in delegated legislation. Consultation is being conducted with a range of stakeholders, including older Australians, their families, representative bodies, advocates, industry peak bodies, industrial organisations, aged-care providers and, in some cases, the general public. All amendments to delegated legislation will be subject to disallowance and, therefore, continue to be subject to parliamentary scrutiny.

The previous government wilfully neglected older Australians and the aged-care system. Labor will not turn its back on the crisis in aged care. This is not a political problem to be fixed; this is a human crisis and needs genuine commitment and a genuine solution. With this bill we are taking the right steps to ensure we leave no stone unturned and help implement all practical measures to guarantee that older Australians receive the highest standard of aged care they deserve.

Older Australians have worked hard their entire lives. They've contributed to their communities and helped to build this wonderful country. We've all benefited from their sacrifices, hard work and achievements. We can repay them by giving them support to live with dignity and humanity in their twilight years. This bill will ensure we are able to do that.

Zoe Daniel (Goldstein, Independent) Share this | Link to this | Hansard source

Aged care, its quality and accessibility is one of the key concerns in the Goldstein community. There are 22 aged-care providers in Goldstein, and, in preparation for this legislation, I had face-to-face meetings with six and received detailed submissions from five others. The key concerns expressed by the providers I consulted are as follows.

Because of increased uptake of home-care packages, people are entering aged care at older ages and therefore requiring increased care from the time they're admitted. The indexation of the subsidy doesn't reflect this increased care requirement, and the wage disparity between the public hospital and disability sectors and the aged-care sector is a problem. The providers also expressed concern about their inability to borrow from lenders, as return on investment is too low. There was much discussion of the AN-ACC funding model replacing the ACFI model, with providers providing this feedback: the quarterly reporting by the AN-ACC external assessors places an unreasonable burden on smaller facilities that do not have the advantage of the economies of scale enjoyed by the larger, multi-facility organisations; this may result in the closure of community-run and regional facilities, and, indeed, it already is. These providers are already under stress with staff shortages. And the health department has already revealed, in answer to questions on notice, that, based on the latest data, fully 86 per cent of small providers—46 per cent in the regions and 40 per cent in the major cities—do not have a 24/7 registered nurse. The resulting decrease of providers is worrying and is reflected in the feedback that I have had from providers in Goldstein.

So, while I am broadly supportive of this legislation, the opposition has proposed an amendment calling on the government to reveal the impact of this on small providers in the cities and the country, in rural, regional and remote Australia. It's a sensible amendment that I support. All members of parliament should have the ability to scrutinise the effect of legislation—whether it does what it's intended to do or falls short—and I urge the government to take a look at what I believe is the intent of this amendment. I note that the member for Mayo has also raised other concerns that warrant investigation.

The pre-assessments required with the AN-ACC model have highlighted significant variations on assessment of individuals. A quality standard needs to apply to the assessors, not just to the facility and residents being assessed—a quality standard that reduces subjective assessment variations. There's a lack of transparency as to how the AN-ACC tool works, as the algorithm has not been made public. This is a problem, particularly for small facilities who do not yet understand how this system will work. Reassessments are expensive, and providers cannot check to see if initial assessments were done correctly.

On 1.7 per cent indexation, providers in Goldstein say that the increasing uptake of home-care packages means that people are entering aged care at an older age and entering with increased morbidities due to that increased age, translating to an increased care requirement of that individual by the time they're admitted. The indexation of the subsidy does not reflect this increased care requirement. Resident care is being compromised, due to indexation not being matched to increased award rates, increased superannuation and increased payroll tax for the mental health levy. There is a significant disparity between wages in the aged-care sector and those in public hospitals and the disability sector. This is leading to staff leaving an already contracting aged-care workforce. Staff shortages were previously filled by agency staff; now those agencies cannot supply staff either.

On 24/7 registered nurses: 85 per cent of aged-care facilities in Victoria already have 24/7 registered nurses in place. And there is no argument—RNs should be on staff 24/7. But, as I said, small providers do have concerns. Ahead of an increase to 215 care minutes, it's also almost impossible to fully staff each shift. It's very hard to find personal care assistants, enrolled nurses and registered nurses, and there's also a concern that these changes could force enrolled nurses out of the system. The definition of what is and is not included in care is challenging. Lifestyle and allied health are not included. These areas provide cognitive and physical support beyond basic care.

There needs to be a clear definition of the care minutes. There's been a failure to recognise the import of enrolled nurses as part of the registered nurse component. Enrolled nurses are generally medication endorsed and do a majority of wound care. Many facilities provide a career pathway for personal care assistants to become ENs and some RNs, and there's a fear that those enrolled nurses will be lost from the aged-care sector due to budget constraints, leaving the lowest paid, less experienced, level 1 nurses and PCAs in charge of the ward. The 215 care minutes needs to be a more nuanced schedule.

Personal care assistants are also not eligible for skilled migration through the mainstream visa program for providing skilled and compassionate care. The Committee for Economic Development of Australia, or CEDA, estimates the industry needs an additional 8,000 workers to meet best-practice standards to combat the 65,000 workers leaving the sector each year. There's a need to make aged care more attractive by removing HECS debt and providing tax incentives. I, as well as the providers in my community, strongly support preferential visas and other incentives to attract staff to aged care to meet the requirement of these legislative changes.

Providers have also spoken about needing to refurbish after 25 years. To remain viable, bigger facilities are refurbishing as soon as 15 years after building, and this expense is coming out of depreciation allocations by the bigger providers. New homes are debt funded and run at a loss for 18 months or so. However, to attract investment in lending, the industry needs a consistent and commercial rate of return. The current rate of return is too low to be attractive for investor or bank funding. Solutions suggested include increasing the rental rate or daily accommodation charge, removing exemptions on the homes value on assets and means test or reinstating the bond or retention. Other comments from providers include overzealous and adversarial regulators, which has staff operating under stress and leads to many leaving the sector for better-paid alternatives in the public health and disability area. There is a deep need to make aged care more attractive to school leavers and to adopt recent CEDA recommendations to make training cheaper.

Finally, aged care is a critical sector and this is critical legislation, but we need to do this the right way and not rush with amendments that have been put forward and not fully considered. Looking after valued older members of our community requires care and respect. Aged care also has an image problem. We must change the reputational problem that, along with rostering and wage issues, is a major disincentive for staff to work in aged care.

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

URPHY () (): Just a few weeks ago I visited Benetas St Paul's Terrace, which is an aged-care facility in Frankston. I was accompanied by the Prime Minister and the minister for aged care. When we were there, I was able to introduce the Prime Minister and the minister to a range of not only residents but also aged-care workers—workers like Simbi, who moved to Australia in the year 2000, starting work in aged care first as a carer, then as a nurse and now as a manager, someone who has lived that industry, knows the sector inside out and was able to provide the Prime Minister, the minister and me with insights that only people who have been in the sector for a long time and done all those different roles can give about the problems we need to fix.

They were people like Andreya, who is the clinic services manager, responsible for clinical leadership and care at the home. She came to Australia as an international student, completing her bachelor of nursing at Deakin University, and has now worked at St Paul's for four years. She was initially a casual employee on Nurse Bank and looked for career advancement, taking on a permanent role in her current position when it became available. Andreya speaks to the need to support people to be able to have a career in aged care, to see it as a profession that is valued and that people can look at for the potential for advancement.

We talked to Jess, who I first met at pre-poll, when she came up and asked me what Labor's policies were about fixing the neglected and broken aged-care system so that she could decide how she was going to vote. She's responsible for administrative functions in the home, but, like so many people that work in the aged-care system, even if they don't have caring responsibilities, her heart and her passion is for the care that is given in the residence. Jess started at St Paul's on a placement when completing her personal-care certificate III, got her qualifications, took on a fixed term maternity leave role at St Paul's and—again—then became a full-time worker.

One of the things that the Prime Minister, the minister and I know—one of the things that the Labor government knows—is that good reforms start with listening to people like Simbi, Andreya and Jess. They start with listening to the people that live in aged-care facilities or live with home-care packages and the people that care for them. That's what we did in opposition. That's what the royal commission was about, and that's what we're doing in government. You only need to see the travel itinerary of the Minister for Aged Care and the facilities that she has visited since becoming the minister to know that for her this is not an academic exercise solely about implementing recommendations from a royal commission; this is about the people whom those recommendations and their implementation impact.

I wanted to start by acknowledging those three women, who are examples of the people, predominantly women, who work across the aged-care industry, because they are the people whom these reforms will impact and they are the people who are dedicating their lives to creating a better life for older Australians. These reforms can assist in those older Australians getting better care.

Other contributors to this debate have gone through the detail of the reforms, so I don't intend to do so, apart from noting that, of course, an important aspect of these reforms is ensuring that there are registered nurses on shift 24 hours a day, seven days a week. The 2020 Aged Care Workforce Census suggested that 80 per cent of residential facilities already had a registered nurse. Certainly, Benetas St Pauls Terrace does have one onsite 24/7. We know as a government that the ambition to have a registered nurse on at all times at every facility is a difficult one because of the problems in the workforce—because of the 10 years lack of workforce planning that was allowed to occur. That was then exacerbated during COVID, when many migrant workers and people on working visas were told by the government, 'We're not going to help you out; go home,' if they couldn't work.

We know that there is a lot of work to do to build up the workforce, not the least of which is to make working in aged care more attractive by making sure that aged-care workers are paid something at least close to what they deserve to be paid and what they're worth. That's why, as a government, we have put in a submission to the hearings before the Fair Work Commission, supporting a pay rise for aged-care workers. But, just as importantly, we have done what good government does and said, 'Not only do we say we support a pay rise; we are willing to be at the table for our share of funding of that pay rise.'

We've also established a wide range of programs to attract staff and support retention, such as 1,300 transition-to-practice positions in aged care for newly graduated nurses; 1,900 scholarships; support for 5,250 clinical placements; and the nurse retention payment, which provides annual payments of up to $6,000. I have no doubt that the significant announcement made at the start of the Jobs and Skills Summit last week about over $1 billion worth of investment in free TAFE courses combined with the establishment of Jobs and Skills Australia and this government's commitment to skilling up Australian workers in the areas that we need workers will go a long way to encouraging more Australians to get the qualifications that they need to work in the aged-care sector. This legislation also caps home-care charges, as the chamber has heard. Astoundingly—and I spoke to the parliament about this last term—there are people for whom up to 50 per cent of their home-care packages are being eaten up in administration and management fees, when it should be about care.

While I'm noting the reforms to home-care packages, I want to touch on the groundbreaking work that the National Centre for Healthy Ageing in my electorate of Dunkley is undertaking. It's a collaboration between Monash University and Peninsula Health. There was bipartisan support for significant Commonwealth investment into the establishment of the National Centre for Healthy Ageing, and I acknowledge the delivery of that funding by the previous government. What that centre has been able to do, under the stewardship of the director, Professor Velandai Srikanth, one of the smartest and most amazing men I have ever met, is to establish a unique combination of Australian-first capabilities in living labs translational research. They use large data systems and data analysis in a way that I sort of understand when they're telling me about it but which I can't pretend to be able to explain, as well as other facilities. And all of that is done to lead research, testing and delivery of innovative solution development for healthy ageing, including ways to help people age healthily at home and stay at home for as long as possible, which, of courses, is what the home-care packages are about.

They're ready to go on to another phase. The Minister for Health and Aged Care came and met Professor Srikanth and had a tour of the centre before the election. He has now been provided with a proposal for what this transformational centre in my electorate can achieve. They want to do more research and more work to prevent premature transition of people into residential aged care, to boost the quality of health care in residential aged care and to build the resilience and adaptability of the aged-care workforce—three priority ambitions of this Albanese Labor government.

Peninsula Health has a program called MePACS, which is a health and wellbeing alarm system for people living in their home. They are able to press a button and speak to someone—almost all women—in a call centre if they have needs or in an emergency, but they are also often able to just ring and check in and know that there's always someone on the other end of the phone who will listen to them and be concerned about their wellbeing.

The National Centre for Healthy Ageing has a proposal to enhance the MePACS response to have a concierge-driven care navigation so that it's a solution able to find best-fit solutions for an individual's health and care needs, including linking them up with primary care and allied health. It's a program that tackles social isolation and safety. As I said, it gives people who have a MePACS device the reassurance there's always someone on the other end of the phone, and it integrates responses with system providers. The proposal from the National Centre for Healthy Ageing would allow rigorous and robust evaluation of health utilisation outcomes and economic value, and, with their ability to use big data, there's an opportunity for it to be translated and scaled up.

They have the capacity to improve healthcare access and outcomes for residents in aged-care facilities by integrating primary care models that link GP, nursing and allied health services. They have the capacity to use their Residential Aged Care Research Network to identify and reduce redundancy in system responses, to ensure best practice and quality of health care, to reduce unplanned hospital presentations and to inform needs and policies.

They want to work to enhance capacity and capability within the aged-care workforce and to establish occupational, psychological, cultural and social determinants of health amongst workers themselves. It's very important to look after the health of the workers. They will look at the changes in health and wellbeing of aged-care workers relative to other healthcare workers and determine the quality of care being delivered to carers when they become ill or injured, determine the burden of disability attributable to work related disease and injury in the aged-care sector and, therefore, improve aged-care workforce satisfaction and retention. One only has to talk to aged-care workers in our electorates who worked through COVID to care for vulnerable people to know how exhausted they are and to know that they, like many others, are struggling with mental health and physical ailments but are often unable to have them attended to because they need to care for other people.

The proposal from the National Centre for Healthy Ageing is, as I said, potentially transformational. I don't just say that because it is based in my electorate. It has been put together by brilliant researchers, academics and people with practical on-the-ground experience. It is something I have provided to the Minister for Health and Aged Care and to the Minister for Aged Care and it is something I will continue to speak about and advocate for because this is the sort of smart, innovative, translated research that the Albanese Labor government wants to support for this country to be again a country known for not only innovation and research but also great delivery.

I'll just conclude. This legislation improves transparency of information. It improves integrity and accountability in aged care so that we know what aged-care providers are spending money on and it provides valuable information about providers' operations. There will be consultation—it's already underway—about delegated legislation to form robust and evidence based policy. This is a system that we have to fix. We can't afford not to. There's a moral imperative and there's an economic imperative. The people we represent want this done. The government will do it steadfastly and as swiftly as possible.

Russell Broadbent (Monash, Liberal Party) Share this | Link to this | Hansard source

In 1968 I moved to a small community called Pakenham and started my own business as an 18-year-old. It was probably unusual for an 18-year-old to be beginning a business, but I came out of a family of entrepreneurs and it was normal for us. That's what you do—create yourself a job. That community was an integrated community, which we didn't understand. It was 1¼ hours from Melbourne CBD, so it was a country community. It was built around sport and business—the horse racing club, football clubs, the town hall committee, women's groups and the CWA. It had all the things of a small country community. Everybody was linked, so a young person who came into the community was integrated into that community straightaway.

Then you had the Pakenham Bush Nursing Hospital. That was provided by local doctors and the whole nursing regime of that time. The most feared woman in the town was the matron of the hospital, because she ran the show. They provided paediatric services and palliative care services and looked after breaks and scratches and cuts and bites; it was all done within this community by the local doctors as part of the bush nursing hospital system.

Because I've got the time, I'm going to tell you that the bush nursing hospital system in Victoria was created by council and state governments, who got together because 25 per cent of women in country communities were dying in childbirth, compared to about five or six per cent in the city in those times. So these country communities right across Victoria got together and created bush nursing hospital systems and drove the rate of death in childbirth down to that of the city. And that's what these bush nursing hospitals were all about. They were really important to women in community.

As an 18-year-old, I realised that the vast number of patients in our bush nursing hospitals were elderly people either needing care or in palliative care, and that usually they were needing care because they could no longer cope at home. What did we do? We drew them into the heart of the community, and they went to the bush nursing hospital and were cared for there. That was probably not going to work, because if all your beds were filled up with ageing residents and there was nowhere for your new babies to come—a few years later my twins were born there and my beautiful daughter, Emily, was born there at the bush nursing hospital—you're never going to have enough beds for the reasonable support of the community.

So the community decided we needed a dedicated aged-care facility right next to our bush nursing hospital. Of course, a fundraising committee was created, and I think my idea was to call the fundraising program 'A cry from the heart: from the elderly to the rest of the community'. That's what we did, and we raised the money to build the dedicated facility on site, which is still flourishing today as an aged-care facility. The hospital, sadly, is gone; the paediatric services are gone; the palliative care services are gone. The cuts and scratches and bruises are now done by the doctor, or it's off to Casey Hospital in my dear friend the member for La Trobe's electorate. It's a marvellous facility, along with St John of God next door to it. Healthcare services and provision have changed dramatically, but we raised the money for the aged-care centre.

I'll tell you a story about aged care, because I've been connected to aged care for all of my life—not only in my political career but in my business career as well. At the same time, I chaired the local disability centre, where we needed a day care centre for people with disabilities—and that's another whole story in itself. My greatest learning experience ever was living the life of chairman at Minibah, our disability centre. That's where you learn how people really do it hard, when they've got disabled children.

Aged care has been evolving for a long time, and I make the point that I now come to today. We've only recently had an election campaign where aged care was an item of discussion amongst the parties. In fact, aged care was used as a stick to beat the former Morrison government. But I'll take you back to 1998, when I was the member for McMillan, and the Howard government had then decided to reform aged care. They were actually very good reforms but politically very dangerous. The Labor Party picked up on that very quickly in that campaign in 1998 and used it very effectively as a stick against the then Howard government. I had said to Mr Howard, the Prime Minister at the time, 'Please do not do these reforms in your first term; wait till your second term.' That was because, in my knowledge of the interaction between families and their inheritance, moving a person who has a home as an asset into an aged-care facility and using that asset as a bond was seen to be removing the children's inheritance.

So part of my loss in that campaign was a very strong campaign by the Labor Party against those reforms. The sad part about that was that because of that loss and losing that battle over aged care, the good reforms were not put into place. This is playing out today and has played out ever since that time. That's even though we have reforms, and have reformed that transition from your home to a new living home in aged care very well. Aged care should be a another step in life. It is not the end or a death sentence, it's just a different way of caring for people in our community. That's how it should be and how I believe it is today.

The last campaign, especially by the nursing federation—which branch, I'm not sure—said that all aged care is terrible: don't go there. And they said that all the people working in aged care are under pressure with this or that—of course they are! I pay tribute, like the member for Dunkley did, in regard to those people who worked through COVID and all the issues around facilities and the provision of aged care. But, mostly, they sent a message about all aged-care providers to the community, that things were terrible in aged care. There were some areas that the royal commission pointed out, very clearly, that needed addressing, and both sides of the House have committed to addressing those issues. My point is that because of the 1998 campaign there were consequences for aged care that were negative. And because of the last campaign there are consequences for aged care now, and I believe they're negative. If we can get a positive out of it, well and good, but we left a stain: why would you choose to go into aged care if all of these arguments around aged care and all of these propositions are that this isn't a good place to work? Things are crook in aged care, why would you go to aged care?

The people who have a real heart for delivery of services to the clientele in aged care are praised by me right across my electorate. I even got to the point where I had to send each organisation a note to say how much we have high regard for the services that they deliver and to apologise for all the negativity that had surrounded the debate around aged care, its delivery and its service.

I think I can say this now, a long time after the event: Prime Minister John Howard said to me just before his government was defeated, 'Russ, do not ask me for any more money for aged care, because we have delivered in buckets.' And he had! But the need in aged care, the exponential growth that came, was something which the Labor Party knew about in 1998. We all knew the exponential growth was coming. That's why that negative campaign then and reforms that couldn't be introduced then had long-term consequences: we're still catching up, still catching up and still catching up. It has been for the whole of the time I've been in this House: we've been catch up, catch up, catch up, because the need was always greater than the government's ability to keep up with that need. So we're paying the price today for bad decisions, probably made by both parties, because we were fearful to make the reforms we needed to make. That was a political decision, and when you make those political decisions there are always consequences.

It may, in my case, have been one of the causes of my demise in that election campaign. However, we face the consequences today for those decisions that were made by political parties during the heat and battle of an election campaign. But, remember, that every decision that you take has consequences. When the royal commission says that you need a registered nurse 24 hours a day in every aged-care facility, that sounds great for those facilities that can afford that. They already are delivering that service. But there are other communities where, because of the size and scale of their organisations, they just cannot afford to have an RN. Secondly, they may not have access to an RN in remote communities or even in regional communities like mine because of the competition from the local hospital, the local GP clinic and especially from other aged-care facilities.

These are all the issues that I as a local member have to look at, rather than blindly giving blanket support to a proposition. I need to know how that proposition is going to affect the aged-care facilities in my electorate on the ground. What will be the outcome of a blanket decision like that? The government said, 'We're offering you exemptions, Russell.' But there's no detail around the exemptions. I already have an issue with my aged-care facilities because of the pressure that COVID has put on them and with our access to human resources because of our regionality where we are. You can't just go down the street in Foster and grab another RN or aged-care worker, because they're not there. They have to come from the districts. So you are competing with other districts for the minimal resources that are there as far as an aged-care workforce goes. It's quite different in the cities, but for us it's difficult.

We've just had an EBA that claims the wage increase is going to come out at around 3½ per cent. But the government's given them only a 1.5 per cent increase, so you're already 1.75 per cent down in the outworking of the finances of the organisation. Worse than that, when you need somebody on deck in the aged-care facilities and you can't get anybody, you have to go to an agency. Of course, the agency cost is far higher than the wage cost of a permanent worker.

So there are a lot of issues around aged care. I'm asking the government to address those very carefully, having regard to the impact it will have on regional facilities. I have to stand with my regional facilities. I have to stand with my own people. That's because I want ageing in place. It has been a tenet of mine for as long as I've been in this place that the aged-care facility needs to be in the community in which a person lives. Therein lies the great difference. If we can have ageing in place, that is my desire.

Josh Burns (Macnamara, Australian Labor Party) Share this | Link to this | Hansard source

I am very fond of the member for Monash, but I want to touch on a couple of things that he said. The first thing is around wages. It really is important to point this out to the House. Those opposite are talking about the wages of those in our aged-care sector without referring to the fact that they weren't even willing to make a submission to the Fair Work Commission to increase the wages of our overworked aged-care sector. That should be their primary focus. They should be apologising to aged-care workers right around the country for not being willing to have their back on the significant wage decision that the Fair Work Commission needs to make.

Opposition Members:

Opposition members interjecting—

Josh Burns (Macnamara, Australian Labor Party) Share this | Link to this | Hansard source

I hear a bit of chirping from those opposite, but the fact remains that they weren't willing to even make a submission on the pay increase that our aged-care sector workers deserve. That's changed, thankfully, with the change of government.

The other thing that the member for Monash was talking about was the difficulties, exemptions and a whole range of things around nurses. We need to have nurses in our aged-care facilities. That's what the Aged Care Amendment (Implementing Care Reform) Bill 2022 is about. I understand there is a shortage of nurses right around the country. Of course there are. That was part of the conversations that were happening at the Jobs and Skills Summit, which the Nationals were happy to attend but the Liberals were not: how do we increase the amount of essential workers in this country? You can do what the previous government and the previous aged-care minister did—hide under a rock, pretend nothing is wrong and neglect a sector that desperately needs help—or you can have a go at fixing this vital sector, giving older Australians the dignity, respect and living standards they deserve.

This bill, on something the previous speaker didn't speak about, goes to implementing the recommendations of the royal commission. In asking how the Labor Party, prior to this election, came up with a suite of policies it was going to implement in order to lift the standard of care in our aged-care sector: it wasn't something done in the back rooms of the party; it was in direct response to the recommendations of the royal commission report entitled Neglect. We committed to the royal commission's recommendations. Those opposite did not. They have a chance in this place to support the steps taken to implement the recommendations of the royal commission, like 24-hour nurses, or they can stand here, oppose them and do nothing, just like in their nine years in office. There shouldn't have had to have been a royal commission in our aged-care sector, but there was. The previous Prime Minister was dragged kicking and screaming to set up the royal commission, and then he ignored it. This bill is a significant step forward in delivering our commitments and our promises to improve the standard of aged care.

The first part of the bill I'm going to speak about is the requirement for a registered nurse to be on site in every residential aged-care home 24 hours a day, seven days a week. I was speaking to the head of one of Melbourne's prominent emergency departments in one of our finest hospitals. I can say this: our emergency health department workers are exhausted. They have had a really difficult winter, with the high number of coronavirus cases but also with the significant number of presentations. The demand for our emergency department has gone up and up, and they're tired. They are looking for policies that are going to assist in managing the demand and the presentations to our emergency departments.

Having 24-hour nurses in our aged-care facilities is going to be one of the most significant things we can do not just for the residents in our residential aged-care sector but for our emergency department personnel, for the Australians who are working on the front line in our hospitals and seeing patients that should have been cared for in a residential setting. For many vulnerable people who are in residential settings, it is quite traumatic to be transferred from the aged-care facility to the hospital. If the journey itself can be avoided, and if the treatment, like administering of oxygen or a range of other medical procedures, can be administered in the residential aged-care setting, that is usually the preferred case. It's far less traumatic, it's far more comfortable, it keeps demand in our emergency departments lower and it gives people care in the settings they are most comfortable in.

I want to take the House through one example of a residential aged-care facility in my electorate, the Emmy Monash Aged Care facility, that I'm extremely proud of. I was pleased to have visited it with the new Minister for Aged Care after the election. The reason why we went to Emmy Monash to speak with Tanya and the staff is that Emmy Monash is one of the centres around the country that already has a 24/7 registered nurse on site. Tanya, this incredible CEO who has spent decades dedicated to looking after our senior Australians, basically said to us that this is a no-brainer—it's a no-brainer for their organisation, a no-brainer for the health and wellbeing of the residents and a no-brainer to have 24-hour nurses supporting the hardworking aged-care staff who are working around the clock.

When we walked through Emmy Monash, it was abundantly clear that this sort of setting is best practice. It's a home, a real home, for people. It's a not-for-profit organisation, and it's a nicely decorated place that is very clean, very comfortable and very welcoming. You could tell that from the residents. They feel at home, they feel at ease and they feel like they have the support that they need to live as independently as they can in a safe and caring environment. It is a place of dignity, a place of respect and a place where the staff work extremely hard.

I pay tribute to not only the staff and the team who are working at Emmy Monash but also all staff who are working in our aged-care settings. They are truly heroes of the pandemic, many of whom turned up to work when the vaccines weren't yet being administered, putting themselves at serious risk. The staff at Emmy Monash and the staff of aged-care facilities right around my electorate and around the country are truly heroes. They deserve our support and they deserve a pay rise.

The other part worth mentioning, in the few minutes I have to conclude, is that this bill will also take action on our election commitment to improve transparency in the aged-care system. It will introduce measures to monitor the costs associated with aged care and place greater responsibility on providers to be transparent and fair. There are many great providers in our aged-care sector, but there are some providers whom it won't hurt to put a little bit of extra transparency and responsibility on.

The legislation also delivers on our election commitment to stop the rorting of home-care fees by placing a cap on how much can be charged in administration and management fees. This will mean that those Australians who are accessing home care can be confident that their money is going directly to care and not to the bottom line of providers. These are important measures that are about addressing some of the public concerns of our aged-care sector. These are important measures that the previous government had an opportunity to implement but never did. These are measures that we are implementing, doing the hard and slow work of restoring dignity, respect and resources to our aged-care sector.

Our aged-care staff, as I said, are heroes. They put themselves on the front line looking after our senior Australians when they themselves weren't protected. They turned up, they turn up and they do their best. You can earn more stacking shelves in Coles or Woolies than you can working in some of our aged-care settings. I am absolutely in awe of our supermarket workers as well—they do hard, physical work—but our aged-care sector and our aged-care workers are remarkable. My grandparents have all been in residential aged care, and the support that they received, and are receiving, is something that gives my family great comfort. I know that many members around this House feel a great sense of gratitude to our aged-care sector.

This bill clearly makes the important reform of getting 24-hour nurses in our aged-care settings. It makes the important reform of providing more transparency in our aged-care sector to give people more confidence. It takes an important step on the road of answering and implementing the recommendations of the royal commission report, titled Neglect. Our older Australians, our senior Australians, have given everything to this country. The least this country can do is give them a bit of respect and a bit of dignity and support those who are looking after them by providing better pay, better conditions and a better aged-care sector that we can all be proud of.

Sharon Claydon (Newcastle, Australian Labor Party) Share this | Link to this | Hansard source

It being almost 1.30, the debate is interrupted in accordance with standing order 43. The debate may be resumed at a later hour. If the member's speech was interrupted, they will be given leave to continue speaking when the debate is resumed.