Wednesday, 7 September 2022
Aged Care Amendment (Implementing Care Reform) Bill 2022; Second Reading
I rise to speak on the Aged Care Amendment (Implementing Care Reform) Bill 2022. I support the aims of this bill and believe that it shows the crossbench continues to be an engine room for key reforms. That is because the measures in this bill mirror two private members' bills which I introduced in the previous parliament and another measure for which I strongly advocated. However, unlike my bills, this bill places an overreliance on subordinate legislation with key—indeed, almost all—details of the measures not yet known because they will be comprised in subordinate principles under the Aged Care Act.
Based on the bill before us, members will be denied any opportunity to debate the devil in this detail. I know very well that many of these provisions could be included in the primary legislation, because I have previously introduced private members' bills that did precisely that. That is why I will move a second reading amendment, which has been circulated in my name, to the amendment moved by the member for Farrer. I move:
That all words after "whilst" be omitted with a view to substituting the following words:
(1) has concerns that the bulk of the substantive measures comprising the bill are to be detailed in subordinate rather than in primary legislation; and
(2) calls on the Government to
(a) provide an opportunity to review the Quality of Care Principles, User Rights Principles and Information Principles proposed to be made under the Aged Care Act 1997;
(b) include in the Quality of Care Principles under Schedule 2 criteria for the exercise of exemption powers which provide for smaller and regional providers taking into account critical workforce shortages among other considerations; and
(c) specify in Information Principles under Schedule 3 financial and non-financial information of value to older Australians, their families and the community that must be published by the Secretary, including:
(i) expenditure on care, nursing, food, maintenance, cleaning and administration;
(iii) payments such as rent to third parties; and
(iv) expenditure on executive salaries".
I call on the government to provide parliamentarians with an opportunity to review these subordinate principles. It is my view that I deserve, and that every other member in this place deserves, the opportunity to properly represent our constituents and ensure that changes to the age-care system are to the benefit of all older Australians.
My second reading amendment also calls on the government to take into account in those subordinate principles that smaller and regional residential aged-care providers which are experiencing critical workforce shortages have flexibility. Many terrific smaller regional providers are already reporting struggles with workforce shortages and, indeed, just to break even. They are really struggling due to the ongoing management of COVID. So I would like to see some recognition by the government that additional funding and support are needed to ensure the regional facilities where older Australians live and where they want to go into care in their communities so that they can continue to age in place.
My second reading amendment also sets out to be inclusive, not exclusive: a list of matters which I believe should be published by the secretary, including executive salaries and such as payments to third parties. This is so that we can avoid, for example, a provider paying well above the market rent to an affiliated third party, and we have seen instances of that. In addition, my substantive amendment to the bill, again, that has been circulated in my name, addresses the risk that the imposition of a cap on administration and management fees for home services doesn't result in gold plating of fees and services or of equipment in other areas—essentially, cost- or profit-shifting.
My constituents tell me that providers have required them to obtain costly occupational therapist reports to secure equipment such as a basic shower chair and, in one case, a hanging basket for the shower, just to contain soap bottles. While such assessments are probably advisable for high-value items, they can cost up to $700 out of a package in a month, only for people to be told that, really, they just need a very simple piece of equipment. Other constituents have been forced to use expensive third-party providers, paying a 10 per cent premium to their aged-care provider for the privilege, or prevented from purchasing identical items, such as hospital beds or showering chairs, which are available more cheaply elsewhere.
When contacting the Aged Care Quality and Safety Commission, my team has been told that these are matters for providers. So anything that we can do in this place to prevent rorting and to prevent gold plating should be pursued here. I therefore urge members—the government, the opposition and of course my fellow crossbenchers—to support these amendments.
To the bill itself: schedule 1 amends the Aged Care Act to require approved residential and flexible-care providers to have at least one registered nurse on duty in residential aged-care facilities at all times. This is consistent with aged-care amendments secured by former senators Stirling Griff and Rex Patrick, for South Australia, in the other place in the last parliament. I advocated for the amended bill in question to be brought back to this place on budget reply day, and I was disappointed that it lapsed with the proroguing of the parliament and wasn't brought on for debate, unlike other amendments that tend to come down from the Senate.
While it's pleasing to see that this measure progressed, I'm concerned that the details of exemptions with respect to the quality-of-care principles made under the act will be absent from parliamentary scrutiny and debate in this place because it's all going to sit in subordinate legislation. These examples will be of immense importance to smaller regional providers in electorates such as mine which are already reporting huge challenges with respect to critical workforce shortages. The risk we run is: if appropriate exemption criteria is not set, smaller regional providers may be forced to close. This could leave regional residents unable to access care in their communities close to friends, close to family, close to where they know and where they grow up—their homes.
The idea that the exemption provisions will be buried in subordinate legislation really does concern me. As the Law Council has pointed out, the primary legislation should identify the decision-maker, prescribe the circumstances in which exemptions should be granted and provide that exemptions can only be granted if safe, quality care can otherwise be ensured. The Law Council also submitted that the bill should set out a mechanism for merits review of exemption provisions. I therefore urge the minister and the department to listen to older people, particularly those in the regions, and to their families, providers and advocates, including their elected representatives, when establishing these exemption provisions.
Schedule 2 of the bill introduces a cap for home-care administration and management charges from 1 January and to ban exit fees for people wishing to change home-care providers. This is an excellent measure but we need to make sure that we get it right. On 25 October last year I introduced my Aged Care Amendment (Making Aged Care Fees Fairer) Bill. My aim was to improve transparency for charges for aged care at home to ensure that home-care fees would be spent on home care rather than on administration management fees, and, I also put in that bill, to ban exit fees. I really do welcome this move by the government. The genesis of my bill was through surveying more than 15,000 residents in Mayo aged over 75. We had more than 1,200 people respond, half of whom said they were really unhappy with their administration and management fees. We saw that respondents were reported paying administration management fees of up to 48 per cent of their package; that would be month on month, even when there was absolutely no change at all to their package. Capping these fees, I think, will make a real difference. We need to make sure, though, that profits and charges are not then transferred to other areas.
At the time when I introduced my bill, it set a cap of 25 per cent on lower-value packages and 20 per cent on higher-value packages which could be charged for administration or care or package management, clearly defined to prevent fees being hidden elsewhere. Following the introduction of that bill I was overwhelmed by the number of older Australians from right across Australia who made contact with me, expressing their support. We know capping fee provisions can be imposed through primary legislation because that's what I did in my private member's bill, so I don't understand why we are not seeing this in this bill here before the House.
Schedule 3 of the bill amends the Aged Care Act to allow for subordinate information principles to specify information about providers and their services that the secretary must publish. The government states that information to be published may include certain financial information, profits, expenditure on care, nursing, food, maintenance, cleaning, administration and non-financial information. But the bill does not provide this detail at all, and I would prefer to see the publication requirements included in the primary legislation and extended beyond the information proposed by the government to include executive salaries and rents. We know that there have been cases where more than double the commercial rent has been charged to an aged-care facility that sits on land owned by other parties. We need to make sure that that sort of gouging stops.
My Aged Care Legislation Amendment (Financial Transparency) Bill 2020, introduced on 19 October 2020, also required residential aged-care providers to disclose their income, food costs, medication, staff, staff training, accommodation and administration moneys paid to parent bodies each year, and to include financial information in annual financial statements. Aged-care providers have this information; it's just a case of disclosing it to the public. That needs to be as transparent as possible for families and for those who are entering aged care. The fact that these requirements were specified in my private member's bill means that the government, with its considerably greater resources than what a crossbencher has—including departmental resources—could specify these requirements in primary legislation if it chose to do so.
So, while I do feel a sense of relief that older members of our community will finally benefit from these practical measures to improve aged care, my gratitude is tempered by the lack of transparency provided in the legislative process, through over-reliance on the use of subordinate legislation. This is my third parliament, and I have heard other members in this place complain bitterly when we saw huge swathes of decision-making put in subordinate legislation, essentially at the discretion of the minister. I am always of the view that there is much to be decided on through debate in this chamber by all of us, not through the pen of the minister.
I thank the government for processing these long-awaited reforms. I do commend this bill, and I seek support for my substantive amendment to the bill and for my second reading amendment, which I have already detailed. We need to ensure that there is prompt implementation in order to make a difference for older Australians living in residential aged care and older Australians who are in receipt of, or desperately seeking, a home-care package.