Carina Garland (Chisholm, Australian Labor Party) Share this | Link to this | Hansard source

Aged-care reform is a really important part of our government's agenda. I remember, during the election campaign in 2022, speaking to people in my community about our ambition to make sure that our older Australians were treated with dignity and respect, because, unfortunately, we saw that this was not the case, and we also saw that the previous government were not taking adequate action to ensure that they were. Aged care is really important to communities right across the country, because this is something that almost everyone has been touched by in some way, whether they are already experiencing living in aged care themselves, whether they have a family member or other loved one in aged care, or whether they are thinking about their own future and what that might mean for their own care. This is something that every single person in this country has a stake in, and I'm really proud to be part of a government that is taking the necessary action to ensure that older people, now and in the future, will be treated with the dignity and respect that they absolutely deserve. I commend the Minister for Health and Aged Care and the Minister for Aged Care for their diligent focus in being able to deliver these significant reforms.

The Aged Care Bill 2024 will replace the Aged Care Act and the Aged Care Quality and Safety Commission Act. This is a landmark, once-in-a-generation reform that will shape the way we support people to live independently and with dignity as they age. This bill builds on the already significant work the Albanese Labor government has done to improve the quality of aged care and increase the wages of aged-care workers, who are incredibly hardworking, compassionate, skilled people who have always been dedicated to the people they look after. I think we particularly saw their dedication and their love during the worst parts of the COVID pandemic, and I really want to note the enormous contribution they made during that time and, of course, every single day both before and since that time.

This bill responds directly to recommendations 1 to 3 of the Royal Commission into Aged Care Quality and Safety, and it addresses 58 recommendations in total. Since the tabling of the royal commission report in 2021, 136 recommendations have been addressed. Notably, 94, the vast majority of these recommendations, have been addressed by the Albanese Labor government. This legislation is going to deliver a rights based aged-care system; a new program to support older people to live independently in their own homes for as long as possible; a new regulatory framework and a stronger regulator; new quality standards; and fair co-contributions to make the Australian aged-care system sustainable into the future. This includes the reforms we legislated through the Aged Care and Other Legislation Amendment (Royal Commission Response) Act 2022 and the Aged Care Amendment (Implementing Care Reform) Act 2022, including the requirement to have a registered nurse onsite 24 hours a day, seven days a week. This bill will place high-quality, safe and compassionate care and services for older people at the centre of the system.

This bill includes a statement of rights for older people and a positive duty for providers to uphold those rights; a single entry point to the aged-care system, with clear eligibility requirements and a fair culturally safe assessment process; the framework for delivery of a range of aged-care services, including residential care and the new Support at Home program; and fair co-contributions from those who can afford to contribute to the cost of their aged care—this is to make sure the aged-care system is sustainable into the future. It includes mechanisms for the Commonwealth to fund aged-care services, including aged-care related grant programs; a new approach to regulating aged care which will balance explicit incentives for continuous improvement in high-quality care, including through new quality standards and stronger regulatory powers to protect people from harm; and a new ministerially appointed complaints commissioner and whistleblower protections to make sure older people, workers and others have clear pathways to raise concerns about the quality of aged-care services.

Aged care is an issue that my office and, I suspect, the offices of many in this place are contacted about all the time. We're anxious to see our older residents treated with the best and safest care possible. I visited a number of aged-care facilities in my own electorate of Chisholm, including with Minister Anika Wells. I'm so inspired by the people who dedicate their lives to working in aged care, who are absolutely the most compassionate and caring people you could hope to meet. I'm glad we're building a system that supports them to do their work but also supports the people who live in aged care to live full and rich lives throughout their ageing process and supports people to age at home as well; we know that, increasingly, people want to age at home and enjoy the comforts of the life they've built for themselves over many years in their communities.

I will summarise the new aged-care chapters. Chapter 1 outlines the objects and enacts a statement of rights for older people and a statement of principles. It includes important definitions and key concepts, like what we mean when we talk about high-quality care. The aim of the bill is to ensure that, in conjunction with other legislation, we give effect to Australia's obligations under international human rights treaties and provide a forward-thinking, robust system of aged care. This chapter also sets out how supporters and representatives can assist people to navigate the aged-care system.

Chapter 2 steps through in detail when and how people can access the aged-care system, bringing together the complex multiple-entry pathways that were criticised by the royal commission. It creates a single, culturally safe entry and assessment pathway. This is really important for people who are entering into the aged-care system who we know may already be quite worried about what the future looks like. This will provide them with some certainty, structure and comfort. The assessment will actively involve older people in discussions about the services they need to support them as they age, and the assessment will be fair and equitable, knowing that we've got to get the balance right around what is funded by taxpayers and what is a co-funded part of the system.

Chapter 3 outlines how aged-care providers must register with the Aged Care Quality and Safety Commission and the conditions that apply to registration. It sets out general obligations that apply to providers, responsible persons, workers and digital platform providers.

Chapter 4 outlines the detailed funding arrangements for aged care and implements the recommendations of a taskforce established in 2023 to deliver a fair framework for individuals to contribute to the cost of their own care when they have the means to do so. This is to ensure that our aged-care system is financially sustainable and enduring, and able to stand up to meet the needs of an ageing population in Australia.

Chapter 5 outlines the functions of the Aged Care Quality and Safety Commissioner, the system governor, the new independent complaints commissioner, and the Aged Care Quality and Safety Advisory Council.

Chapter 6 provides the Aged Care Quality and Safety Commissioner and the department with regulatory powers consistent with those of other Commonwealth regulators. This is really important.

Chapter 7 protects certain aged-care information and data and balances those protections against the need for information transparency. Significantly, this chapter facilitates the use, collection and disclosure of aged-care information and data where it is necessary for the proper operation of the aged-care system and for other appropriate purposes.

Chapter 8 details important operational matters: appropriating consolidated revenue for the purpose of funding aged care, delegation of decision-making authority, specifying those decisions that may be reconsidered and externally reviewed; and outlining our plans to review the aged-care system in the future.

I think we can all agree in this place, or at least I hope we can all agree, that it is a really fundamental role of government to make sure that everybody in our communities is treated with dignity and respect and has their health and basic needs met. Our rights based approach to aged care and the reforms that we have already implemented and seek to implement through the introduction of this legislation will mean that we have a sustainable, robust and compassionate system that is fit for use now and well into the future.

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

The Aged Care Bill 2024 is a very important bill. The aged-care industry is a huge part of Australian life and has been through huge changes over the last 10 to 15 years. We've been through the royal commission, and there's not much that's been said in the explanatory memorandum or in speeches in the second reading debate about all the things that we had already done. It's almost like this bill is meant to rewrite history.

I want to put on the record that most of the recommendations of the royal commission were enacted already by the last government. There was an extra $18 billion added to the aged-care budget by Senator Richard Colbeck and Minister Greg Hunt, who were the Minister for Senior Australians and Aged Care Services and the Minister for Health and Aged Care respectively. We already had an Aged Care Quality and Safety Commission and Commissioner, although, from reading the documents, one would think this is a new position. I just want to put that on the public record. Also, we created funding for thousands more home-care places, which are part of the aged-care spectrum of care. We have many more people who are cared for at home. The plans to merge simple assistance at home with aged-care packages and put them all in one homogeneous system were a policy development of the last government.

We're obviously supporting this bill because we support the aged-care industry, but I would like to make some other comments. It's all very well to say we have the new means-tested user-pays entry, but it appears that not everyone is paying more—just self-funded retirees, who again are cross-subsidising those who don't pay as much. Fortunately, due to the negotiations by our shadow minister for aged care and health, the terms and conditions are grandfathered for those who are already in or have signed up for an aged-care situation, so they won't be giving an extra amount of refundable accommodation deposit and they won't be charged more than what they signed up for, There is a lifetime cap of $130,000 on the contributions, but that only includes funding of their home-care package contributions and their non-clinical care. So if you get to the stage in aged care where you are the means tested funder, you may well go over that $130,000, because they define clinical care as different from independent support and everyday living. As I mentioned, they seem to be trying to rebrand the aged care commissioner, who has slightly more powers. But we had addressed a lot of the things when it is sort of implied that this is the legislation that is finally fixing up this whole tranche of problems. It's a new act, but a lot of the recommendations from the royal commission, the vast, vast majority, were already addressed in the last period of coalition governments.

I might add there are a few other comments I would like to make. Not only was there the development of a lifetime cap and a time-limited cap as well of four years, we also put in a $300 million capital funding round for rural, regional and remote aged-care facilities so that they could upgrade some of their facilities or expand their facilities, because in many of these rural and remote areas, there is no way in a month of Sundays that a lot of the people going in to rural nursing homes would have the capital to give a refundable accommodation deposit of, say, $1.5 million, which happens in Sydney. We have had aged-care providers come into our area during my time who have taken on aged-care facilities that they thought would have millions of millions in accumulated refundable accommodation deposits. When our current care provider came into Gloucester, they found it was $120,000, not $1.2 million, and they were shocked. But that is the way it is in country Australia.

We also got some more sensible policy evolved through these negotiations with the government to remove the criminal penalties from the act. There was no recommendation from the royal commission to have criminal penalties applied to board members or operators of nursing homes. In fact, you wouldn't have had any staff left. Those people are often unpaid directors of aged-care facilities in country Australia. It would have been hard to find any new directors, I can tell you. There are existing workplace health and safety laws, there are banning orders and there are Criminal Code provisions for the regulatory framework that applies, but telling people working in an aged-care facility that they could be put in jail is pretty scary.

The upgrade of nursing homes is an ongoing pattern, but I do note that during the time of this government, which is only a bit over 2½ years, 49 aged-care homes have closed around Australia. There was nothing like that happening when we were in government. We kept a few aged-care facilities open. In my electorate, we had one very prominent community built and operated aged-care facility that was taken on by a major provider, only to be shut down two years later. I'm so pleased that it has now been bought by another local not-for-profit community controlled organisation, which seems to have a much better business model that offers all the services, not just residential accommodation, which means people in the Bulahdelah district will be able to age in place when they do get to that stage of their life. They will be servicing the aged-care facility; upgrading the rooms at Cedar Wharf Lodge in downtown beautiful Bulahdelah, offering palliative and respite care services, as well as Meals on Wheels and other facilities in the aged-care home-care packages et cetera.

Many of the people in the aged-care industry are obviously happy for this legislation to occur, but what they are worried about is that a lot of the details of the bill will come later, in subsidiary legislation. A lot of them want to know the fine details. So there is a frustration with all the delegated legislation.

We also don't think that every nursing home needs to have an RN on duty around the clock. Most of the aged-care facilities in my electorate wouldn't be able to recruit that number of registered nurses. Even in metropolitan Australia, you would have trouble doing that, because the payment system for RNs in an aged-care facility is less than in a hospital system and in other areas like the NDIS.

This is an important bill. We will be supporting it. We think the contribution caps need much more detail, but it appears that self-funded retirees will be bankrolling a lot of the extra income, rather than facilities getting more from the federal government. We don't want aged-care facilities to be turned into a purely medical model, because they aren't meant to be hospitals. That's the thing. In aged care, the use of the phrase 'nursing home' gives some people the impression that it should be like a hospital. It's not meant to be a hospital. It's meant to be a home for senior Australians so that they are in a comfortable, well-managed, well-cared-for environment. By all means, don't try to turn it into a hospital.

But, apart from those concerns, I commend the bill to the House. We should look at getting a reduction in the costs of running aged-care facilities, and one way of doing that is removing the mandate to have totally fixed numbers of hours per person. It sounds good in theory, but in reality it means there's not much care happening but there's lots of filling out of forms and you have a lot of overqualified people that are mandated, which puts huge costs on low-margin businesses. There are many aged-care facilities whose costs are going up but whose incomes are not going up to match them. It would be better to reduce their cost burden with cheaper electricity, cheaper food and less rigid application of that nursing model rather than a care model.

Mr Tony Burke (Watson, Australian Labor Party, Leader of the House) Share this | Link to this | Hansard source

I'm just going to move some procedural things that will allow a debate to happen a little bit later, because something happened in this Chamber earlier that prevented consideration in detail, which I think some members of the opposition and the crossbench wanted. Some people missed their speeches in the second reading debate as well. This will allow them to make those speeches. To do all of that, the first thing I need to move is that the debate be adjourned, so I move:

That the debate be adjourned.

Question agreed to.