Tony Zappia (Makin, Australian Labor Party, Shadow Assistant Minister for Medicare) Share this | Hansard source

I speak in support of the amendment moved by the member for Franklin in respect to the Aged Care Quality and Safety Commission Bill 2018. Australia's aged-care system is in crisis. Over the last two decades or so there have been around 20 inquiries that in some way relate to Australia's aged-care system. We've just concluded another inquiry by the parliament through the Standing Committee on Health, Aged Care and Sport. That inquiry, whilst concluded, now goes into its next phase, which is to look at the issues of staffing in the sector. We've also seen in recent years several media reports relating to the failures of the aged-care system. We also know that complaints in the sector are increasing. In 2017-18 the number of complaints received by the Aged Care Complaints Commissioner rose to 4,315.

Finally, we now have a royal commission called by the government. I welcome that royal commission. Whilst I am disappointed that the terms of reference do not include inquiring into retirement villages, I nevertheless welcome the royal commission and look forward to its findings. Let me be absolutely clear. The royal commission should be no excuse to defer action or funding on matters of concern that have already been raised, that are known and that need to be urgently addressed. Nor do I believe the royal commission should simply be used by the government as an excuse to put off decisions until after the next federal election.

The royal commission, whilst based in South Australia, should also not be a distraction from the widespread concerns raised in respect to the aged-care sector simply by focusing its attention on what happened at Oakden, which was in South Australia. Oakden, of course, deserves condemnation. But it's had its own ICAC investigation from within that state. It's also been the subject of a Senate inquiry of this parliament. And the facility is now closed. Oakden was not an isolated case. It is clear from the people I've spoken to, the evidence that I've heard and the revelations to date that the abuse and poor care of elderly people in residential aged-care facilities is widespread. That's both from within for-profit centres and not-for-profit centres.

Let me also make it clear that the Makk and McLeay wards in Oakden, the two most heavily criticised, were inspected and licensed by the federal government's health department. This was through the work of the quality assurance agency that, over many years, carried out inspections of that facility. These inspections were carried out over the very years that the abuse was occurring and where complaints were continuously being made. Indeed, between 1 January 2012 and 13 June 2017 there were 64 visits made by the quality assurance agency to that centre. Some 54 were made in 2017, when the centre was in its dying stages.

So there were numerous visits by that agency over the years, and it was only when the public spotlight was shone on Oakden that the agency started to find flaws with the facility. Indeed, from my recollection, there were about a third of the conditions that were not met in the final inspection. I fail to understand how at a time that the spotlight was being shone, and when there was likely to be greater effort made to comply with the conditions, that the agency suddenly found 15 conditions that were not being met when in all the previous years there were no such findings.

The existing regulatory oversight of our aged-care sector has badly failed Australians, and the government has finally faced up to the reality, through this legislation, that change is required. I hope that this legislation brings about the improvements that we all want to see. I support the legislation, but only time will tell just how effective it's going to be because there are two other important changes that are urgently required if this legislation is going to make the difference that we hope it will. Firstly, there needs to be a culture change across the whole sector, from the regulatory agencies right through to the operators of these facilities. Secondly, there needs to be additional funding, and considerable additional funding in some cases. Without it, I can't see how we're going to make the improvements that the community is calling for.

Every day around 200,000 people are being cared for in an aged-care facility somewhere across Australia. In the course of a year, about 240,000 people will have passed through these facilities. Around 85,000 people are currently in receipt of a home care package, and those numbers are rising—121,418 people are currently on the national prioritisation queue, waiting for a package. We know that those figures continue to rise and, indeed, the real concern is that the government's commitment to providing those packages is not even keeping up with the number of people that each week come onto the waiting list. In the last decade, 33,667 new residential aged-care places were added to the system. Over the next decade, it's expected that around 83,500 will very likely also be added.

The problem, however, is not just that there are more people coming into the aged-care system; with respect to residential aged-care facilities, they enter aged care at an older and more vulnerable age. Over the last decade, those people who were in these residential aged-care facilities and were in what would be referred to as the 'no-care or low-care' classification represented about 45 per cent of people. Today, that figure is down to 15 per cent. Conversely, the people who were considered to have high-care needs 10 years ago were about 28 per cent of the population of those facilities. Today, that figure has gone up to 58 per cent. So we've seen a very clear change in the type of people in these facilities and in their needs. And with greater needs, of course, comes greater cost and greater support required.

Not surprisingly, the industry now claims that some 43 per cent of their facilities are either operating at a loss or are struggling financially. The funding is inadequate because of funding cuts by this government, including the dementia supplement cap that was made some years ago. This government's failure to properly index funding has resulted in a real effect, where billions of dollars have been cut from this sector. This is what the Aged Care Guild said about financial viability in a letter that it sent only last month:

Current funding for aged care services in Australia is inadequate and needs to be addressed. According to independent data from StewartBrown, Chartered Accountants and provider of the most comprehensive financial data across the aged care sector – has calculated that care funding for residential care falls short of cost by $7.30 per day, per resident. The Guild is concerned that the disparity of over $558 million per year of care funding will - without redress – lead to further failures in the system and put senior Australians at risk.

It goes on:

Operating costs for aged care providers are currently growing at an industry average of 5.2 per cent per annum, while average care funding will grow by only 1.2 per cent for 2018-19. This is on the back of zero growth in care funding for 2017-18. This is unsustainable and is forcing providers to either reduce services, close or sell their operation, or continue operating whilst financially hampered and risk non-compliance with quality of care standards. In fact, 43 per cent of providers are currently operating at a loss and the remaining 57 per cent are forecasting similar outcomes over the next twelve months.

That letter sums up the state of the industry right now. Whilst I accept that it's a letter from the industry and obviously they've got an interest in their remarks, the reality is that it also reflects the conversations that I have had with so many of the centre operators and with other people currently within the sector and, indeed, the experiences of what we're seeing within these facilities.

The issue is even more critical with respect to regional and rural locations, where residential aged-care facilities are not only critical; in many cases they might be the closest place that an older person can be taken to. They don't have a choice, in many of the regional and remote areas, as to where an older person can be cared for when they can't remain in their own home, and so those facilities are absolutely critical to those communities. And I know that for many of the regional and rural centres the financial viability is even tougher. Residential aged-care facilities are also important for those communities because in many cases they add immensely to the local economy and job creation within those communities. If they fail, not only is the care that they provide then not available to those communities in the future, but it directly affects the whole township because of the jobs that are lost.

What we have seen in recent years throughout the sector is that the financial pressures are resulting in cost cutting, which in turn results in fewer staff, poorer levels of care, lower food quality and less access to allied health and other social programs that were previously provided. The expectations being placed on staff within those facilities are unrealistic. Some of the stories that I have heard from people who've come to see me about it make me very concerned about how staff could possibly provide the care that is required by residents in those facilities, given the work pressures they are put under.

The other concern that arises from all of that is that it is a false saving for government. What is happening today is that because there is inadequate staff in many centres, when a resident becomes unwell, rather than calling in a doctor or having a registered nurse on site who might be able to attend to the needs of that person, they are immediately being taken to the local public hospital. That in turn puts pressure on the local public hospital—and our hospitals, as we all know, have their own pressures to contend with—to provide a service which could have be provided within the residential aged-care facility, had the facility been properly staffed. I know that is happening because, again, I have spoken directly with people in the emergency sections of public hospitals around the country.

In addition to all of that, we now know that even the doctors are not wanting to go to residential aged-care facilities as they did in the past. One in ten doctors surveyed have stopped going to aged-care facilities altogether in the past five years. We know that one in three GPs have now said that they will phase out or scale down their visits to aged-care facilities over the next ten years. They won't go there, because the compensation, the money they get under the MBS from the government for visits to aged-care facilities, is simply inadequate for the time that they spend at those facilities. It does not adequately compensate them. So, again, if we don't have doctors visiting residents within the facilities, of course they'll end up in the public hospitals, which in turn comes at a much greater cost to the public. So it's actually a no-win situation to cut back on funding to the residential aged-care facilities if ultimately we are going to end up sending them to the public hospitals.

The last point I want to make is this—and I think this is a critical matter. There was a 13-year study by Professor Joe Ibrahim, who found that one in six deaths that occur in residential aged-care facilities was preventable—one in six. That in itself should have rung alarm bells for government and said something is wrong and we need to act and act urgently. If we can prevent those deaths then we should be doing so. The only reasons they were not prevented were, again, the financial pressures and the staffing shortages within those centres. I look forward to the outcome of the royal commission findings.

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