Kelly Hoare (Charlton, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Aged Care Amendment (Security and Protection) Bill 2007. This bill proposes to introduce new compulsory reporting arrangements with requirements for aged-care providers to report suspected and alleged sexual abuse and serious physical assault of residents. It will require providers to ensure there are internal processes in place for the reporting, by staff, of all incidents of suspected or alleged sexual or serious physical assault and that the identity of staff who report is protected and that staff who report are not unfairly treated as a result of making a report. It will give the Department of Health and Ageing greater capacity to investigate complaints and to require aged-care providers to correct failures to meet their responsibilities. A new Office of Aged Care Quality and Compliance within the department will be responsible for this.

The bill also proposes to replace the current Commissioner for Complaints with a new Aged Care Commissioner to provide an independent mechanism to hear complaints about how the department has responded to complaints and about the conduct of the Aged Care Standards and Accreditation Agency and its assessors. The Aged Care Commissioner will also have the capacity to initiate its own reviews.

Labor will be supporting this bill. This bill highlights the need for better protection of older Australians who are placed in aged-care facilities. In the last couple of weeks I have been contacted by two constituents who have raised serious concerns in relation to two aged-care facilities in my electorate. I know that many members will have been touched by similar examples of poor treatment of vulnerable people in aged-care facilities.

In the first instance a constituent has, quite rightly, expressed anger and frustration at the treatment her elderly father has received. This gentleman has moderate to severe Alzheimer’s disease and requires total care. He cannot communicate and is restricted to a wheelchair. His condition requires that he be restrained by a seatbelt so he does not slip from his wheelchair. On Sunday, 28 January this year his family received a telephone call stating that this elderly man had fallen from his commode chair. The injuries sustained to his face were severe and required stitches. After being transported by ambulance to Belmont Hospital, the man and his distressed wife were forced to endure a nine-hour wait before he received medical treatment. For the duration of his time at the hospital his incontinence pad was not changed. He became dehydrated. He was not treated with the due concern and respect all elderly Australians should receive as a matter of course.

Unfortunately for this particular family, other concerns for this older Australian remain a matter of daily concern. The wife of this gentleman is obliged to visit her husband at the aged-care facility twice a day to ensure he is fed and receives an appropriate level of fluids. The stress and burden of this daily routine are untenable. The family reports that staff shortages at this aged-care facility are such that patients, including my constituent’s father, are not out of their beds before 11 am. Often patients are still in their beds at lunchtime and sometimes they are returned to their beds in the early afternoon.

My constituent is also devastated to visit her father only to find him frequently unshaven and unwashed. She reports that on occasion she has found him still seated in his wheelchair with pools of urine under his chair. My constituent feels that, unless a family member is present, it is ‘in the lap of the gods’ as to whether her father gets fed or not. She expresses outrage that she has seen many other patients being totally ignored at meal times.

Another constituent has contacted me this week in relation to similar concerns involving a different aged-care facility. Again the concerns relate to her father, an 81-year-old man who has encountered an indifferent and struggling aged-care system. This gentleman took up residence in a facility in August 2006. On 5 October 2006 he was admitted to the Newcastle Mater Misericordiae Hospital suffering from bedsores, which were so severe he remained hospitalised for approximately 15 weeks. My constituent claims that her father was clearly an at-risk patient, susceptible to bedsores. She claims that the severity of his lesions is indicative of poor patient management. Three weeks ago this elderly man was discharged from the Mater and returned to the aged-care facility. Incredibly, staff were unable to catheterise him and the procedure had to be undertaken at John Hunter Hospital.

On 5 February 2007, my constituent was contacted by the director of nursing and informed that her father was unwell. She was assured her father was being cared for and told not to worry. My constituent felt uncomfortable with this and immediately visited her father. She found him alone and in a weakened state. On insisting her father receive immediate medical attention, she was told a doctor had been called. Ultimately an ambulance was required and her father was taken, under lights and sirens, to John Hunter Hospital, where a severe urinary and blood infection was diagnosed. My constituent is refusing to return her father to this aged-care facility and will instead be placing him at another facility, probably some distance away from her home. My constituent is gravely concerned that staff shortages, staff inexperience and poor quality care combined to place her father at risk during his time in residence at this aged-care facility.

Access to quality aged-care services should be an inalienable right of all elderly Australians. The failure of the system to provide appropriate services can be resolved if we commit ourselves to demanding the very best for older Australians. We need to set a benchmark of accessibility and excellence that is not corrupted by income or postcode. We need to ensure that once in an aged-care facility each and every older Australian is accorded respect and the right to personal safety, appropriate medical intervention and the right to protest if their treatment is anything less than satisfactory.

The Health Services Union has detailed horror stories in relation to substandard aged care. HSU National Secretary Craig Thomson has reported that one facility was found by government inspectors to be so short of care staff that there had been no time to document or analyse problems among residents, including incontinence, skin tears, pressure sores and scabies outbreaks. In 2004, the Health Services Union reported almost 1,000 complaints had been made about aged-care facilities in the previous financial year, which were an indicator of the scale of the problems in the industry.

Training staff is imperative to securing quality care. Stakeholders in the aged-care sector consistently affirm that staffing numbers and the level of training afforded to staff are sound indicators as to the quality of a service. To attract committed and competent aged-care staff it is essential to provide them with sufficient training and remuneration. By training staff in the knowledge and awareness of elder abuse, we are empowering not only them but their patients. By recognising the special skills needed to manage and develop rapport with elderly clients, we also empower staff to report any issues that may negatively affect clients. The HSU reports:

Widespread staff shortages are severely affecting the care of elderly residents in aged care with clear evidence they do not get adequate treatment or therapy and face a much greater risk of violence and assault.

The HSU outlined details and examples of serious issues and concerns relating to employment in the aged-care sector in a submission to the 2004 Senate inquiry into aged care. The issues canvassed included: employers escaping proper scrutiny by making major changes to staff numbers, care plans and records in the days before an inspection takes place by the Aged Care Standards and Accreditation Agency; inadequate care in facilities without sufficient staff, with residents more likely to be injured or assaulted, not given the proper care or therapy, left in bed until after lunch or showered at 5 am; increasing assaults, with staff regularly left alone with little or no training to care for more than 50 residents; care staff forced to spend most of their shifts cleaning and doing laundry; nurses and care staff avoiding the industry because of the terrible pay and conditions; and employers taking advantage of a lack of regulation of the industry to cut spending on staffing and care levels.

While Labor welcomes the government’s announcement of $1.5 billion in funding for aged care over five years, there is no denying that this sector has been in crisis for many years. The government’s failure to resolve critical and longstanding problems in the sector is reprehensible. Its ability to ignore the pleas of stakeholders over an extended period of time underscores its absolute lack of compassion and foresight at a time when Australia faces an ageing population base. Let us make this very clear: the current aged-care funding mess was created by the Howard government in 1997. When then Minister Bronwyn Bishop planned to introduce a bond for all residents in aged care, the voter backlash saw the government back down. As a result we have a system filled with problems and shortfalls that have never been properly resolved.

In 10 years the Howard government has failed to cultivate a reputable and proficient aged-care sector. Instead we have witnessed a serious decline in the numbers of aged-care beds available. We have heard horror stories outlining the degradation and humiliation of sundry elderly Australians in the very environments that are supposed to nurture and support them. When Labor left office in 1996 there was a surplus of 800 aged-care beds. Today we face a shortage of 5,000. That represents 5,000 men and women whose needs are not being met. It also represents many more families who are struggling to care for people they love and respect. While the measures announced in the government’s package will go some way to alleviating the distress and frustration that surrounds aged care in Australia, it will not resolve all the issues and will not alleviate all the concerns that abound in the community.

I would also like to briefly raise the distressing situation of placing young people in nursing homes. The Young People in Nursing Homes National Alliance reports:

... over 6,500 young people across Australia are forced to live in nursing homes because they have nowhere else to go ...

We need to recognise that the placement of young Australians with acquired disabilities and high or complex support needs is inappropriate and further compromises the service delivery within an aged-care facility. The vision of the national alliance is to see:

A well resourced long term care and support system that enables young disabled Australians with high or complex support needs to have age appropriate accommodation and support service options, including access to their communities, where and when required.

Finally, without addressing the issues of minimum staffing levels and minimum training levels and without ensuring the rigorous scrutiny of aged-care facilities, the problems I have addressed today will only continue.

Tony Windsor (New England, Independent) Share this | Link to this | Hansard source

There are a number of issues that I would like to raise in this second reading debate on the Aged Care Amendment (Security and Protection) Bill 2007. I will obviously support the legislation. The changes that were proposed last year are very worthy and build on what I see as a good attempt by the government to come to grips with aged-care issues. I know we can always do better, and that is the dilemma that governments have and the demand that people make, but I believe that in my time in this place the various ministers—Ministers Andrews through Julie Bishop and now Santoro—have attempted in the main to address the issues that are out there. This piece of legislation, particularly in securing the safety of our older Australians, is to be commended.

As members of parliament we have probably all seen circumstances in aged-care homes where the reporting of various incidents and complaints from residents or relatives of residents have left a little bit to be desired. Many people, particularly the relatives of residents, even though there has been a process in place—and I have been involved in the process a number of times and I thank the people in the department who have been involved in the process—from time to time feel as though the process has not served them terribly well. In some cases that may well be because of a fear of reporting alleged incidents through the complaints arrangements, or it may well be that the relatives feel there might be some form of retribution.

Some people feel from time to time that, when an inspection of an aged-care facility is asked for because people feel there might be some problems of cleanliness or whatever, there are warning signals sent out and then the aged-care facility is in tiptop shape when the inspection comes along. I am not saying that happens terribly often, but I think this legislation will assist to overcome some of those issues—hopefully in a much more transparent arrangement—so that residents who have genuine concerns about their future have a process in place, because it is a very trying time for many people to see their parents becoming older and having to be placed in an aged-care residence, particularly in high care. The Aged Care Commissioner that is mentioned in this bill and the various complaints arrangements and how they will be carried out I think are to be commended.

There are a number of other aged-care issues that I would like to raise while I have the opportunity—and I am pleased to see that the Assistant Minister for Health and Ageing is now in the chamber, because I know he has had an interest in the particular issue that I am about to raise: young people in nursing homes. I know the Australian government and the state governments have been engaged in a process looking at this issue concerning young people who have had accidents and are disabled to a certain extent being placed, in the main, in old people’s homes. I think we all recognise that is not appropriate accommodation. That is not a criticism of aged-care facilities. It is just that they are not the appropriate form of accommodation for young people who are likely to live for many decades. Obviously, there are a whole range of other issues that revolve around the needs of those young people in terms of their social outlets as well as their physical and care needs. I would encourage the government, particularly the new minister, to proceed as fast as they possibly can because there are 6,000 people out there who need some form of care and are classified as young people in nursing homes.

I know there is the normal banter between the states and Commonwealth as to what can be done over the funding arrangements, the red tape and the bureaucracy that has been put in place, but I think we have got to look a little bit past that and try to engage with these young people who really do require accommodation better than what we have been providing for them and their lifetime needs. I do not issue any criticism of anybody in relation to this. I think we are all aware of it and governments are attempting to come to grips with it. But I would urge some degree of pace and some degree of additional funding as well, because the funding packages that have been put out in recent years for discussion at the state and Commonwealth level have clearly been inadequate. They are a start to fixing the problem, but we will require much more, bearing in mind that, if specialist facilities are put in place for young people who are currently housed in nursing homes, that actually frees up a bed for an older person who may be waiting for accommodation in an aged-care facility.

Another of the issues that I want to raise concerns our smaller communities, and I know that the assistant minister, who is in the chamber, and the Minister for Agriculture, Fisheries and Forestry, who is at the table, are well aware of this issue—and I do not want to be too complimentary of the government as I might be struck down with some disorder! I refer to the multipurpose service arrangements issue. I have raised it before but I think it is worth raising it again, because consideration of the multipurpose service arrangements that have been put in place is an ongoing process. I again congratulate a former member for New England, Ian Sinclair, who did a lot of work on the process at the time to come up with a resolution to the problem of old people who were not sick being housed in small country hospitals. Obviously, there was a funding dilemma: if they were in a hospital the state should pay but if they were not sick they really should not have been in a hospital.

The way of overcoming that problem—through the Sinclair report, and an aged-care specialist in my region, Paul Cook, was involved in that particular report as well and I congratulate him and the others involved—was in fact to put in place what are called multipurpose services, or MPS. I think that is a dreadful name and that the services should be renamed, because I do not think it actually describes what they do. For those who do not know, the system is a combination of health services as we know them—hospital services—and aged-care services in smaller communities. The health side of the MPS is funded by the states, as are the hospitals, and the aged-care arrangements—the actual beds—are funded by the Commonwealth. This is a really good example of how you can actually achieve a very good outcome for smaller communities and do it so that there is some degree of cost-effectiveness: if the Commonwealth and the states concentrate their minds on the end result. I refer back to the young people in nursing homes issue; both the state and Commonwealth governments should be congratulated on that particular issue.

I will always remember a lady from a little place called Emmaville. Emmaville is not the biggest town in my electorate; I think there are only five, six or seven hundred people there, although it is within a surrounding rural area. Their hospital, which was called the Vegetable Creek hospital, was going to be closed down by the state government some years back because it was an old facility. Members of that community, particularly some ladies including one called Ellie Seagrave, did not want their hospital closed down because in a sense it was their health provider, their hospital, and also because many of the older people in the hospital were not sick but were using the hospital as an aged-care facility. Ellie Seagrave—or She Who Must Be Obeyed, as many people in the area referred to her—took on the state government at the time. It was at the particular time that the Sinclair report was being discussed and, to cut a long story short, Emmaville became one of the first MPSs. It has been an extraordinary success.

I went back to Emmaville about two years ago, I had a little meeting there and Ellie Seagrave said to me: ‘We need more beds. You’re the local member—go and get some more beds’—which one had to comply with of course.

Christopher Pyne (Sturt, Liberal Party, Assistant Minister for Health and Ageing) Share this | Link to this | Hansard source

Easier said than done.

Tony Windsor (New England, Independent) Share this | Link to this | Hansard source

Yes, but you can’t say that to Ellie Seagrave. I said, ‘But, Ellie, there are the formulas and everything’—because it had only been open a few years; I might be getting my years mixed up. ‘How many old people over 70 in the region, subregion et cetera has determined the number of aged-care beds in the facility. Why do we need more?’ ‘We’re full,’ she said, ‘and we need more.’ Then she made a statement to me that I will never forget. I had said, ‘Why is there increased demand?’ She said: ‘We’re getting people who were raised in Emmaville and left Emmaville because they were worried about the facilities but who want to come back in their twilight years and live in Emmaville. That is an additional demand and we need more aged-care beds.’

That brought home the point to me that this is an issue beyond health and aged care. Some people are leaving their country communities because they are planning for their twilight years and are worried—in the Emmaville case, at least—that not enough health and aged-care facilities exist in their communities, so they are removing themselves at an earlier time rather than staying. In that sense, even though we see it as an aged care and health funding issue, the MPS is very important for people making decisions about their regional locations—especially those who live in country towns.

Another issue that I would like to raise briefly is pensioners. We have heard a lot of talk over the years about the debt of the nation being reduced, and I congratulate the government on doing that, even though I do not agree with some of the asset sales made to achieve it. With the resources boom and surplus budgets we are awash with money, in a sense. But I constantly see in my electorate—and I am sure others do in their electorates as well—that pensioners and older people who are not in nursing homes but are not working any more are really struggling under the regime that exists at the moment. I make this plea to the government: if there are surpluses and additional funds available, do not forget those people who have made a contribution to the development of this nation and have put us in a position where these surpluses can be generated. I think most of us recognise that the arrangements through indexation that currently exist are not keeping up with the real world of a pensioner. There are other issues as well. If a husband and wife are living at home and one of them dies, there are issues of the cost of keeping up their house—electricity and so on. I think it is time to revisit what we are doing for our older people and pensioners. There is no better time to do that than when there is a surplus that has been partly generated through the circumstances of—

Peter McGauran (Gippsland, National Party, Deputy Leader of the House) Share this | Link to this | Hansard source

Good management. Say the words: good management.

Tony Windsor (New England, Independent) Share this | Link to this | Hansard source

Did Hansard get that?

Peter McGauran (Gippsland, National Party, Deputy Leader of the House) Share this | Link to this | Hansard source

It would be nice to hear you say it.

Harry Jenkins (Scullin, Australian Labor Party) Share this | Link to this | Hansard source

Order! The honourable member for New England will not encourage the minister by way of inviting him to get comments in the Hansard because, as the minister knows, all interjections are out of order, even when a member is sitting in their appropriate place.

Tony Windsor (New England, Independent) Share this | Link to this | Hansard source

It is very pleasing to see an active sign come from the minister. I am not afraid to say the words. In many senses, there has been good economic management, and there has been a resources boom. The minister has woken me up now. There have been a whole range of activities out there, but it is not all about good management; it is also about the secure nation that we have had for many generations that has developed an environment where investment and a whole range of other things can take place. Those older people that I was talking about are part and parcel of that creation. If we do have a set of circumstances where there are good times, then our older people should be included in the equation.

The other issue I will raise briefly is Meals on Wheels. I congratulate the Prime Minister once again on the $1.5 billion announcement of last week. He recognised that a lot of people are staying in their homes longer and that, when they do go into aged-care facilities, the degree of care is much higher—even though it might be for a shorter period—and hence so is the cost of those people going into care. Meals on Wheels is a very important ingredient for some of those people staying in their homes, not only because of the food but also, in my view, because of the spirit of the volunteers. That is probably just as important as the food.

Within Tamworth, for instance, the president of Meals on Wheels, Laurie Beattie, and his committee have been working very hard to establish a new kitchen. I am pleased to say that Deputy Prime Minister Mark Vaile announced some funding for that in recent weeks, but there is a shortfall and I hope that the government would look favourably at any further application, as I hope the state government would as well. I raise the Meals on Wheels issue because I think it is a very important part of what the Prime Minister addressed in his announcement the other day about how older people will be staying in their homes longer. We are encouraging them to do that and obviously nourishment is a very important part of enabling them to do that. So Meals on Wheels is a critical ingredient in many of our towns.

The last thing that I would like to mention is in some way a criticism. I have raised on a number of occasions in this House the need to look after our older veterans, particularly those who served in the Second World War but did not have what is called ‘qualifying service’. They did not have an angry shot fired at them. The treatment that has been meted out to these people is quite different to that meted out to someone who served overseas where there were angry shots fired and who had ‘qualifying service’. I have argued a number of times in the parliament—and others have as well—that the gold card be extended to those people.

That group of people is dying at the rate of 800 a month. I think it is time that we recognised those veterans. The other day the Minister for Defence talked about encouraging people into the defence forces. We are putting in place a ‘try before you buy’ type of program and a whole range of encouragements. Young people enlist in our defence forces, but we have this very distressing and awful arrangement at the end of some veterans’ lives where they are being treated differently because, even though they may have given up five years of their life to be trained to defend the nation, they have participated in the war in Australia rather than under gunfire or by having bombs dropped on them.

I would like to recognise, very briefly, a man who absolutely fought for this issue, a man called Ken Coulton, who recently passed away in his 90s. Ken fought to be recognised. He was an extraordinary man, but he had in a sense a guilt complex that he had been treated differently to others. He spent five years willing to defend the nation. My father was in the Middle East. If the Japanese had kept coming, my father in the Middle East would have been useless in defending people on Australian shores. The people who did not leave our shores were the ones who would have been here to defend us, and I think they should be recognised in the same way that other veterans who did serve overseas are currently recognised.

Christopher Pyne (Sturt, Liberal Party, Assistant Minister for Health and Ageing) Share this | Link to this | Hansard source

In reply—I am pleased to sum up today the Aged Care Amendment (Security and Protection) Bill 2007 on behalf of the Minister for Ageing, Senator Santoro. I would like to thank those people who have spoken on the bill: the members for Gellibrand, McPherson, Moreton, Blaxland, Riverina, Richmond, Canberra, Hindmarsh, Charlton and New England. It has been a very useful debate. The opposition have raised a few issues that I would like to comment on. I am pleased that they are supporting this bill and that they are welcoming the reforms, including the new Office of Aged Care Quality and Compliance and the new Aged Care Commissioner.

The opposition have, however, raised a few issues that I would like to touch on in this summing up. The opposition have suggested that there has been too little time to respond to this bill and that the shadow minister has had insufficient time to consider it. I make the point that the bill was introduced in the first week of this sitting to allow maximum time for consideration in this parliamentary sitting and the debate has not been cut short. The opposition have been offered a number of briefings. The shadow minister was briefed last week and has requested a second briefing, which I think is occurring today. The Senate inquiry into this bill will also provide an opportunity for everyone to have input into the bill.

The opposition have also made the audacious claim that there has been too little consultation with industry. Anyone who knows the Minister for Ageing, Senator Santoro, will know how much he likes to consult over and over again with many different people, so the claim that he would not have consulted with industry does not stack up. He has told me how he has personally met with as many people as possible—nurses, managers, the approved providers, residents and their families—and I think one accusation that could not be levelled at the Minister for Ageing is a lack of consultation. The minister and the department have also undertaken ongoing consultation with the Aged Care Advisory Committee which, as the opposition would know, comprises most of the peak industry bodies, consumer groups, and medical and nursing bodies.

The opposition have also said that the principles of the delegated legislation have not been made available. The department has prepared and circulated a very detailed explanatory guide, which is available even on the department’s website, which describes the proposed content of the principles. The shadow minister has been briefed on this and has requested a second briefing, which is occurring today. The department will continue to consult on the proposed content of the principles and, of course, we would welcome any input that the opposition might have into what is a very important and very sensitive issue.

The opposition have also claimed that the government have taken too long to do anything about the sexual and physical abuse of the aged in nursing facilities. Obviously abuse is an extremely difficult and sensitive issue and the government is acting by implementing a very multifaceted response. Police check requirements have already been legislated and the Aged Care Standards and Accreditation Agency is already undertaking increased spot checks. This further part of the package, this bill, implements even more measures to address the issue. They are important and complex measures and the government has very properly taken the time to consult extensively and develop appropriate legislation. It seems passing strange that we would be accused by the opposition of not consulting enough and also of not bringing in the bill fast enough. The opposition cannot have it both ways. We have tried to meet the market in both areas and the bill that we are passing today, the Aged Care Amendment (Security and Protection) Bill 2007, is an excellent response. I congratulate the minister, I congratulate those people who have contributed to the debate and I commend the bill to the House.

Question agreed to.

Bill read a second time.