James McGrath (Queensland, Liberal National Party) Share this | Link to this | Hansard source

On behalf of the Chair of the Senate Community Affairs Legislation Committee, Senator Askew, I present additional information received by the committee on its inquiry into the provisions of the Aged Care Amendment (Aged Care Recipient Classification) Bill 2020.

Helen Polley (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Community Affairs Legislation Committee, additional information, Aged Care Amendment (Aged Care Recipient Classification) Bill 2020 report. The amendments made by this bill allow for the introduction of a new classification system that focuses on independently determining the care needs of older Australians, assessing residential aged care and some types of flexible care.

Currently, the fiscal contribution that the Australian government makes to aged-care providers is administered through the Aged Care Funding Instrument, better known as the ACFI. The ACFI is a tool which assesses the care needs of residents and is the largest source of revenue for residential aged-care providers. The ACFI is based on dependency, so there are limited incentives for aged-care providers to actively encourage re-ablement and rehabilitation methods.

In reports produced by both independent researchers and the statutory Aged Care Financing Authority, it was found that ACFI provides strong incentives for providers to deliver outdated methods of care to produce higher subsidy payments. Concurrently, many aged-care providers are not commercially viable. These corporations usually employ complicated business structures which, while being legal, cast a veil over their financial performance and transactions. Transparency must accompany this sector by increasing reporting requirements. This will allow for more informed policy and investment decisions.

Labor also believes we need better transparency around funding. We need to know that the funding going into aged care is actually improving quality of care. At the moment we know it isn't, because the Morrison government rates aged care like a monkey dancing on a razor blade. They have no idea about, let alone interest in, the care of senior Australians in aged care.

This mechanism is clearly broken and has been for some time. There has been report after report into the aged-care sector, around ACFI and the fact that this system is broken. It took the government finally calling a royal commission—so now, finally, there's been a light shone on this sector and the lack of accountability by this government and previous Liberal governments in this area, where we have not had a minister who would take responsibility, have a plan and be able to address the real challenges that this sector is facing.

There needs to be a complete overhaul of the financing of aged care. That's the only way that we are going to move this aged-care crisis along. The excuse that the government have been using since they set up the royal commission is, 'We can't do anything because we have to wait until the final report is brought down.' Well, we know that there's been report after report after report, so on the issues that will be highlighted out of this final report, dare I say that many in this chamber have known about these issues for a long time and have been trying to get this government to act to ensure that older Australians and some of the most vulnerable Australians are well cared for, are not being abused and are getting the care that they so richly deserve.

In 2017, there was a review of ACFI which found that this outdated instrument needed to be replaced. So what have the Liberals done since 2017? Nothing. The government sat on this report for four years, and, in line with their very slow approach to the management of and any reform in the aged-care sector, they've just ignored it. They've just shoved it under the rug, hoping it'll go away. It hasn't, and it won't. Unfortunately, this government has a real reputation for having reports and having inquiries, allowing those reports to sit on the ministers' shelves and in the Prime Minister's office gathering dust, and not doing anything with them.

Labor has been saying for a very long time that there needs to be more transparency so that older Australians and their loved ones know what's happening, how they're being looked after and that their needs are being properly provided for. There have been a lot of questions about transparency surrounding the taxpayer funds that go into aged care. Over $20 billion a year goes into the aged-care system, to support older Australians at home and in residential care. What we need is more accountability about where that money is going. We need greater oversight about how it's been expended and we need to know that there is going to be transparency so that families will be able to make the very clear judgement—if they need to put their mum, their grandmother, their grandfather, their loved ones or their friends into residential care—that there is transparency about the care and the funding that's going into the residential sector in this country, just as older Australians have every right to expect that, once they have been assessed for a home-care package, the level that they are assessed for will be delivered to them before they die. We have spoken—and I know I have countless times—about the wait times for people who are waiting for a home-care package in this country, and it's an absolute disgrace.

Under the amendments to this bill, there will be a move to a new instrument as a possible replacement for ACFI. This has been designed by the Australian Health Services Research Institute at the University of Wollongong. In 2017, the group undertook the resource utilisation and classification study, RUCS. On 10 February 2019, the government announced a trial of an alternative residential aged-care assessment tool. It was called the Australian National Aged Care Classification, AN-ACC, assessment tool. This tool is based on six key design elements:

1 Resident assessment for funding to be separate from resident assessment for care planning purposes.

2 Assessment for funding purposes to be undertaken by external assessors capturing the information necessary to assign a resident to a payment class.

3 Assessment related to care planning to be undertaken by the residential aged care facility based on resident needs and underpinned by consumer directed care (CDC) principles.

4 Provision of a one-off adjustment payment for each new resident that recognises additional, but time-limited, resource requirements when someone initially enters residential care.

5 A fixed price per day for the costs of care that are shared equally by all residents. This may vary by location and other factors.

6 A variable price per day for the costs of individualised care for each resident based on their AN-ACC casemix classification.

The Department of Health has estimated there will be around 250 full-time equivalent assessors. Funding for these assessors has been estimated at $90 million. The assessors will be required to hold a qualification such as a registered nurse, occupational therapist or a physiotherapist. While we will support the recommendations of this report, we do have concerns that the Aged Care Quality and Safety Commission will not regulate the estimated 250 full-time assessors of this new instrument. The regulation of these assessors will be the responsibility of the Department of Health.

There are also concerns about the practical implementation of this instrument, including the automated decision-making for reviewing classification decisions and workforce consideration. The fundamental problem with this report is that the government, on the benches opposite, have no idea what needs to be done or what they're prepared to do as a plan to turn the aged-care sector around. They cannot be trusted with aged care. Minister after minister has failed. The Prime Minister has failed on his election commitment. They cannot be trusted to care for older Australians. I seek leave to continue my remarks later.