Wednesday, 9 December 2020
Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 2) Bill 2020; Second Reading
The Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 2) Bill 2020 changes the administrative arrangements for paying home-care subsidy to approved providers of home care. This is the government's second phase of home-care payment arrangements. This is of course something that Labor has been calling on the government to deal with for some time. The first bill changed the payment of home-care subsidy to approved providers from being paid in advance to being paid in arrears. This bill changes it so that home-care providers will only be paid the subsidy for the care and services delivered to a home-care recipient during a month, with Services Australia retaining any unspent subsidy the home-care recipient is eligible to receive each month. This means that we are going from paying in arrears to paying after services have been delivered, on a month-by-month basis. We saw with the NDIS that, when this was first established, the government payment process was very, very slow, so we're hoping that the government has now fixed that.
The bill will also introduce a mechanism whereby providers who elect to return current unspent funds that are held by them for home-care recipients start to do so within six months of the bill coming into effect. It should provide better transparency for the overall use of home-care funds. Providers who elect to return unspent funds will do this through a subsidy reduction until their unspent funds are exhausted. Any unspent subsidy withheld as a result of this bill will be available to the provider to draw down on behalf of a home-care recipient as care and services are provided into the future. There is no change to older Australians' access to their full subsidy and there is no change to the treatment of current consumer contributions as part of this bill. I understand that in the lead-up to the introduction of this bill the minister sought the advice of the Aged Care Financing Authority, and I understand the government is expecting to implement these changes by September 2021.
Labor does have some concerns about this bill. We will be supporting it, but I want to take time to put some of those concerns on the record. Firstly, there have been growing concerns around the increasing amount of unspent home-care funds that are currently held by approved providers around the country. These unspent funds are a combination of Commonwealth subsidy and the consumer contributions being held by providers. According to the Aged Care Financing Authority, there was $751 million of unspent funds as at 30 June 2019. This is an increase of 39 per cent from the $539 million that was held as at 30 June 2018. Based on the rate at which unspent funds are increasing, ACFA estimates that the current amount of unspent funds for home care sitting with providers is over $1 billion. This is money that could be available to help those 100,000 older Australians on the home-care waiting list.
There are, of course, legitimate reasons why some people may have unspent funds. They may be saving for aids and equipment, or they may be saving for times of respite. But to have nearly $1 billion sitting there, and for the government to take so long to respond and so long to get these bills through parliament, is completely unacceptable. According to the aged-care accountants StewartBrown, the average amount of unspent funds per client is approximately $7,000.
With this bill, there's also a risk that some smaller service providers, particularly those in regional, rural and remote areas, will not have adequate cash flows to deal with the payment changes and will be unable to hold unspent funds. We have sought some assurances from the government that support will be provided, particularly in those areas where there are smaller markets and the providers do not have the cash available. ACFA says some service providers may have to revert to finding other financing arrangements, including loans or some form of equity injection, to deal with this transition. The government needs to be careful about this transition phase, and it will be held accountable by us if any of the smaller providers fall over because the government did not do its job.
We know the government has not done its job when it comes to home care and the waiting list. We know that the interim report of the royal commission's very first recommendation was for the government to deal with the home-care waiting list of over 100,000 older Australians. We know that 30,000 older Australians died without the care that they had been approved for. We know that 30,000 other older Australians went into residential care when they wanted to stay at home, but they couldn't because they couldn't get a home-care package.
It is completely outrageous that the government continues its inaction on the home-care waiting list when it was the No. 1 priority from the report that it commissioned called Neglect. Neglectthat was the title of the report. The government needs to do more. The government should be doing more, and the government needs to own up to the fact it has not done enough with the home-care waiting list. It's simply not good enough to have 100,000 older Australians continuously—for two years—sitting on a waiting list, to have the Productivity Commission say, 'The median wait time for the highest level of care is almost three years.' Almost three years! Imagine being in your 90s, with a terminal illness, being told you have to wait three years for a home-care package!
To have the Prime Minister in this place in recent days saying how great it is that he keeps making all these announcements about home care—the reality for older Australians and their families on the ground is completely different! They are being offered inadequate packages, they're having to wait forever for them and they're not getting the care they need when they need it.
The government needs to listen to its own royal commission. It needs to do something about the home-care waiting list as a matter of priority. It cannot wait until the final report in February. MYEFO is due next week. The government needs to do something about the home-care waiting list, because older Australians and their families have had enough. They're tired. They're tired of having to care for their elderly parents. They're tired of what has been an incredibly difficult year. We've got more Australians who want to get home care. They're frightened to go into residential care because of the debacle of this government over what happened in residential aged care, particularly in New South Wales and Victoria, in those facilities where people didn't have access to PPE; where people didn't have infection control training; and where the staff are overworked, underpaid and under-resourced. The government didn't do enough on that, and what they did do they didn't do soon enough. The government's not doing enough on home-care packages, and it didn't do enough. It needs to do more on all fronts. Frankly, everybody knows this government has failed older Australians when it comes to aged-care services. They need to do more. I move:
That all words after "That" be omitted with a view to substituting the following words:
whilst not declining to give the bill a second reading, the House notes:
(1) the government's inaction to reform the National Prioritisation Queue;
(2) for the past two years there have consistently been more than 100,000 older Australians waiting for their approved home care package;
(3) in three years more than 30,000 older Australians have died waiting for their approved home care package; and
(4) in two years more than 32,000 older Australians have entered residential aged care prematurely because they could not access their approved home care package.