Rachel Siewert (WA, Australian Greens) Share this | Hansard source

Today I rise to contribute to the debate on the Aged Care (Single Quality Framework) Reform Bill 2018. This bill amends the Aged Care Act 1997 and the Australian Aged Care Quality Agency Act 2013 to enable the introduction of the aged-care quality standards. This single set of quality standards will replace the four current sets and will apply across all aged-care programs. The standards themselves will be enacted via delegated legislation and will come into effect on 1 July 2019. The Australian Greens support the introduction of a single set of quality standards, which is a measure from the 2015-16 budget. The standards will eliminate some of the complexity currently within the aged-care system and provide clarity to consumers about what they can expect. The standards also shift focus to consumers and will hopefully lead to improvements in the quality of care provided. We certainly need to ensure that.

The quality of care being provided to older Australians by some care providers has, in recent times, been substandard. We've seen that from the numerous inquiries, in particular the numerous inquiries into the absolutely appalling situation that we saw at Oakden. Those inquiries include the Senate inquiry that I chaired, and I'll come back to that in a minute. There have been occasions of, quite frankly, shocking care, which are very regularly reported on in the media. During the Senate inquiry into Oakden, it highlighted not only the shocking care but some of the gaps in our current regulatory process. In my opinion, it highlighted the failure to properly enforce the existing regulations at the time and the standards that were operating at that time.

It's essential that this situation is rectified. We need to stop seeing these repeated appalling circumstances where older Australians are not receiving the care that they should be receiving. The community expects very high standards of care for older Australians. Changes such as these, in this framework, go some way towards strengthening the protections that are in place and ensuring that we have adequate standards for consumers. When we talk about 'consumers', these are residents in aged care or people receiving aged-care services. We need to ensure that we have adequate standards for them.

While the standards themselves will follow later, the final draft is now available online and consists of eight standards. I'm aware that this process has been through significant cycles of consultation. Each standard has a consumer outcome, has an organisation statement and contains requirements for an organisation to demonstrate adherence to the standard. Each provider will only be required to meet the standards that correspond to the care they provide and the environment they provide it in.

We note that the Department of Health published a summary of submissions it received in response to the first release of the Draft Aged Care Quality Standards last year. Two of the broad themes identified by the department were concerns relating to staffing levels in aged-care services and concerns regarding the capacity of the National Aboriginal and Torres Strait Islander Flexible Aged Care Program providers and voluntarily run organisations to comply with the standards. We share these concerns and particularly encourage the government to work with smaller providers that have limited capacity during the transition period.

I will note here that in the budget of 2018-19 the government announced that it would provide $50 million to residential aged-care providers to help them transition to the new standards. That's residential aged-care providers assistance, as we understand the measure, to provide them with the capacity to transition, which in itself I think is good. However, the question must be asked as to why it is only residential aged-care providers, when I've just articulated that this extends to other programs. I'm particularly concerned about the Aboriginal and Torres Strait Islander Flexible Aged Care Program, which is commonly called ATSI Flexi. Those providers will need some assistance, as do other providers. So, I have a question mark there, and I'll put on notice that when we're in the committee stage I'll be asking the government about that and whether there will be some extra funding or whether the $50 million is in fact available to other service providers. I think that's a particularly important question.

While there has been wide support for a single set of quality standards and for the draft standards, we acknowledge that some providers and consumer groups have expressed concerns. For example, National Seniors, who took part in the consultation process, recently said:

… we’re pleased to see several indicators in the standards that directly relate to people in home and residential aged care. The standards require providers to have processes in place to identify needs and deliver aged care to meet them. These process standards are intended to focus on the end user.

But how will the process standards operate in practice? They don’t measure the outcomes experienced. They simply insist a provider has a certain process in place. The focus on process may not improve outcomes without adequate resourcing. What’s also needed is sufficient and appropriately skilled aged care staff to meet the identified needs of the people they are looking after.

They went on to say:

National Seniors is sceptical about the capacity of providers under the current funding and regulatory arrangements to meet the proposed new standards and improve outcomes for those they care for. Changes to standards alone won’t drive improvements in quality. Calls for more and better trained aged care workers are increasing. A recent National Seniors research report of home care found almost 40 per cent thought "things could be done better".

And National Seniors have made several points in their comments here relating to the issues around staffing and the workforce.

We know that there's a lot of work being done on the workforce, but I can't stress enough how important it is that we ensure that we have in place a workforce that is appropriately qualified and that we have enough, with the demands that we're facing—not just residential aged care, which a lot of people focus on; there are a lot of other aged-care and older-Australian services that need a well-supported, trained workforce. I know that Senator Hinch will be addressing that issue, and he's circulated some amendments around ratios. I'll have more to say during the debate on those amendments but will flag that the Greens do support the concept of ratios, However, it's not simple, because, depending on the acuity—for example, if you're talking about residential care, if you're talking about the acuity of the residents—we know that more and more people are staying at home longer, which is very strongly supported by the community. But that means people are frailer when they go in, so you may need a different ratio than for those who aren't as frail. When you're talking about dementia, it depends on the model that you use for care for a person with dementia. Of course, we know there are a large range of types of dementia, and that will have a bearing on the ratios needed to be used.

I also want to just focus very briefly on the issues around support for people who are homeless and in residential care. In 2013, when the new Living Longer Living Better amendments came in, the government of the day—I'll give them their due for this—made sure that there was a homeless supplement as part of that process. The Greens negotiated that with the government, and I was very pleased to see that supplement put in place. Unfortunately, that supplement is not keeping up with the cost of care. There are providers that specialise in providing residential care for homeless people, which demands a particular type of care. For example, most people who are homeless and who are successful in finding residential care don't have a relative who can take them out if they need a specialist appointment. They don't have relatives who sometimes supplement or provide additional things for them. They can have complex and difficult behaviours, particularly those who have been long-time homeless. In fact, that may be related to why they were homeless in the first place. That all demands extra resources from the provider. So I urge the government to once again look at the aged-care supplement, because the figures that I have seen from those who are providing home care to people who were homeless show that they can't make ends meet—increasingly, they're further and further apart, to the point where those providers are also going to end up in crisis. We've seen recently that 40 per cent of residential providers are not making money or are not considered viable, and we have some very strong concerns there.

I also just want to touch very briefly on the issues around Aboriginal care. I was very pleased to see the changes that were made in the budget to ATSI flexi. We have to think very differently about the provision of aged-care services for many of our First Nations people. They need different sorts of residential care and different sorts of home care, so I think we need to be making sure that we are being as flexible as the term 'flexible funding' implies. But there is quite a long way to go there, and I'm aware that there are continuing housing problems. I'm not going to go into the whole remote housing issue per se, but I know of a number of providers who are still having trouble housing their staff. How can you provide quality care if you can't attract the staff because you can't accommodate them? We need to make sure that we are supporting these providers as much as possible.

This bill also makes an amendment—as I think I heard Senator Polley say as I came into the chamber—to the Freedom of Information Act 1982 to make protected information exempt from disclosure under the FOI Act.

The Greens do support this bill. We do think these are important reforms. We take on board the criticisms that have been made. I just articulated some from the National Seniors. The Combined Pensioners and Superannuants Association, the CPSA, has been quite critical as well, arguing that the 'new standards will hollow out an already insufficient system' and are not sufficiently prescriptive to ensure quality care. A part of the reforms being made is the new commission, which the government has made a commitment to. It will be bringing in legislation around that shortly, and obviously that is also critical to how this new commission will operate. I agree that there are some very, very critical issues in aged care in Australia—not just residential care but also home care. We know that the waiting list is outrageously long.

I know that there's a continuing need for the injection of funds. I know, having just spent last week talking to aged-care providers in a committee inquiry, that there are very serious and significant issues facing the viability of residential aged care and also home care—in particular, that there are more reforms to come with CDC, consumer-directed care, and further reforms along those lines to residential aged care.

I agree that there are continuing issues and that operationalising this framework is quite difficult in the circumstances, and so I agree with their comments. I will note, however, that COTA Australia has welcomed the consolidation of the four existing sets of standards and acknowledges the considerable work that has been undertaken to develop simple, relevant, meaningful and measurable standards. We also support bringing the single quality framework into being, and so we do support the concept of this legislation. Next is operationalising it, and there are a whole lot of other levers that we will need to pull to make sure we have a quality aged-care system.

We will be supporting this legislation and we look forward to debating Senator Hinch's amendments in Committee of the Whole in the not-too-distant future.