Tracey Roberts (Pearce, Australian Labor Party) Share this | Link to this | Hansard source

I rise today to address a matter of profound importance to the lives of millions of Australians both now and into the future. The care and dignity of older Australians is what we are focusing on. As we grow as a society, we must ensure that those who've helped to build our nation are treated with the respect, care and compassion they deserve as they enter their senior years. We are all aware that Australia is ageing; over the next 40 years the number of Australians aged over 65 will more than double. Those over 85 will more than triple. These are staggering numbers and reflect a demographic shift that requires urgent and thoughtful action.

The reality is that older Australians have specific needs and the systems in place to support them must be ready to rise to the occasion. The Albanese Labor government is committed to delivering the most significant reform to aged care in over 30 years, a reform that ensures older Australians can live with dignity and independence whether at home or in residential care.

We understand that aged care is not just a matter of infrastructure or financial management. It is about people; it is about families; it is about providing care to those who spent their lives building this nation and making it the prosperous, vibrant country that we all love. That is why today I am proud to highlight an historic $5.6 billion reform package for aged care. This package represents the largest improvement to aged-care services in decades and reflects a growing demand for better, more personalised care for older Australians. This is not just reform, it's a transformation.

At the heart of these reforms is a simple but powerful goal: giving older Australians more control, more independence and more support to stay in their homes in their communities for longer. And I think that is something we can all agree upon, giving people the dignity of choice. We know that more and more Australians want to remain in their homes as they age. Without a doubt, the statistics tell a clear story. In the past 10 years, the number of Australians using in-home care has increased fourfold. If you ask older Australians directly, as we have done through consultations, they tell us the same thing. Overwhelmingly they want to age in place. They want to live in their homes and communities they have known for decades surrounded by the people they love. To meet this growing demand, the Albanese Labor government is launching the Support at Home program, a revolutionary new system of home care designed to cater to the needs of older Australians. By 2035, we anticipate that 1.4 million Australians will benefit from this program, enabling them to remain in their homes and maintain their independence for as long as possible.

Support at Home is a program that will begin 1 July 2025. It will provide support that ranges from clinical care, such as nursing or occupational therapy, through to assisting with daily-living tasks like showering, dressing and taking medications. It also includes help with everyday activities like cleaning, gardening, shopping or preparing meals. This will allow people to stay in their homes for longer without putting pressure on them to move into residential care unless it is absolutely necessary.

One of the stand out aspects of Support at Home is that it is flexible and personalised. Older Australians will be able to access tailored support depending on their individual needs. Whether they need a little bit of help each week or more comprehensive care, the program will adjust to meet their unique circumstances. This isn't a one-size-fits-all approach. It's about empowering people to make choices that work for them.

Critically the government will cover 100 per cent of clinical care costs under the program. For other support services, such as help with showering, meal prep or cleaning, people will contribute based on their income and assets, much like the current system, but we have worked hard to ensure that these contributions are fair and means tested so that no-one is unfairly burdened by costs they can't afford. A key innovation in this system is the lifetime contribution cap. No individual will ever contribute more than $130,000 to their non-clinical care costs over their lifetime, no matter their wealth or how long they need care. This provides financial certainty for families and ensures that no-one is left struggling to pay for the care that they need.

And the benefits don't stop there. Support at Home will also provide for home modifications. That's $15,000 available to make homes safer. Whether that means installing ramps, grab rails or other necessary adjustments, older Australians will have the opportunity to adapt their home to suit their changing needs. For those recovering from illness or injury, there will be expanded access to restorative support with a 12-week program designed to help older Australians get back on their feet. This program will involve teams of allied health professionals under the specialists who can work with individuals to restore independence after a hospital stay or major illness.

Perhaps one of the most compassionate elements of the Support at Home program is the option for older Australians to receive up to $25,000 in additional support to spend their final months at home, should they choose. We know that up to 70 per cent of Australians would prefer to die in the comfort of their own homes, surrounded by loved ones, but fewer than 10 per cent actually do. Support at Home will make it easier for people to spend their last precious moments where they feel most comfortable, instead of in a hospital.

While this focus on home care is essential, we must not forget about the critical role our residential aged care continues to play. As the Aged Care Taskforce has noted, our residential aged-care system is under pressure. By 2050 we will need an estimated $56 billion in capital funding to upgrade existing facilities and build new ones to accommodate the growing demand. Current funding arrangements are simply not sufficient. In 2022-23, 46 per cent of aged-care providers reported making a loss on accommodation. This is unsustainable, and without action many facilities may not survive. This will lead to fewer options, and poorer quality care for older Australians will occur. That is why our reforms include a range of measures designed to improve funding and quality of residential care. It is important.

New entrants will see means-tested contributions to their accommodation while still ensuring fairness and affordability. In fact, half of new residents will not pay more under these changes. All fully supported residents and seven out of 10 full pensioners will see no increase in contributions. For those who can afford to pay more, contributions will be scaled according to income and assets. Importantly the treatment of the family home will not change, providing certainty for families worried about protecting their most significant asset.

For every $1 an Australian contributes to their essential care, the government will contribute an average of $3.30. This ensures that residential aged care remains accessible and that providers of resources need to deliver high-quality care. To provide further security, we're introducing a no-worse-off principle—

A division having been called in the House of Representatives—

Sitting suspended from 15:02 to 15:13

Before the suspension, I was speaking about the 'no worse off' principle. This means that anyone already in aged care will not be affected by these changes. They will not be required to make any additional contributions. Those receiving home-care packages before the Support at Home program begins in 2025 will maintain their current level of funding and will be able to retain any unspent funds.

Our reforms are not just about improving care; they also represent responsible financial management. Aged care is one of the largest-growing pressures on the federal budget. Without action, spending in this sector is expected to more than double over the next 40 years. But, with our reforms, we have carefully designed a package that improves care while also being fiscally responsible. The net impact of these changes will be a $930 million spend over four years but a $12.6 billion save over the next 11 years. This is about ensuring that the system remains sustainable for future generations. In fact, as a result of these reforms, annual growth in spending on aged care is expected to moderate from 5.7 per cent to 5.2 per cent over the next decade. Aged-care spending as a share of GDP will also decrease slightly, even as we expand care and improve quality. This is a testament to the careful and considered approach that the Albanese Labor government has taken to designing these reforms.

Beyond the numbers, though, we must also address the fundamental rights of older Australians in care. That is why we're introducing new laws to protect the rights of older Australians. These laws will enshrine a statement of rights, placing a positive duty on providers to uphold these rights. We are strengthening regulatory powers, creating a new independent complaints commissioner and introducing whistleblowing protections to ensure that any wrongdoing is swiftly identified and addressed.

At the heart of these reforms is a simple principle: putting the 'care' back into 'aged care'. Older Australians have spent their lives contributing to their country. They have raised families, built communities and helped shape the vibrant, diverse society we live in today. Our duty is to ensure they receive the care, respect and dignity they deserve in return.

I would like to thank the honourable Minister Wells and her team for preparing and presenting this bill for discussion. This reform is a once-in-a-generation change. It reflects the values that we hold dear: fairness, compassion and responsibility. As Prime Minister Anthony Albanese has said, these are reforms we are proud to deliver, as we promised we would.

Keith Pitt (Hinkler, National Party) Share this | Link to this | Hansard source

'I'm writing to advise that, on Tuesday 21 March, BlueCare commenced the planned, controlled and respectful closure of Millbank residential aged care, due to a number of issues that make it difficult to continue to deliver a sustainable residential care service and ensure our long-term commitment to aged care in the Bundaberg region.' This is from correspondence to me on 21 March 2023 from BlueCare. To paraphrase, it goes on to say: 'Many regional towns have been forced to rely heavily on agency staff. As a not-for-profit organisation, BlueCare acknowledges ongoing workforce challenges have impacted the viability of our site. With Millbank's age and current design, bringing it to current and future standards is and will be financially unviable.'

On 27 March 2023, I wrote to the Minister for Aged Care and Minister for Sport, the honourable Minister Wells, and asked what action the Albanese government would be taking to ensure that these desperately needed facilities are maintained. We've checked every digital provider, every digital bookcase and down the back of the digital couch. We've looked at snail mail and every other possible manner that we could have been approached, and, to date, I can't find a response from Minister Wells, which is disappointing. I understand that the minister is busy, but the end result is that this facility closed. From memory, it was roughly 49 jobs and 49 beds, and it's not alone. In the last year, 49 aged-care homes have closed in this country. Those were desperately needed facilities.

Whilst this bill, the Aged Care Bill 2024, is being praised highly by many, we need to face facts, and the facts are that it is an increase in costs for those who are utilising the service. It is booked as a budget saving by the Albanese Labor government, and, on top of that, no-one has looked to address costs. It is quite easy to go and find more funding from those who have to pay in a user-pays system. Addressing costs is more challenging, but one of the fundamental reasons that these facilities find themselves in trouble is the policies of this government. You have mandated particular items, such as mandated nursing ratios. All of those things are not based on actual need. In regional areas, this government made commitments to policies that couldn't actually be delivered. There was no workforce to deliver those services, and, as a result, those facilities have closed. Add in interest-rate changes, inflation, cost for food and cost for services—all of which have gone up.

I want to be very, very clear: this is an increase in contributions by those individuals who utilise the service, particularly if they are part-pensioners and self-funded retirees. I have had this variously described to me as a seniors tax and as death duties by stealth, because it will take wealth from older Australians. We need to be clear about that.

These services need to be provided—desperately—but never underestimate the impact that the government has, through the policies that it sets, on the costs to the facility. There has been a one-size-fits-all application, which may not work for a small facility in a regional town that might only have 10 residents who don't need advanced aged care because that is the facility that they put in place through community organisations, through not-for-profits. So, whilst I'm disappointed not to get a response from Minister Wells, I am even more disappointed in the loss of 49 aged care beds in my region, where we have one of the older demographics in the country, significantly older than other areas.

This is not the coalition's bill. We did not develop it. We have obviously worked hard to try and get changes. When you have facilities like BlueCare, a not-for-profit agency, closing their facility in Bundaberg off the back of policy settings that they simply cannot meet, then we need to identify and recognise that there is something wrong with the system.

I'll come back to an even more fundamental element, and that is the application to get into aged care. Almost everyone I know—everyone that approaches me and my office—has to get their lawyer, their accountant or their financial planner to fill in the forms to enable their loved ones to enter aged care or even to apply. It is that complex. In fact, I went to the Parliamentary Library and asked quite a straightforward question, I thought, which was: what will be the increase in costs for the services under this bill? Unfortunately, the library advised that they couldn't model it because of the complexity of the system and how it impacts different individuals differently. It sounds obvious, but they simply couldn't model it.

Self-funded retirees—who have clearly worked hard to save their money, who have worked incredibly hard to not be on the pension and who are quite happy to look after themselves—are the ones who actually get the biggest increase, in terms of their contribution. They will now have a daily limit of up to $101.16. There is a lifetime cap, which I'm sure is a relief—currently, on reaching $130 in total contributions, or four years after making contributions, indexed twice a year at the current inflation rate of between four and five per cent. The maths is pretty straightforward. It's going to keep getting away from you every single year over the four years. It will cost more. Yes, the family home is not included, but my understanding is that once there's no protected person still living in the home, it will become an asset for those who are in aged care.

As was outlined previously by the member for Lyne, Dr David Gillespie, if you live in Sydney and your house is worth a couple of million dollars, the impact on you is not quite as high. But if you live in a regional area where the suburb average is under $400,000, as it is in some suburbs in areas like mine—some are substantially higher, but not by that much—you simply don't have that much money; you just don't have it.

The Parliamentary Library has said that the government estimates, the new arrangement, will result in around half of new residents paying more for residential aged care. They provided a series of case studies, which I won't get too far into. The self-funded retiree that owns their own home and has enough super that they're not eligible for the age pension will contribute $62,800, up from $49,400 on current arrangements. So, clearly, it will cost the consumer more.

We should be upfront about this. This legislation will take more money from part pensioners and self-funded retirees in order to fund aged care because of the policies of the government. That is the reality. The government has had the gall to book a budget saving on top of it. I think, whilst it's absolutely essential that we have aged care facilities that are suitable, they still need to be based on need, not broad-blanket policies across the board for which there may be absolutely no requirement, depending on the model that's used by the home.

I want all Australians to age with dignity—there is no doubt about that—but I also want to be upfront with them about what the cost will be and who will be paying. Clearly, it will be the consumer. If this government doesn't act on inflation, if it doesn't act on the increasing cost of living which is completely out of control, if it doesn't get electricity costs under control and if it doesn't reduce interest rates which are linked to inflation, then it won't matter what is in this bill because it will require more funding and more contributions—more from the taxpayer and more from the consumer—because inflation will continue to spiral. There are some quite fundamental elements in this legislation which I'm very pleased about, such as the security of the additional investment of $300 million in capital funding for regional, rural and remote aged-care providers. But it'd be unnecessary if we didn't lose 49 providers in the last 12 months—many in regional areas and many run by not-for-profit community organisations, with community members on their boards and with small facilities, who simply cannot meet the standards that are now being set, particularly when they have a model which doesn't require it. When it comes to health funding, I agree with Dr Gillespie, and I'll leave my comments there.

A division having been called in the House of Representatives—

Sitting suspended from 15:25 to 15:36

Anne Stanley (Werriwa, Australian Labor Party) Share this | Link to this | Hansard source

I rise to make my contribution on the Aged Care Bill 2024. This bill, once enacted, will replace the Aged Care Act 1997 and the Aged Care Quality and Safety Commission Act. The existing framework regulating aged care is being significantly altered. The bill is split into eight chapters that will enact distinct elements of the new regulatory framework for the provision of aged-care services. The bill is in response to the Royal Commission into Aged Care Quality and Safety and to the Aged Care Taskforce, which was established in 2023. The taskforce considered how to sustainably fund aged care into the future. This bill responds directly to recommendations 1 to 3 of the royal commission and fully or partially addresses 58 recommendations in total.

The Aged Care Bill is a landmark, once-in-a-generation reform that will shape the way government supports people to live independently and with dignity as they age in years to come. Given the significant nature of the reforms, the government conducted extensive consultation with a wide range of stakeholders, including older Australians and their families; state and territory governments; unions; the aged-care sector; consumer advocates; service providers; and the public generally. The Department of Health and Aged Care conducted an extensive 12-week consultation on an exposure draft of the bill between December 2023 and March 2024. This was in addition to the extensive consultation that was undertaken by the royal commission. The taskforce undertook consultation in relation to contribution arrangements and accommodation payments. Thousands of people were directly engaged in the reforms through webinars, surveys, discussion papers and focus groups. This included 320 submissions and 800 surveys. The government has ensured that consultation was undertaken relating to all aspects of the new regulatory model and the Support at Home program.

The bill implements a number of commitments that the Albanese government took to the last election. These include mandatory aged-care food standards, stronger investigative powers for the regulator, new civil penalties, new whistleblower protections, worker registration, a new compensation pathway, and a statutory duty of care for registered providers of aged care. It builds on the work done by the Albanese Labor government to improve the quality of aged care and increase the wages of aged-care workers, particularly the requirement for aged-care facilities to have a registered nurse on site 24/7. Since the royal commission report was tabled in parliament in 2021, the Albanese Labor government has addressed 94 of its recommendations. Our government is implementing a rights based aged-care system alongside a new program to support older people to live independently and remain in their homes for as long as possible.

There will be a new regulatory framework and a stronger, more powerful regulator. This is absolutely necessary given the shocking failures uncovered at the royal commission. High-quality services, safe and compassionate care and fairer contributions are at the centre of the Albanese government reforms to aged care. This is in stark contrast to the former government's approach to aged care, which was summed up with a single word: neglect. To achieve this, the bill includes a statement of rights for older people and imposes a positive duty among aged-care services to uphold these rights. It creates a framework within which aged-care services, including residential care and the new Support at Home program, should be delivered by aged-care service providers. Additionally, there will be a single point of entry into the aged-care system. Eligibility requirements will be clearly designed and involve a fair, culturally safe assessment process for people seeking assistance. Funding arrangements will be reformed. This will include mechanisms to fund aged-care services, including aged-care related grant programs. The system of fair contributions will be established for those who can afford to contribute to the cost of their care. Not only is this fairer but it will ensure the aged-care system remains sustainable into the future.

The new funding arrangements set out in this bill will cost $900 million over the forward estimates yet are projected to save $12.6 billion over the medium term. A new complaints commissioner will be established to make sure that older people, aged-care workers, families and others have clear pathways to raise concerns about the quality of the care that is provided. This will also include strict whistleblower protections.

After nearly a decade of neglect, funding cuts and general dysfunction under the former government, our government through this bill continues the reconstruction of aged care in Australia. These reforms, as I and many others have mentioned, are a landmark, a once-in-a-generation reform that will improve the quality of aged-care services provided to older Australians. It builds on the work that has already been done by the Albanese Labor government in increasing the wages of aged-care workers and implementing the requirement for aged-care facilities to have a registered nurse on site. I commend the bill to the House.

Anne Webster (Mallee, National Party, Shadow Assistant Minister for Regional Health) Share this | Link to this | Hansard source

The opposition's position on this bill was provided in the House on Tuesday 8 October 2024. I would like to respond to the bill as the shadow assistant minister for regional health from the regional perspective, through the prism of the regional aged-care summit that I convened in July 2023. Before I do so, I want to commend the shadow minister for health, Senator Anne Ruston, for her efforts in negotiating with the government on this bill. She secured many significant changes from the government, one of which was negotiating what was going to be a 17.5 per cent inclusion of assets for contribution towards care costs, which is now down to 7.8 per cent.

For older Australians who have paid their taxes and not had the benefit of superannuation, who have worked hard to ensure they would not be a burden on society in retirement, who made significant sacrifices and volunteered for their country, it sticks in their craw that an arbitrary and immediate date threshold will now see some of them contributing so much of their assets to the cost of their care in later years in a home or a room beside other people who made far less effort for their country, who contribute nothing and who get the same care for free.

Given the chronic obstacles aged-care providers told me about in delivering quality and equitable care in regional areas, I hosted the national regional aged-care summit in Mildura in 2023, bringing together front-line workers, providers and peak bodies from across Australia to consider policy solutions to the many problems they face. Government ministers were invited but did not attend, nor did departmental or Aged Care Quality and Safety Commission representatives but they undertook to receive and respond to a copy of the summit communique. It took some time to get a response, and to say it was underwhelming is being kind. So, to do justice to the 100-plus attendees at the summit, I will review this bill by stepping through that summit communique. It says:

Regional aged care services face similar difficulties to the broader healthcare system in rural and regional Australia. There is a significant shortfall in … workforce leading to under-staffed and under resourced services, which ultimately means older people in regional areas receive a lower standard of care than their metropolitan counterparts.

I will come back to workforce issues a little later. The first topic that we surveyed on that day was 'Regional residential aged care—viability'. Under that heading, the communique says:

There is a cost premium for delivery of regional, rural and remote aged care that needs to be recognised and addressed by government under the equity principle. This is reflected in travel costs for clinical staff and providers to deliver services to rural patients; capital and maintenance costs for regional aged care facilities and increased expense of service delivery compared to urban areas.

Solutions to this cost premium must be adopted to ensure viability of the sector in regional Australia.

The summit proposed:

I'm pleased to say that Senator Ruston managed to negotiate a $300 million fund for regional service providers. It goes on:

The Regional Aged Care Summit held in Mildura in 2023 looked at the Modified Monash Model and considered it:

… ineffective and not for purpose with geographical social and economic framing resulting in clear disadvantages for regional Australians, particularly those living in Modified Monash Model category 3 and 4 (MMM3-4)—

such as Mildura, my own home town—

and fails to acknowledge the costs of workforce attraction in those regions.

Aged-care facilities are paying three times the average nurse wage for agency nurses and, of course, for FIFO locums who come in and out. This creates an intolerable burden on their budget. Yesterday, there was a release of the Medicare reviews, including for workforce, the Modified Monash Model, distribution priority areas and the distribution workforce shortage mechanisms. The government released the Working Better for Medicare Review: final report and the Review of General Practice Incentives: expert advisory panel report to the Australian government, with Minister Butler acknowledging to the Royal Australian College of General Practitioners that morning that he is constantly lobbied on the distribution priority areas and the Modified Monash Model.

From the moment Labor changed the DPA, I've been calling out the negative impacts it has been having on regional Australians. The Working Better for Medicare Review: final report found:

The current method of determining DPA status via automatic application of MMM2-7 blankets means that of the 827 GP catchments across Australia … (85%) now have DPA status. The almost universal view of submissions and consultations suggest DPA in itscurrent format is no longer an effective distribution lever.

It proposed:

… MMM should no longer be used to establish blanket rule exemptions.

It also determined:

… each GP catchment area would individually be accorded DPA/non DPA status.

Thirdly, it held that a similar mechanism, the distribution of workforce shortage, was no longer fit for purpose, saying:

There are too many areas within cities, and heavily populated centres outside these cities, that are classified as DWS.

In short, the review says what I've been saying for years and what the regional aged care summit said and communicated to the government a year ago: the Modified Monash Model is no longer fit for purpose, and Labor have wrecked the DPA workforce lever to shunt far too many international medical graduates into suburban areas of capital cities. Poor primary and preventative care services through a lack of doctors results in people developing poorer health and entering acute-care services—which are far more expensive, and including residential aged care—sooner.

The Regional Aged Care Summit communique stated:

Regional aged care is a poor cousin in the care economy and is a victim of sectoral competition not just with acute care, but now with the National Disability Insurance Scheme. Governments must, to the greatest extent possible, remove perverse incentives which prioritise motivation to practice in other areas of the care economy in preference to aged care, for example wage differentiation between the public hospital system versus the private or public aged care system … Regional private and not for profit providers suffer, in particular, from an administrative burden from regulation—

one could almost say overregulation—

that should be addressed by government and the regulator. A government subsidy system must be established to support not-for-profit aged care providers in a way which balances the advantage state funded public aged care facilities have in 'top-up funding' per bed per day, and a backing for running at a loss, which 70 per cent of not-for-profit facilities currently experience.

That is extraordinary:

Community-led home care services represent a strong model for regional Australia, providing local residents with a sense of community, purpose and assistance from people who know the community.

While there has been a slight improvement, the silent waiting lists for elderly regional Australians—namely access to ACAT (Aged Care Assessment Teams) and the time lag between home care package approval and implementation—remains unfairly delayed in regional Australia.

This brings me to the question of grandfathering arrangements proposed under this bill. The government has signalled that those in the system at the time of the government's announcement of this bill will benefit from existing arrangements and will not have to pay more their for care. Firstly, that is effectively legislation by press release, and that is problematic. Secondly, what if someone applies for an aged-care place before 1 July 2025, or whatever the start date is settled at through this legislative process, and has or has not received a place? Are they both grandfathered? What if someone applies on 30 June 2025?

The communique says:

2022 data shows that more than 50,000 older Australians died while waiting for approved home care since July 2017.

Access to home care packages for older indigenous Australians is a particular issue, and face-to-face information regarding ACAT assessment, provided by indigenous health services and workers, is a preferred model to the current information on the MyAgedCare website and reading materials.

The cost premium for regional services means that home care packages are not fully meeting the needs of recipients.

As one constituent, Rose, pointed out to me in the last couple of weeks, she has an $80,000 package in her home-care funding but what she really needs is cataracts. As she points out, there is little point installing home help if she cannot see because she will not be able to live at home. The wait times in Victoria's public health system are so bad that there could be permanent damage to Rose's eyes by the time she receives cataract replacements. But her package money could be used, and she could save her eyesight and continue to live at home.

The situation highlights the broader problems in the care funding arrangements, the legacy arrangements of different silos of Medicare, aged care, NDIS and other funding streams, and whether we need to look holistically at federal health funding to focus on outcomes, not process. I even had one constituent in his early 60s ask if he could access his superannuation to address his need for cataracts, as he was getting little help from his fund. These are the lengths to which older Australians are trying to go to ensure quality of life in their latter decades or years in the absence of appropriate regional health care. In my view, this is an absolute priority. We know that preventive primary care saves a lot of money for the federal government by keeping people out of tertiary care. This is the same in aged care, and the government needs to focus on how to assist older Australians to stay at home. The Regional Aged Care Summit recommended that a growth funding round for CHSP, the Commonwealth Home Support Program, is required to enable more providers to enter the market in regional areas. Capital funding should be targeted at a needs based approach, and government must acknowledge that smaller providers may not be able to invest the same time and funds in grant applications as larger providers and take this into account when awarding grants. The market cannot always be relied on to provide aged-care services in remote parts of Australia.

I don't have time to go through the rest of the regional aged care summit communique, but I just want to say that regional Australia needs to have a priority place in whatever funding, proposals and mechanisms are put in place by this government, and I urge the government to look at this more seriously.

Daniel Mulino (Fraser, Australian Labor Party) Share this | Link to this | Hansard source

The Aged Care Bill 2024 is an extremely important bill in relation to a key plank of Australia's safety net. This is a once-in-a-generation reform of an element of our social service supports for some of the most vulnerable people in our society, which has long been in need of reform. This bill is designed—

A division having been called in the House of Representatives—

Sitting suspended from 15:56 to 16:31

I was just in the middle of saying that this bill relates to one of the core elements of our safety net. If one thinks about our safety net, one of the first elements of the safety net, going way back to the years just after Federation, was the age pension. Indeed, this was one of the first elements of safety nets around the world, including in Bismarck's Germany in the 1880s and in other countries. When one thinks about the healthcare system, much of that is directed towards providing assistance to the elderly in our society. Indeed, just yesterday the Member for Hughes and I were at the launch of a paper on preventive health measures for older Australians. So there are many parts of our safety net that are directed—and rightly so—at older Australians, but our aged-care system is an absolutely critical part of that. It's the part of the system which provides so many of our older people with their accommodation, and it's also the place in which they receive services.

This bill is a significant, once-in-a-generation strengthening of the way in which those services are funded, regulated and provided to older Australians. What lies at the heart of this is to provide additional choice and agency and also guarantees in relation to quality of care. I won't step through absolutely every element of the bill, because it contains many, many elements. It responds to many recommendations coming out of the inquiry by the royal commission. But I will look at a couple of areas that are worth focusing on.

One is the rights of older people being put front and centre. A statement of rights is provided for in this legislation, and that will outline what Australians can expect from aged care. In addition, the greater clarity and protection of rights will provide for more culturally sensitive, appropriate and trauma-aware services being provided to older Australians. As a member representing a very multicultural part of Melbourne, I am certainly very aware of how particularly important it is that culturally sensitive services are provided to our older Australians, given that that's an age at which they often particularly rely on those kinds of services.

There's a considerable amount in this bill which provides for greater empowerment of people relying on aged care. For example, there's a minimum age requirement of 65 for aged care, and there is a different age requirement for First Nations and homeless people. Those minimum age requirements will ensure that spots are not being taken from those who most need them.

There's significant additional funding—$4.3 billion in additional investment—for support services for those at home, and there is also better tailored support for those at home. That support will now be tailored with eight levels of support rather than the existing four, so there's additional funding and better targeted funding. There's also going to be the 'no worse off' principle, which will provide greater certainty to people already in or assessed as needing home care. And then there are key protections and guarantees in relation to quality of care. There's a duty of care both for employees and for clients, which is critically important. Of course, clients need to have that duty of care applied to them, but we have also become increasingly aware, over recent years, of the need to protect the workforce, to train the workforce and to provide the supports that the workforce needs. There are going to be greater powers for the regulator and the independent complaints commissioner. The royal commission was critical of current weak and ineffective regulatory arrangements that often merely paid lip service to delivering high-quality regulatory care, so new regulatory powers are essential and will provide significant benefits.

Then there are a range of measures in relation to workforce. The royal commission uncovered that aged-care workers are systematically underpaid and undervalued. Low wages and poor employment conditions are obviously a bad outcome for employees, but they're also bad for the sector. They lead to greater rates of turnover. They lead to lower rates of people applying for positions. They lead to lower investment in skills that are specific to the sector while people are there. For a whole raft of reasons, it's absolutely critical that we pay people appropriately and that we train people better. That will lead to better outcomes for people working in the sector, and it will lead to significantly better outcomes for clients as well. So there's going to be much greater prioritisation of the training of well-skilled and empowered workers, who will then be in a position to deliver higher quality care, and the bill will also introduce new worker-screening measures, which are absolutely critical. In addition, there will be strength and quality standards which will require providers to engage with workers at a service level on workforce planning.

I also wanted to touch on some of the measures which lead to greater sustainability in the financing. Before touching on those, I thought I would just make some observations about the longer term, macro, systemic challenges that we, like all societies, are facing. We're aging, and I want to start by saying that's a wonderful thing, because it reflects the fact that we're living longer. It reflects the fact that we are having longer and healthier lives on average. This is a great gift that is provided to us by better health care, healthier lifestyles and a whole range of things, but, at a macro level, our rising average life expectancy and our rising median age create challenges for our society in the sense that we are trying to fund and finance services from a relatively shrinking taxpayer base. If we look at some of the statistics that came out of the Intergenerational report 2023, six per cent of GDP was constituted by the care economy in 2002. That will rise, based on median projections, to 17 per cent by 2062, which is not all that far away. In effect, in less than 40 years, there will be a tripling of the care economy as a share of GDP, compared to where it was just 20 years ago. If you look at the workforce requirements, that will rise from one million to well over four million—around 4½ million—in that same period. These are drastic changes in an economic sense.

If we think about it in terms of a commonly used metric, which is the dependency ratio, the old age dependency ratio is the ratio of people aged 65 and above to those of working age, generally measured as 20 to 65. That ratio was 15 in 2002, and it's projected to rise to 38.2 by 2062. Again, that's a wonderful thing. It means that there will be more of us living longer lives. It means there will be more grandparents around to take care of grandkids. Certainly, well before 2062—I'm certainly going to be older, but I'll definitely be old by that time. I'm looking forward to being part of that 38.2. That's a good thing, but that 38.2 is a ratio that, when it more than doubles in that period, raises questions about how a society is going to provide sustainable services. If one looks at the total dependency ratio, that is also projected to rise, when one includes young and old members of society who aren't of working age. That's projected to rise from 25 to 45. These are challenges, and if one goes back to the nineties, superannuation was, in part, a response to these broader macro trends. But some of the measures included in this bill, which are very balanced and sensible measures, are also necessary long-term horizon reforms that are a response to these changes that we know are coming in the decades to come.

What this bill provides for is sustainable funding for an ageing population where the number of older Australians is expected to double, and also where they are expected to significantly increase as a share of the economy relative to working-age Australians. Just to stress from the outset that this government, even after the measures contained in this bill are put into place, will continue to be the major funder of aged care. There are no new taxes or levies contained in this set of provisions and there will be no changes to the means testing of the family home. What we are bringing in is a range of measures that will provide that some people, based on means testing, will provide a well-calibrated contribution, and I'll set out some of the specifics over the coming part of my contribution. This is a very sensible and balanced and necessary set of measures that are important if we are to maintain the stability and sustainability of our system.

The measures that we are bringing in include the full funding for 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. Support at Home means you will no longer have to pay a flat weekly fee and the contribution that you make will be means tested. Residential care, where residents can afford it, will now involve some residents making a contribution towards the hotelling supplement and non-clinical care; but, as I said before, this will be based on a means test. And there will be a change to accommodation pricing, to indexing daily accommodation payments so that their true value doesn't diminish. And people who pay with refundable accommodation deposits will pay a two per cent retention from the principal deposit for a maximum of five years. There will be a lifetime contribution cap for care costs and that 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.

As I said, these are really important measures. They form part of a package of measures that include more rights for people who are living in aged care, that include more protections, more agency and more choice. Also, as I spelt out in the last set of changes, they provide for greater systemwide sustainability. And that is absolutely critical, because our older Australians and those of us going to be older Australians soon enough deserve to know that the system is sustainable. They deserve to be confident that the expectations they have are realistic and that the government and our society will see them through and fulfil those expectations.

I'm very pleased to speak to this bill. It's a really important bill. It's a once-in-a-generation change in response to a whole series of recommendations made by the royal commission to what I believe is one of the key planks of our safety net. Australia has one of the great safety nets in the world, and those aspects of our safety net which protect the interests of our older people are, for me, some of the most important parts of that safety net. I commend this bill to the House.

Garth Hamilton (Groom, Liberal National Party) Share this | Link to this | Hansard source

I hope the member for Fraser knows how much I appreciate his contributions, and it's a very important point he makes around the long-term bipartisan approach to providing that safety net that Australians do enjoy.

In speaking to the Aged Care Bill 2024, I am going to make a request of the minister, on behalf of a constituent of mine—someone who has become a dear friend. But before I do so I want to be very clear: the opposition seeks to work in good faith and closely with the government to ensure that our aged-care system provides older Australians with the dignity they deserve, particularly in those last years when dignity can be easily taken away from you as old age sets in.

At the heart of our contributions there has been a question, not of right or wrong or absolutism, but, simply put: how do we fund aged care so that it is sustainable, and how do we do that so that the costs are borne out fairly across our community in a way that we can feel confident—look each other, as Australians in the eye—to ensure that we are both caring for each other but also providing the right level of responsibility for each other as well? The member for Hinkler made some very good observations on the funding viability of aged care. I won't repeat those, but I'll point to them as an important contribution in this debate.

I want to relay a story that I think speaks to why it's important we continue to work together. I hope in telling this story, you, Deputy Speaker, will see the good nature and the good faith in which we are entering into this debate. John Currie was a very good man. John Currie was a firefighter in our region for 23 years. He put himself in harm's way. When he had to carry pain in the course of his duties, he did so manfully. He is someone whose name, I would hope, would be remembered for the way he lived his life. Sadly, he passed away in extraordinary circumstances, which are entirely relevant to the intention of this bill. I want to recount them, because I think it's important, and it's been very important to his daughter, Kim, that John's story is heard and that lessons can be learnt from his story and taken into account, particularly in this bill. When we talk about a statement of rights, this could not be more important.

John was diagnosed at the age of 86 with pancreatic cancer. He spent 15 weeks in the Warwick Hospital. Pancreatic cancer hurts. Anyone who knows anything about it will tell you that the pain that is experienced by the patient is at the unbearable level. John was discharged from the hospital to an aged-care facility in my region, in Toowoomba. When he was discharged, the recommendation was that he would be given a powerful painkiller called TARGIN. It's an opioid. In conversations with the doctors at that point, John's family were advised that the likely outcome would be that he would go into palliative care and probably would not last long.

What happened has been throughout the media and reported on widely, particularly in A current affair. John was left to deal with pancreatic cancer and the pain of it with only paracetamol for three weeks. He was a tough man, and for most of those three weeks, he could bear that pain. I hate to think—and I go back to the word 'dignity'. It is absolutely right that we are hear talking about aged care and improving aged care in a bipartisan manner. What John Currie went through was extraordinary. Sadly, it gets much worse. He was at times deprived of additional pain relief, even paracetamol, whilst he was there. He was mocked for faking it by nursing staff. He deteriorated significantly, as you can expect, during those three weeks. It got so bad that his last three days were spent screaming and writhing in pain. He was bruised in the process of trying to restrain him. Mercifully, upon being transferred to the Toowoomba Hospital, he was administered morphine and died shortly after. He was a man who served his community as a firefighter, who was there when we needed him, when multiple citizens needed him, to come out and save either their life or their property. He was a man who was willing to put himself in harm's way for the greater good. He died a death without dignity. I find it hard to accept that this is the Australia we work for, that we come here and fight for. I, with open arms, look across the bench and I accept that there is a bipartisan effort to make this better. This is what we are here for and Australia should see that.

I have worked with John's daughter, Kim, for a prolonged period of time. It was very important to both Kim and I that we would never politicise this situation, that we would never be opportunistic or point the finger. We simply wanted the learnings from John's passing to be heard to make sure, as Kim has said multiple times, that no-one should die a death like that in an Australian aged-care facility ever again. This is beyond what we can accept as Australians. This should never ever happen again.

I have met with Kim many times. I am blown away by her dignity. She could give this speech without pausing, as I have. She has an incredible strength and a desire to make sure her father is remembered for his contributions. I thank her for all of her efforts in raising these issues with me and I am committed to standing beside her to ensure that when I leave this place I can look back and say that I did everything I could to make sure that no-one ever suffered John's fate.

I would ask humbly for the minister to reconsider her decision not to meet with Kim. When we look at the intent of this bill, what it is hoping to achieve, its objectives, which are important, which we all agree on, how we get there is an important discussion of politics, and that is the debate we must have. But we all agree in our hearts that things must improve; they must get better. And surely a case like John's Curry's must be heard at the highest level to ensure that whatever we can find from that, that whatever changes we can make legislatively or within regulation are made.

I brought Kim down to Canberra. We met with the shadow minister. As I pointed out, we have never sought to politicise this. We advised Kim to reach out to the minister to make sure that the government were fully aware of the story as well and were as informed as they could be. Kim has met with an advisor to the minister; she was promised a meeting. It would not just be for the benefit of Kim, not just for John Curry's memory, but I think it would be in the national benefit for John's story to be heard by the minister of the day. I really do. I would hate to think that after John's passing we can't offer him dignity in death. But we can give some dignity to his memory and make sure that his story is heard. Minister, please meet with Kim Sutton. It is an important meeting. Do this and work together with us, please.

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

Our fathers, our mothers, our grandparents and our loved ones all deserve the best care in their old age. They have worked hard their entire lives, paid their taxes, volunteered in our communities and raised families. They deserve to live out their twilight years with dignity and respect. But, instead, the final report of the Royal Commission into Aged Care Quality and Safety provided a damning assessment of how many older Australians have been treated in aged care, an assessment summed up in one word: neglect. The report exposed a failing system where treating older people without dignity was normalised. Since the final report was tabled, 136 recommendations of the royal commission have been addressed under this Labor government, 58 of which are directly addressed in this bill that I stand to support today.

This bill, the Aged Care Bill 2024, addresses recommendation 1 of the royal commission. This new act will put older Australians, not providers, at the centre of aged care. It promotes positive attitudes towards ageing and empowers people with choice and control in the planning and delivery of their care. It builds trust and confidence, with strong complaints mechanisms that prevent mistreatment, neglect and harm from poor quality and unsafe care. Importantly, it addresses the pain and suffering that so many older Australians, their families and workers have experienced in aged care.

Under the former government, so many families in my electorate contacted me to raise their serious concerns about these challenges. Donna, a personal-care attendant in a local aged-care facility, came and spoke passionately at a forum I held in Armstrong Creek. Donna spoke about low wages, insecure work and the frustration of being unable to properly care for frail and elderly residents. These are her words—and I think she was such a brave person at the time to speak so boldly:

I love my job. I wanted to make lives better, but … we're facing a roadblock. We've got six minutes to put each resident to bed each night.

That's why I'm so proud to stand and support this bill. This bill and the many reforms we've rolled out under this government are for people like Donna. Thank you, Donna. As a direct result of stories like yours, aged care is changing for the better under a Labor government. It's stories like yours that have shaped this bill—a bill that, for the first time, includes a statement of the rights for aged care.

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 with dignity and respect, individuality and diversity, independence, choice and control, dignity of risk and privacy. As a result, 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. Including a statement of rights in this bill is about empowering older people to have conversations about the dignified care they deserve. If a provider breaches the rights in this bill, the Aged Care Quality and Safety Commission will have tough enforcement actions at its disposal.

On top of this, 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, because 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 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 and older. 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 systematically underpaid and undervalued. Low wages and poor employment conditions meant that the sector struggled to attract and retain well-skilled people. One of the hallmarks of the Albanese government's approach to aged care has been to recognise the value of all aged-care workers.

First, the bill prioritises the training of well-skilled and empowered workers to deliver 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.

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 assisted technology like walkers and wheelchairs, and it will 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. It will provide palliative care support to ensure older people can spend their final days at home, surrounded by their community and loved ones. It's not an overstatement to say that this bill, if passed, will change lives.

So these reforms are important, and to deliver them we need a sustainable funding system. 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'll 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 will make contributions towards services that they have been paying for or have 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 the means test, and you'll only contribute to what you use. In residential care, the 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. This will ensure residential aged-care providers can attract the investment they need to keep current facilities open, improve quality and build new homes. 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.

In closing, this bill has the potential to provide an enduring foundation for the Australian aged-care system for years to come. Of course, it builds on the many reforms the Albanese government has rolled out since coming to office. 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 Aged Care Amendment (Implementing Care Reform) Act came shortly after, delivering greater transparency, capping home care fees and, most importantly, putting nurses back into nursing homes 24/7.

The creation of an Inspector-General of Aged Care reinforces 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 demonstrates that we are holding ourselves to the 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. We're delivering an $11.3 billion investment in an historic pay rise for aged-care workers. A registered nurse is now on site in aged care 99 per cent of the time, across 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.

This is incredible progress, but we know that there's more to do, and that's what this bill is all about. This reform will put the rights of older people first. Thank you to all the older Australians; to carers, including Donna, who I met all those years ago; to union providers; to advocates; and to other experts who helped us get this incredibly important milestone to this point. I hope that it will now be passed and that it will become a reality. Thank you.

Kylea Tink (North Sydney, Independent) Share this | Link to this | Hansard source

The Royal Commission into Aged Care Quality and Safety revealed an industry rife with neglect and one failing to deliver the services, safety and dignity Australians deserve. Australia's decades-old Aged Care Act has not been fit for purpose for many years and is long overdue for reform. In that context, I welcome the government's commitment to reform the aged-care system, because Australia's population is aging. According to the ABS, 17 per cent of Australians are currently over the age of 65, and, in 40 years, that percentage is expected to double. Given these demographic projections, it's clear the sector needs to evolve, and we need to work towards a sustainable aged-care system that delivers a dignified quality of care, consistent with our aspirations to be a nation that looks after our own.

In reviewing the Aged Care Bill 2024, I can see the time and effort that has gone into it. It is as complex as the system it is aiming to reform, and there is a lot to like in it, including the rights based paradigm, the simplification of the assessment pathways, the focus on aging at home, the improved standards of care in allocated funding to reduce wait times and, finally, the stronger regulatory framework. But there are also areas that my community wants to see strengthened.

Firstly, while the legislation purports to be rights based, I was surprised to find that the International Covenant on Civil and Political Rights is mentioned only in the explanatory memorandum and does not appear in the bill itself. The upholding of human rights is an issue that's really close to my heart and the heart of my community, and I've long advocated for the establishment of a human rights act that will enshrine our basic rights in law. Many of the abuses and injustices of the past in our aged-care system might have been avoided if our most vulnerable had the fundamental protections of a human rights act. Instead, the statement of rights appears to be a selection of rights afforded under international human rights law with many key rights missing, such as the rights to life, liberty and security of person, freedom of movement, freedom of religion, freedom from restraint, the presumption of legal capacity and the prohibition against torture. While an improvement, then, the statement of rights for individuals and the statement of principles to guide service provision included in this bill are a continuation of Australia's piecemeal approach to protecting basic rights. Arguably, a better outcome could have been achieved by introducing a federal human rights act.

Despite the best of intentions to put older Australians at the centre of aged care, the reality is the system is a closed one with an interdependent and shifting balance of power held between government, approved providers and the regulator. Many older Australians have little real choice about whether they enter aged care, particularly if their needs are high, and the availability of services often dictates whether people can stay in their community or who provides their services. While the bill includes a positive duty on providers to uphold the statement of rights, it is severely limited by the fact that it only applies to providers rather than the whole of the aged-care ecosystem, including aged-care advocates and needs assessors. There is also the practical ability for providers to limit rights, for example, to prevent harm. But, concerningly, the bill does not distinguish between permissible limitable rights and absolute rights.

Strengthened aged-care quality standards and additional powers of the Aged Care Quality and Safety Commission will be critical, as they are the sole basis on which those receiving services can enforce their rights. Similarly, an effective compliance mechanism and whistleblower process will be crucial to ensuring older people are heard because these things are not currently protected in our legislation. Under this bill, rights can ultimately only be upheld through the complaints commissioner. Separating the complaints commissioner from the regulator is important in establishing trust. However, as it stands, there is no pathway for review for those unhappy with the decisions of the commission. Some in my community have also expressed their disappointment that the government reneged on the imposition of criminal penalties for bad actors. In removing criminal penalties, the needs of providers have been prioritised ahead of aged-care recipients and is likely part of a deal to get the coalition's support.

A focus on dignity, independence, privacy and control for people as they navigate ageing well should go without saying. This focus is necessary if we are to rebuild trust in the system and establish the new foundations for a robust and fit-for-purpose aged-care sector. This focus on these rights and principles should apply regardless of whether older Australians are accessing government funded services or paying privately. The number of people over 65 in my community of North Sydney is close enough to the national average of around 17 per cent, with most living or renting in private accommodation, including in retirement villages and social housing. Financially, these people live within a range of means. Some are on the full pension, many are Commonwealth seniors health card holders, while nearly 35 per cent are fully self-funded retirees who access non-government funded services rather than join the currently lengthy waitlist. However, despite that relatively high percentage of self-funded retirees, many still live within relatively modest means and should therefore be recognised for taking financial pressure off the aged-care system and rewarded with equal rights under this legislation.

When the superannuation regime was introduced, it promised to be a cornerstone of the government's retirement income policy. The aim was and continues to be, as far as I am aware, to move people towards self-funded retirement and it is working. In the past 20 years, the number of partially or fully self-funded retirees in Australia has more than doubled and now sits at around 43 per cent of those aged 65. But, because these people after accessing aged-care services outside the government's subsidised framework, they will not benefit from the same rights and contribution caps under this legislation, and that hardly seems fair. Ironically, in fact, this may incentivise people to access support within the currently struggling government funded system, which is undoubtably not in anyone's best interest. Ultimately, whether publicly or privately funded, there should be an equivalence of rights, as without equal rights we cannot ensure older people are being universally treated with the same level of care and dignity regardless of the service provider.

Acknowledging and responding to the desire of people to age at home for as long as possible is commendable and is consistent with what I hear from my community, both from older members themselves and from those providing unpaid care and assistance to older relatives and friends and, let's face it, it is what many personally hope for ourselves. By remaining in familiar surroundings, older people preserve their emotional wellbeing and maintain a sense of independence and autonomy, and these factors contribute to overall happiness and quality of life. A well-functioning system for supporting people to stay home is therefore critical and is rightly one of the key ambitions of this legislation. To be clear, the current home-care supports are, quite frankly, a mess.

Since coming to office, my team has heard consistently that wait times between being approved for a home-care package and receiving any funding have been steadily increasing as the availability of the local home-care providers has fallen. Wait times can be as long as nine months, with no indication of when their funding will become available. Obviously, this presents a significant practical challenge for people who need immediate support to live independently at home. Often the burden of this delay is borne by the family. Those with means are turning to privately paid care, not understanding the implications this can have for exacerbating wait times if, for example, they have turned down a lower-level package in order to wait for the one they have been approved for.

The additional funding to be provided to the new Support at Home program to address wait times is therefore welcome but many are actually questioning whether it will be enough. With forecasts suggesting that the funding will only effect the desired improvement by July 2027, we are set for another three years of people waiting excruciatingly long times for the help the government has agreed they need. This doesn't even include the often lengthy time it can take to be assessed in the first place. It wouldn't be alarmist, then, to state that some people will literally die waiting for care.

Along with wait times, another significant issue that has been brought to me by my community is the administrative complexity and difficulty in navigating the aged-care system. This includes navigating the assessment process, understanding the options for residential and home care, meeting the associated costs and interactions of contribution caps and means testing, understanding how to access funding and choose a care provider, accessing the availability of appropriately qualified care providers, navigating wait times and the decision of whether to hold out for the package funding or obtain a private service, and trying to stay close to family and community. The list goes on and on and on. This would be difficult for someone at the top of their game to navigate, let alone someone struggling with health concerns and general worries about ageing, finances and changing circumstances.

Streamlining the assessment process is an important first step, and I look forward to seeing additional detail and timeframes for the implementation of a single assessment workforce. Given the importance of the assessment as a necessary first step in the process for accessing funding services, it's surprising that the assessment workforce will operate outside the act with no obligation to have regard to the statement of rights. Any outcome from the assessment process should have reference to the rights.

Similarly, streamlining various contribution caps and ensuring there is a total cap across both Support at Home and residential costs is a welcome improvement. However, some members of my community have expressed concern that the need for them to contribute more will push them into poverty. Without seeing the modelling, it's impossible to reassure them that they will be left with a living income. One older woman I spoke to queried what will happen to Commonwealth Home Support Program recipients beyond 2027. She literally said to me, 'Does the government assume I will be dead?'

The financial sustainability of the aged-care sector is rightfully a key issue, given our ageing population. This has implications both for the federal budget and for the financial viability of providers, because the government relies on services being provided by private and non-profit institutions. However, the shift to a user-pays aged-care model represents a significant change in how aged care is funded in Australia. While it aims to create a more sustainable system, it also raises important questions about fairness and accessibility. The 'no worse off' principle and the introduction of additional means tested contributions from July 2025 have generally been well accepted by my community, notwithstanding the fact that it's likely that additional means tested contributions will lead to most paying more for aged-care services than otherwise. A critical caveat to that is the implicit guarantee that an increased contribution will result in an improved standard of care—both in the quality of care provided and through a requirement for increased transparency—so people can have confidence that their money is being applied to services they need and that they are in fact receiving. Again, with trust in the current system lacking, this increased transparency and accountability is crucial. I note the government has made inroads here with the dollars-to-care information available via My Aged Care.

Ultimately, this improvement will come down to the definition of 'high-quality care', the detail in the various standards being applied to providers, the ability for providers to attract and retain an appropriately qualified workforce and how the commission monitors and enforces those standards. It's important the government gets these standards and definitions right in the rules as they are a critical expression of the standards older Australians can expect and rely on under their statement of rights and will also determine what is funded as clinical care and what services require a contribution.

Like others, I'm concerned about where the lines might be drawn, particularly in relation to services that maintain independence. Does someone who has a clinical condition that means they cannot feed themselves have feeding included as part of their clinical care, or is it considered a service to assist in independence? Similarly, if someone cannot physically shower themselves, does their right to personal hygiene come down to affordability? The detail in the associated rules is paramount, and I will continue to listen to my community and other key stakeholders to ensure these rules meet community expectations.

Of course, quality care can only be delivered by a well-qualified and experienced workforce. The heartbreaking stories of neglect, pain and distress unveiled by the royal commission identified poor staff ratios, underqualified staff and inadequate training as key contributors to the systemic breakdown of the sector. The government's response to date has included some positive initiatives by way of the aged-care worker pay increases and fee-free TAFE courses. However, there is community concern that this does not go far enough and that the standards must specify carer ratios and qualification standards. I support the recommendations of Dementia Australia on mandating dementia care training. Similar to workers in the NDIS, the aged-care workforce should be registered with the Aged Care Quality and Safety Commission to ensure oversight and minimum skills.

None of this is easy. The government has inherited a silo system of aged care on the one hand with complex practical independences on the other. On balance, my community and I welcome this bill. But, like others, I will be monitoring the rollout to ensure the community's expectations are met and that the promise of increased fairness, transparency and sustainability is being achieved across the board, from those who are most vulnerable to those who we are increasingly relying on to fund themselves.

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

In my early years as the member for Macquarie in opposition, I witnessed our aged-care system descend into a crisis of neglect. We saw it happen. Since Labor came to government, we've made it a priority to reform the sector so ageing Australians receive the dignity and the quality of care they deserve. We've done this by lifting wages in the sector, putting nurses back into nursing homes, giving carers more time to spend with residents and offering fee-free TAFE so we can encourage more people to take up qualifications in aged care—and we've also improved transparency and accountability. These changes in two years have pulled the aged-care system out of crisis and brought back dignity, respect and quality. But there is so much more to do. We need to secure a long-term and sustainable future for the whole aged-care system, or, quite frankly, there will not be enough support to care for our ever-ageing population.

There are two major challenges we face. In the next 40 years the number of Australians aged over 65 is expected to more than double, and the number of those aged over 85 to triple. The current residential aged-care system just doesn't have enough beds to accommodate the ageing population, and at the same time—I know from speaking to older people, some of whom are simply my friends; we're all getting older—no-one, if they can help it, wants to leave their own home. People want to stay in their own home—and that includes my 84-year-old mum. But most people recognise at some point that they can't do it on their own. They simply can't do it alone. The Albanese government has listened to that message. We've heard what people are saying, and, along with improving the funding and viability of residential aged care so that providers will invest in building more rooms, we're investing $4.3 billion in a new system of home care that will help Australians remain independent in their homes and their community for much longer. We've worked really hard to achieve bipartisan support on these changes so that we have long-term certainty for older people, for aged-care providers and for aged-care workers.

The first thing I want to talk about is supporting people to be in their homes. That's what's going to be called Support at Home, starting from 1 July 2025. It will allow quicker access to support from the time you're assessed and provide more tailored support with eight levels of care. The top level will provide around $78,000 a year in support. There'll also be support for home modifications, with up to $15,000 to make homes safer, plus faster access to assistive technology like walkers and wheelchairs, and there'll be a new equipment loan scheme. These are all really practical things. If I think about the time it takes to get into the system right now, it isn't the assessment that takes time; it's being able to access a package. Faster access to a package, whatever level it is, will make a difference to people. I have heard people's frustration. It is the same reason we're training up workers so that that's not the area where the delay happens. It's making those packages available.

There's a new category. Support at Home participants will also have access to an expanded support program to get back on their feet after an illness or an injury, with a 12-week program that works with a team of allied health and other care professionals. That is often what people need—short-term support rather than ongoing support. So I'm really pleased to see that, and I know that's because the minister has listened to what I've been feeding through about what the needs are.

There's one other new support that is so crucial, and this is around palliative care. According to the Productivity Commission, up to 70 per cent of Australians would prefer to die in the comfort and privacy of their own home, but fewer than 10 per cent actually do. Support at Home participants will be eligible for up to around $25,000 in additional support to spend their final months at home so they can be surrounded by loved ones in a familiar and cherished environment instead of spending those precious last months in hospital and having family trying to see them within those constraints. This is another really significant part of the reforms that this bill brings in.

I think that at this point it's really important to make clear that, for people who are already on a My Aged Care package, there won't be any additional costs, and, for new entrants, the government is going to pay 100 per cent of clinical care services, with individuals making some contributions to the help they receive around independence—which might be help with showering, getting dressed or taking medications—and everyday living—the things that we do all our lives, such as shopping, cleaning, gardening or meal preparation. How much someone contributes will be based on the age pension means test and will be highly dependent on their personal circumstances. It is not going to be one size fits all. It will also be dependent on the level of support they are assessed to need and their combination of income and assets.

If you are eligible for contributions once you begin to access aged-care support, whether it's in your own home or in a residential setting, there will be a lifetime cap on what you pay, at $130,000. I think that really deserves a little bit more explanation. One of the things I want to absolutely clarify and make sure there's no confusion about is that there will be no changes to the means testing of the family home. Older people with low means will still be supported to access the care that they need. They're the things that just will not change. The government will also remain the major funder of aged care.

There are a whole lot of technical differences that will come through. In Support at Home, for instance, you will no longer have to pay a flat weekly fee. You will make a contribution towards services categorised as everyday living or independence, as I've said, and that amount will be assessed. In residential care, those residents who can afford it will make contributions towards the hotelling supplement and the non-clinical care, based on a means test. Accommodation pricing will also change. There will be an increase to the maximum room price and to daily accommodation payments, which will 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 principal deposit for a maximum of five years.

These are some of the modest things that we're doing to ensure that there is sustainability for the aged-care providers. What we've seen in the last decade is no significant new residential accommodation built. There has not been enough viability and certainty for that sector. Quite frankly, I look around this chamber, and not all of us will need it as early as others—I think I'm probably the oldest one here, so I'll probably need it first! But I know our families will want to know that in the long term, into the future, this system is strong.

I'd like to talk a little bit about the approach to this bill. It is really about putting older people at the centre of their care and making sure the system works for them rather than anything being configured around the system. It is all centred on older people, and it's about high-quality, safe and compassionate care and services for older people.

It's also worth saying at this point that the people who work in aged care now are absolute heroes for the work they do, and I've witnessed this in recent years. My father spent two years in aged care. It was mainly during COVID, from 2020 to 2022. He died in 2022. During those two years I witnessed wonderful care being provided to him. People would have a joke with him in even the most dire circumstances. That's why those workers are so important. It's why one of the very first things we did in government was ensure there was a significant pay rise for workers in aged care. We've delivered more than $15 billion in funding for pay rises to workers. This has seen registered nurses earning up to $10,000 a year more and personal care workers earning up to $7,000 a year more. We want those care workers to also be treated with respect and dignity. We've made sure that across Australia there are registered nurses on site in aged care homes 99 per cent of the time so that our residents get the care they deserve.

Older Australians are now receiving an additional 3.9 million minutes of care every day thanks to our changes, and that has resulted in changes to the wellbeing of residents. 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. We're also seeing improvements in the star-ratings data, with fewer one- and two-star rated homes and more four- and five-star rated homes. That's about making sure the quality of care meets what we would all expect our older family members or neighbours to receive, and for us to receive one day in the future.

Along with this legislation around the financial reforms and changes and the new Support at Home program are things like a statement of rights for older people and a positive duty for providers to uphold those rights. There are also statutory duties for registered providers of aged care and there are civil penalties and a compensation pathway attached to those. There's a new approach to regulating aged care which really balances the incentives for continuous improvement and high-quality care and the stronger regulatory powers and civil penalties to protect people from harm.

Significantly, there is a new ministerially appointed complaints commissioner and whistleblower protections to make sure that older people, workers and other people have clear pathways to raise concerns about the quality of aged-care services. I think for older people and their family members, for carers, for advocates and for workers—and I really want to stress that—that a new complaints commissioner with powers and responsibilities independent of the regulatory commissioner means there is a voice to raise issues, to have them heard and to have them taken seriously, with an expectation that providers will work to address them or face really serious consequences.

This is a package of work that I'm really pleased to be supporting. These reforms are really significant because they are the next step in implementing the recommendations of the royal commission into aged care. The interim report of that royal commission was called Neglect, but many of us could see that neglect happening long before it was the title of a royal commission report. It's what drove us to want that investigation to look into the practices, the systems and the flaws, and to try and identify where it was working and how we could replicate that across the board.

I'm very confident that the changes that we're bringing in will lead to a different way of thinking about aged care and about being supported at home. The changes will mean Australians have respect and dignity as they age. They get to stay in their home for longer—as long as they can be supported there, and we hope that that will be longer. I hope it also means that families will feel less of a challenge in supporting their older relatives, and I really commend this bill to the House.

Monique Ryan (Kooyong, Independent) Share this | Link to this | Hansard source

Aged care is one of the most important parts of the federal government's responsibilities to its citizens. The Aged Care Bill 2024 results from the most significant recommendation of the Royal Commission into Aged Care Quality and Safety in 2020, and it has been long coming and the subject of much consultation. There are unfortunately significant residual concerns with respect to the limitations of its rights based approach, to its complaint mechanisms, to its provision of supports for older Australians with a disability and those from a culturally and linguistically diverse background, and to its definitions of quality care.

This new aged care bill emphasises a rights based approach. It outlines a statement of rights for older people; however, those rights are not enforceable in any meaningful way. Parenthetically, this speaks to a bigger issue, which is the lack of a human rights act in this country. The bill relies on the Aged Care Quality and Safety Commission and the complaints commissioner to uphold the rights of older Australians, but there is no positive duty for providers to ensure that those rights are met. This lack of enforceability means that the rights it identifies are unfortunately, in reality, more aspirational than practical.

This positioning of a statement of rights in aged care is at odds with the rights to access healthcare. The Australian Charter of Healthcare Rights specifically sets out the right to access healthcare services and treatment which meet individuals needs. It's incongruous that we guarantee the right to healthcare services in this country to receive treatment in a medical fashion when you need it but we don't guarantee the same thing—we don't reciprocate this basic right—for older people. This seems curious, particularly given, as the previous speaker has pointed out, that our population is aging and that escalating aged-care needs will be in tandem with escalating healthcare needs for the Australian population.

Moreover, the rights delineated in this bill do not guarantee Australians quality aged care delivered when and where they need it. Rather, all the bill guarantees is the right to be assessed for eligibility for funded aged-care services. We all know that an assessment is pointless if the services that are required are not available. It's also worth considering that the statement of rights concludes, 'Nothing in this division creates rights or duties which are enforceable by proceedings in a court or tribunal.' This means that the rights enshrined in this aged care bill are enforceable only as far as the strengthened quality and safety standards extend. It means that the impact of a rights based approach is reliant on the effectiveness of the roles of the regulators, the system governor, the Aged Care Quality and Safety Commissioner and the complaints commissioner.

Unlike health care and the NDIS, the Aged Care Act retains a rationed approach to health care. Access to care is not a universal entitlement based on the needs that are assessed. This approach can lead to lengthy waiting periods and to inadequate support for people who need help. For people with a medium priority, the expected wait time for an approved homecare package is one to three months for level 1, three to six months for level 2 and nine to 12 months for level 3. I'm sure I'm not alone as a MP in having heard from many frustrated, anxious constituents and their families, who have been waiting for months on end to access the care that they need. Just last month, I heard from the daughter of a man who'd been waiting nearly 12 months for a level 4 package. On escalating the inquiry, the only immediate solution offered by My Aged Care was to go back to the existing level 2 provider to see whether any additional services could be offered under the gentleman's current package. It's not good enough.

Waiting for aged-care packages can have a significant impact on families. It leads to emotional, physical and financial strain. There are also productivity costs. I hear from family members who have had to reduce their own work hours or leave their jobs to provide care for elderly loved ones. It's not good enough for those family members and not good enough for those elder Australians. As this legislation does not address the need for a universal entitlement to care based on the assessed need, supported by adequate funding mechanisms, there is no guarantee that waiting periods will improve.

Secondly, although the new aged-care bill aims to improve the quality and accessibility of aged-care services, there are widespread concerns in the disability community that it falls short in supporting older people with disability. Firstly, it fails to provide a clear definition of 'disability' within the bill, which could lead to inconsistencies in how services are provided and accessed by older persons with disability. Secondly, the bill maintains a separation between aged care and other services such as health care, including allied health, and the NDIS. This siloed approach could well lead to fragmented care and support, making it difficult for people with disability to navigate the system.

The separation creates a gap where older people with disability may well not receive the comprehensive support they need. For instance, individuals diagnosed with dementia at age 65 receive limited home support, pushing them towards residential care. In contrast, those diagnosed at age 64 receive much greater support under the NDIS and can often remain at home for longer. Another example is several constituents of mine who have post-polio syndrome. Many were too old to access the NDIS when it was introduced, and they are now appropriately concerned there may be no pathway to adequate support via the aged-care system.

The EM for this bill has to clearly explain the bill's intention and purpose in relation to older people requiring disability supports. It should explicitly state that the aged-care act will facilitate provision of disability supports to older people who would otherwise qualify for the NDIS were it not for its age limitations. Further, the act should facilitate the development of a shared specialist disability assessment pathway which should be co-designed by and with people with disability and their representative organisations.

I have other concerns with respect to the legislation of eligibility for aged-care services for some people with disability aged less than 65. For the very first time in Australian history, this aged-care bill provides eligibility for aged-care services for people with disability aged between 50 and 64 who are from First Nations backgrounds, homeless or at risk of homelessness. These services include residential aged care and home care. This represents a policy reversal of over 25 years, with the federal government having promised to work to solve the issue of young people in residential aged care. There's real concern in the community that this eligibility change will lead to more young people with disability being institutionalised in aged care. These facilities are not suitable for their needs. This is occurring at a time when the Commonwealth is still claiming to be actively pursuing a national target to have no person aged less than 65 in residential aged care by January 2025.

I also point out that the bill's reliance on a market based model for aged-care services is problematic. It assumes consumer choice will drive sector development, but it's not always feasible for older people who may not have the capacity or desire to shop around for services. We need a values based public policy framework that integrates aged care with mainstream health and community services. We've seen the issue of leaving things to the market before with the NDIS. It didn't work with the NDIS, and we don't seem to have learned the lessons from that policy failure.

Ultimately, this bill's success will hinge on the availability of a well-trained and adequately staffed aged-care workforce. We note the workforce faces significant issues at this time. There's a risk that the bill's increased demands and higher standards of care could exacerbate existing workforce shortages. Without a concurrent focus on attracting new workers and retaining existing staff, the aged-care system might well struggle to meet the bill's ambitious objectives. On reviewing this legislation, Margaret, a 76-year-old constituent from Kooyong, summarised this issue for me:

There is a challenge and a tension between the aims for a quality and humane provision of care for older Australians and the realities of funding and staffing challenges.

She also noted:

This could push smaller, not-for-profit providers out of business while larger providers' priorities for profit are counter to better quality care.

I couldn't agree more, Margaret.

This bill introduces new practices such as the focus on supported decision-making and the revised incident management framework. These will necessitate substantial investment by aged-care providers in upskilling and training programs for their workforces to ensure that they can effectively implement the bill's provisions. The act does not, however, implement robust training requirements for aged-care workers, as was recommended by the royal commission. Those workers in all aged-care centres around Australia need to receive explicit training, as recommended by the royal commission, on cultural safety, trauma informed care, dementia care and palliative care to ensure high-quality care for all aged-care recipients.

Further, the bill lacks direct provision for services tailored to culturally and linguistically diverse groups. This oversight can lead to inequitable access to care for older people from diverse backgrounds, many of whom will have unique needs and preferences. In my electorate of Kooyong, nearly 20 per cent of the community are Chinese Australian. There is no dedicated Chinese residential aged-care facility nearby and only two in Melbourne. The bill does enshrine the right to services in recipients' preferred language, and we know that older people—particularly those with cognitive loss, but all older people—tend to revert to their language of childhood in late adult life. So we need to be able to make sure that all constituents can receive aged care in a setting where the people caring for them speak their language—in this instance, Mandarin. But there's no guarantee for my Chinese Australian constituents that appropriate aged-care facilities will be available for them when they need that. The fact is that best-practice care really necessitates future planning and taking into consideration all aspects of the patient population, but there is no facility in this bill for that.

Finally, the use of automated assessment tools for determining care needs is another area of concern, and many members of my community have expressed concern about this. These tools, many of which are AI based, may not adequately consider the complexities of individuals' disabilities and comorbidities. If they don't capture all of the needs of the patient, how can they possibly provide all of the care required?

Further, the bill expands the collection, use and disclosure of information within the aged-care system. This raises important data privacy considerations. It authorises information sharing between a number of entities, including government agencies, regulatory bodies and law enforcement agencies. While some data sharing might be necessary for coordination and oversight, the broad scope of the bill does raise concerns about potential misuse or unauthorised access to sensitive personal information.

The bill includes provisions for whistleblower protections, aiming to encourage the reporting of suspected contraventions. That's a good idea, but the effectiveness of these protections in practice, particularly the requirement for anonymity of complaints and preventing victimisation of people in an aged-care setting, will require careful monitoring. The bill promotes transparency by requiring publication of certain information about aged-care providers, such as details of banning orders. While transparency is crucial for accountability, it's really important that we strike the right balance between public access to information and protecting the privacy rights of vulnerable individuals.

The introduction of co-payments has raised concerns for many of my constituents who are concerned that we are potentially creating a two-tiered system in which those who can afford to pay will receive better services. It could lead to inequitable access to quality care, particularly for those with higher needs, who may be discriminated against by providers.

In conclusion, while the Aged Care Bill 2024 does represent real progress in addressing the needs of Australia's aging population, it falls short in a number of critical areas, particularly in supporting people from culturally and linguistically diverse backgrounds and those with a disability. The lack of enforceable rights, the separation of services and the inadequate provision of specialist disability support are significant concerns that really need to be addressed. We need to advocate for a more integrated and comprehensive approach which will ensure that older people with a disability and older people from other cultural and linguistic backgrounds can always receive the care and the support that they need. All Australians deserve the very best aged care, which has to include clear definitions, enforceable rights and a commitment to equity and inclusivity in provision of our aged-care services.

Shayne Neumann (Blair, Australian Labor Party) Share this | Link to this | Hansard source

I think I have spoken more on aged care than just about any other topic in this place. I am delighted to have the opportunity to speak on the Aged Care Bill 2024. This legislation represents the most significant structural reform to aged-care laws in a generation. Some of the speakers in this debate have spoken in detail on the bill. I intend to talk about the background of what led up to this bill, why the bill is necessary and then give an overview of it. Our new Aged Care Act will modernise a labyrinth style system to be more future-facing and to enable generational reforms to the sector. The current Howard-era Aged Care Act was put in place with the primary focus of how to fund aged-care providers. But this new act will put people at the heart of care.

The bill implements a number of election commitments that we took to the last election while in opposition such as mandatory aged-care food standards, statutory duty of care for registered providers of aged-care workers, screening, and stronger investigation powers for the regulator. These new laws aim to protect older Australians in aged care with stronger powers to investigate bad behaviour and civil penalties for breaching standards. Reforms like this don't happen every day; they are generational and are a significant shift.

It is important to look where we have come from because this is another area where the Albanese Labor government has had to clean up a mess left by the former coalition government. Their record was summed up in the title of the 2019 interim report of the aged care royal commission—Neglect. The reality is that the coalition, in nine long years, failed abysmally in the aged care of our people whether in residential aged care, in home care or through the Commonwealth Home Support Program. This is a government that had a revolving door of aged-care ministers.

One of the first acts of the Abbott government when they came to power in 2013 was to get rid of the aged-care workforce development fund, which we brought in as part of our $40.2 million living longer, living better package. This had a severe impact on aged-care workforce, including in regional areas, and they failed to develop an aged-care workforce strategy to replace it. They moved aged care out of health and ageing and into the mega portfolio of social services. Eventually, after Labor and stakeholders campaigned for years to bring it back into the health portfolio, they finally did so. They abolished the panel for positive ageing, which was led by Everald Compton, Susan Ryan and Brian Howe. But that committee went ahead anyway and did their report despite the fact they were defunded and abolished.

One of the other early acts back in September 2013 was to get rid of workforce supplements. That was funding to go to residential aged care to increase wages, training and workforce development. When Labor opposed that—and I was the shadow minister for ageing at the time—it took the coalition 32 minutes in the House of Representatives to cut $1.2 billion in funding to aged care. Then in June 2014 they cut the dementia supplement and the veterans supplement which were helping people stay in their homes and get the care they needed. That is why there was a royal commission, that is why its interim report was titled Neglect and it is why the final report talks about the far-reaching and almost dramatic changes that need to happen in the sector because those opposite neglected it again and again and again. They could barely find a budget or MYEFO where they didn't cut funding again and again. In the 2016-17 budget, for example, they cut $1.2 billion over four years through changes to the scoring matrix of the aged-care funding instrument that determines the level of funding paid to aged-care providers. That is not the $1.2 billion I was talking about before; that is an additional cut. So they cut $1.2 billion directly from the sector and they wonder why it was neglected. They wondered why people were leaving the sector when they weren't paid enough and didn't have career development, training or opportunity. People were malnourished. There were maggots in wounds. People were literally starving in soiled bedsheets and soiled clothing on the previous government's watch.

Our government's trying to make up for the failures of those opposite, who failed the aged-care sector and failed those people who were going before us and who need care. They were vulnerable. They were living with dementia; more than half the people living in residential aged care are living with dementia. Those opposite failed them massively. They shuffled money around all the time, and that's why the sector was crying out for reform and why the bill that we're bringing today is so necessary. The former coalition government should have had a look at the interim report that was handed down in October 2019, but what did they do? They continued to use sleight of hand to cut the funding, and they did this just before the interim report was handed down. If they could find a bit of money for aged care to placate the aged-care providers, they did so, effectively to try and pre-empt and gazump the interim report.

In contrast, what we need to do is structural reform, so we're providing structural reform and billions of dollars in this bill. This is necessary for a sector where Australians have been failed. Care, dignity and respect was the title of the royal commission's report, and that's what those opposite failed to provide—the care, dignity and respect that seniors deserve. We are taking steps and acting on the recommendations of the royal commission and the Aged Care Taskforce, and we know it's backed by the sector.

The bill before the chamber today, the Aged Care Bill 2024, replaces the Aged Care Act 1997—the Howard-era legislation—and the Aged Care Quality and Safety Commission Act 2018. The bill builds on the work that the Albanese government has already done to improve the quality of aged care and increase the wages of aged-care workers. It responds directly to recommendations 1 to 3 of the Royal Commission into Aged Care Quality and Safety and addresses 58 recommendations in total.

The legislation before the chamber is going to deliver a rights based aged care system; a new program that supports older people to live independently on their own, in their own homes, 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. It includes reforms that 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 24/7. The bill will place high-quality, safe and compassionate care and services for older people at the centre of the system. The bill will enable the government's broader aged-care reforms to be implemented. We're on the precipice of an historic moment for aged care in this country and for older Australians and their loved ones. It's a landmark reform. It will shape the way people will live independently and with dignity as they age.

Since the tabling of the royal commission report in 2021, 136 recommendations have been addressed. As part of the government's response to the Aged Care Taskforce, we are rolling out a $5.6 billion reform package, including $4.3 billion for a new home-care system called Support at Home. One point four million Australians will benefit from the new Support at Home program by 2035, helping them to remain independent in their homes and communities for longer and contributing in those communities. This will come into effect from 1 July 2025. Critically, this will reduce wait times for in-home care, with a target of three months by July 2027.

Several principles underpin the reforms in this bill. Australians will get the support they need and make a reasonable contribution according to their means, as the taskforce recommended. Everyone already in residential and home care will benefit from a 'no worse off' principle from their place in the system. The government will pay all clinical care costs, with individuals contributing to the kinds of costs they would typically have paid throughout their lives, and the government will continue to pay for the majority of aged care costs. These reforms respond to the recommendations of the Aged Care Taskforce, which brought together older Australians, experts, residential aged-care providers and workforce representatives and recommended that Australians pay a reasonable means-tested contribution to the costs of their care. The reforms have bipartisan support, and we thank the opposition for their constructive engagement in the process, notwithstanding their abysmal record in government.

The Albanese government wants to give people more choice about the kind of care they can receive and help them stay in their homes and maintain their independence for longer. I know older people in Ipswich, the Somerset region and the Karana Downs area want to live independently in their homes. Our new Support at Home program will help to make that possible and will mean shorter waiting times for people to receive help. But if the time comes when a person needs to move into residential care, they deserve to live in a comfortable space that meets their preferences and needs.

These are the most significant aged-care reforms in 30 years. They will improve the funding, viability and quality of aged care and protect Australians in aged care from harm. And let's be clear about this: it's not about new taxes and it doesn't change the treatment of the family home. What it does help make room for in the budget is to ensure that we fund better services in the future and put aged care on a more sustainable footing. The government's reforms will provide certainty for the aged-care sector in my electorate.

I have been a strong supporter and advocate for local aged-care providers. Indeed, my family has worked in the aged-care sector in Ipswich for three generations. Earlier this year I arranged a visit by the minister for aged care to Cabanda Care in Rosewood to discuss the government's reforms and meet with staff and residents. Last month I visited Villa Maria Centre in Eastern Heights, in my electorate, to celebrate 30 years of Catholic health care in the Ipswich region. I know some smaller communities and regional providers like Cabanda will have concerns about what some of these reforms will mean for them around funding and workforce issues, and that's justifiable. It's good for them to have an opportunity to speak with a federal MP and the minister.

Prior to my coming to parliament in 2007, for 14 years I sat on the board of what is now known as Carinity, an aged-care provider in Queensland. As a lawyer working in private practice, I and my firm acted for many aged-care providers and many stakeholders who work with and for the sector, so I know a bit about this area and I'm pleased to see the progress we're making.

At a personal level, most of us know someone—whether it's a friend, a loved one or a relative—in home care or aged care and want to see them get the support they need. These changes will help us deliver better care for more people in our community in a sustainable way. We promised to act and we have. The bill has the potential to provide a new and enduring foundation for the aged-care sector from 1 July next year and for years to come. From then on, the aged care for people that we will put in place will put the rights of older people first.

The new Support at Home program will support all of us to live independently as best we can in our own homes for as long as we possibly can as we age. The aged-care system will be fairer, it will be financially sustainable and it will provide for contributions towards the cost—

A division having been called in the House of Representatives—

Sitting suspended from 18:02 to 18:20

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

I rise to speak on this Aged Care Bill 2024. In July this year, I had the Lansdowne Aged Care Facility organise some of its residents to visit our parliament. It was the first time ever that Lansdowne Aged Care Facility have brought their residents here. They wanted to expose the seniors to Canberra and to the workings of parliament. It was organised by their manager, Nam Pham. She reached out and said, 'Do you think you can make it happen?' I did. I brought four elderly ladies—a couple with their walking sticks and walking frames—up to the members' dining room and hosted them to a nice lunch. It took them three hours to drive from Cabramatta to parliament. We were hoping to get them into question time but that three-hour drive and the whole experience in parliament was just so overwhelming that, after lunch, they drove back home. But it was a great experience for them and a great experience for Lansdowne Aged Care Facility to really see Canberra and Parliament House.

Lansdowne Aged Care Facility caters to our culturally and linguistically diverse community, in particular, Southeast Asian residents who have cultural needs in their food and care, particularly their language. I engaged with the Lansdowne Aged Care Facility when the draft of this bill was released. I reached out to them and other community providers, workers, as well as nurses in the system to get their feedback on what is working and not working.

Nurses who came to the forum were visibly frustrated with the understaffing of aged care. A nurse who attended the forum said, 'There is a growth in aged-care residents from multicultural backgrounds yet there is a lack of nurses with the appropriate language skills to ensure the residents' needs are supported. This is a gap.' Another nurse said, 'I want to do my best so each resident receives the care that they need but there are only a few of us at a time. To be honest, the aged-care sector is not really that attractive.' Nurses are the cornerstone of a functional aged-care system, and any health system for that matter, but they do not feel sufficiently supported. While there are current incentives available, there must be further conversation on how to better support nurses and, in turn, effectively assist older people within aged care.

Overall, I heard from providers, nurses and children of individuals about where our aged-care system has gone wrong. It was a mixture of different pain points: aged-care residents not having their needs adequately addressed, the lack of nurses wanting to work in aged care, understaffing, juggling competing demands, certain aged-care providers not doing the right thing, the minimal resources, the lack of training to address the complex needs of aged-care individuals of culturally and linguistically diverse backgrounds, and compliance—the filling out of paperwork, the demand on providers to provide that rather than focusing on the individual care—and the list goes on.

In my doorknocking, I came across elderly people who chose to stay home because their children feared that the aged-care homes would fail their elderly parents. For example, I met Mrs Kwang, who is 104 and still living independently—

Hon. Members:

Honourable members interjecting—

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

I know! Independently and in her home. She lives on the third level of a block of units in Carramar. I was so surprised because, when I knocked on the door and it opened up, there she was with her son sitting there. Apparently the children take turns in coming and cooking for her and cleaning for her. But I was so amazed to see this 104-year-old sitting there in her bed on the third floor of her block of units in Carramar.

I have also visited many other nursing homes within my electorate to speak to aged-care residents to understand the state of our aged-care system. I found some of our aged-care facilities in Fowler to be so professional. The staff provide so much care, especially when speaking the resident's language, and they provide the culturally appropriate food that is needed. I know that, if you're coming from a culturally and linguistically different background, it's very important to have food that you grew up with, and so some of those areas are working for them.

The population of people aged 60 in Fowler in 2021, according to the ABS, was about 39,498 people, which is more than 20 per cent of the entire population of Fowler. As of June 2023, there are 28,648 recipients of aged-care services in south-west Sydney. The cohort of the aging population will only continue to grow.

Constituents have attended my office and written in about the issues with the aged-care system on behalf of their parents or loved ones. Interestingly, a young consistent named Jennifer wrote to me, saying:

I would never put my parents in an aged care facility as I heard it is full of substandard care and even neglect. My parents cannot speak English well so it's more concerning.

I think this is a stigma currently attached to the aged-care system—that it is distrustful, incapable and not fit for purpose. The issues and concerns shared were not far from what was found in the report of the Royal Commission into Aged Care Quality and Safety.

There is a lot to unpack with the Aged Care Bill. I understand that the Aged Care Bill will address 60 recommendations of the royal commission's report and the Final report of the Aged Care Taskforce. The bill will establish a modern rights based legislative framework that focuses on the safety, health and wellbeing of older individuals and places their needs at the centre of the aged-care system. I'm glad to hear that this approach will be taken, and I commend the government for following the royal commission's report recommendations in drafting the objects of this bill.

It is crucial to get the objects of this bill right to set the scene for an aged-care framework that's workable, sustainable and trusted. If we all put ourselves in the shoes of those needing aged care—we will all age and be in need of aged care one day—wouldn't we want a system that has a high level of service and care that would ensure individuals accessing aged-care services are free from mistreatment, neglect and harm, that the services are accessible and more? Surely, we all would want a system of aged care that is of the highest standards.

However, as my constituent Jennifer shared, it is important to ensure that the needs of individuals of diverse cultural and linguistic backgrounds are being addressed and that they do not become unintentionally neglected. Whilst the object does provide for an aged-care system which takes into account the needs of the individuals first, regardless of their location, background and life experiences, I urge the government to clearly stipulate that the new aged-care system will ensure that the needs of culturally and linguistically diverse people are also being effectively accounted for.

When I spoke to my constituents, it was a common theme that they wanted an aged-care system which supported their ability to live at home safely. This is particularly relevant to older people who came to Fowler as refugees and migrants and who have invested their whole life working to buy their family home, so there is an undeniable attachment.

Again, in my doorknocking, I have met so many seniors living at home and being cared for by their loved ones because they believe that our aged-care system doesn't cater to their cultural needs. This is where our home-care package is crucial. The royal commission's report revealed, 'Older people are not getting the home-care package at the time and level needed, with the wait time to be as long as 34 months'—that's about three years—'for those with the highest needs.' This meant that people could literally die waiting for a home-care package. The report also found that the home-care packages were insufficient to meet the needs of many older people, such as the highest level of care only getting eight hours and 45 minutes of service per week. This is disappointing to hear.

I understand the government will be introducing the new Support at Home program, replacing the home-care packages and short-term restorative care to the tune of $4.3 billion, which works out to be about $19 per person. This is supposed to include more tailored support determined at assessment and eight ongoing classifications, instead of the four Home Care Package levels, starting at $11,000 per year and reaching $78,000 per year for the top classification. These figures might make sense to the policymakers who developed them, but the critical point will be: will this new program provide adequate care for our aging population? Not only that, but the government needs to ensure that this latest information is clearly explained and provided to those in culturally and linguistically diverse communities in Fowler and across Western Sydney. Too often when the government makes policy decisions and changes from the ivory tower of Canberra, by the time it gets to where lives matter, the information gets lost in the lack of translation and practice. Home-care services reported that the largest proportion of recipients were those with a preferred language other than English. Will the government ensure that the brochures are circulated in various languages to assist CALD older individuals navigate the new Support at Home program?

There will be new rules for aged-care providers and workers. Aged-care providers will be required to apply for registration which will be decided by the commissioner. There is also a separate set of obligations on aged-care workers and 'responsible persons of registered providers' to comply with the aged care code of conduct. Failing to do so will incur civil penalties. This is in line with recommendation 92 of the royal commission's report. There is pressure for the aged-care providers to do the right thing or risk a high civil penalty or lose their registration.

Aged-care providers who attended my aged-care forum shared two primary concerns regarding the Aged Care Bill during the exposure draft: financial sustainability for providers to meet the compliance requirements; and whether it would lead to uninsurable risk, such as that providers will not be able to obtain insurance due to the high civil penalties. To be clear, I think the new aged-care system must have strengthened compliance requirements for aged-care providers to ensure that individuals accessing the service are not subjected to harm or neglect. Providers doing the wrong thing need to know that there will be dire consequences under the aged-care reform.

However, there must be a balance and a compromise with key stakeholders, such as providers, for long-term and sustainable reform. We do not want to be in a position whereby older people will not be able to access the residential care and support that they need because providers are unable to support their operations. And we do not want to burden providers with excessive bureaucratic demands of filling out paperwork instead of focusing on what they do best, which is to provide care for our loved ones in an aged-care facility.

This aged-care reform is critical for Australians, and I welcome the government's efforts in taking the steps to respond to the royal commission's report for a better aged-care system. Aged care being a rights based model is a step forward. I reiterate that it is important that these reforms be explicitly inclusive to the needs of the culturally and linguistically diverse ageing population, especially those in my electorate of Fowler.

Alison Byrnes (Cunningham, Australian Labor Party) Share this | Link to this | Hansard source

As we all grow older, our lives change in both expected and unexpected ways. There are the stages we see coming such as retirement, watching our children grow and create families of their own, and perhaps downsizing to a smaller home. These are moments that we can emotionally and practically prepare for. However, there are also moments that catch us completely off guard, like the sudden decline in one's health or the unexpected challenges of caring for a loved one who now requires more support than before. These changes, whether gradual or sudden, affect not only individuals but their families as well. Families often find themselves struggling with complex emotions like stress, guilt and worry. There are scheduling difficulties like managing time and medical appointments and then there are the finances and caregiving responsibilities. This is in addition to trying to maintain their own busy schedule.

In the Illawarra, we have faced significant challenges. After a decade of neglect and a lack of investment by those opposite, we have a shortage of aged-care places across Australia. This has put enormous pressure on our aged-care providers and our health system, and none more so than in the Illawarra. Through this neglect, the Illawarra Shoalhaven Local Health District have lost over 600 aged-care beds. This has now left a deficit of around 900 beds in the Illawarra Shoalhaven region, which was confirmed by the Department of Health and Aged Care. In Wollongong, we are really feeling the pressure of this deficit as 14 per cent of our population is aged 70 and over, which is higher than both the New South Wales and national averages. During the past winter period, the number of patients in Illawarra Shoalhaven hospitals awaiting placement into an aged-care facility peaked at 156 patients per night. These numbers paint a really stark picture of the crisis we are facing in the Illawarra and the Shoalhaven.

The shortage of aged-care places isn't just a statistic. It has a profound impact on the lives of families across our community. Patients who should be in a supportive aged-care environment are instead in hospitals which are already stretched to capacity. I would like to take this opportunity to thank Margot Mains, Margaret Martin, Megan Foye, Professor Jan Potter and Dr John McKenzie from the Illawarra Shoalhaven Local Health District. They have worked tirelessly to help manage this crisis which has placed pressure on our local hospitals. Margot and her team's dedication to providing the best care possible in difficult circumstances is truly commendable.

While hospitals are essential for providing acute medical care, they aren't suitable for the long-term aged-care needs of our elderly. Older adults, especially those with chronic conditions, thrive in specialised aged-care facilities that provide a supportive homelike atmosphere. Extended hospital stays can lead to increased infection risks, social isolation and inadequate rehabilitation. Aged-care homes and home based services are designed to enhance quality of life, ensuring the comfort and ongoing support that older individuals truly need.

I have met with many people who have shared with me the immense challenges that they face in trying to care for their elderly parents. Juggling work, the needs of their children and their own personal lives while searching for suitable aged care can be overwhelming. They speak to me about long wait lists, limited choices locally and the anxiety of not knowing when or if they will find the right care for their loved ones.

I met recently with a woman called Renee. Renee's story about trying to find appropriate care for her father is one that is truly heartbreaking. Renee contacted my office in June. She and her family were severely frustrated with the lack of available beds and respite. Renee's father, James, had advanced dementia and had been cared for by his wife, Jan, for over five years. Sadly, due to the decline in her physical and mental health, Jan was no longer able to provide the care that James desperately needed. Renee and her family faced a wait for a reassessment for James to get the care that he deserved. He was assessed while he was at home, while he was being cared for by Jan, but, as his needs changed and he was admitted to hospital, he was in need of a reassessment. James would be in hospital for the foreseeable future while the family waited for an assessment.

Caring for a patient with advanced dementia, like James, requires specialised support due to the unique and complex nature of the disease. Many staff in our hospitals are not equipped to provide high-quality and specialised dementia care. Dementia affects different people in different ways; each patient has a very unique experience. Medical professionals that understand this and have the appropriate training are able to provide better care.

Despite the family's efforts to find a suitable aged-care facility that had specialised dementia care to meet his needs, James's health continued to decline. While getting treatment for an eye infection, James developed pneumonia. On 20 August 2024, James sadly passed away. Renee's last memories of her father were not ones that she would have hoped for. She wanted somewhere where her father could live out his final days with specialised care in an aged-care setting.

Sadly, Renee and her family are not alone in this situation. Many families in our community are facing similar struggles trying to care for their loved ones. Stories like this truly break my heart. They keep me up at night thinking that too many families in our community are facing this struggle. Addressing the aged-care shortage in our region is crucial for these families and it has been something that I have been working to fix with the Minister for Aged Care and my New South Wales colleague, the Minister for Health and member for Keira. Our community deserve to know that when the time comes they will be able to access the right care for their parents without sacrificing their own wellbeing. Sadly, we don't have a magic wand to wave to make the years of neglect from those opposite and the subsequent problems we are now facing go away. We need to roll up our sleeves, do the hard work and find the much-needed solution.

On a local level, we have worked together and introduced a range of short-term, medium-term and longer term initiatives to take the pressure off the healthcare system and ensure that the elderly in our community receive the care that they need. The Albanese and Minns Labor governments have worked together to provide significant additional support for aged care in our region including joint funding for 35 new transition care places through to June 2025 to help transition older people out of hospital and back into their homes. They are also introducing the New South Wales Aged Care Outreach Service, a special flying squad of doctors, nurses and specialists who visit aged-care homes across the Illawarra. We've also got funding to the Acute to Residential Care Transition Service program, run by Dementia Support Australia, which assists people living with dementia and their families in transitioning from hospital to residential care. We've also supported an eight-place specialist dementia care program at HammondCare Horsley. We've also opened the Wollongong Medicare Urgent Care Clinic in Corrimal to provide urgent care and reduce unnecessary hospital presentations. We've also secured $16.5 million in federal funding, through the Aged Care Capital Assistance Program, for the Illawarra Retirement Trust. This funding will enable the opening of 48 additional much-needed beds—18 of which will be part of the memory support wing, helping people with dementia—as well as refurbishing 50 two-bedroom suites. All of this will be completed late next year.

On top of this, the Albanese Labor government knows the importance of aged care and how instrumental all staff working in this sector are. That's why we've committed to providing a much-needed wage increase to retain the skilled aged-care workforce and to providing fee-free TAFE courses to attract more people to the industry. During the recent local government elections, I called for an aged-care planning review, and the new Wollongong council lord mayor, Tania Brown, has committed to an aged-care planning review to help address this pressing issue.

These measures are already making a difference, but there is still much work to be done to address the ongoing aged-care shortage in our region, and this bill is set to do that for the long term. The introduction of the Aged Care Bill 2024 marks a landmark, once-in-a-generation reform that will shape the way we support people to live independently and with dignity as they age. I want to take this opportunity to commend the minister for her hard work to make the aged-care system better and fairer. These changes are bold, they are brave and they are a turning point in how we care for our aging population. They will ensure that older Australians receive high-quality care that is designed around their individual needs. They set out to improve their quality of life, whether they are receiving services at home, in the committee or within residential aged-care facilities. The legislation introduces a new era of transparency, accountability and respect, aimed at restoring trust in the aged-care system

One of the many key changes that this bill is set to bring about is the introduction of the Support at Home program, scheduled to commence on 1 July next year. This program will replace existing home-care systems, allowing older Australians to receive more tailored support that promotes their independence and enables them to remain in their homes for as long as possible. For many Australians, aging at home is the preferred option, allowing them to stay in familiar surroundings with the care and support that they need. This means around 1.4 million Australians will benefit from the new Support at Home program by 2035, helping them to remain independent in their homes and communities for longer.

In addition to Support at Home, the bill responds to the recommendations of the royal commission by focusing on key areas of reform. This legislation is also going to deliver a rights based aged-care system; a new regulatory framework and a strong regulator; new quality standards; and fair co-contributions to make the Australian aged-care system sustainable into the future. The reforms respond to the recommendations of the Aged Care Taskforce, which brought together older Australians, experts, residential aged-care providers and workforce representatives. The government's response to the Aged Care Taskforce will ensure that the aged-care system is adequately resourced to meet future demand. This includes making sure that funding is allocated in a way that is fair and equitable, ensuring that all Australians, regardless of where they live or their finances, have access to quality aged care.

The government will now fully fund all clinical care, while participants make contributions towards services that they have paid for or been responsible for their entire lives, such as gardening, cleaning and personal care. The 'no worse off' principle will ensure participants are no worse off because of the reforms. This will ensure that participants will make the same contributions, or lower, that they would have under a home-care package arrangement.

In residential care, residents who can afford it will now make contributions towards the hotelling supplement and non-clinical care based on a means test. These measures will ensure residential aged-care providers can attract the necessary investment to keep current facilities operational, enhance quality and build new homes. A lifetime contribution cap for care costs will be implemented across the aged-care system, ensuring no-one will contribute more than $130,000 to their care costs regardless of their means or duration of care.

The Aged Care Bill also recognises the vital role aged-care workers play in delivering high-quality services. By establishing an enforceable code of conduct for aged-care providers, the bill ensures staff are held to the highest standards of professionalism and care. This code will provide protection for older Australians while giving providers clear guidelines on how to meet their obligations. It is a step towards creating a culture of respect and accountability within the aged-care sector.

In addition to this, the new regulatory framework will give the Aged Care Quality and Safety Commission greater powers to take enforcement action when providers fail to meet the required standards. This will ensure that aged-care facilities are not only compliant with regulations but actively delivering the best possible quality care. This bill is not just about fixing the problems of the past; it is about building a system that respects and cares for older Australians in the way they deserve.

For the Illawarra, these reforms are crucial. We need more beds, better services and a system that delivers the care and dignity that our older people are entitled to. Through increased capacity, improved quality standards and greater support for both workers and providers, the Illawarra and all of Australia will be better equipped to care for our ageing population. Together, we can make a real change to so many Australian lives through this once-in-a-generation opportunity, ensuring that no older Australian is left waiting for the care they need and that they can live their later years with the dignity and respect they deserve.

Elizabeth Watson-Brown (Ryan, Australian Greens) Share this | Link to this | Hansard source

So many touching personal stories are being related here. I and many others can absolutely relate to them personally, through personal experience. We need reform.

Labor says this bill, the Aged Care Bill 2024, is a once-in-a-generation reform. But who is this supposed reform for? It seems it's not for all older Australians, who deserve dignity and respect as they age. No, it seems it is more for the for-profit providers, who are looking to squeeze every cent out of that profit out of an already problematic, some would say broken, system. Any aged-care reform needs to be actual reform centred on the dignity and the rights of older Australians. Instead, it appears we're getting a somewhat suspicious deal between Labor and the LNP that's a dream for for-profit providers and a nightmare for potential participants. I've certainly had many concerns raised with me by the older citizens of Ryan, and the Greens and I share their significant concerns about what this deal will mean for older people. It's absolutely critical that older people have a say on this bill and the implications it will have for them. We can't risk creating a two-tiered system that bakes in inequality. The government needs to fund an accessible system for all Australians who need it.

Opening the door to an expanded user-pays model risks serving only to increase the profits of private providers, many of whom are effectively committing daylight robbery of older people—we've seen it—with no consequences for those operators. It's cruel treatment when we should have a system of proper care and support. We should be building systems that last and that provide for everyone in our community, not continuing down the path of prioritising profits over older people.

The Greens have long called for a shift to a rights based framework in which older people must have rights that are unequivocally clear and enforceable. We're concerned about the lack of enforceability of rights in this new bill. The elderly are not commodities for the profit of aged-care providers; they are citizens who have made lifelong contributions to our communities, and they deserve respect, dignity and care. We all deserve to know that in our later years we will be looked after. It should be an obligation for the government of any moral and mature society to ensure that older people get the care they need. But Labor has yet again let their agenda be driven by the coalition and for-profit providers to the clear detriment of older people. So much of this process, problematically, has been discussed behind closed doors, and older people must have a right to input and to understand the extent of the changes that will impact them. What we do know is that under Labor and the LNP's deal, they've already made significant changes to the benefit of the providers like actually removing any criminal penalties for any wrongdoing.

The Royal Commission into Aged Care Quality and Safety exposed the appalling neglect and abuse in our aged-care sector and made recommendations designed to fix these systemic issues, yet the Labor government has again decided to merely tinker around the edges, rejecting the royal commission's recommendation for an aged-care levy, opting instead to increase contributions from aged-care participants. Fundamentally, any reforms to aged care should enshrine the rights of older people who are seeking or receiving aged care. If the government is truly serious about making sure this is true once-in-a-generation reform, we need to get it absolutely right. For these reasons, the Greens will be opposing this bill in the House and reserving our final position in the Senate.

Tania Lawrence (Hasluck, Australian Labor Party) Share this | Link to this | Hansard source

Human beings need care. Without care, none of us would have survived our arrival into the world. We need thoughtful, loving care when we are children. We need care when we are in trouble or unwell in any way. That is throughout our lives. We have to look after each other. The toughest and strongest don't always feel tough and strong. A person who seems invincible one day can be vulnerable and uncertain the next. As mature adults, we see our relationships not only with our parents and older family members but with older people generally changing and evolving. We don't all age the same way. There are people in their 80s and 90s who are forces of nature, bold and challenging, and there are others who seem to have lost their sense of themselves and their place in the world, who are heartbreakingly vulnerable, even fearful. All of them deserve and must receive our respect. If we wish to be respected as we mature and age, we have to set the example. On an individual level, the vast majority of us do that the best we can. Working adults are often time poor, and looking after older family members ourselves is often not an option, and particularly in a culture—unlike in some other cultures—where we are not a nuclear household, that is made even that much harder. On a societal level, it is complicated. It takes intense and serious commitment.

The Royal Commission into Aged Care Quality and Safety established in 2018 was initiated by reports of appalling carelessness, heartlessness and actual brutality. Aged care, it was not. It was neglect at best and was in places much worse than that. Was this the future that awaited our parents, ourselves and our children one day? Once you could no longer earn a living or fend for yourself, could you be treated as worthless? The royal commission's final report tabled in March 2021 was entitled Care, Dignity and Respect. It called for a new act which would have as its objective the provision of a system of aged care based on a universal right to high-quality, safe and timely support and care to (1) assist older people to live an active, self-determined and meaningful life and (2) to ensure older people receive high-quality care in a safe and caring environment for dignified living in old age.

The Albanese government was elected in May 2022. Aged care is now on our watch and what have we done? Well, in July 2022 we set to work. We reached out to some of the most vulnerable of all older Australians, older First Nations people. We invested $106 million in the provision of face-to-face support and $115 million to build culturally safe aged-care facilities. In the same month, we made it clear that a qualified registered nurse was to be on site in every residential aged care across Australia 24 hours a day, seven days a week. That has now been achieved. We set aside $9.5 billion in funding and made provision for an additional 40,000 home-care packages. In October 2022, we initiated a $3.9 billion package of reform. We provided $25 million for research into dementia, aging and aged care. The May 2023 budget announced an overall spend of $36 billion on aged care for the financial year 2023-24.

Taking aged care seriously means taking aged-care workers seriously. The people caring for our aged should be skilled and valued professionals who are treated accordingly and able to devote themselves to their careers in this vital field. The Albanese Labor government made a commitment in 2023 to fund the 15 per cent award wage increase determined by the Fair Work Commission. This is already bearing fruit. The turnover of staff in aged care had been very high, and now that's dropping. In places it's down to half of what it used to be.

I was thrilled recently to visit the Midland North Metropolitan TAFE with the Minister for Skills and Training, Andrew Giles, and to see and meet the new young generation of people working towards a career in aged-care services. They are delighted and enthusiastic about their career path ahead. This means greater stability, greater continuity and the chance for aged-care workers to really get to know the people they're caring for as human beings. We're spending billions on this, as we should.

Here's an important point though about spending billions: you have to do it carefully and deliberately in pursuit of what you believe to be right and necessary. You look at what you want to achieve and move towards it step by step, with each step being sustainable and heading in the right direction. We've set ourselves a goal, putting the rights and needs of older people at the centre of the aged-care system. The older people you love and who you will become have rights—the human rights that many of them, in their different ways, work for. Like every human being, they have needs. They need respect, friendship, support and dignity. We have a statement of rights for individuals and a statement of principles for government agencies and bodies. The statement of rights declares Labor's belief in the essential right of independence, autonomy, empowerment and freedom of choice. People receiving aged care have the right to make decisions and be supported in making those decisions and the knowledge that those decisions will be respected. They also have the right to take personal risks in pursuit of a quality of life, social participation and intimate and sexual relationships. Let's think about that for a minute. It's a declaration of belief in the right of a human being to go on growing, challenging themselves and learning. Whether or not they are retired from paid employment, they should not be expected to retire from life.

Labor is also emphasising something at the heart of all we do in every aspect of policymaking: the importance of equitable access. The right to equitable access to education, training, care of all kinds and the chance to be all that you can be is a fundamental Labor value. We acknowledge the right to be treated with dignity, respect and safe, fair, equitable and non-discriminatory treatment. We insist upon the right to have one's identity, culture, spirituality and diversity valued and supported.

A couple of weeks ago Minister for Aged Care, Anika Wells, someone who actually worked in the sector, managed to remove coalition disagreement to another set of investment in the proper care for senior Australians. I hope I don't sound too cynical when I suggest that perhaps some Liberals and Nationals hoped that voters in years to come will imagine that these ideas and changes were theirs when they were not. The minister was able to announce an additional $900 million worth of incentives and funding to support aged care in so-called thin markets like regional and rural areas and peri-urban, like mine is, areas. Under the coalition, despite the presence of the Nationals, these areas often missed out. So, when Labor says 'all Australians', we mean it. The Aged Care Bill 2024 is a big step forward for the people we love, for the people we know and respect, for ourselves—all of us, the people we will become—and for Australia's children and, of course, their children. I commend the bill to the House.

Gavin Pearce (Braddon, Liberal Party, Shadow Assistant Minister for Health, Aged Care and Indigenous Health Services) Share this | Link to this | Hansard source

We all want our older Australians to have the care that they deserve and that they so desperately need. We all want equity in our aged-care system. The care that you receive should not be determined by your postcode. It should not be determined by whether you live in a remote region or in the middle of a city. Every single Australian, irrespective of where they live or their situation, should be able to seek their own pathway into retirement clearly and be able to look forward with confidence, not fear, to how they will live in their later years. Unfortunately, that's not always the case in today's aged-care system, so it is beholden on government to do better—much, much better. Our goal as a parliament must be to create a world's-best-practice model of care when it comes to our older Australians. That's the only benchmark that our older Australians deserve, and it's a model of care we must start delivering immediately, forthwith. This cannot wait.

The new Aged Care Bill 2024 will replace the existing aged-care laws, including the Aged Care Act 1997 and the Aged Care Quality and Safety Commission Act 2018. The introduction of the bill follows the release of the exposure draft of the Aged Care Bill on 14 December 2023 and the Final report of the Aged Care Taskforce on 12 March 2024. The bill will cover all aged-care and home-care services that are funded by the Commonwealth. The primary aim of this bill is to simplify the aged-care sector. It moves it away from being far too complex to navigate to being a system that tries to remove the stress involved in transitioning into this phase of one's life.

For its part, the coalition has worked tirelessly for six months with the government, in good faith, in order to progress the bill. But, to be clear, this bill represents Labor's reform package, and this has not been a co-design process. We have fought hard to make amendments where we believed that changes were necessary, and we have achieved significant changes throughout this process—changes that will ensure that the dignity of older Australians is at the front and centre of our policymaking agenda, and changes that will ensure that no Australian is penalised because of their geographical location, cultural background or financial position.

The aged-care sector is growing exponentially when it comes to funding for aged care. In 2021-22, the government spent $24.8 billion on aged-care services for around 1.2 million people. In the next 40 years, there will be around 3.5 million Australians over 80 years of age. This will mean that the cost of providing residential and home-care services will continue to rise exponentially for the foreseeable future. We will need to see at least 10,000 new beds opened each year for the next two decades in order to keep up with that demand. This is an unprecedented challenge for the sector as a whole, which is currently not profitable as it stands today. The Aged Care Taskforce report highlighted that 69 per cent of residential aged-care providers made an operating loss in the year 2021-22. The report stated:

Unless the aged care sector's financial viability improves, it will be difficult to attract investment, either as debt or equity. Improved financial viability is necessary to deliver improvements in service, quality and to address service gaps.

The bill proposes significant changes in how aged care is funded. Government funding currently constitutes around 75 per cent of the total cost of residential aged care and around 95 per cent of home-care funding. The Aged Care Taskforce noted in their report that this was 'not an optimal or fair mix'. Their recommendation was that the participant co-contribute an increased amount in order to make this sustainable. This is a recommendation that government has adopted.

Of significant concern to us, as the coalition, was the retrospective nature of Labor's bill and Labor's proposal. If it had been implemented, Labor would have placed significant financial penalties on those who are already in aged care. All aged-care residents and their loved ones would have planned for their retirement in good faith, based on the arrangements that they had prior to making that arrangement. They shouldn't be penalised for this. That's why the coalition negotiated so hard for the government to adopt a grandfathering arrangement for those already in aged care.

The coalition has advocated on behalf of older Australians who are currently in the aged-care system, to guarantee that they will not pay one cent more for their aged care during their lifetime, and we've been successful in bringing about changes to this bill. Anyone in residential care when reforms begin on 1 July 2025 will be exempt from the fee restructure. This will also be the case for anyone who was on the waiting list for home care on Thursday 12 September—the day of the package being announced.

When it comes to older Australians in the bush in regional and rural Australia—this is particularly pertinent to my own electorate—older people living in rural, regional and remote Australia face significant challenges and barriers when accessing aged care. Disproportionately, older people living in rural Australia experience delays in accessing aged care or simply do not receive the aged care that they need or deserve. This leads to increased frailty, to functional decline, to increased hospitalisation and to premature entry into residential aged care. It's heartbreaking to see families pulled apart from their loved ones when they must relocate to communities hours away, making it difficult for connections.

Aboriginal and Torres Strait Islander peoples represent a higher proportion of people living in remote Australia. However, the number of older Aboriginal and Torres Strait Islander peoples accessing aged care in remote areas is low. This indicates that there's a lack of culturally safe and appropriate aged care on country, where they live and where their communities are. There are significant workforce shortages in rural Australia also, and attracting and retaining an appropriately skilled and multidisciplined aged-care workforce is exponentially difficult.

Higher operating costs, workforce shortages, travelling distances and smaller population sizes limit economies of scale in remote areas, creating unique challenges for the provision of aged care in the bush. This is a snapshot of life in the bush, and this bill must address the current inequities between the capacity to provide aged care in the city and in the bush. That's why the coalition fought to ensure Labor understood the realities of living life on the land, in the bush and in the regions.

Our advocacy for regional and remote communities ensured that the bill now contains an additional $300 million for infrastructure funding for those regions. This funding stream will be available through the ongoing Aged Care Capital Assistance Program that funds regional, rural and remote aged-care providers. This funding is critical for upgrading facilities that often struggle to meet the necessary standards due to fiscal and financial constraints. Older Australians will now have better access to quality and safe aged-care services, regardless of where they live, and that's only right.

The bill's specific provisions for regional areas will also include an investment of $600 million in Support at Home, as part of a $5.6 billion aged-care reform package. This funding will be available for eligible Support at Home providers from 1 July 2025, and the grants will benefit people with diverse backgrounds and life events, while supporting service stability in rural and remote Australia.

Introducing criminal penalties into the bill was a promise Labor made. This included jail time on what they termed as 'dodgy aged-care providers' who were negligent or who mistreated residents. This was not a recommendation put forward by the royal commission, and it's simply another example of this government's heavy-handedness and naivety when it comes to the regulation of the industry.

Labor's proposal has been described as terrifying by those in the industry. That is the last thing we want when we are trying to attract good people to the industry. The coalition's position on criminal penalties has always been clear. We have responded to recommendations of the royal commission, we have listened to the aged-care sector, and what they told us time and time again was that it will force highly capable staff from the sector in fear of being criminally punished. It will do nothing to improve safety. We would see an exodus from the industry at a level not seen before and not seen by any other industry if these were to continue.

Of course the coalition supports the need for older Australians to be safe and be cared for in our aged-care system. However, in the middle of a severe workforce crisis Labor's plan was heavy-handed, it was an approach that was not needed and it imposed an unacceptable risk in our opinion. The threat of jail time if the last thing that aged-care workers and volunteers need as they work hard to care for older Australians in their care. We were non-negotiable on this issue and were pleased that Labor listened and were able to remove this from the provision of the bill.

Moving through the aged-care process should not be traumatic; it should be as seamless as possible. We want an aged-care system that is driven by the desires and expectations of our older Australians, models that reflect the way they want to live in aged care. For that to occur, aged care must be sustainable. The coalition will work continually with older Australians and the aged-care providers to ensure this model is fit for purpose and robust enough to ensure the support of future generations as they age.

As I close, I want to also mention something that is not in the report. As I travel around my electorate and visit my aged-care providers, it takes me about two minutes to work out as soon as I walk inside the door what the culture of the place is like. You can see it in the eyes and in the faces of those in the aged-care home. Nine times out of 10 it is a positive place and our older Australians love being there. That is not mentioned. That culture, that leadership, that care, that empathy, that understanding, that respect that we want for every single aged-care home throughout all the states and territories must be at the centre of every piece of legislation. We must refer to that and reinforce that and encourage that because that is what makes an aged-care facility a home. After all, that is what older Australians expect and deserve. They need a home and they need someone to respect them.

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

It might be said the health of a society can be judged on its treatment of its elderly people. On that score, Australia's record is far from perfect. A quarter of a century ago, not that long ago, we were treated to the horrors of nurses ordering kerosene baths for nursing home residents. What followed was a litany of cases of neglect in aged care and, at worst, abuse. The COVID-19 pandemic exposed even more shocking failures in the treatment of people who deserve the utmost respect in their advanced years. After decades of indifference to the operation of Australia's aged-care industry, we could no longer go on looking the other way, ignoring how the system was failing our most vulnerable citizens—our elderly.

The Royal Commission into Aged Care Quality and Safety did not call its interim report Neglect without good reason. Evidence to the commission revealed a government-commissioned report that estimated there were no fewer than 50 sexual assaults per week in aged care, the majority being perpetrated by other residents with dementia and cognitive disabilities. Under existing regulations, there was no requirement to report or even register those attacks and still it goes on. In February, the Aged Care Quality and Safety Commission reported more than 1,000 cases a month of neglect in residential aged care. A 'concerning spike', the commission called it—concerning indeed. In what other sector of our community would we tolerate this failure of care? That quarterly report on performance standards confirmed 3,134 cases of neglect in residential care homes and 556 in home care. Rates of neglect have increased since late 2022, when 1,861 cases were reported by the commission.

It's very likely that the spike in cases was a consequence of providers taking the issue more seriously and being more diligent in reporting incidents to the commission. If so, it's better that we know the true situation in our residential aged-care homes, but it is still not good enough. Nor is the process leading to this legislation. Yes, there was an exposure draft, but the bill we have before us is the result of closed-door negotiations between the government and the coalition. No sunlight shone on those discussions. Again, this House is being asked to put the cart before the horse. The Senate inquiry currently underway gives the opportunity for the quality of the legislation to be publicly assessed and for stakeholders to have their say. But, again, we are being asked to vote on a bill before it has been fully scrutinised. The Senate inquiry is also arguably being conducted in such a rush that stakeholders are still scrambling to make submissions, even as hearings are already being conducted. Given the level of neglect and abuse that has been exposed in aged care, this is concerning.

Australians facing the prospect of accessing residential aged care need to have full confidence that the horrors exposed by the royal commission are a thing of the past. That said, it seems most stakeholders—both representatives of aged-care facilities and services as well as representatives of the aged themselves—have welcomed the legislation as a step forward. The Council on the Ageing, for example, says there have been improvements since the consultation around the exposure draft. However, COTA says:

It is still our view that the Act should proceed, hopefully with amendments … to improve its approach and implementation.

COTA applauds the direction of the legislation on several fronts. There is the focus on person centred quality care; the availability of services to all Australians, irrespective of their means; a stronger regulator to monitor and enforce provider obligations; and a complaints process focused on resolution, headed by an independent commissioner.

It was originally envisaged that providers could face criminal penalties for substantial breaches of good practice and good standards. This was central to the concerns raised with me by providers in Goldstein, who argued that they would provoke an exodus of capable workers from the sector due to fears of criminal punishment. These criminal provisions have been dropped from the bill. Instead, there would be civil penalties for providers, including fines of more than $1.5 million for serious failures that lead to a person's death. However, COTA points out:

Most civil penalties proposed in the Act will require the Commission to initiate and successfully prosecute poor practices by providers.

We are concerned by the curtailing of the Commission's ability to issue infringement notices—

or fines—

compared to both their powers today, and the broader powers originally proposed through the exposure draft.

One question is whether the commission will have the resources to ensure it is effective. It costs more money and takes more time to initiate legal action than it does to issue infringement notices. Infringement notices might also have a greater deterrent effect than the threat of legal action, with offenders knowing they have the resources to delay legal action rather than to clean up their act or act more responsibly in the first place.

The creation of an independent complaints commissioner is welcome. It's important that, in a change from the exposure draft, the commissioner would have the powers to secure an enforceable undertaking from a provider as part of the resolution of complaints. COTA, though, would like the legislation to go further, to include mechanisms to ensure mediation and consultation as part of the complaints process are enshrined in the legislation. Should that be the case, we could be well and truly assured of the minister's prediction that the commissioner would be:

… 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.

We will know for sure once the Senate has completed its inquiry and made its recommendations, and once we have seen whether the government acts on these concerns.

The Inspector-General of Aged Care—who's responsible for overseeing the administration, regulation and funding of the system by government—already has reservations, stating in a submission to the Senate inquiry that the government has fallen short of implementing the quality of safeguards envisaged by the royal commission. The submission says:

The Office does not consider the approach taken in the Bill to embed high quality care meets the standard envisaged by Royal Commissioners.

…   …   …

The Office considers the approach taken in the Bill to safeguard individuals' rights to be largely aspirational. In particular, the Office is concerned that it will not implement a rights-based framework as clear or as robust as Royal Commissioners envisaged, because the pathways available to individuals to understand and assert their rights lack the necessary vigour to drive real change.

COTA also believes there are shortcomings—for example, that the statement of rights should apply equally to government officials or those contracted to implement their functions in the same way as is being proposed for aged-care providers. COTA also says it's concerned that 'the new legislation does not have an exceptional circumstances pathway for people under 65 years of age to access the most appropriate service for them'. That may be the aged-care system in particular for sufferers of early-onset dementia. COTA adds that 'while supportive of the fact that 99 per cent of participants in aged care will be over this age, we remain concerned that some younger people could be left unsupported as there is no alternative'.

One of the big remaining questions is whether the new arrangements will make the aged-care system financially sustainable and more equitable. I think all MPs in this place know that many aged-care homes are struggling. The government and the coalition agree it will, so either way the bill will pass. It is right that those with more should pay more. It's also right that the maximum amount people will contribute to their care at home or in an aged-care facility will increase from the current lifetime cap of $79,900 to $130,000. And it's sensible that the new cap will be indexed to inflation. Those in residential care when the reforms begin next year will be exempt from the new fee structure, as will anybody who was on the waiting list for home care when the package was announced last month. That decision is also welcomed. Introducing more means testing arrangements for everyday living and nonclinical care costs should allow taxpayer funding to better target support towards residents with less financial means.

There is no doubt that this bill is a step forward, and a considerable step at that, for a sector that has been plagued with problems and scandals for decades. However, some of the remaining issues with the legislation could have been sorted out so that we wouldn't have legislation that will change once the Senate inquiry has concluded.

I finish by saying that there are profitability and workforce issues in aged care, and the system remains a huge challenge for families to navigate; I'm sure every staffer in an electorate office around the country would agree with that from their dealings with constituents. The system is very complicated. There is much more to do.

Keith Wolahan (Menzies, Liberal Party) Share this | Link to this | Hansard source

In the brief time remaining, I will speak to this being a moment of the parliament at its best. Many people in the community lament the lack of reform out of this place and the lack of constructive engagement. This bill, the Aged Care Bill 2024, has both. This is an example of the parties of government working with each other on a critical part not just of our economy but of our society. It is about who we are. We know all Australians deserve an aged-care system that is sustainable into the future but also provides for a dignified retirement for Australians who deserve no less.

I will briefly speak to the people in my community who are passionate about this area. Someone who is very close to me, Helen Jurcevic, is someone who gives up a lot of her time to work for others. She runs a group called the Women's Friendship Group. It is a group of women, many of whom lost their husbands years ago and many of whom live in facilities that are subject to this act. They gather regularly, share stories and acknowledge different multicultural days. It's quite a diverse room. I want to thank Helen and all of those who are with her for the work that they do in giving that dignified life that is not lonely.

When I go to events that are run by Helen and I speak to many people who either are in these facilities themselves or have friends who are, they tell me how much the staff mean to them. Of course, we know that the staff who provide medical care—those who are nurses and look after people who have particular needs—are important, and they are really valued, but you often don't hear about the other staff: the people who make their food for them with care; who chat to them in their own time, their spare time on their breaks; and who show a smile when they're tucking them in at night or helping them do things that might otherwise make them feel embarrassed. It's that human touch that really matters.

Recently, I got to go to one of the facilities where the staff were being recognised for the good work that they do. What I saw there was a mostly female staff, mostly multicultural—most of them weren't born here. They were proud of the work that they do. They were honoured to serve people at this stage in their lives and also listen to them about all of the stories and experiences that they've had in life. You could tell that they get joy from that job, but it's a bloody hard job.

I'll finish in the remaining time by saying: thank you, Helen, and thank you to all of the staff, at all levels, who work in this critical area. To future generations of Australians, I say: you can be proud of the parliament. This is an example of us working to keep future budgets in check and not see them fall apart. We do keep one eye on the Intergenerational report, and this is one of the five key line items that we have been warned to address. This parliament has turned its mind to that, and that is a great credit to the government and also to the opposition and all those in this place who have worked towards that. Thank you, Deputy Speaker, and thank you, everyone—on indulgence.

Andrew Wilkie (Clark, Independent) Share this | Link to this | Hansard source

It being virtually 7.30 pm, in accordance with the resolution agreed to by the House on 11 September 2024 and varied on 9 October 2024, the debate is interrupted. The resumption of the debate will be made an order of the day for the next sitting. I thank all of the staff of the Federation Chamber for your assistance today.

Federation Chamber adjourned at 19:27