Maria Kovacic (NSW, Liberal Party) Share this | Hansard source

I rise to speak on the Aged Care Bill 2024 and the Aged Care Legislation Amendment Bill 2024. While these bills are ambitious in scope and the coalition will support their passage, they contain a number of concerns that should be addressed to achieve their intended goals.

Earlier this month the community affairs committee tabled its final report on the inquiry into the Aged Care Bill 2024. I thank the shadow minister for health, Senator Ruston, for facilitating the opportunity for senators to scrutinise these reforms via public hearings before their passage through this chamber. Throughout the inquiry, senators heard directly from providers, and from older Australians and their families.

While there is broad support for the reforms proposed in these bills, many stakeholders emphasised the need for adequate time to implement these changes effectively. This concern is especially relevant given that much of the detail remains in subordinate legislation which has yet to be released in full. The coalition has agreed to the passage of these bills because it is necessary to embed a rights based framework and to ensure a world-class aged-care system in our country. However, the coalition remains deeply concerned about the lack of appropriate transparency, particularly the absence of critical rules and implementation guidelines.

This bill doesn't meet the aged care royal commission's recommendation to establish a right to access care. It lacks clear timelines and reporting mechanisms to track wait times from application and assessment to receiving care. Witnesses also raised concerns that the bill includes no safeguards to prevent the government from reducing the number of aged-care places. Genuine reform cannot succeed without clarity, consultation and an achievable timeline for the providers who must deliver these changes.

Aged care reflects our values as a society. The way we care for older Australians mirrors our commitment to dignity, respect and humanity. These reforms should embody that commitment, but they fall short.

Over half of the aged-care homes in Australia are operating at a loss. In the last year alone, under this government's watch, 49 aged-care homes have closed. By 2042, a mere 18 years from now, the number of Australians aged 85 years and over is projected to double, increasing to over one million people. By the 2060s, just 36 years away, one in five Australians will be aged over 65.

It is important to note the work the coalition has done in aged care. We initiated the Royal Commission into Aged Care Quality and Safety and delivered over $18 billion in immediate funding to the sector following that royal commission. We've secured critical changes to this legislation, including grandfathering arrangements, fairer financial contributions and additional support for rural and regional providers.

Workforce shortages are a critical issue in the sector, with aged-care providers struggling to attract and retain staff. Financial pressures on families and providers are escalating, compounded by inadequate support for essential services.

The substantive bills have been rushed through the parliament, leaving providers and older Australians unable to properly prepare for their impact. During the inquiry the CEO of Community Based Support, Ms Allyson Warrington, stated:

… we haven't had enough detail on the overall rules and change to be able to financially model what that care management looks like …

Transparency is lacking, with key details hidden in subordinate legislation which is yet to be released.

This bill implements the first of the recommendations of the royal commission—a new rights based framework for aged care—and it seeks to promote dignity and independence for older Australians. They are both critically important. However, arbitrary caps on things like cleaning and gardening services undermine the ability for older Australians to age at home. The primary message we got from the inquiry is that people want to age at home for as long as possible. These services are essential; they are not luxuries. Mr Jim Paterson, the senior manager at Advocacy Tasmania, told the committee that the 52-hour-per-year cap was far too low. He said:

The cap at 52 hours in a year is very low for cleaning, and, for some people, 18 hours for gardening is also extremely low. And, for some people, when you look at consumer directed care, they might be the two items that they want actually more of, compared to some of the other items they may not need yet in their package …

Foundation director of the Australian Health Services Research Institute, Professor Kathy Eagar, expressed concerns that the shortfall in services would lead vulnerable elderly Australians to move to the cash economy:

If you can only get an hour of gardening or cleaning, you'll end up being in the cash economy, paying somebody locally. For an older person, particularly someone who's got cognitive loss, this is a really risky issue. We actually want a community aged-care system that is socially engaging with people and that people trust to identify their needs as they get older.

Ms Beverly Baker, Chair of the Older Women's Network New South Wales, captured the human element of the issue when she stated during the Newcastle hearing:

An hour of cleaning a week—for heaven's sake! It takes me longer than that to clean up my kitchen after one meal. It is absolutely unreal. If you're living in Sydney, with our climate, you can hear your grass grow … As you get older your eyesight isn't as good and maybe you don't see the dirt as clearly as you could when you were younger. Those sorts of things are really important. Older women are not dirty. Sometimes they simply can't see what's in a shadow or in shade … It is an insult to say to somebody, 'You can clean your house in an hour.' That is not possible. It doesn't matter how small your house is; it's going to take you longer than an hour to clean.

Evidence presented during the inquiry raises important questions around these caps. Who exactly determined this to be a reasonable community expectation? Which segments of the community were consulted to assess whether these timeframes truly reflect needs?

The $10,000 grants available for providers for ICT upgrades not only are inadequate but also fail to reflect the complexity and cost of implementing these changes. We also don't know whether the department itself is ready for the changes with their own ICT upgrades. Evidence presented during the Senate inquiry highlighted that ICT upgrades involve significant financial and operational challenges, including updating systems, training staff and ensuring compatibility with government systems. The costs far exceed the limited funding on offer.

Coalition senators recommend that transition arrangements include a provision delaying the start date for any changes requiring ICT builds until six months after key milestones have been met. These milestones include receiving pricing from the Independent Health and Aged Care Pricing Authority, tabling the chapter 4 rules and ensuring that all associated government ICT changes are either in place or scoped sufficiently to provide certainty around system capabilities.

If this government is serious about delivering historic reforms, it must match its ambition with meaningful structural and transitional support. Without realistic timelines, providers will struggle to implement the necessary changes and deliver the outcomes that these reforms are intended to achieve. The push to move elderly Australians from hospitals into aged-care facilities prioritises system efficiency over individual needs. We need to ensure that older Australians are given options to return to their home after extended hospital stays, rather than being directed to the aged-care residential system. Such transitions should be guided by personal preferences, wellbeing and the opportunity to age respectfully at home. The government has failed to release key subordinate legislation, leaving stakeholders in the dark. Providers and families cannot adequately plan for these proposed changes.

The Albanese government is introducing punitive tax changes on superannuation balances over $3 million. These changes will double the tax rate on some super earnings, including unrealised capital gains. Younger Australians and self-funded retirees will ultimately bear the brunt of these tax changes. Simultaneously, these same cohorts of Australians are being asked to pay more for aged-care services, with no real guarantees of improved quality. Rising property prices and rents are eroding Australians' abilities to save for aged-care costs, like refundable accommodation deposits and daily accommodation payments. This comes at a time when this government is expecting Australians to depend on their home equity to fund their aged-care needs. Risks preventing Australians from building long-term financial security required to meet their aged-care needs are something that we need to address.

As of 31 March 2023, 63 per cent of Australians aged 65 and over received income support payments, with 92 per cent of those receiving the age pension. This amounts to around 2.8 million people. This number will only continue to grow as a greater proportion of our population ages. Without homeownership, these Australians face significant financial insecurity as they age.

The aged-care sector faces a workforce crisis. Staff shortages are placing significant strain on providers, with rural and regional areas hit the hardest. It is also where aged-care workers are overburdened and underpaid, leading to higher turnover rates. The government has failed to outline a clear strategy to address these workforce challenges.

Since coming to power, the Albanese Labor government has introduced over $315 billion in additional spending, much of it poorly targeted. Rising inflation and interest rates are compounding financial pressures on families and providers. Australians are facing higher taxes and fewer services with no relief in sight. Ensuring Australians can age at home, if they choose, with adequate support is critical. Demanding the release of all subordinate legislation and clear timelines for implementation are critical. Targeting training, retention and recruitment to build a sustainable aged-care workforce is also critical.

Aged care is not just a policy issue; it is the measure of our humanity. In the current form, and without the full scope of subordinate legislation, these bills lack the clarity and transparency needed to fully address the challenges facing aged care in Australia. The coalition will continue to advocate for reforms that deliver dignity, choice and quality care for older Australians, and we will hold this government accountable and ensure that every Australian can access the care they deserve. We have a duty to our older Australians to ensure they are treated with dignity and respect, and we have an equally urgent responsibility to young Australians to safeguard them from inheriting the crushing tax burden of a broken and inefficient aged-care system.

This is a pivotal moment, a chance to create an aged-care system that not only rises to the challenges of today, but becomes a foundation of fairness, sustainability and dignity for generations to come. I move the amendment as circulated in Senator Ruston's name on sheet 3072:

At the end of the motion, add ", but the Senate calls on the Government to:

(a) revise the transitional arrangements of the Support at Home Program to allow sufficient time for implementation by in-home aged care providers;

(b) provide certainty to the aged care sector through a clear transition path, including implementation information beyond 1 July 2025, recognising the cost, both in staff training time and monetary value, of the measures in this bill;

(c) undertake an extensive education and information campaign about the measures in this bill, targeted at both older Australians and their families and the wider aged care sector, to address the understanding gap clearly articulated throughout the Community Affairs Legislation Committee inquiry;

(d) expedite the design of the Commonwealth Home Support Program (CHSP) replacement program to:

(i) give aged care providers sufficient time to make necessary changes and to prevent the challenges associated with rushed policy implementation as seen with this bill,

(ii) enable providers to undertake ICT changes for both Support at Home and the CHSP replacement program concurrently, and

(iii) ensure greater emphasis is placed on the additional value delivered by organisations, such as Meals on Wheels, when determining contracts and pricing for services;

(e) undertake further consultation on care management fee caps and service delivery, including with clinicians, to:

(i) provide greater transparency about the factors used to determine the Service Lists,

(ii) ensure arbitrary decisions such as the caps on cleaning and gardening services do not remove choice and control from the centre of aged care, and

(iii) ensure that there is greater flexibility in use of care minutes so that residential aged care homes can deliver individualised, fit for purpose care that is within the limitations of their market, while still ensuring high quality care;

(f) immediately assess the scale of risk in relation to unrecoverable debts and ensure that the liability for any unrecoverable debts rests with the appropriate entity; and

(g) ensure that:

(i) consideration is given to regulatory requirements to ensure that dignity of risk is never removed from the centre of high-quality care,

(ii) aged care providers are not adversely penalised until transitional measures in this bill are completed, while protecting the rights of older Australians, and

(iii) consideration is given to the exclusion of Refundable Accommodation Deposits (RADs) from aged care asset testing provisions where the person has sold their family home to pay the RAD, to align the treatment of RADs to their treatment in the age pension assessment and recognise that residential aged care is an individuals' home".