Tammy Tyrrell (Tasmania, Independent) Share this | Hansard source

I rise to speak on the Aged Care Bill 2024. First up, I will say that there are parts of this bill that still need to be tweaked but it is a step in the right direction. I've spoken with many who have lived experience in the aged-care industry and I've spoken with stakeholders about the bill's pros and cons. We know the bill has been watered down from its original draft. Criminal penalties have been removed in favour of civil penalties. I can understand the reasoning behind this when it comes to the individual carers but I still feel we need a bigger stick for aged-care providers. Older Tasmanians have given distressing evidence about facilities not meeting quality standards and I have asked about this previously. I will be watching how this compromise plays out very carefully, because we all know it is our most vulnerable who suffer when standards are not met.

Another area I still think needs more work is how registered aged-care providers will have to monitor and manage unregistered providers, pushing a level of oversight onto parts of the sector that should really sit with the aged-care commission. I'm talking about platforms where independent contractors offer their services task by task. We have seen similar issues in the NDIS, where unregistered providers have ignored quality standards. Nobody wants these issues to impact aged care too. These platforms and their contractors or employees should be meeting the strengthened aged-care standards at a minimum and should complete the same audits and reporting requirements as other providers. Employee based platform Hireup have spoken with me about how other platforms are using complex corporate structures to bypass registration requirements within our aged-care industry. This is not right. All providers should be meeting in the same care standards and we need better transparency around this.

The regulatory scheme in the bill needs more work because accountability is important. We need to know who is monitoring providers, which providers are meeting regulations and which ones aren't, and we need to know whether the aged-care commissioner actually has the power to do something when standards are not met. I've been told the commissioner has no teeth when it comes to enforcing the standards, which makes me wonder: 'Why do we go to all this effort to create rules and regulations in the first place?' And then there are the rules. These are the pointers for the aged-care industry, spelling out how the bill will actually work and what we need to do to meet the regulations. But many rules are still in consultation and haven't been released publicly or are still being written. Even with flaws, I can see this bill is a step forward for the aged-care sector and that its intention is to better protect the rights of older Australians.

One thing I am celebrating about this bill is the requirement for all aged-care workers to complete competency-based training. This training includes delivering care that has the person at its heart, care that is based on the rights of older Australians and care that considers cultural factors, trauma and healing. But the training I am most pleased has been included in the new rules is for dementia care. One woman told me about her husband's experience in residential aged care. He lived with dementia and was diabetic but the facility did not give him the right food, which caused ongoing issues for him. The same facility shut down the wing he was in when a patient contracted COVID and he was not allowed outside for fresh air or sunlight for weeks, which impacted his routines and sent him into a spin.

Another woman told me about her grandmother, who also lived in a residential aged-care facility and who had dementia. We've all heard about the number of minutes of care each person is supposed to receive in residential facilities each day, but that was clearly not the case for this woman's grandmother. She was frequently left for hours in her room without anyone checking on her, to the point where she fell asleep standing up in her bathroom when she was caught between her mobility walker and the wall. It was hours before someone found her. None of this is right.

I've been speaking with the minister's office about the importance of good-quality dementia care and why it's necessary within the aged-care sector. Dementia can affect anyone but is most common in people aged over 65 years. Dementia Australia estimates there are more than 421,000 Australians living with this disease, and as our population ages this figure is only going to grow. The Royal Commission into Aged Care Quality and Safety recognised this fact and recommended, in recommendation 80:

… that all workers engaged by providers who are involved in direct contact with people seeking or receiving services in the aged care system undertake regular training about dementia care and palliative care.

The recruitment for ongoing dementia care training is a start, but I want the government to go a step further and make dementia care training mandatory for all people working in the aged-care sector, both at residential facilities and for at-home care support. This means that anyone caring for older Australian would be educated to a level where they have a deep understanding of dementia and the intricacies of care needed for people living with this condition. Dementia Australia agrees. This organisation's response to the royal commission recommendations included a section about the adequacy and quality of dementia care training in aged care. Eighty per cent of people who responded to Dementia Australia's question said aged care staff were not adequately educated about dementia and best-practice dementia care in order to meet the needs of persons living with dementia in the community or residential aged care settings. We have recommendation 80 from the royal commission and evidence from within the aged-care system that better and more dementia care training is needed.

There is some amazing dementia care training already out there, and it's free, but it's not being used by enough aged-care providers. The Department of Health and Aged Care, Dementia Australia, Dementia Training Australia and the Wiking Dementia Centre all have accredited training programs for dementia care, but if people want to go further they can take up a Cert III program that includes dementia care, or enrol in the University of Tasmania's Diploma of Dementia Care. We don't need to reinvent the wheel. The training programs are already there.

I'm calling on the government to do more than just require ongoing training. We need to set the minimum standard for dementia care at Cert III level. As it stands, people training to work in aged care do a Cert III in aged care or individual support in ageing. There is a unit on dementia care in these programs, but it's elective. I think dementia care should be essential, and I know it could be incorporated into the existing Cert III programs. I've told the health minister and her advisers this, and they agree. They have told me they are working towards a mandatory minimum level of dementia training for the aged-care sector. I'll be watching that with interest, because I know how important this care is for older Australians and their families.

We need ongoing training that reflects the impact dementia has on a person's health, personality and general wellbeing, plus the implications of this condition in an aged-care setting. But it's not just about providing the ongoing training; aged care workers must be supported to complete dementia care training the same way they are supported to do other professional development. That means paid time to complete the course. If we really want aged care that actually supports people living with dementia then we owe it to them to have well-trained people providing the services that they need. We owe it to the aged-care workers to support them as they train to provide the best-quality care they can.