Derryn Hinch (Victoria, Derryn Hinch's Justice Party) Share this | Link to this | Hansard source

For decades in my past life as a radio and television commentator, I used the same comment over and over when talking about the latest scandal involving nursing homes or retirement villages, and, tragically, there were lots of them. I could even go back to that scandal where old people in Melbourne were being given kerosene baths. I would say: 'The only difference between old people and us is that they got there first.' Some of the people most guilty of forgetting that fact were politicians, and, sadly, that still seems to apply today, 30 years later. I was going to say, 'You forget that we will get there too one day,' but I guess at my age I already qualify. But I have not forgotten the plight of elderly Australians, which is why I put forward the Aged Care Amendment (Ratio of Skilled Staff to Care Recipients) Bill 2017 to try to improve the lot of people, often defenceless people—people being treated abominably, being treated inhumanely, being treated like nuisances in our nursing homes or being treated purely as cash cows.

I can anticipate the reaction, so I will acknowledge that, if you can afford it, there are some terrific establishments in this country. Ironically, some of the best are the ones run by Wintringham in Melbourne and country Victoria. They will also soon be in Tasmania. Wintringham is there for formerly homeless people over 50. They have fantastic quality facilities. I visited one in Port Melbourne several weeks ago. But there are some real shockers. As Rob Harris reported in the Herald Sun this week:

Nineteen Victorian nursing homes failed to meet some of the most basic standards of care in the past year—including one eastern suburbs facility which was forced to close.

A damning report has revealed an emerging crisis in the aged care sector, showing almost 600 facilities across the country did not meet industry regulations in the past five years.

An audit summary, seen by the Herald Sun, has named and shamed the homes for the first time—detailing breaches across the board …

For example:

Marlborough Gardens Hostel, in Heathmont, was forced to shut its door in July after meeting just 27 of the 44 accreditation standards following an on-the-spot audit from government regulator, the Australian Aged Care Quality Agency.

That is only 27 out of 44. Remember, there have been allegations that nursing homes have, on occasion, been given prior warning that an 'instant inspection' was coming their way. The article continues:

Among its many failures, the hostel operated by Noble Care Pty Ltd failed to have an effective infection control program and had not minimised fire or security risks.

The audit found there was insufficient staff—

This is a big point—

at the 35-bed home to meet all of the needs of care recipients.

Alarmingly, it found the home's medication system did not consistently ensure residents' treatment were managed safely and that staff did not always follow prescribed orders.

'Care recipients are not always receiving medication based on instructions by a medical officer. Medication was not always packed or dispensed according to relevant legislation,' the report found.

The agency said its decision to revoke Marlborough Gardens Hostel's aged care accreditation 'reflects the seriousness of recent failures to meet the Accreditation Standards'.

As I said, 19 Victorian establishments failed to reach accreditation standards, and, boy, it makes me tempted to do a 'shame, shame, shame'. Don't forget that this comes after a flu outbreak in Victoria that killed seven people aged between 70 and 94 in Wangaratta last month. That belatedly forced federal government intervention, to make flu shots compulsory for all staff. You'd have thought that that was a given, but it was too late for those flu victims and, also, their families at Wangaratta. The federal Minister for Aged Care, Ken Wyatt, will soon get an urgent report into fixing the aged-care system which was commissioned after frightening details came to light of the treatment of residents at the Oakden nursing home in Adelaide. I know that the Nick Xenophon Team's been right onto that one.

Allanvale Private Nursing Home in Altona Meadows failed to meet five crucial standards, including clinical care, medication management and skincare. The Boort District Health Low Care, a 30-bed facility in north-west Victoria, also failed basic standards that demand residents receive 'adequate nourishment and hydration'. That's bureaucratic speak for food and water, for God's sake! Both homes were given some months to fix their breaches and were later reaccredited by the agency.

Too many times in too many places, profit is the name of the game. Some companies running these places know that you can keep that profit margin up by cutting costs, cutting staff numbers and playing games with the numbers so that it looks like there are more staff physically dealing with the wants and needs of the residents than there actually are. You've got the gardener, the accountant and the kitchen staff in the so-called 'care army' for the residents. It's not true. They're also shaving dollars off the daily food budget. That goes on all over the country.

I know, from experience, that I ate a hundred times better in jail at HM Prison Langi Kal Kal several years ago than most pensioners do whether they're at home, in a nursing home or a retirement village. When it comes to quotas and ratios—this is what this bill's all about—I have been receiving damning emails from aged-care workers saying things like this:

We are too scared to speak out about ratios, about what we see and what we know. We all received an email from head office recently instructing us that if we receive any inquiries from the media we are not to answer any questions. We were told to say: 'I am unable to answer your questions. You will need to ring our head office in Melbourne'. How many other nursing homes around the state have got this warning? That is why carers are too scared to speak up for fear of losing our jobs that pay our bills. And scared of the legal ramifications.

I want to pass on the closing words of a carer who detailed an exhausting day in her life, made even worse by an outbreak of gastro in her unit. She said:

I love the residents I love most of my work mates but I am exhausted. I give my hand over to the medication carer. Now this story was on a good day! You show up to work not knowing what is going to happen. There are falls, deaths, sickness, residents who are having an off/bad day. I have missed out on lunch … because of resident's collapsing and the 3 carers who are meant to be attending to it are dealing with another problem. (Residents pay a lot of money to be in a nursing home) I am writing this story about personal care workers who look after the elderly in nursing homes because in the media there has been a lot of bad press against us carers. Yes there will be those who are at fault and should not be in the industry but there are those who truly do care and do their best to care for the residents. The world neglect has been used. Neglect is a negative word that makes us look like we—

don't—

care and we're inhumane. The fact is we do care, we go home crying and frustrated that a resident was left to sit in—

his or her—

urine because we couldn't get to them.

WE NEED MORE PCW's NOW. It's not just the RESIDENTS WHO ARE SUFFERING, but THE STAFF as like I said at the beginning of this letter, staff are going home EMOTIONALLY, MENTALLY & PHYSICALLY EXHAUSTED and that's not just the PCW's but the RN, Admin, cleaning & Kitchen staff. For the health and wellbeing of not only the staff but the residents as well, PLEASE reconsider the resident/staff ratios and act accordingly, if not for the staff but for the RESIDENTS. THIS IS THEIR HOME. They are not just paying for their meals and a room, they are paying to BE CARED FOR and they are NOT receiving the care they deserve.

That is true: many are not receiving the care that they deserve. That is a disgrace in 2017.

One of the problems is that the Aged Care Act 1997 does not demand a minimum staffing standard for aged-care residential facilities that are funded by the federal government. It does not specify what constitutes appropriately skilled and qualified staff for the purpose of providing care. I know that New South Wales, Queensland and Victoria do prescribe staffing requirements for some residential aged-care facilities, but all elderly Australians deserve the best level of care when they can no longer live independently and have to rely on other people for their health, wellbeing and protection. It doesn't surprise me—in fact, it's common sense—that international research shows that higher registered nurse staffing levels, higher total staffing levels and a higher skills ratio mix of registered nurses to other nursing staff will lead to better quality care. It's bleeding obvious.

Finally, keep in mind what a lot of politicians seem to ignore or conveniently forget—these people, these elderly Aussies, have contributed valiantly to our society throughout their lives. They have helped make Australia the great country it is today. They have worked. They have paid taxes for decades. They have raised their families. Some have been to war. Many live with the scars of those wars. Some of their relatives made the ultimate sacrifice and paid with their lives. But, unfortunately, many of these Australians who have given so much to society are highly vulnerable. I believe they are not guaranteed these days the standard of care that they deserve within our aged-care facilities as many of them operate in the way they operate today.

I will finish up by saying just remember what I said at the start: the only difference between old people and us is that they got there first. For years on radio and television, I used to ask the question: who is looking after the children? Sadly, these days, I have to amend that and ask you: who is looking after the elderly?

Helen Polley (Tasmania, Australian Labor Party, Shadow Parliamentary Secretary for Aged Care) Share this | Link to this | Hansard source

Labor is extremely pleased to talk about the hundreds of thousands of aged-care workers supporting older Australians to grow old, because they are a group of people that the Turnbull-Liberal government has forgotten. Personal care workers, nurses, support staff, allied health professionals and a range of other workers are critical in ensuring older Australians can choose the care they want, receive it where they want and grow old with respect, dignity and safety.

Unfortunately, we have had four years of inaction when it comes to the aged-care workforce from the Turnbull-Liberal government. Indeed, in four years the only thing that the Turnbull government has actually done is to scrap Labor's $1.5 billion workforce compact. This was a policy that was working to deliver higher wages, improve career structures for aged-care workers, enhance training and education opportunities, improve care development, improve career development and workforce planning, and develop better work practices. This was a policy that was developed by an independently chaired workforce advisory group to ensure workforce reforms led to improvements in services for older people and benefits for the workforce. The care of older Australians and the hardworking Australians who care for them has simply dropped off the agenda for the Turnbull government, which appears to be more focused on its own survival.

Labor strongly supports moves to ensure that we have adequate, safe and appropriately skilled aged-care staffing levels that meet the care needs of recipients. It's clear that more work needs to be done to support and grow our aged-care workforce. The demographics of our nation are well known. Around 1.3 million Australians are currently receiving some form of aged care, provided by almost 400,000 aged-care workers. About a quarter of all Australians are expected to be 65 years and older by the middle of the 21st century. As a result, demand for residential aged-care services is projected to increase by almost 68 per cent in the next 40 years. Ensuring there is a sufficient workforce to meet the increasing demand in aged-care services is a major challenge for the sustainability of this sector's future. Increasing demand is predominantly driven by two factors: the ageing population and the increased prevalence of dementia, with the associated need for higher levels of support and care.

The Productivity Commission's Caring for older Australians report in 2011 stated that, in order to meet ever-increasing demand for aged-care services and support, the aged-care workforce will need to more than triple by 2050. This need for significant growth was again affirmed in 2015 by the Aged Care Financing Authority. This represents a workforce growth rate of about two per cent annually in order to meet future demand, at a time when the overall employment-to-population ratio will be declining. By 2050 we will need to have more than one million Australians working in the aged-care sector—a 300 per cent increase. According to the National Aged Care Workforce Census and Survey, the aged-care sector is already confronting workforce shortages, which will be exacerbated as sectors competing for the same workforce, such as disability services, simultaneously grow with the increased rollout of the NDIS.

Further, increasing rates of complex chronic conditions and a mismatch between the first language of some older Australians requiring care and the current workforce present some even greater challenges in keeping pace with the diversity and skills required for the care of our ageing population. Indeed, the growth rate of the number of older Australians living with dementia—currently at around 400,000 Australians and expected to exceed 900,000 by 2050—is a key consideration in the future of the aged-care workforce. The aged-care workforce will need to broaden its skills and capacities in order to assist older Australians with increasingly complex needs, such as dementia and other cognitive impairments, the increasing incidence of mental illness, palliative care and HIV. We're not even touching the effects of the epidemic we're having at the moment with drugs such as ice.

More than 80 per cent of direct-care workers in home and residential aged care are women, and as many as 40 per cent of recent hires in residential care were migrant workers. This paints the picture of a diverse workforce that has significant capacity but that also faces unique and complex challenges. In the context of cost pressures in residential care, in particular, it is also worth noting that staff costs represent 67 per cent of the total expenses in residential care. That's a significant amount of their budget.

Aged-care providers are accredited and monitored by the Australian Aged Care Quality Agency. The regulation of staffing and the provision of Commonwealth government funded aged-care services is legislated in federal law. Aged-care providers must comply with accreditation standards detailed in the Quality of Care Principles 2014, overseen by the Aged Care Quality Agency. While there is no prescribed minimum staffing standard, the accreditation standards for residential care facilities require there to be appropriately skilled and qualified staff sufficient to ensure that the appropriate services are delivered to older Australians. With the exception of public Victorian and Queensland aged-care facilities, most state and territory jurisdictions do not legislate minimum staffing ratios or determine a required skill mix for nursing.

While the vast majority of aged-care providers in Australia provide high levels of care and support and have well-managed and well-resourced staffing systems in place, we have serious concerns in regard to a number of significant failures of care at facilities only months after being found to have met accreditation standards. As a result, Labor has backed the Commonwealth government's independent Review of National Aged Care Quality Regulatory Processes, which is currently under way. It is expected that this should consider how regulatory processes can be improved to support appropriate staffing levels and staffing mix, and we look forward to reviewing the findings and recommendations of this report later this month.

It's critical to the future of the aged-care sector that families can have faith that their loved ones will be safe and will receive a high level of care in residential homes. There is no doubt that more work needs to be done to address deficiencies in the current regulatory processes.

While Labor has shown a genuine commitment to work with the government and the aged-care sector to ensure senior Australians can age safely and happily in their own homes or in residential homes, the lack of urgency shown by this government is deeply disturbing. Too often we hear stories of aged-care homes where just one registered nurse is responsible for the care management of hundreds of residents, sometimes across multiple homes. Too often we hear stories of personal-care workers with little more training than a first aid certificate being responsible for the primary care of vulnerable older Australians. This is unacceptable.

Labor will stand with aged-care workers and aged-care recipients and demand better outcomes that support our workers and protect older Australians. Fundamentally, the question of how we can achieve these outcomes, whatever it comes down to, has to be based on evidence. We have to have an evidence-based approach to our regulatory system.

Labor is completely committed to working with the unions and aged-care providers to support a strategy to meet growing demand in the aged-care workforce, with a framework that ensures decent conditions and career progression for workers and a high level of care for consumers. We fundamentally believe that this approach includes looking at the issues of 24-hour registered nurse coverage, nurse ratios and the skills mix that will enable enrolled nurses, assistant nurses and personal care workers to provide sustainable quality of care. Labor believes that the skills mix is critical to ensuring sustainable, quality care. It requires regulatory and administrative processes that will support that outcome. An evidence-based approach to the training and educational development of the workforce, and a review of regulations that govern accreditation, quality and compliance, are critical to this process.

Labor continues to progress this commitment from opposition through a number of mechanisms. Importantly, we have been a driving force behind the inquiry of the Senate Standing Committee on Community Affairs into the future of the aged-care workforce. Can I put on record that that committee travelled around Australia. We went to regional Australia and to remote Australia. We had people from the government. We had senators from the government. We had Green senators. I travelled along with my colleague Senator Watt. We all heard the same evidence. There is no doubt that the government is fully aware of the issues facing this sector. But the reality is that it's not just the responsibility of the people on the committee or the minister responsible for aged care; it is the responsibility of every member of parliament and every senator, every member of state government and every member of our local governments, because we all need to play an active role in ensuring we address not only the aged-care issues in this country but also issues concerning ageing. We all have to take that responsibility. In fact, there needs to be a greater conversation in our communities about how we want to show our respect and give safe, well-trained, highly skilled care for older Australians. We should never accept anything less than that.

The inquiry investigated a number of key issues and addressed some key questions in the future development and regulation of the aged-care workforce. There were 19 recommendations in the report, which all aligned with Labor's 2016 federal election commitments and which were unanimously supported by the government senators, the Greens Senator and the Labor senators. There is a clear need for an aged-care workforce strategy, and the report made a number of recommendations about what the strategy needed to address. It's pleasing to see firm recommendations about the active role that the Turnbull government needs to take in workforce development. They're a key stakeholder and funder of the aged-care sector, after all—unlike the former minister, who said it was not their responsibility. Quite frankly, it's a responsibility of government, the sector and the unions. We all have a role to play.

Other key recommendations for the government include the examination of the introduction of a minimum nursing requirement in aged-care homes; a national employment screening and working registration scheme; the implementation of the national code of conduct for healthcare workers; the publication of staff ratios in aged-care homes to help people make informed decisions; and nationally consistent accreditation standards to ensure quality across the board. The report also made recommendations on the direction of the aged-care workforce task force, which was allocated $1.9 million in the 2017-18 budget, which include better support for regional and rural workers; efforts to tackle pay issues in aged care; and a national campaign to promote the benefits of working in aged care.

Labor strongly supports the recommendations of The future of Australia's aged care sector workforce report. The approach detailed in this report includes further examination of minimum nursing requirements in the context of increasing demand and the complex needs of these older Australians. Unfortunately, this approach requires the Turnbull government to actually confront these issues and provide guidance and resources in regulating the growth of the aged-care workforce. Importantly, the report, which was adopted unanimously, as I said, by all political parties, recommends the age care workforce task force include all stakeholders—that is, the unions, the workers and the providers. All of them need to be involved. This makes good old-fashioned common sense. If the task force is to be credited, it must have representation from across the full range of providers, unions, carers, health professionals, employees and consumers. For a moment, we had a glimpse of hope from the Turnbull government that maybe, just maybe, they were starting to understand the importance of aged-care workforce development and regulations. Indeed, Minister Ken Wyatt said in response to the release of the inquiry report:

The task force will be required to consult widely within the health and aged care sector, and engage with other sectors, including social services, education and employment.

Planning for this is well underway, with the task force expected to be established in July 2017

This appeared to be a positive step, particularly considering the statement from Senator Nash, who stated in February estimates of 2016—my favourite time of the year here in the Senate is estimates—that the aged-care workforce is a matter for the sector. Unfortunately, this appears to have been nothing more than a hollow promise. We are now into the second week of September, many weeks after July, and there is no detail about who will make up the task force, no detail about when or how the funding will be delivered—no progress whatsoever.

To add insult to injury, it appears that a package that sits alongside the task force, the $33 million Boosting the Local Care Workforce package, designed to help existing service providers in the disability and aged-care sectors grow their workforce, has dropped the aged-care sector from its focus altogether. In a media release from 30 August 2017, the Turnbull government announced that 10 organisations have been shortlisted and invited to apply to deliver the $33 million package. The 10 organisations include groups and peak bodies for the disability and employment services sector.    Even though the grants are supposed to be targeted to the aged-care service sector and the disability service sector workforces, no aged-care peak body has been invited to apply for the grant. It's just another clear sign that the government is recklessly overlooking the needs of older Australians and the people who provide their care.

We know for sure that the nature of aged-care provisions is changing, and it is changing for the better. We're all living older, but we need to keep up with the times. When last in government, Labor delivered the biggest reforms to aged care and ageing policy in a generation. Labor's $3.7 billion strategy known as the Living Longer Living Better aged-care package provided a ten-year plan to deliver choice, fairness, quality, sustainability and respect to our aged-care system. We delivered a strong framework to build the aged-care services that Australians deserve, and progress was being made. As a result of this approach, more Australians are able to choose the type of care and support they receive when they grow old, and more Australians are able to choose to grow old in their own home and decide who provides their care.

But if we are going to go forward—Labor did all the heavy lifting, but we didn't do it all on our own. We showed the leadership that was needed, but we worked with the opposition of the day, the unions, the sector and consumers. That was the framework that was supposed to be the foundation. These guys in government have absolutely taken their eye off the ball. You can't take $4 billion out of a sector and then expect the same type of care. It just cannot be delivered. I thought we'd made progress in that Senate committee, and I commend Senator Duniam, who was very open to seeing what was happening in our community, not only in aged-care homes but in what we're trying to deliver in our own homes. There are some real challenges there, and we have said time and time again that Labor wants to work with the government, but we have to earnestly address these issues— (Time expired)

Jonathon Duniam (Tasmania, Liberal Party) Share this | Link to this | Hansard source

It's always a delight, and somehow I always have the good fortune, to follow Senator Polley in debates. It's a Tasmanian thing. We travel everywhere together in pairs, and here we are again.

It is a pleasure to be able to rise to speak on Senator Hinch's Aged Care Amendment (Ratio of Skilled Staff to Care Recipients) Bill 2017. I commend any senator or any member of parliament or any member of the community or any stakeholder who takes an interest in this issue and actually wants to do something to ensure that some of the things we've read about, heard about, seen for ourselves or know about don't occur again. I don't think there's anyone out there without serious issues who doesn't want to address these issues, although it's a case of making sure, as Senator Polley rightly pointed out in her contribution—one of the one or two things that she said that was right and accurate—that responses to these issues are evidence based and that we have the facts at our disposal to make sure we make the right decisions. I absolutely agree with Senator Polley on that very point.

There's a couple of things I want to highlight. I was having a look at the explanatory memorandum of this bill. It made a reference to ensuring that aged care is more focused on the protection of the elderly than on the profit margins of aged-care facilities. One thing I did notice—and I'm sure it's unintentional—as we travelled around the country meeting with stakeholders and aged-care providers is that there were a great many providers that are not for profits. They run on the smell of an oily rag. If you go and meet with these entities you see that they're not making huge profits, building large staffrooms and taking their staff on big retreats overseas or anything like that; they are actually very trim and efficient organisations. I think we need to acknowledge that fact as well—that some of these organisations do the best they can with what they have, particularly in my home state and the state of Senator Polley, Tasmania. Many of the aged-care providers run things very efficiently and do a great job with limited resources.

Senator Polley referred to the inquiry that took place through the Community Affairs References Committee, which I had great delight in participating in as a member. It was one of my first inquiries. Being a new senator and someone who hasn't had a great deal of experience in this space, it was very much a learning experience to meet with stakeholders and understand how the industry actually works, what consumers are looking for, what hurdles the industry faces and what government needs to do, along with stakeholders, to address the concerns raised in this inquiry. As senators may know, over an extensive period of time this inquiry had 12 public hearings right across the country. We travelled to every corner of the country from April 2016 through to June of this year—Melbourne, Perth, Bunbury, Darwin, Alice Springs, Launceston, Canberra, Townsville, Wollongong, Adelaide and Broome—plus there were a number of very informative site visits, not all of which I could attend.

The committee did a very thorough job, and I commend Senator Polley for driving that inquiry and setting up the agenda for the work the inquiry undertook. We were left with very few questions as to the state of play in the industry, so it was an excellent learning experience for me. I'm not sure whether Senator Hinch has read the report, but I do recommend that he has a look at it, and I will go through some elements that I think are salient to this debate. A lot of issues were canvassed, including the one this bill touches on and that we as a committee deliberated on at length. As Senator Polley acknowledges, it was a consensus committee report. There weren't additional comments. There was no dissenting report. We actually all agreed that there were things that needed to be done. As a government senator on that committee it was my view—and, Madam Acting Deputy President Reynolds, you were on that committee as well, and you shared my view—that it was that committee's role to make these recommendations.

One of the key things that jumped out at me in the hearings I participated in was rural and remote or regional aged care and being able to provide the necessary workforce to communities that probably don't have access to the larger numbers of prospective employees—and skilled employees at that, if we refer to this piece of legislation—that larger population centres do. Even in Tasmania, Hobart, its largest city, and Launceston, its second-largest city, have their own struggles when it comes to attracting people to these professions. As the report notes, particularly on this issue of remote and very remote areas, aged-care services may be provided by a limited number of organisations and in some cases by just one provider. We heard about one organisation, a local government organisation in the MacDonnell Regional Council, which was the only provider in their region for aged-care services in the eight remote Aboriginal and Torres Strait Islander communities in Central Australia. That gives you an indication, at one very extreme end of the spectrum, of how difficult it is for some organisations to provide and sustain these mandated ratios we're talking about here.

The Australian Institute of Health and Welfare noted in relation to this issue that people who live in rural and remote areas face additional difficulties in accessing health care and ageing related services. Rural and remote areas have fewer services available, particularly in close proximity to where people live, and the services that do exist may not be attainable, for example, due to the cost or lack of transport. In addition, service providers in rural or remote areas face challenges in service provision. The costs of building and operating facilities are higher, and—this is probably the most important and salient part with regard to this piece of legislation—there are fewer skilled workers available.

So, while I agree with the principle and the intent of this legislation, I think we need to take stock of what the committee report found and look at the recommendations of this committee report with regard to this particular issue, because there are some difficulties and complexities around how you achieve these sorts of things. The end aim, I think we would all agree, is a better standard of aged care for everyone; as for how we do that, there are many different avenues and issues that we need to deal with. But, when we hear things like this from institutions like the Institute of Health and Welfare, we need to make sure we understand the complexities, because simply putting in place a mandated ratio may have unintended consequences and will have aged-care providers like the MacDonnell Regional Council falling foul of that, meaning they may not be able to operate their service in a set of communities that require it, and no-one else is going to be able to provide those services.

The committee also looked very closely at the changing nature of aged-care services and services for the ageing in this country. It isn't what it used to be 20 years ago; I think that's fairly widely acknowledged. It's a very different landscape, with much more complex sets of needs on the part of many residents in many facilities, with increasing numbers of dementia patients with high-care needs, and all sorts of ailments and illnesses that carers now need to deal with. According to our report, the estimate is that the number of workers required for the aged-care sector will need to grow from 366,000 to 980,000 to meet the needs of increasing numbers of older Australians accessing aged-care services. That's a huge number of people that are going to be needed to be brought into this industry to support this vital part of our community—the people who have, in the generations that have gone before us, built our country.

In Tasmania alone, interestingly—being a very passionate Tasmanian—we'll require an additional 4,000 workers by 2025 to meet future demand. That's greater than the population of the town in Tasmania that I grew up in. That's a significant challenge that we have to take seriously and address, but by way of a measured and comprehensive response to the issues and not a blunt instrument or one element of the problem being dealt with to the exclusion of others. I think it is important we deal with this in an holistic way and make sure we don't leave off the agenda other elements that need to be dealt with.

Indeed, the changing service delivery in the aged-care sector is something that we considered and many submitters expressed a great deal of concern about. You'd have to agree that there are many providers who thought the Consumer Directed Care model was an unsustainable model—and they're in the know; they're the ones who are trying to provide the services as they're funded—but this model does demonstrate again this problem we have with regard to rural and regional communities. This model, where customers have greater choice and control regarding the services they access, is difficult in a very remote or a regional community, where, as I've already stated, there are limited services available and limited people that may be able to provide those services in a qualified way.

Noting some of the comments in the report around this particular issue, the report says, as I've already stated:

Some submitters also raised concerns that CDC is not appropriate for remote communities, as it presumes the existence of multiple service providers from which to choose, which is generally not the case in remote areas. Additionally, the generally smaller numbers of people accessing services, and the additional costs of delivering services in remote locations, have not been factored in to CDC modelling.

We have to take that into account, and I think the same would apply for a mandated ratio as the one-size-fits-all approach to dealing with this issue. In some cases—again I refer to the MacDonnell Ranges example I cited earlier—mandating that floor for skilled staff may make an entity unviable, unsustainable, and the end result may be that there are no services provided at all. We have to take that into account when considering this piece of legislation. Indeed, the block funding model, which has been used previously, is something that submitters indicated would be better for these rural, remote, very remote and regional communities. That's something to take on board and it may be a way of dealing with how to ensure that these regional communities can provide the suite of services at the best standard that Senator Hinch is calling for—something I do support.

I turn to the issue of making sure we can attract and retain qualified, skilled and appropriate staff in this sector. As has been noted a number of times already, it is difficult to attract people into the industry, particularly in rural and remote communities. It was interesting to hear—I suppose on reflection this was something I should have expected to be the case—about the difficulty that providers have in attracting staff to join the aged-care sector. The unions echoed that very sentiment, and it was interesting to hear why that was the case. All of this feeds into a problem I think we'll have in addressing the intent behind this bill, and that is ensuring that there are people coming through to meet the mandated ratio this bill proposes.

Submitters to the inquiry said that the reputation of the sector was very poor—when people are choosing a career path, aged care might be way down their list when they compare it to being a nurse in a hospital or having some other career in the care sector. This was a career, according to the people submitters had spoken to, that those in the industry, those contemplating life post training and where to get a job, would put at the bottom of their list, for a number of reasons. The working conditions are less than optimal, which goes to many of the points that Senator Hinch has made, and Senator Polley also. Importantly, there is a lack of career path and professional development opportunities.

I was encouraged, though, to see many institutions across the country, indeed some universities, getting in on the act of improving this situation—some of the new training opportunities and the innovative ways that prospective carers are being trained—and we saw some world leading practices and new programs with regard to hands-on training for future aged-care workers, particularly in the dementia space. It was really encouraging to see that, but I note the concerns of many submitters that there was not enough of a career path. Where does the career path take individuals who want to work in this field and what professional development is there? That's an important note for all providers, those who employ carers, and the employee representative groups, the unions, to take on board—as, indeed, is the issue of low rates of remuneration. All of these things feed into a concern I have about simply trying to mandate a specific number of skilled staff to do a certain job in certain areas.

Specifically, though, the committee did examine the issue of mandating staffing ratios. A number of submitters did express extreme difficulty with the concept of implementing such ratios in their businesses, in their not-for-profit organisations. Some said that ratios could stifle innovation. They suggested that mandatory ratios are incompatible with consumer directed care, a matter I discussed a little earlier—the need to provide these consumer directed care models will be stifled through the implementation of a mandated minimum ratio of staff. They also indicated that the expected change to the role of rostering and service provision to be customer led rather than industry led is also of concern. It comes back to that point of the sustainability of the entities that provide these services. That's not to say we shouldn't work towards ensuring that we do have the best possible suite of resources available to support the people who live in these facilities and require the support that's being provided to them.

That is what our committee report found: there are a whole suite of things that we need to work on. Sadly, it's not as simple as one small, discrete area of policy that needs reform; it is a whole-of-industry change that this committee looked at. With all of the concerns provided over the more than 12 months that evidence was taken, the 12 hearings we had and the numerous site visits, there was a comprehensive view of all of the issues the industry faces. The for-profit providers, the not-for-profit providers, the union groups, individuals and the training facilities all had their perspectives on this and they all provided their views. I would urge Senator Hinch, if he hasn't already, to have a look at this report. It is excellent reading.

Just in the time I have remaining, I will look at the recommendations. As Senator Polley said, there were 19 recommendations. They were good recommendations, and I'm hoping we'll see a response to those in the near future. As Senator Polley mentioned, the aged-care workforce strategy is a crucial piece of work to actually make sure that, moving forward, the industry does deal with the issues that this bill deals with. Also those who participated in our inquiry, by way of submissions or as witnesses, raised those issues with us as well. On the development of that strategy, the committee also—as Senator Polley pointed out as well—recommended that we have at our disposal the data necessary to understand where the workforce is going and what we need to do to ensure that we can sustain its growth. It has to be evidence based; any solution to this issue has to be evidence based.

The committee did, on this particular issue, recommend that the government examine the introduction of a minimum nursing requirement for aged-care facilities, in recognition of the increasing majority of people entering residential aged care and the complex health needs that they have. It also recommends that an aged-care workforce strategy include consideration of and planning for minimum nursing requirements, amongst the other 19 recommendations. They were, as I say, very comprehensive, as was the entire inquiry. I encourage Senator Hinch to have a look at the fine work of this committee and thank him for bringing on the bill for debate.

Claire Moore (Queensland, Australian Labor Party, Shadow Minister for Women) Share this | Link to this | Hansard source

Senator Hinch, as I said to you earlier, when people thank you for bringing an issue to this place it usually means we're all going to talk about it. When you bring forward these particular issues, it's an opportunity for the Senate to again re-examine things that are so important and so critical to our community and, indeed, as you pointed out in your contribution, to everyone of us. No-one is isolated from the issue of looking at aged care and the needs of aged care.

In terms of the process, I'm just wanting to put on record some of the concerns that have been raised over years of consideration through a range of committee inquiries and the Productivity Commission review in 2011. The Productivity Commission did an independent review of the future of aged care in Australia and put on record a number of key statistical pieces of information on which financial decisions and budgetary decisions need to be made. Consistently though that review, it reminded all of us that the needs and the numbers of people requiring care are continuing to grow and also that the complexity of those needs are continuing to grow.

I'm taking up some of the points that were raised by Senator Polley and Senator Duniam. However, when we have a chance to come here to talk about an issue, such as aged care, it is always an opportunity to go back and have a look at the number of community affairs inquiries that have touched on this issue. Even since I've been here—I have counted and I guarantee this won't include all of them—over 100 recommendations have been made by various groups saying what should happen in this space, and there's such a common element across these concerns. Always, it begins by saying that we understand that this is a really important issue. Then the recommendations go on to talk about the need for trained, effective staff, saying that these needs will become more difficult, and that there needs to be a whole-of-government response, and in particular that the response should take into account the needs across the whole of our country.

I think the way that Senator Duniam reflected on the most recent report of the Senate Community Affairs References Committee—which I was not a member of—made those points very clearly. That report was again an example of the strength of the community affairs committee and the general committee process in this place. When you look at the terms of reference that were agreed upon and then at the interest and the passion expressed by the wider community in being involved in the process, you understand why it is absolutely important that there are opportunities for people in the community—people with lived experience, people with concerns—to be involved in the process of the Senate committee experience. They should then be able to have a sense of confidence that the effort they have put into coming forward and the great bravery that many of them have shown in talking about their own experiences will be responded to by the government of the day, whichever flavour it is, and that the response will reflect some consideration of future policy direction. That is often where there is frustration about the way the system operates.

The committee affairs committee inquiry into the future of Australia's aged-care workforce went on for over 12 months. It travelled across the country, as we have heard from senators who were part of that process. Committee members talked with hundreds of people who came forward to give evidence to this inquiry. I understand there were very many more submissions. Out of that came a very detailed inquiry report, with 19 recommendations, some of which referred specifically to the issues in the private member's bill brought forward by Senator Hinch, as well as going across general conditions in aged care, regulation in aged care and resourcing for aged care. The recommendations also went to making sure that any Australian citizen, any Australian person—anyone living in our country—who requires aged-care support will be able to have that support in the best possible way for them and their families. So, again, trying to enforce absolute models can be very dangerous in terms of policy direction. However, given that statement, I need to say very quickly that I am concerned that, too often, a focus on flexibility and innovation can be a way of excusing taking no action at all.

I am always concerned that, when we fall back into talking about innovation and working in different ways, that is somehow being used to take any focus away from the issues and problems that have been raised. I am very much aware of the concerns about putting in place mandated ratios, but when I am told, and when I read the evidence, that that could stifle innovation, I'm very concerned that is another way of saying that that could stifle actual care. In terms of the information we have before us, I want to stress that not only should the Senate committee process allow a wide range of engagement from the community, from care givers, from providers of services and from people who are seeking service; there should also be a very formalised process through the general government process to ensure that there is open consultation and regular advisory processes that allow people who are actively interested in this space to give advice to government, to respond to any of the concerns that are raised and to bring forward their ideas as to how the system can best work. That could be a way of balancing concerns about innovation with looking at exactly what the needs will be.

The recommendations from the latest aged-care inquiry said that there needed to be awareness of future aged-care workforce requirements, including the impacts of sector growth, changes in how care is delivered and the increasing competition for workers. That last element refers to the wider aspects of care in our community. As we look at the introduction and expansion of the NDIS, we have constant demands for better and more available trained staff in that space. One of the things that has been raised in this discussion is that we can't now look at individual areas of care need without taking into consideration the wider care expectations of the community. So, at the same time we're talking about specialist care needs in the aged-care sector, we have to be aware that we now have more information, more evidence and more designated need for people who have care for a whole range of disability requirements across the country. This is, indeed, creating this quite serious issue around increasing competition for workers. This actually leads on to an understanding about the way in which we need to have clear training programs across the whole area so that the people who do make the choice to work in this industry understand they will be well protected, that they will have effective training and development, and that they will have an opportunity to use their skills in the best possible way.

In the general committee process we have in this place we have the opportunity to listen to people who want to talk to us. One of the more effective programs we've had in the parliament around the issues of aged care and disability care is the opportunity for people to come and talk to us in the parliament about what they most need for their personal circumstances. I well remember a few years ago, in a previous Senate community affairs committee inquiry into aged care, around the year 2012, we had visitations from people who were users of the aged-care system and who came to see anybody in this parliament and talk with them about how they viewed their own lives, how they viewed the increasing care needs they were looking at into their futures, and what they expected from their government in terms of response. It was incredibly valuable, I think, for senators to sit down and talk with people in the Main Committee Room here who had come voluntarily as people currently receiving aged-care services, and to listen to them about how they felt about their situation and how they felt about the people providing care for them in their homes.

Senator Hinch, one of the most impactful statements that you made in your contribution earlier was when you made it very clear to all of us that when we're talking about aged-care facilities or aged-care service centres, what we're talking about is the home for people who are living there. I think sometimes that is forgotten in the discussion. There is such a semimedicalisation of the process that we do not see that, for people who are living in the various facilities—and that seems to be the generally accepted term, 'facilities' or 'areas'—this is where people live. This is where they are needing care to just get through the days and nights of their lives. I think the concept that must remain central is that we're talking about home in that sense.

In thinking about that term, one of the things I want to talk about—because I know we're going to hear contributions from a number of people about the aged-care process—is a linkage that I have always felt is particularly important, which is the linkage between effective aged care and palliative care. One of the previous committee inquiries in which I was involved was an inquiry in 2012 into the issue of palliative care in Australia. In that inquiry, one of the most impressive forms of evidence we got was from people who were working in aged care and were talking about how they believed that there should not be a distinction at that level between aged care and people who were living towards the end of their lives in those processes. There's considerable data that looks at the fact that people who are now moving into high-care facilities are moving at an older age and with many more complex needs. They are very much more fragile as they move into that time of their lives.

What we heard in that particular inquiry is that there doesn't seem to be any acknowledgement or, in fact, more specifically, any funding or resourcing acknowledgement for the extra care that is needed for people who need actual end-of-life care under the model of the palliative-care processes. We had really interesting and very compelling evidence from a number of facilities who had, at their own cost because there was no funding model which applied in this process, put resourcing in to allow them to have a very high level of particularised, very specialised care under the palliative care model which ensured that people were not only getting the appropriate medication and having regular GP attendance but also, at that time, having personal contact. People were able to sit with the person who was at that time of their lives over extended periods of time so that there was this personal relationship. There was not only skilled knowledge but also quite personal relationships.

That's important because what we heard very often throughout the various inquiries which we've been a part of is that one of the real elements under the resourcing models that we have is that there is simply not enough time for the people who are working in the various facilities to spend personal time with the people for whom they're caring. They have a range of professional duties which they have to perform, all of which are counted in the accreditation process. That's particularly important. No-one actually denies that there has got to be this basic level of personal care and professional support, but what we lose is that element of genuine personal relationships and care.

That issue was raised by the people from various facilities who talked to us about it, and it was certainly raised by the patients' families who said that, when they go to visit, they find that their loved one—their family member—is lonely, feeling isolated or has not had the opportunity to effectively communicate their own needs. It has been so strongly enunciated to so many people in this place by actual workers who are now working in the industry, and these are workers who have professional care qualifications. They're certainly workers who have nursing qualifications and they're people who work in the facilities themselves. They say that they just do not have the time to provide that particular personal care. They gave us data that indicates the number of people for whom they have to provide care for within a certain time and the number of people who are working on wards in that period.

Recently, the New South Wales government moved to reduce the ratio of nurses in their state-controlled aged-care services. It was brought out by a number of people that you need to have a particular ratio of nurses on duty in any of the facilities over a particular time to fulfil a range of particular professional duties, medication needs and nursing procedures and to ensure that they have the appropriate supervision in an agency. But what they also wanted to ensure is that people felt as though they were being supported and cared for when they most needed it in their facility.

We have heard statistics this morning. We've heard about a number of things that the government is doing. One of the things that we're waiting very impatiently for is the result of the Tune review which was required to be done on the legislation that was passed in 2013—the Aged Care (Living Longer Living Better) Act. If anything, the particular title of that legislation is one that I think we should hold very close to. If you're looking at how we can best survive in this life, you'd say that a piece of legislation that was designed to allow people to live longer and live better is something that legislation should be designed to do. As a result of that legislation, there was required to be a comprehensive review about the whole process. That review has been completed by David Tune, and it has been presented to the minister, Ken Wyatt. We are now waiting for that to be made public.

Again, in the many Senate inquiries which people have been involved in, many people put forward their suggestions and took up the opportunity to be a part of that review. Consumers, carers, representatives of consumers, aged-care workers and aged-care providers all came forward and gave their information about how they felt that program of legislation had been implemented and their suggestions for what could be done better.

One of the things that did strike me, though—and I think this is a concern in the particular environment in which we're operating—is that very many of the submissions that were put up on the website for this review were put forward anonymously. That has not happened in many of the Senate committees in which we've operated. People gave their names, came forward and spoke openly about their issues around aged care. But when I was reading through the submissions that were up on the website, for this review that was done on Living Longer Living Better, very many were anonymous, and I'm concerned about that. I'll be interested to see, when this review is tabled by the minister, whether any reason is given for that.

The reason I say this is that, in the evidence we have received in previous inquiries and also in evidence about the New South Wales situation where they were looking at changing the ratios, people expressed that there was a fear amongst workers and a fear amongst residents of putting forward any concerns or complaints. That in itself is a genuine worry. If we cannot have a process where people are able to give information freely and to give evidence about which they are deeply concerned, we are not going to have that open consultation that we best need. As parliamentarians, as policymakers, we need to have confidence that people will come and talk to us. We have that so often in our Senate inquiries. If we lose that, if people become frightened of expressing positions of difference or frightened of giving advice, I think we will not be able to effectively develop good policy.

The issues around ageing and aged care are important. Senator Hinch, I think it is absolutely critical that the hot-list discussion continues and we have further consideration of the issue of mandated ratios. I think that will be part of an evidence based—I do love that term—process into the future. But I do not want to have any issue around care, and ensuring that we have absolute standards of care for our people across the community, being pushed aside to say that we have to be more concerned about innovation in this space and being more flexible.

Lucy Gichuhi (SA, Independent) Share this | Link to this | Hansard source

I rise in support of this bill. There's no doubt that the Australian demographic is an ageing population. There are over 5.5 million Australians aged over 50. Some of the oldest are already moving into aged care. To accommodate the needs of the rising population will require a quadrupling of the aged-care workforce by 2050. Recent reports on the ageing of baby boomers show they are eight times more likely to have health problems than the previous generation. Currently, the number of people over the age of 65 receiving aged-care services exceeds 1.2 million. Of those, 83 per cent are classified as requiring high-level care. An estimated 60 per cent of these high-care-needs residents have dementia. More than 40 per cent suffer from chronic pain, over 50 per cent are incontinent and 45 per cent have a sleep disorder. The list is endless.

The management of these complex conditions and combinations of conditions require the skills of experienced registered nurses supported by doctors and other allied health care providers. Over the past decade there has been a marked shift in the composition of the residential aged-care workforce. Skilled registered and enrolled nurses now account for less than 30 per cent of the aged-care workforce. This is concerning, given the complexities that the elderly residents face in their day-to-day lives. Registered and enrolled nurses working in aged-care homes have been trained in administering medication, controlling infection and ensuring that residents receive adequate care, overall care. According to the current Aged Care Act 1997, providers must 'maintain an adequate number of appropriately skilled staff to ensure that care needs of care recipients are met'. Without clear guidance on definitions of 'adequate number' and 'appropriately skilled staff', there are a list of aged-care providers interpreting this very broadly—a risk that Australia cannot afford for our seniors.

The ability of nursing staff to respond to residents' needs in an effective and timely manner is largely dependent on reasonable, effective nurse-to-resident ratios. I recognise that further research is needed to better understand what the appropriate skills mix should be. Federal legislation is urgently, if not immediately, required to ensure that, at a minimum, aged-care homes have registered nurses on site at all times. Registered nurses are specifically trained to assess, monitor and, to a certain degree, manage complex medical conditions. This would reduce the need for the older clients being transferred to hospital emergency rooms unnecessarily.

Gavin Marshall (Victoria, Australian Labor Party) Share this | Link to this | Hansard source

Senator Gichuhi, please resume your seat. You will be in continuation, as the time for this debate has now expired.