Tony Zappia (Makin, Australian Labor Party) Share this | Hansard source

The aged care sector is in crisis, and it has been for several years. That's why I speak in support of the amendment moved to the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill 2020 by the member for Franklin. When the royal commission was called by this government in to the aged-care sector, the previous aged care minister, the member for Hasluck quite rightly said, 'We don't need a royal commission; we know what the problems are.' When I say 'quite rightly', he was absolutely right with his comments about the fact that with know what the problems are. We knew what the problems were because there have been, in recent decades, over 30 different inquiries into the aged-care sector. Amongst those 30 inquiries there was an inquiry into the Productivity Commission in 2011 and there was an inquiry by the parliamentary Standing Committee on Health, Aged Care and Sport that reported to the House in 2018. Both of those inquiries carefully looked into the needs of the aged care sector.

Indeed, I was a member of the health, aged care and sport committee of the parliament that handed down its report with its 14 recommendations in 2018, and I can recall the hearings of that committee throughout the course of the inquiry. A number of people from every sector of society, from the health professionals to the staff within the centres, to residents' families and even to resident operators, highlighted the flaws, the problems and the needs of that sector. And so, when I say the sector is in crisis, it was absolutely clear to me then that it was in need of complete overhaul, or at least of a great deal more support than it was getting. And yet, this government, which has now been in office for seven years, simply fiddles on the edges with respect to the decisions that need to be made.

Indeed, the royal commission for all of its value, is highlighting to date the matters that were already brought to the attention of governments. I see the royal commission as an excuse by this government to simply defer making the necessary commitments that need to be made to the sector. Whilst the royal commission is in progress, the government continuously says that we need to wait for the findings of the commission. I accept that we do, but I also accept that what matters are known to government need to be addressed right now.

Not surprisingly, the royal commission handed down an interim report 12 months ago which called for a number of changes to be made. It was an interim report entitled Neglect. That term alone highlights and says it all with respect to the sector. Regrettably that neglect has continued over the last 12 months since that interim report was handed down. When we look at the number of people who have died as a result of COVID-19—the total deaths around Australia as of the last figure I saw was 905—683 of those were from within the aged care sector. It's a sector where people would have thought there was a level of care going above and beyond what is possible, even at home, and yet it was quite the opposite. For those who were in aged care—and I stress the word 'care', unfortunately, that wasn't to be the case. Some 2,000 of them contracted COVID-19 and, as I said, 683 died. That highlights that not only is the sector in crisis but also that, even since the interim report, very little has been done to change it.

This legislation makes three key changes to the process of making payments with respect to both home support and homecare packages. The first is that the payments will go from advance payments to payments in arrears. The second is that any unspent money will be held by the department and not by the providers of the service, as was previously the case. The third is, if there is unspent funds for a particular package, clearly that package will be reassessed and then the new package will be based on the expenditure incurred. All three appear to be fairly sensible cases, but I do note that as at June 2019 to date, homecare packages, in terms of the money that's been set aside or unspent as a result of payments not being made, was $750 million. I understand that by June 2020, when the figures are released, the figure is more likely to be about a billion dollars.

As other members have pointed out, home-care packages come in four different levels. Yes, it is true that there are over 100,000 people waiting for packages, but some of those people are on lower packages than they have been classified for. The fact that they are on lower packages still means that they have unmet needs. It means that the packages they have been approved for are not being provided to them. So 103,000 people, as I understand it, are still waiting for their approved package. I note the government made a budget announcement of an additional 23,000 packages. What I don't know is over what period of time they will be allocated, how many of those packages have already been added to this year's allocations, how soon they will be rolled out and what level of packages they are. Will they simply be packages that give level 1 support, which for most people is nowhere near adequate, or will they address the real shortage of packages that people are waiting for? Time will tell when the statistics are assessed. Perhaps in 12 months time we'll know just how committed this government is to those 23,000 packages.

It has been rightly pointed out that we live in an ageing society. Indeed, my understanding is that, by the year 2056, 22 per cent of the population will be over 65 years old. Currently the figure is about 15 per cent. Effectively, there will have been a 50 per cent increase in the number of Australians proportionally who will be over 65. Therefore, the need for age services will undoubtedly increase. It's also the case that people are not only living longer but, because of that, are entering residential aged-care facilities at an older age, which means that they enter those facilities at a time in their life when they have greater need. Indeed, my understanding is that of those people in aged care right now over 50 per cent suffer from dementia or dementia related illnesses. That means that the level of care that is needed for them is much greater than it might have been in the past. So for the 220,000-odd people who are in aged care right now, when more than half of them are at a high level of care, it obviously means that the centres providing that care will require more staff and more support services for them. Yet, from the parliamentary inquiry that I participated in, it's clear that the level of allied medical services in particular for many centres is declining—it's not getting higher. It's not improving or getting better; it's declining. Indeed, for many of those centres I understand even GP services are starting to fall back, because GPs find that it is not viable for them to continue to provide the services that they have been providing, so some of them have stopped going into those centres. That creates another problem, because as soon as someone in aged care requires medical support the aged-care operators immediately transfer them to a public hospital, and that in turn clogs up public hospital beds when the level of care could actually have been provided in the aged-care facility had there been access to a GP and to qualified nurses to provide the medical support that was required.

The interim report from the royal commission highlights not only the things that we knew but some of the things that urgently need to be done. I note that counsel assisting the commission has released another 124 recommendations embracing a whole range of human rights principles and an independent process for oversight of the aged-care sector. Both of those matters go to the heart of the issues that were exposed by the committee of this parliament. In particular the aged-care principles and the rights of people within those centres were a real concern to members of the committee, as, I might say, were the oversight principles. In my view, there was insufficient government oversight of many of those facilities. I know that legislation has gone through this parliament to try and improve that, but, again, it appears from the royal commission's reports to date that not much has changed.

There are some 2,700 aged-care providers across Australia, and 1,000 providers—less than 50 per cent of the total providers—responded to the royal commission's service provider survey. They self-reported 274,409 instances of substandard care over a five-year period to the year June 2018. That is 50,000 instances of substandard care being reported per year. I don't know what the total numbers would be if all providers had responded to that survey, but 274,000 suggests to me that the figure would well and truly be close to, perhaps, a million instances of substandard care being reported. And this is voluntary reports. I can only guess at what the number would be if every operator was prepared to honestly report all of the issues that were raised with them. Those issues include things like: physical abuse; dreadful food and malnutrition; poor continence management—and I understand something like 75 to 80 per cent of residents in these centres have an incontinence problem; dehydration; patchy and fragmented palliative care; inadequate prevention and management of wounds, sometimes leading to septicaemia and even deaths; maggots in open wounds, as we've heard in this place many times; falls that have not been attended to and ultimately lead to death; overprescribing without consent of sedative drugs and physical restraints; inadequate allied health support; and then we have the figure of some 50 sexual assaults each week being reported. Those stats alone highlight the woeful state of the aged-care sector in this country. In a very recent report, only one in four aged-care clients of home and residential care believed that their care needs were always being met—one in four. Those figures alone should be of concern to this government.

Why are there these problems? It's because the sector is underfunded, there are inadequate staff within the sector—often insufficiently trained—and the sector is essentially driven by profit. Since 1997, when the laws were changed, the sector has become one where profit now seems to be the motivator for many of the people within the sector. While the government provides some $25 billion in funding, and that represents about 80 per cent of all of the funding that goes into the sector, the reality is that a good deal of the operators—something like 41 per cent of the operators, and that doesn't mean 41 per cent of the beds but 41 per cent of the operators—are private operators who clearly put profit before service.

The issue with this legislation, as others have highlighted, is that some of the smaller and regional providers might find it more difficult as a result of getting payments in arrears, and that is a genuine concern. And for the regional and smaller operators—again, this was made very clear to the parliamentary committee's inquiry—it is much more difficult to remain as viable operators. My concern about all that is that if viability goes out the window for them, then people in country and regional Australia will be left without any service whatsoever, unless the government steps in and provides additional support to those smaller operators. That's not where the private operators want to go, because they can't make profit out there. But the people out there need the aged-care services, just as they do right across Australia.

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