Andrew Wilkie (Clark, Independent) Share this | Hansard source

The community obviously wants a choice for older Australians. Older Australians want choice. They want to have the choice to grow old and even to die at home. We need to give them that choice. That's certainly what my community is saying to me. It is what older Australians are saying to me. It is my own lived experience.

If you'll excuse me for being a little indulgent, Mr Deputy Speaker Zimmerman, I'll recount my own family's circumstances. First my father and then my mother both desperately wanted to grow old at home. They both did grow old at home exactly as they wished. In fact, they both died in the family home, as they wanted. I certainly got to see, firsthand, the importance of giving people that choice and making it work. I would have thought, too, that my honourable colleagues would see the sense in compassionate policies and that the bean counters would see the sense of allowing people to stay at home for as long as possible, if only to ease the pressure on the residential aged-care system. Having said all of that, I find it unfathomable that governments haven't really been fair dinkum about funding home-care adequately.

I fear that in many ways a number of governments have paid lip-service to it over the years, because, how else do you explain the fact that there are currently more people waiting for home-care packages than there are people receiving home-care packages? Clearly we are not taking it seriously enough. Clearly, governments are not funding it adequately. I think it goes back to the whole funding model. It should be demand driven. It should not be budget capped. It shouldn't be the case that someone who is waiting for a home-care package literally has to wait for someone to go into residential aged-care or to die. What sort of policy is that? What sort of funding model is that? There are people waiting for other people to die before they can get the home-care package they need to continue to live at home with dignity. As the member for Indi recounted, there are people who are being effectively forced into residential care, because they can't get the home care they need. That's another reason why the residential care system is under so much pressure and performing so badly.

What governments need to do is get fair dinkum about this and fund it properly. Yes, by some estimates it will cost maybe a couple of billion dollars extra a year to come up with the 100,000 or so extra home-care packages, but surely we can afford that? Surely it's all about priorities.

At the risk of sounding like a broken record in this place, can I just remind my colleagues, the government and the minister that we're a fabulously wealthy country. We can afford to look after our very young with adequate early childhood education. We can afford to look after people with a disability properly. We can afford to look after people who are relying on the aged-care pension properly. We can afford to look after people properly in their home with home-care packages. We can afford to look after people who go into residential aged care. By examining figures that have already been provided by the federal Department of Health, I see that we might need $2 billion to $2½ billion extra to go into home-care packages to fill the very severe shortfall. Well, we are the 11th richest country in the world measured by GDP. We are the second wealthiest people on the planet when compared by median wealth per adult, second only to the Swiss. If there's a country in the world that can get rid of this shocking situation where people are waiting years for a home-care package, surely we're the one country in the world that can achieve that. Not only do we need to find the money to do this right so that people genuinely have the option of staying at home, being well looked after, living with dignity and staying out of residential aged care for as long as possible, or perhaps forever—not only do we need to look at that, but we also need to look at the design within the system.

I have been saying to governments for years that the way the service providers structure their fees for people benefiting from home-care packages needs to be seriously looked at. It just beggars belief that it is not unusual for service providers to be taking 30, 40, 50 per cent—I've even seen one example of 70 per cent—of the budget for that home-care package, stripping it out in fees. That is just ridiculous. I can't explain it. There is no way to explain it. A cynical observer would say it's mismanagement, inefficiency, gouging or I don't know what. How on earth a home-care service provider can routinely take half of the government's package in fees is just beyond bizarre. I'll give you a case study. I'll use his first name, Les; he's a lovely fellow in my electorate. Les is being billed $483 a month for 'case management'. What is case management? How does it cost $483 a month? At $40 an hour, that's 12 hours. That's just absurd. That's an hour on the majority of the working days of the month. Les is also being billed for 10 hours travel for service provider personnel within a 31-day month, and he lives in the middle of Hobart! Les lives in the middle of Hobart, and the service provider is billing him—in other words, taking it out of the government's package—for 10 hours of travel a month. That needs to be looked at.

I've raised these issues with governments for years. I was assured by the government several years ago that when home-care packages went to consumer directed care the market would work it out. I was told that, when consumers could choose their service providers for home-care packages, they would shop around and it would force service providers to become leaner and more efficient and to bring all of these management and other fees down. But that just hasn't happened. Frankly, I think we should all have known that this would be the case, because a lot of people aren't able to shop around. That can be for 101 different reasons. Let's say you're a person of faith; you'll probably just default to a service provider of that faith. There's nothing wrong with that; it's understandable. But it does tend to debunk the whole idea of consumers shopping around and forcing service providers to improve their service and lower their fees and for the consumer to be better off. This is a particular issue in Tasmania. Much of Tasmania is what you might describe as a thin and regional market. If you're in a small town, you might be lucky to have one service provider. You're not going to shop around. The service provider has a monopoly. They'll charge 50, 60 or 70 per cent in fees. Chances are if someone is on a package of $50,000, the service provider will pocket $25,000. If for whatever reason the consumer doesn't have access to everything they might need or want, or even be aware of it, they might end up buying $15,000 of home care, effectively, with a $50,000 package. That's an extreme example, but it's not an unbelievable example. Frankly, I think the whole idea of consumer directed care fixing problems in the industry—and it is an industry—is proven to be misplaced.

I'll tell you something I've learnt from my own lived experience of my mum and dad growing old and dying at home and their wishes being fulfilled. They were both in receipt of home-care packages, and they were very grateful for those home-care packages. They were lucky to have home-care packages. They didn't have to wait years like some consumers do. But they were ultimately only able to grow old at home like they wanted because my sister, a nurse, gave up nursing for a decade to be their carer.

As we talk about home-care packages, I think we need to also be talking about carers, because—let's face it—home-care packages can't meet all of the needs, and often carers, who are most often family members, are giving up their livelihoods, their professions and their social lives. They are staying at home and helping out with their mum, dad, brother, sister, son or daughter. I got to see first hand how a very talented senior nurse gave up nursing for a decade. It was obviously to the detriment of the community that that person wasn't able to work, at Tamworth Base Hospital in this case. But also it meant that that person didn't have a regular income for a decade, couldn't accumulate super for a decade and lived on quite a paltry carer's payment.

I think we as a country should have a different approach to carers. I don't think we should see them as people on welfare from Centrelink. I think we should see them as public servants or members of the community doing a genuine public service. I don't even think Centrelink should pay carers. I think they should be paid what we might characterise as a wage, have access to necessary things like workers' compensation and even be paid super. That is a fairly bold idea, but I think that would elevate carers to their correct position or status in all of this. They are not people on welfare. They are people who are working, and they are saving the government a fortune. They are saving the government billions of dollars. They are ensuring, too, that the loved one in care is in the most loving environment and not stuck in some ordinary residential aged-care facility where the long-suffering, overworked and underpaid staff might have eight minutes in the morning to get the resident sorted, help them wash, have their breakfast and whatnot. I think carers are among the unsung heroes of the country. They are actually a critical component of the home-care system, and I think we should treat them as such. They save the government a fortune. Why don't we compensate them a little better? If we do nothing else, let's pay them super. I think that would be a really positive start.

Let's not forget there is a gender dimension to this. Those carers are most often females, who are already behind the eight ball when it comes to their professional development and progression and their super balance. That is another reason to look carefully at this.

This is a desperately serious matter. The fact is that we are very short of home-care packages and the government needs to find the money to meet that need. It is not a case of 6,000 more packages one month and 20,000 more packages at another time, because we would just be putting bandaids on the problem. We need 100,000. We need an approach to funding which is demand driven. We as politicians, as leaders in the community, need to be able to look our older Australians in the eye and say: 'We guarantee that we will look after you as you age. We guarantee that, if you choose to live at home, you will get all of the support you need and you will get it within months of applying. We guarantee that if you decide to or need to go into residential care that that residential care facility will be world's best practice and absolutely first-class. It will be safe, it will be comfortable and it will be loving. Your meals will be just like you used to get at home.'

We can afford to do all this. We are a fabulously rich country. It is all about priorities. We seem to have thousands of priorities, but what really matters? I would have said it is our very young people, our very old people and people with a disability—disadvantaged members of the community. I think that is what really matters. All of us here can look after ourselves. But there are an awful lot of people out there who need help from us, and it is our duty to help them. I am very grateful for this time tonight, because this is such an important issue.

Debate interrupted.

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