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

I move:

That this bill be now read a second time.

Introduction

The final report of the Royal Commission into Aged Care Quality and Safety was a damning assessment spanning five volumes, summed up in one word: neglect.

The report illuminated a systemically failing system where treating older people without dignity was normalised.

The report highlighted a sector mired in crisis due to a lack of ambition.

Most Australians were shocked by the findings of the royal commission.

Commissioners pulled the curtains back on a macabre theatre left to decay in the dark despite best efforts of brave advocates.

But others weren't surprised by its findings at all—the final report validated their trauma and painful lived experiences in black and white for all to read.

The royal commission delivered a stern rebuke. It said we, as a nation, had let older people down.

And yet it wasn't just about the past or the present. It was also about the future: tomorrow, next week, 20 years from now, and beyond.

Since the final report was tabled three years ago, 136 recommendations of the royal commission have been addressed—58 of which are directly addressed today, as part of this bill.

This moment marks the most impactful aged care reform in 30 years.

Today, we address recommendation 1 of the royal commission—

Today we introduce a new rights-Aged Care Act to replace the Howard-era, 1997 Aged Care Act.

A New Act to put older people, not providers, at the centre of aged care.

Reform to date

Since the election of the Albanese government in 2022, we have worked hard to fulfil the mandate delivered by the royal commission.

The very first act of the 47th Parliament was passing aged care legislation responding to the royal commission.

Its passage delivered a new funding mechanism for residential aged care, a sector-wide code of conduct, an expanded serious incident response scheme and stronger provider governance.

The implementing care reform amendment came shortly after, delivering greater transparency, capping home care fees and most importantly, putting nurses back into nursing homes.

The creation of an Inspector-General of Aged Care reinforced the Albanese government's commitment to being open with the Australian public about how aged care is administered and how it is being reformed.

It demonstrated that we are holding ourselves to the same high standard that we expect of the sector.

We made aged care more transparent with star ratings for residential care, empowering older people and their families to make informed decisions.

The addition of the Dollars to Care program to star rating profiles holds providers accountable for how they spend their budgets.

And… my proudest achievement to date as the Minister for Aged Care—the Albanese government's $11.3 billion investment in a historic pay rise for aged care workers.

These reforms have had tangible impact on the lives of older people and the friends, families and workers who care for them.

Right now, there is a registered nurse onsite in aged care 99 per cent of the time in Australia.

Older Australians are receiving an additional 3.9 million minutes of care every single day—1.7 million of which are delivered by a qualified, registered nurse.

There has been a statistically significant decrease in the proportion of residents experiencing polypharmacy, antipsychotic medication use, falls that result in major injury, use of physical restraints, significant unplanned weight loss and consecutive unplanned weight loss.

Trend analysis for the most recent quarter shows that for the first time the prevalence of one or more pressure injuries is declining over time.

We're also seeing improvements in the star-ratings data, with fewer one- and two-star ratings and more four- and five-star ratings.

This is incredible progress, and I want to particularly thank the aged-care workers who have delivered this care.

But there is more work to do, and our mandate continues.

Since 1997, aged care has been in a slow state of evolution. Some changes have been far-reaching and others incremental, but Jim Carey, a 94-year-old aged-care resident and member of the Council of Elders, said last month:

When you're building something, the first thing you need is a good foundation, and right now aged care doesn't have a good foundation.

And Jim's right; aged care doesn't need a renovation—it needs a revolution.

Person- c entred aged care

The primary focus of the 1997 Aged Care Act is the funding and operation of aged-care providers.

It lacks purpose, values and mission, and it lacks a focus on people.

As the minister responsible for one of the few service-delivery portfolios in the federal government, I believe that's what aged care should be about: people.

We all have at least one person that immediately comes to mind when aged care comes up in conversation or on the news—a grandparent, a loved one, a neighbour, a friend.

I think about the residents that I used to care for and the women who were my colleagues when I worked in aged care as a uni student: Peg, who wanted prunes every morning as her first course of breakfast; Daisy, a resident who lived in the secure wing and had a cat that she lovingly looked after; Sharon, who ran the kitchen while I pushed around the tea trolley; Nia and Iris, who used to do the 5am-to-1pm shift and then rush off to get their kids from school; and Margaret, Sandra and my mum, Deb, who worked in the office doing admin and rosters, and, because of staff shortages, had me do physio and diversional therapy

But the 1997 act does not take into account the lives of people like Peg or Daisy or Sharon or Nia or Iris or Margaret or Sandra or my mum.

In fact, it barely mentions people at all.

That ends today.

The new rights-based Aged Care Bill we are introducing puts older people, and the services they need, front and centre.

It promotes positive attitudes towards aging.

It empowers people with choice and control in the planning and delivery of their care.

It builds trust and confidence with strong regulation and complaints mechanisms that prevent mistreatment, neglect, and harm from poor-quality and unsafe care.

The cornerstone of this bill is a statement of rights, underpinned by Australia's obligations under the International Covenant on Economic, Social and Cultural Rights and the Convention on the Rights of Persons with Disabilities.

The statement of rights outlines what all Australians can, and should, expect from aged care: person-centred care that is culturally safe and trauma aware; dignity and respect; individuality and diversity; independence; choice and control; dignity of risk; and privacy.

The rights of older people will be embedded in care delivery, in the way workers are trained and in the way people talk about the care they receive.

We heard that rights need to be enforceable—but also balanced.

Including a statement of rights in this bill is not about opening the litigation floodgates; it's about empowering older people to have conversations about the dignified care they deserve.

Under this bill, providers must take all reasonable and proportionate steps to act in accordance with the statement of rights.

This is backed up by an enforceable registration condition that will make sure providers have practices in place to deliver care consistently with the statement of rights.

In plain English—if a provider breaches the rights in this bill, the Aged Care Quality and Safety Commission will have tough enforcement actions at its disposal.

The bill also introduces a new model to embed supported decision-making across the care system.

Supporting older people to make decisions for themselves for as long as possible is at the heart of this bill—recognising that in a system that prioritises dignity and respect, the will and preferences of older people must always come first.

As Rosemary, an 84-year-old aged-care resident, said:

We are still people even though we are in aged care and we have the right to live our own lives and be treated with respect and dignity.

The rights in the new Aged Care Act will give me more autonomy over my decision making and my daily life.

We have been contributing members of Australian society all our lives and we don't suddenly become inanimate objects when we enter aged care.

Duty of care

In my previous job as a workers compensation lawyer I represented people who had been injured at work, and at the foundation of every claim was a simple legal principle: employers owe a duty of care to their employees to take reasonable steps to prevent harm.

It's a duty created to protect workers, because the inherent power imbalance between employer and employee can lead to physical and psychological injury.

The royal commission was clear about the need to create a duty of care for providers, which will hold them and the people in positions of leadership accountable when things go wrong.

In line with their recommendations, this bill includes new duties on providers and a limited group of people in leadership roles.

The duties mean that providers and responsible persons must not act in a way that puts older people in their care at risk or actually causes more harm.

The duties are carefully targeted towards the most egregious conduct.

Leaders who fail to fulfil their duty of care without reasonable exception will face significant civil penalties.

Good people who understand the responsibility that comes with caring for older people should in no way be deterred from taking on positions of responsibility because of these new duties.

Access

The bill brings together the complex, multiple entry pathways criticised by the royal commission with a single, culturally safe entry and assessment pathway.

Assessment will actively involve older people in discussions about the services they need.

The bill continues our mission to take younger people out of aged care and into accommodation that meets their needs.

Right now, there is no statutory age minimum for aged care.

The result is that aged care has become a system of last resort. We've seen younger people who aren't able to get the care they need elsewhere relying on residential aged care as a safety net.

This bill seeks to legislate, for the first time, a requirement that makes it clear that aged care is for people aged 65 years or older.

For First Nations people and those who are homeless or at risk of homelessness and aged over 50, aged care is still available when all other options have been considered and that person chooses to enter aged care.

Stronger regulator and independent complaints commissioner

A strong, capable and world-class aged-care regulator is essential to ensure the sector can uphold best practice for older people.

The royal commission was critical of weak and ineffective regulatory arrangements that paid lip-service to delivering high-quality care.

Weak regulation lets down older people, who fall through the cracks, and also stunts providers.

As a first step, the Albanese government brought forward the capability review of the Aged Care Quality and Safety Commission to ensure the regulator has the right foundations, resources and support to meet its responsibilities now and into the future.

Of the 32 recommendations, 31 have been completed or are underway and the final will commence in 2025.

Today we are introducing a strong regulatory model that increases rights and protection for older people.

The new regulatory powers will ensure voices of older people and their advocates will be heard without fear of retribution, safeguarded by powerful whistleblower protections with financial penalties.

It will strengthen the Aged Care Quality and Safety Commission and empower it to act to maintain the integrity of the aged-care system.

For providers, the new regulatory model explicitly outlines what obligations they have and how they'll be assessed against them.

It will educate and support providers to continuously strive towards delivering high-quality care with new graded assessments and longer registration periods to encourage excellence.

For older people and their family members, carers and advocates, and for workers, today we introduce a new statutory complaints commissioner with powers and responsibilities independent of the regulatory commissioner—a voice to raise issues, to have them heard and taken seriously, with the expectation that providers will work to address them or face serious consequences.

Workforce

It isn't just older people receiving aged-care services or aged-care providers that will be affected by this bill; it will also affect the aged-care workforce.

Among the many dark themes that emerged from the royal commission was that workers are systemically underpaid and undervalued.

Low wages and poor employment conditions meant that the sector struggled to attract and retain well-skilled people.

That and the unacceptable staffing levels have led to substandard care.

A prejudicial bias became ingrained in our society which said that some work is inherently worth less because of the types of people doing it.

This is arguably no more evident than in aged care, a system carried on the shoulders of women and migrants.

One of the hallmarks of the Albanese government's approach to aged care has been to recognise the value of all aged-care workers.

The significant improvements we've made over the past 2½ years would not have been possible without the skill, care and tenacity of our aged-care workers. Without them we have nothing—workers like Emma, Nicole, Teresa and Suzanne from the United Workers Union; Catherine, Sriti, Raju and Lobsang from the Health Services Union; Jocelyn, Sue, Donna and Michelle from the Australian Nurses and Midwifery Federation.

I want to thank these workers, and the hundreds of others who I have met in aged-care homes and in the parliament to hear their stories and learn about their experiences of how our reforms are actually rolling out on the ground.

I see you, I hear your feedback, and that's what I'm doing about it.

First, the bill prioritises the training of well-skilled and empowered workers to deliver high quality care, including specialised dementia care.

Second, the bill introduces new worker screening measures—an important step towards professionalising the workforce through positive registration.

Third, the strengthened quality standards require providers to engage with workers at a service level on workforce planning and delivery of care.

Fourth, the bill is mindful to ensure that the Statement of Rights is balanced with the rights of aged-care workers to have a safe and respectful workplace.

Support at Home

We know older Australians want the freedom, support and choice to remain in home and with the community that they love.

Our $4.3 billion investment in Support at Home will deliver better and more tailored support to more people.

Support at Home will cut wait times to receive in-home aged-care services.

It will deliver more tailored support, with eight levels of ongoing care instead of four.

It will ensure faster access to assistive technology, like walkers and wheelchairs, and increase the maximum level of support available from $61,000 to $78,000.

Support at Home will offer a temporary boost in funding available to those who need restorative and allied health support to help them stay at home after an incident.

And it will provide palliative care support to ensure older people can spend their final weeks at home, surrounded by their community and loved ones.

It's not an understatement to say that this will change lives.

Take someone like Val Fell, a 93-year-old dementia advocate and proud member of the Australian government's council of elders.

Earlier this year, Val was admitted to hospital after she fell ill.

When she was ready to return home, she was incorrectly told by the hospital that she could only get an ACAT assessment if she was moving to residential aged care and that she could only get temporary support at home if she kept her PIC line in.

In total, Val was in hospital for three weeks before she was discharged through the 'hospital at home' program.

And after she was discharged her daughter moved in with her to provide her additional support.

That happened to Val—a fierce and articulate woman who understands the aged-care system.

If it can happen to Val, it can happen to anyone.

Support at Home will cut the time that Val has to wait for in-home support.

Val will have access to restorative support, including a 12-week program guided by a multidisciplinary team of professionals.

Our reforms will create better and safer care for Val and for every older Australian.

Aged - care finances

These reforms are important, and to deliver them, we need a sustainable funding system.

The time to act is here, our population is ageing.

In the next 40 years, the number of Australians aged over 65 is expected to more than double, with those aged over 85 expected to triple.

The great unanswered question from the royal commission was how to make aged care equitable and sustainable into the future, a question governments so far had been too scared to examine—until now.

Last year, I assembled the Aged Care Taskforce to review funding arrangements for the sector, and develop options for a system that is fair and equitable for every Australian.

For the first time, older Australians, consumer advocates, unions, provider representatives and experts in economics, finance, public policy, ageing and aged care and First Nations came together.

And in their final report, released earlier this year, they recommended that Australians make a reasonable means-tested contribution to the cost of aged care.

These reforms, based on the recommendations of the Aged Care Taskforce, deliver a fairer aged-care system, and foster quality and innovation.

Some things won't change.

The government will remain the major funder of aged care.

There will be no new taxes or levies.

There will be no changes to the means testing of the family home.

And older people with low means will still be supported to access the care they need.

But some things will change.

The government will now fully fund all clinical care, while older people make contributions towards services that they have paid for, or been responsible for, their entire lives, such as gardening, cleaning and personal care.

In Support at Home, you will no longer have to pay a flat weekly fee, you will make a contribution towards services categorised as 'everyday living' or 'independence'. The amount you contribute will be based on the pension status and means test and you'll only contribute to what you use.

In residential care, those residents who can afford it will now make contributions towards the hotelling supplement and non-clinical care based on a means test.

Accommodation pricing will also change. There will be an increase to the maximum room price, daily accommodation payments will now be indexed so their true value doesn't diminish, and people who pay with refundable accommodation deposits will pay a two per cent retention from the principle deposit for a maximum of five years.

This will ensure residential aged-care providers can attract the investment they need to keep current facilities open, improve quality, and build new homes. A lifetime contribution cap for care costs will apply across the aged-care system. No-one will contribute more than $130,000 to their care costs—whatever their means or duration of care.

And the 'no worse off' principle will provide certainty to people already in or assessed as needing home care or already in residential care that they won't make a greater contribution to their care than they have already planned for.

Last June I said we needed to be ambitious for aged care.

This bill delivers that ambition and, for the first time, delivers a sustainable aged-care system where older Australians have more choice about where and how they age, and one where providers are able to invest and build for the future of aged care.

Concluding Remarks

To conclude, I cannot overstate the importance of this moment and the task that this parliament has before it.

This bill has the potential to provide a new and enduring foundation for the Australian aged-care system from 1 July 2025, and for years to come.

From then on, aged care will put the rights of older people first.

The new Support at Home program will support all of us to live independently, in our own homes, for as long as possible as we age.

The aged-care system will be fair and financially sustainable, with those who can afford it making contributions towards the cost of their own care.

Older people will be cared for by skilled workers who are properly respected and fairly paid.

This bill puts high-quality, safe and compassionate care and services first.

It implements a system of caring for older people living with dementia that incorporates contemporary, evidence based, care.

And it delivers our election commitment for better, more appetising, and more nutritious food underscored by new food standards.

But we cannot realise this potential if parliamentarians do not come together and pass this bill.

I would like to conclude by thanking the many advocates who have contributed to the development of this legislation.

In particular, I would like to thank:

In preparing this bill, the government considered over 320 submissions, 800 surveys and 14,500 separate points of engagement through webinars, workshops and round tables.

Thank you to the older Australians, carers, workers, unions, providers, advocates and other experts who helped us get to this incredibly important position today.

Debate adjourned.