Tony Sheldon (NSW, Australian Labor Party) Share this | Hansard source

I rise to speak on the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 2) Bill 2020. Along with my Labor colleagues, I ask that this bill be referred to the Selection of Bills Committee for further scrutiny. Under the changes contained within this bill, home-care providers will only be paid for care and services delivered to a home-care recipient during a month, while Services Australia will retain the unspent money that a home-care recipient is eligible to receive each month. In other words, rather than service providers holding on to unspent subsidies, the Commonwealth government will.

Labor understands the rationale of this change. Currently, many aged-care providers are holding on to large and growing pools of unspent subsidy money, and these measures provide a degree of probity for these balances. Aged-care accountants StewartBrown estimate that the amount of unspent subsidies could already exceed $1 billion. Yet, while the sums of money grow, the government continually fails to provide enough funded places. There are more than 100,000 older Australians waiting for care.

Like most legislation that this government proposes, this bill is another wasted opportunity. The government has missed a chance to act on the tragic shortcomings in our aged-care system. According to the Report on government services 2021, in 2019-20 there were around 840,000 older Australians on the Commonwealth Home Support Program, which is the entry-level support package for those living independently in their own homes. These recipients receive basic services, like domestic assistance, personal care, social support, and allied health and respite services. There were a further 172,000 clients of home-care packages. These are more intensive packages for people who require additional care in their homes, such as help with showering or clinical care. That is over a million Australians taking advantage of home-care services, but these most advanced home-care services are not adequate for the needs of older Australians. More than a third of older people who are living in households and in need of assistance reported that their needs were not being fully met—one-third. This increases to 42 per cent for those with a profound or severe disability. With these sorts of numbers, it's clear we are failing our older Australians. The recipients of these packages are in their late 80s or maybe their 90s, with chronic or terminal illnesses, and they are waiting up to three years to receive the services that they need to function.

The ABC reported just recently, in September last year, a story about Evelyn Micallef:

Evelyn Micallef is 93, has dementia and can no longer walk.

Her daughter Ann Innis and Ann's husband Steve use a hoist to get her out of bed and into a wheelchair every day.

They feed, dress and take care of her.

Despite the relentless work, they do not want to send her to a nursing home—

particularly due to the threat of COVID. The article continues:

Evelyn gets by on a low-level homecare package worth $15,000 a year.

She was approved for the highest package available, worth $50,000 a year, in May last year, but like more than 100,000 older Australians, she's still waiting for the Federal Government to fund it.

In the meantime, her home-care provider charges as much as $550 a month just for administration. A third of her $15,000 package is gone before her family have used the money on the simplest things, like a carer to help Evelyn shower.

The interim report of the Royal Commission into Aged Care Quality and Safety said this:

The Australian Department of Health, which oversees this system, has no mechanism to follow up with people who are on waiting lists to give them updates, including about whether they have progressed up the waiting list or how long it will be before a Package is available.

According to this interim report, the direct results of these shocking waits include 'declining function, inappropriate hospitalisation, carer burnout and premature institutionalisation because necessary services are not provided'. In the past three years, more than 30,000 have died waiting for their home-care packages to be approved on this government's watch. That is more than the number of additional places the government has recently announced. This government obviously has not prioritised older Australians, and older Australians have had to pay the ultimate price. In January 2020, the Productivity Commission released the median wait time for home-care packages. It had blown out in the last year by more than two months. Some older Australians are entering residential care or even emergency departments instead of receiving their approved home-care package.

The aged-care system is broken and, as the royal commission has noted, it suffers from neglect. Of course, that's why the title of the report is Neglectneglect by this government. This government gets complaints relating to aged care, and of course nothing happens. This is a government that has been in power now for eight years. The aged-care watchdog failed to issue a single fine or warning, despite receiving more than 2,000 complaints from April to June of 2020, of which 340 were directly related to COVID-19 infection control. From 2,000 complaints, not a single regulatory action appears to have been taken.

According to expert evidence provided to the royal commission into aged care by the CEO of Presbyterian Aged Care NSW & ACT, Mr Paul Sadler, unspent money accrues for one of four reasons:

a. A contingency amount negotiated between the consumer and provider.

b. The consumer deliberately planning for a large expense, such as an equipment purchase or period of respite care …

c. The consumer's needs have been accurately assessed, but they exercise their choice to refuse particular services …

d. Because their assessed level of HCP is higher than their actual service needs.

We can easily see pressure from the provider being a reason, as well as a desire among home-care clients to have their funding for a rainy day. Allowing the Commonwealth rather than the aged-care provider to maintain control of the money has support in the sector, but there are serious and unanswered questions about how the many aged-care providers on thin margins, including in rural or regional areas, can manage without the reserve of funding. The government again fails regional Australia.

In the wake of the pandemic that has deeply shaken the aged-care sector, is now the best time to upturn the entire funding model of aged-care providers? The better question to ask is whether 2021, a year when COVID-19 has deeply rattled the aged-care sector, is the best time to upturn funding models that aged-care providers rely on. The best way to manage these questions is to refer this bill to the Selection of Bills Committee for further consideration.

Home care is a devastatingly underfunded sector. The demographics have been clear for many, many years. Demand for aged-care services is only going to rise. Reform in the sector is a good thing, but if reform puts aged-care providers on the path to unviability, we must determine what we can do to soften this bill's impact on marginal providers. We must provide more general aged-care providers to be certain that they do not need to take shortcuts whilst providing their critical care.

Today the ABC told another story about aged care. An article by Michael Atkin told the story of Christine Radke and her 95-year-old father, Herbert:

Herbert has dementia and physical ailments, which means Ms Radke needs to assist him with every part of daily life from getting out of bed to going to the toilet.

…   …   …

Ms Radke is trying to keep her father out of residential aged care, but managing each day is a challenge.

She said her father felt guilty about how much help he needed because he lived independently until recently.

…   …   …

They receive some help through a limited, federally funded home care package worth about $16,000 a year, which for Herbert means a support worker showers him three times a week.

But in June, Herbert was assessed as needing the highest home care package available, known as Level 4, which would provide another $36,000 in funding.

The Radkes don't know how long they'll have to wait before more Federal Government funding is made available to them—only to expect it will be at least another six to nine months—

that is, if they're lucky. The article continues:

Ms Radke is trying to cherish the time she has left with her father, but looking after him is challenging.

Older Australians shouldn't have to spend their final years feeling like an imposition on their children. Older Australians deserve much better than this, and it's time for this government to do much better.