Monday, 21 June 2021
Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021; Second Reading
I am not alone in this place in being someone who has experienced having a parent in residential aged care. My wonderful father, Jack, spent the last couple of weeks of his life receiving beautiful, high-quality palliative care in a residential aged-care facility in the town where he had spent most of his life. High-quality care should not be the exception to the rule; it should just be the rule. The Aged Care and Other Legislation Amendment (Royal Commission Response No. 1) Bill 2021 is a first step in making some rules that will enable higher-quality aged care, because high-quality aged care must extend to everyone. One of my attempts at ensuring that this could happen again in my own community was to take up a position as volunteer director for an aged-care facility, and I did my best to make sure that we could deliver the highest-quality care to people in our facility.
This bill introduces restrictive practices limitations. Restrictive practices include chemical and physical restraint, and environmental restraint such as seclusion. It clarifies the definition of 'restrictive practices' so that this mirrors the much better NDIS definition, and it will expand the Aged Care Quality and Safety Commissioner's ability to respond to breaches, issue written notices and make applications of civil penalty. This is a good place to start in aged-care reform, because we have all seen the heartbreaking testimony of the royal commission and we all have images of what it looks like to see an older person strapped to a chair, either with ties or with a table clicked into place, or, indeed, restricted in their movement due to the use of sedative drugs. It's an awful sight and one that I never welcome seeing. I know it shocks many people when they see it, but the question here is: why would this be happening in the first place? Why would restraint ever be used, and what consent would be required if it were determined to be the only remedy, the last resort, to guarantee a person's safety?
We know that behavioural and psychological symptoms of dementia, known in the trade as BPSD, are a very challenging aspect of aged care. In Australia around 60 to 80 per cent of all residents in aged-care facilities have a cognitive impairment related to dementia. We know that the rates of dementia are rising. The associated behavioural and psychological disorders associated with dementia frequently result in the prescription of antipsychotic drugs and the use of these other forms of restraint. Person-centred care approaches to the management of behavioural and psychological symptoms of dementia has not been widely implemented, despite their reported effectiveness, and the barriers to the use of the non-pharmacological strategies need way more research. We need an evidence base that tells us what's stopping this happening in residential aged care. But what evidence we do have tells us of the positive impact of a person-centred approach, with skilled staff utilising, for example, music therapy, exercise and story work, ensuring that medical issues such as urinary tract infections and unmitigated pain receive rapid diagnosis and treatment and ensuring that issues like polypharmacy are addressed.
But at the core of this are staffing issues that preclude 24-hour access to registered nurses. We need to see all staff, including our personal care assistants, trained in behavioural management and we need to have access to experts in aged care, such as older persons nurse practitioners and mental health clinicians. Nurse practitioners are an incredible resource that could be mobilised across our aged-care sector if the policy levers were shifted to allow them to operate in a way that they could. Their access to Medicare items needs addressing urgently, and I call on the government to work closely with the College of Nurse Practitioners to get this happening. I know the Minister for Health has an interest in this area. So I encourage him to really get going on this.
I have seen the job satisfaction and joy that aged-care workers experience when they are resourced in a way that allows them to give high-quality care and when they are resourced in a way that makes the use of restraint truly one of last resort and only implemented with full and informed consent—the last resort rather than the go-to. We must not see restraint as a default mechanism to compensate for inadequate staffing levels. So many aged-care workers do incredible work, with great love and care, and this bill is one small step to alleviate decisions of desperation—decisions that are made because of constraints, of there not being enough people on the floor. There are roughly 1,650 people living in residential aged care in Indi, and I want this bill to ensure that there should never be an instance when anyone visiting a loved one sees that loved one restrained without full knowledge and consent. Informed consent is key to the contract of trust that a provider enters into with a resident and their family. We need good, functional decision aids to assist staff and carers to give informed consent.
The second part of this bill is around home-care assurance reviews. I have advocated for greater numbers of aged-care packages from the very first day, my very first speech in this House. It's crucial. It's what people want. I have been encouraged by the government's funding of additional aged-care packages in the last budget. And, of course, I call on them to keep going with that and to make sure that they cut that 100,000 people waitlist right back—well, completely, really. When we are paying good taxpayer money for aged-care services in the home, we want to see the highest-quality services that we can get. We want value for money and we want to see the right services delivered at the right time in the right place. We don't want to see packages eaten up by administrative fees or travel. We want to see adequate services in local areas close to where people live. I think the home-care assurance review is one step to making sure that that happens.
In Indi, over the last quarter, in 2020, 167 new people received a package. What I have been concerned about is what kind of packages they receive. We know that some people approved for high-level packages still remain on waitlists and are receiving lower-level packages. Again, I hope this bill goes towards improving the overall efficacy of the rollout of home-care packages, because we know that, when a person does not receive a home-care package at the level they need, it forces their hand to enter residential aged care much earlier than they otherwise would have. If, for example you live somewhere like Bright or Myrtleford, in the beautiful Alpine Valley region, there are very few residential beds available. There is no high-care aged-care facility in Bright at all. So, instead, we have people with high-care needs making the heartbreaking decision to move away from their homes to receive adequate care.
They move into the bigger regional centres such as Wodonga, Wangaratta or Benalla. For some people who have spent their entire life in a beautiful little alpine village, this may as well be another planet. For their relatives, often elderly, having to make the trek to that other town is extremely difficult and heartbreaking. For some people, in winter, travelling from Bright through snow-covered mountains across to Mount Beauty is a trip they simply can't do. This often means that husbands and wives are separated, and that's a decision that no family should ever have to make. No longer can anyone just drop in on their way past to fit in with sports and school. A trip to see grandma or grandpa can be an hour and a half's drive away. For ageing friends with mobility issues, it's even harder to keep close.
The need for a high-care residential facility in Bright isn't new. This issue has been raging since the 1980s. That they are still waiting for a solution 30 years on tells its own story of intergenerational neglect of our older people in regional Australia by this government and successive governments. Bright needs better aged care so that our older community members can age in the place where they've raised their families and lived and contributed their whole lives. Luckily, though, we are united on a solution. We need a new 35- to 40-bed high-care facility run by Alpine Health and co-funded by state and federal governments. Alpine Health is now looking for money to have their master plan for redevelopment funded. This is the first step. The master plan and the feasibility study from 2015 identified the full redevelopment of the hospital, including the provision for aged care, with some extension into the vacant hospital block.
The master plan redevelopment was left out of the federal and state budgets. For the life of me, in an environment in which we are really promoting high-quality aged care, I don't understand why. But, in my conversations with ministers from both governments, they say they're happy to come to the table and work together to find a way forward to support aged care for people in Bright. I had a really constructive meeting with Mr Coulton, the Minister for Regional Health, Regional Communications and Local Government, who is very sympathetic to the situation. Like me, he knows rural communities right to his bones. We do share the experience of parents in aged care in our small rural towns. He sees a pathway forward to work with all parties to get the aged care this community needs, and I will continue to work with him and his office as we move this forward. A few weeks back I met with Mark Barnes and Cathy Eldred from the Bright Hospital redevelopment committee who have worked tirelessly for over a decade to get high-level aged care in Bright. I visited Alpine Health several times and met with residents and the CEO, Nick Shaw, on this proposal. I know that this is possible, and I know they have all the skills they need to make this happen.
Aged-care reform happens on a national level, like this bill, but change happens at the facility level—at the place and at the moment that people decide to enter residential aged care. I want to see state-of-the-art residential aged-care facilities in Bright. I want to see high-quality aged-care practices wherever people are, and that's where reforms in this legislation should play out. So, today, I call on the ministers and those holding the pen. We need more than platitudes. In places like Bright and in the alpine region, the need couldn't be any more clear. Follow up on the broad-reaching reforms in this bill with something we can see on the ground. I really look forward to working with the committee of Alpine Health and the federal and state governments to get this done.
This is a good bill, and I commend it to the House. I do, though, also support the member for Mayo in her call for a parliamentary committee to oversee the recommendations of the royal commission. This is one of the most important and one of the biggest reforms our nation will see. We have to get it right. We will all be judged by this. We must get it right.