Milton Dick (Oxley, Australian Labor Party) Share this | Link to this | Hansard source

I want to continue my remarks about the poor standards of aged care in this country and also the piecemeal approach to aged care that this government continues to offer older Australians. When I was elected, the number of those on waiting lists was somewhere around the 70,000 mark—a shocking number—which was too high at the time and which the government has now left to skyrocket to six figures. I note that new data has revealed that there are now 102,000 older Australians still facing a lengthy wait for home care, in my opinion, confirming in crystal-clear data that the Morrison government has failed to respond to the initial findings of the royal commission.

We know the royal commission's interim report described the waiting list for home care as 'neglect' and called for urgent action last year, yet 100,000 Australians are still waiting for care. It is not good enough. Despite a number of splashy and over-the-top announcements for so-called new home-care packages, once again, the Morrison government is found to be delivering big on headlines and announcements but failing to deliver real change for older Australians waiting for care. Putting it simply, there were 100,000 Australians waiting for care when the royal commission called for action, and there are still 100,000 waiting today. The tragic failure of the Morrison government to not better protect older Australians in aged-care homes from COVID-19 will only mean more people will choose to receive care at home.

The home-care packages announced in the budget won't come close to fixing the lengthy waiting list. My question to the government today, to the minister and to the Prime Minister's office, is: how is it acceptable that older Australians in their 90s are waiting for years to receive the care that they have been approved for? Last month officials confirmed more than 30,000 older Australians had died in the last three years while waiting for care packages that they had already been approved for. Those are some a pretty hard-hitting facts, and it's a tragedy that I have to rise in this parliament and speak out for those people who don't have a voice within this government.

Day after day, the evidence mounts of serious neglect in aged care, and all we're seeing from the government is them simply running away, passing the buck and not accepting their own failures. Today I draw the line in the sand and speak out on behalf of aged-care residents and people in desperate need of care packages in my own electorate and call out the government for its neglect. It's quite frankly shocking that the government isn't on its feet every day, trying to look at solutions for this.

In my home state of Queensland, where I represent and talk to older Australians, one of the last things I did before we went into lockdown was host my seniors morning tea in the suburb of Jindalee, at the Jindalee Bowls Club. I put on a morning tea once or twice a year, and hundreds of seniors join me, normally with our local hardworking state member, Ms Jessica Pugh, and members of the Queensland Police Service, for safety tips at home. Once again I was bombarded with residents coming to me to say a loved one, a partner or spouse, was in desperate need of care yet the government was simply ignoring them. Quite frankly, it has simply got worse during the COVID crisis.

The aged-care community of this nation are the legacy holders for our country, and it is the government's responsibility to look after the very people who brought us here today, the people whose work this nation was built on. I'm very proud to represent thousands of seniors in the Oxley community. I speak for them and their families when I say that when I met with them in their homes, pre-COVID, or when I've spoken to them on the telephone during the pandemic and coming out of it there has been fear in their voice and there have been tears in their eyes. It's unacceptable that people at such a vulnerable time in their life are left with literally no hope due to the ridiculous delays in processing these home-care packages.

The Prime Minister says the government wants to help people with 'the choices they want to make about their future', but these figures prove that older Australians have very little choice. Not a single pensioner is choosing not to receive the home-care package they have been approved for, yet that is what the government is forcing them to do. National seniors advocates—respected Australians like Ian Henschke—have said older Australians overwhelmingly want to stay in their homes, which costs the government less than it would to place them in nursing homes. To take a look at the concerns about how this is impacting the community, you need only turn up to any seniors gathering. They will all tell you the same thing: home-care providers are flat chat. And I pay tribute to all of those amazing frontline workers who have continued to provide aged-care services in homes.

There is another issue that I want to place on record today. I represent over 50,000 people who were born overseas or have family from overseas. The lack of non-English-speaking aged-care package support workers is a huge problem. I know the member for Greenway, who represents a diverse community, has had representations from local residents with cultural and language barriers. There's a significant problem in the Vietnamese community that I represent. In the Oxley electorate I represent one of the largest Vietnamese communities in the country, in the suburbs of Darra, Inala and Durack. These are people who helped build those suburbs. They came out with absolutely nothing and have made such a wonderful contribution to our local economy through business endeavours and through support for education and higher education, yet we see a lack of non-English-speaking support services. I know that places additional strain on family structures where there are people with early-onset dementia, who have confusion over language and sometimes return to their first language. It's very difficult for families to coordinate aged-care services. So, once again, I call on the government to look particularly at home-care packages for people from non-English-speaking backgrounds.

As I said, these reforms have done nothing to address the growing home-care package waiting list. Sadly, we know that around 25,000 older Australians have entered residential aged care prematurely in the past two years because they could not access their approved home-care packages. They are 25,000 Australians who wanted to stay in their home but, because those home-care packages weren't available, were, in some cases, removed from their local support networks, whether it was their local GP, their local pensioner club or their neighbours, and placed in a residential aged-care facility. They perhaps couldn't afford to go into it, but it was all that was available. That is an absolute disgrace when, under the Morrison government, Australians were promised choice.

The median waiting time for older Australians going into residential aged care has grown by more than 100 days under the Liberal and National parties—from just one month to a five-month wait. The Productivity Commission's report on government services, released in January this year, pre-COVID, revealed that older Australians waiting for high-level home-care packages are waiting almost three years to get the care they've been approved for. The report also revealed that older Australians are waiting longer, as I've said, to enter residential aged care. The government has made improvements to the transparency of home-care fees, however, home-care recipients are still raising concerns about the rising cost of administrative and daily fees that're deducted from their packages, therefore, impacting on the amount of care hours they receive.

Then finally we come to the Royal Commission into Aged Care Quality and Safety interim report, which was handed down in October last year. The commissioners have already put forward what needs to happen urgently, and yet we are a few months well down the track now and still nothing has taken place. Our seniors need the care they need most in the comfort of their home. We need to end the over-reliance of chemical restraint in aged care. We need to end the unacceptable amount of young people entering residential aged care.

As usual, the government's response to the interim report has been utterly hopeless. The commissioner has recommended urgent action to address the home-care packages waitlist, but the government has only put around 5,500 home-care packages into the system from 1 December last year. As we saw, this is woefully inadequate, as there are more than 100,000 older Australians waiting for their approved home-care package.

I am really pleased that the shadow minister, and member for Franklin, has been highlighting this, alongside our Labor leader, Anthony Albanese, who has given keynote speeches and will continue to hold the government to account on their appalling record when it comes to aged care. I know from consulting with my own local residents; aged-care providers in the Oxley electorate, brilliant aged-care providers who are stretched to the max and having my own lived experience with parents who have lived in residential aged care—point in case with my mother living in aged care for around seven years. She loved the aged-care facility that she was residing in, but due to staffing short cuts she was admitted to hospital with dehydration and malnutrition. That is not a reflection on the level of care that she was given. It was simply they didn't have the resources. She is only one of literally tens of thousands of people who have suffered due to poor care, because this government is not investing and not supporting the aged-care sector.

I'll finish where I began. I am strongly in support of the second reading amendment today to highlight to this House the government's piecemeal approach to aged-care reform. I will continue to keep speaking out for older Australians in the Oxley electorate. I will continue to keep speaking out for older Australians in this country. We need to do better for those who are frail and vulnerable and this government needs to start listening to that message.

Jason Falinski (Mackellar, Liberal Party) Share this | Link to this | Hansard source

I thank the member for Oxley for his contribution to this debate. Unfortunately, it is incumbent upon me to make a number of corrections to the statements that he's made to the House. Firstly, it would occur to the House that many of the statements that he made are inherently contradictory. On one hand he says that because people couldn't get hold of home-care packages they are entering residential aged care sooner than they wanted. On the other hand, he claims that people are coming in to a residential aged-care homes later than they wanted because this government isn't spending enough on aged care. One has to wonder though whether $27 billion is chicken feed to those opposite, because $27 billion of support by the Australian taxpayer seems to me quite a substantial commitment of spending for aged care in this country.

Those opposite continue to say that there are 100,000 people waiting for home-care packages. What they don't point out though is that the overwhelming majority of those people—it fluctuates between 85 and 95 per cent—already have aged-care packages but are simply seeking to get further enhancements to those home-care packages.

The other thing that no-one in this chamber ever says is that so much of the home-care packages that this parliament, that the Australian taxpayer generously provides to those people who wish to stay in their home is, in fact, not care. A lot of it is domestic help. A lot of it is gardening services. A lot of it is cleaning services. In a recent review we found out that a not insubstantial amount of it goes on things like home repairs. There was a constituent of mine who saved up their home-care package so they could use it to get their roof retiled. I am not entirely sure that the Australian taxpayer really believes that this is a proper and fit purpose for their taxes. This bill is all about—

Ms Swanson interjecting—

Maybe those in Paterson believe that, instead of caring for the elderly in their home, caring for the elderly in aged care, it should be used for tiling roofs. Maybe those opposite believe that that is proper and fit care while talking about fact that we don't spend enough on aged care.

I would also mention to those opposite that I have been involved in a number of these debates in this chamber—and the member for Oxley once again alluded to it just before—where they had made claims of, frankly, criminal behaviour by aged-care providers. They are very happy to do that in this chamber with the protection that this chamber provides them. I ask them to step out of this chamber and name those people who've committed criminal acts, because if they believe a scintilla of what they are saying then they should have the courage to do that because those people are still operating in the aged-care sector. If criminal acts have been performed and if they have knowledge of them then I believe they have a responsibility to step outside and to make those claims in public, not under privilege, but they don't. But I note they don't.

Now, those of us who are perhaps too old and too cynical may come to a view that perhaps those claims are made for political purposes rather than the fact that they actually did occur. So I warn those opposite, as I said in an MPI only last week, that the greatest attack on the credibility of this chamber is the creation of myth. If criminal acts are occurring in residential aged-care facilities, if criminal acts are occurring by providers of home-care services, name those people who recommitting those acts of criminality and don't just use it as some convenient political point to be made when talking about aged care. Stop scaring elderly Australians.

This government—

Ms Swanson interjecting—

I say to the member for Paterson once again: if you have knowledge of people who have committed criminal acts, step outside, step outside this chamber and make those claims so that they can be properly investigated by the authorities. But I once again suspect that that won't occur.

The government has introduced the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill 2020 to pay home-care providers after they have paid services to align with current government payments and to ensure a sustainable system as more home-care packages are released and in readiness for future reforms. This bill amends both the Aged Care Act 1997 and the Aged Care (Transitional Provisions) Act 1997 such that a provider will not receive a payment in advance but will be paid the full monthly subsidy for a home-care recipient upon lodgement of a claim with Services Australia after the end of each month.

This is a sector that I spent 15 years in before entering this place. I have seen the massive changes to residential aged care in that time period. When I started in this sector around the year 2000, many nursing homes resembled Dickensian work houses. The stench of ammonia and urine was very hard to take. People were isolated on one hand and on the other hand they were stuck in rooms with four other people. The provision of services was not great. Around that time, the Howard government introduced reforms to the aged-care sector, and in those reforms they allowed the private sector to enter this system and to provide innovation and money. They also allowed individuals to contribute to their own care. Having done that, we now see the provision of five-star care in residential aged care.

That hasn't stopped those opposite making claims of criminality, without evidence—without the courage to step outside—and without the courage to report those things. We know that, in the last 35 years, the level of care that is provided to Australians who need it has improved beyond our capacity to imagine it 15 short years ago. By the way, probably only seven out of a thousand Australians will find themselves in residential aged care. The vast majority of us will pass from this Earth, will shuffle off this mortal coil, while at home, not in a residential aged-care facility.

But many of the people who are now entering residential aged-care facilities, who have had the capacity to stay in their own homes longer, find themselves entering that care in a frailer state. I know that the member for Oxley can simultaneously claim that people are coming in too soon and that they're coming in too late. We noticed that incoherent proposition that he put to the House. As a matter of fact we know that, actually, because of these home-care packages, people are able to stay in their homes longer. Because of that, they are entering residential aged-care facilities later and the level of care they require is higher; and, because the level of care is higher, the level of spending by the taxpayer and also by the individuals involved in that care is also higher because the provision of care is better and more suited to what they need.

This bill is an important step towards the delivery of an improved home-care system into the future. It's about improving aged care for all senior Australians, which continues to be one of the government's key priorities. We're not about scaring people; we're about telling people in this country that, in their last few years, Australians look after each other. We're not about trying to claim, for political purposes or because our donors make a big fuss, that there's criminal behaviour where there is none. This bill, if passed, will also establish a unified system for the care of our elderly in their homes. It delivers a seamless system of care, tailoring services to the needs of those people in care, not the one-size-fits-all system that we inherited so long ago. Improving care is the goal of this bill; that is the goal of this government's policy. The changes to payments in arrears back our commitment to that goal. The bill continues to ensure that more Australians have access to home care and that those who need it are able to access support quickly, and it prepares the system for important future reforms.

We are delivering record spending to the aged-care system. It was $13.3 billion in 2012-13 under the previous government and it is growing to $23.8 billion in 2021 under this government—under the Liberal Party. It is estimated that funding for aged care will grow to more than $27 billion in 2023-24. Since the 2018-19 budget, the government has spent $4.6 billion for an additional 73,000 home-care packages. It is estimated that home-care packages will have increased from 60,000, when Labor was last in power, last in government, to 185,000 this financial year. That's an increase of 125,000 places. I think that is something that should be celebrated, not ignored and certainly not sneered at. Under this government, in a single year—between 31 March 2019 and 31 March 2020—there has been a 38 per cent increase in the number of people receiving home-care packages. In addition, the number of people in the home-care national prioritisation system, NPS, dropped by 20 per cent in one year, between 31 March 2019 and 31 March 2020.

These are things to be celebrated, not criticised. The current system of home care allows for packages of $8,900 up to $51,900, and this funding has historically been provided in advance to providers. This means that money often sits untouched in providers' bank accounts and has created a rising level of unspent home-care funds. This way of funding differs from how the Australian government ordinarily pays for programs and services. The discrepancy in payment arrangements has been highlighted by the Aged Care Financing Authority and a number of aged-care stakeholders.

In the 2019-20 budget, the Australian government announced improvements to payment arrangements for home-care packages, with services to be paid for as they are delivered. Last year, the Aged Care Financing Authority and the Department of Health undertook extensive consultation on how these changes should be and would be implemented. Initially, the measure was to commence providing home-care payments to providers in arrears in June 2020. On 27 March 2020, the government announced that the implementation of improvements to payment arrangements for home-care packages would be placed on hold due to COVID-19 to ensure the key role of the aged-care sector was to help combat this virus and support older Australians.

This bill will allow home-care payments to be paid to providers in arrears from February 2021, once the bill has passed. The February commencement date will be legislated by proclamation. The initial change requires minimal system and operational changes. Home-care providers will receive the January 2021 advanced payment in mid-December, as per normal for that time of year. This will be the final advance payment. Providers will not receive a February advance in early February but will instead receive the full payment for February when they lodge their February claim in early March. Providers continue to lodge their claims as per normal and with the same information that is currently required.

This government is doing what it takes to make sure that people in their final days, amongst us, live a comfortable and prosperous life. It is not always possible, but we are doing the best we can on behalf of all Australians that wish us to do so.

Rebekha Sharkie (Mayo, Centre Alliance) Share this | Link to this | Hansard source

The Royal Commission into Aged Care Quality and Safety observed in its interim report that a fundamental overhaul of the design objectives, regulation and funding of aged care in Australia is clearly required. This bill, the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill 2020, will not address the issues raised by the royal commission. It will not decrease waiting times, improve affordability of home-care packages or make it easier for older Australians to take control of their own care needs. The purpose of this bill is to change the payment of home care package subsidies to approved providers from one month in advance to one month in arrears. This is a small change, but the broader policy proposal underlying the bill will have implications for both providers and recipients of home-care packages.

Under the current system, home-care providers use an online claiming system to report relevant information to the department, such as gaps in services, where the client has chosen not to receive assistance, due to holidays or alternative family arrangements, or when the client stops receiving home-care altogether as a consequence of a transition into aged-care hospitalisation or indeed passing away.

The system relies on the provider to accurately report on and reconcile funds advanced to them by the government for the care of their consumers and to disclose the unspent funds they hold on behalf of their client because, notwithstanding the limited funds available to consumers in receipt of home-care packages, there are instances where the funds allocated for the care of the client are not spent in their entirety. On these occasions, the funds remain in the approved provider's books to be drawn upon by the client as needed.

In recent years the reporting by providers has revealed a cache of unspent funds. The royal commission heard evidence that the average underspend per person per package was around $6,720 per annum across all four care package levels. They received evidence from leading aged-care services in Australia that in October 2018 a total of $34 million in unspent funds was held by just 17 providers managing just over 6,000 packages. Earlier this year, financial analyst StewartBrown revealed the results of their latest Aged Care Financial Performance Survey, incorporating data from over 34,700 home-care packages. The quarterly survey is a known benchmark of financial performance in the aged-care sector. Their analysis suggests that the biggest single issue of concern in the industry is the level of unspent funds, with the average amount of unspent funds per person now over $7,290, up from $6,720 a year ago. Their analysis also estimates that the total unspent funds on the books of providers across the country may grow to $900 million by the end of the year.

The true case of the unspent funds phenomenon is unclear. Accusations have been levelled at ACAT teams for allegedly assessing clients at a higher level than their genuine need on the premise that an individual is likely to wait 12 to 18 months for a package and, during that time, their health will possibly decline and their reliance on others to address their care needs will increase. Others have suggested it is a consequence of a lack of client awareness on how best to direct their funds or, indeed, a mistaken belief that the funds should be stored away for a rainy day.

The royal commission will consider the reasons behind the causes underlying the growth in unspent funds in their final report, but what concerns me most is the lack of transparency around how these funds are being used. Are clients going without care or with reduced care to enable some unscrupulous home-care providers to apply the subsidy to their own capital expenditure programs? We simply don't know. Whatever the cause or use of the unspent funds may be, the lengthy delays facing over 100,000 people currently awaiting their home-care packages is clear. On the government 's own quarterly report on the national prioritisation system, those in need of a level 4 package, the highest available, will face a wait of at least 12 months, with other reports, such as the Productivity Commission' report on government services, suggesting the wait will be possibly up to even three years.

This bill will not address the delays, but it will potentially improve transparency with respect to how and where these funds are being spent by providers. In the 2019-20 budget, the government indicated that the current reconciliation process was unsatisfactory and set out a suite of reforms to the home-care package system. The bill gives effect to the first stage of reforms, which the government says will improve payment administration arrangements for home-care packages and, in turn, improve financial integrity in aged care.

The reforms as announced form three parts. Part 1 is the bill before the House today which changes the payment of subsidies to providers in advance to arrears. Part 2 would require providers only be paid the subsidy for the goods and services they actually provide to the client rather than receiving the full monthly subsidy amount. Again, this could be paid in arrears rather than in advance, with any unspent package funds for the recipient to be held by the government on behalf of their client. Part 3 would provide for subsidy payments to providers to be reduced by a portion of the unspent package funds for that recipient. There would be no change to the amount paid to approved providers and nor would it change the amounts received by home-care package recipients.

At the request of the government, the Aged Care Financing Authority was tasked with examining the impact of these proposed reforms on the aged-care sector. With respect to part 1—the change from advance payments to arrears payments—the ACFA believes that most providers would likely absorb the short-term cashflow issues without difficulty; however, smaller providers operating in thin or difficult markets and under financial pressure may face challenges in dealing with the change in payment arrangements.

I've spoken to home-care providers in my electorate and am concerned that the transition to payments in arrears will place an undue burden on already struggling providers in locations in my electorate where they provide an essential service to a small number of people within a small community. These providers operate on narrow margins and, if they go under, we are unlikely to see larger providers move into the marketplace, simply because it's not profitable to do so. The profitability of some home-care providers is already in question, with both ACFA and StewartBrown noting that earnings of home-care providers fell by over 60 per cent in the 2018 year and that further declines continued in 2019.

While the government has established a business advisory service operating via PricewaterhouseCoopers that will provide managerial and accounting advice to home-care providers to assist in their transition, it relies on providers recognising that they may have an issue in the first place. I then query what assistance will be provided to those providers who, through no fault of their own, but rather as a consequence of the size or perhaps location of their services, are running on margins that will not manage the transition without some impact on the quality of care provided to their clients. In that instance, I support the recommendation of ACFA to extend short-term financial assistance to these providers. It may be that assistance provided to residential aged-care providers through the Business Improvement Fund could be extended to approved home-care package providers.

While noting that part 2 and part 3 of the reforms are not before the House today, the government must ensure a smooth transition for approved providers, which may require not only financial support but some additional time for providers to adjust to the new system. The government has stated that the proposed reforms will improve financial accountability and allow for better transparency over the actual use of funds for home-care service delivery, and, while I broadly support that statement, I echo the concerns of stakeholders in seeking to ensure that those providers, particularly in rural and regional areas, are provided with support throughout the transitional period. I look forward to working constructively with the Minister for Aged Care and Senior Australians to ensure measures are in place to identify and support these particular providers through the government's reforms.

Finally, the government's proposed reforms will, in theory, reduce the amount of unspent funds sitting in providers' accounts and, instead, those funds will remain in government coffers. But transferring from one account to another is hardly addressing the inefficiency in the system identified by the royal commission. Redirecting unspent funds back into the system would greatly assist those with unmet needs as a result of funding being assigned at a level at less than assessed need or those waiting for funds to be assigned.

I expect, and my community expects, that the government will reinvest the estimated $900 million per annum in unspent funds to address the delays in the national prioritisation queue while we await the recommendations from the royal commission and the government's subsequent response. The rationing of home-care packages must end, because care should not be based on the funding whims of a government but rather be provided in accordance with assessed need. This should be a basic entitlement for everyone in the aged-care system. I think of the elderly people I've met in my electorate, those in their 90s who have waited more than a year for their aged-care package, and one elderly gentleman saying to me, 'If I'm 93 and I've waited this long, my goodness, who does qualify for an urgent package?'

Katie Allen (Higgins, Liberal Party) Share this | Link to this | Hansard source

The importance of the aged-care sector has been on full display this year. Australia knows the Morrison government is committed to delivering quality care for senior Australians, particularly with our increasing commitment to home aged care—something senior Australians tell us they want. They want to be in their home for longer and for a safer period of time. This bill is an important step towards the delivery of an improved home-care system in future.

This bill has been introduced so that home-care providers are paid after they have provided services, rather than in advance, as is currently the case. This brings the payment practice in line with current government payments and, indeed, standardised practice in the private sector. The current system of home care allows for packages of $8,900 up to $51,900, and this funding has historically been provided in advance to providers. This means that money often sits untouched in providers' bank accounts and has created a rising level of unspent home-care funds.

With senior Australians increasingly choosing to remain in their own homes for longer, and the government committed to supporting this choice, this bill is important to ensuring taxpayers' money goes to delivering the services for which it is intended. Since the 2018-19 budget, the government has invested $4.6 billion for an additional 73,105 home-care packages. Home-care packages are estimated to increase from 60,000 in 2012, when we came to government, to 185,000 in the 2020-21 budget. That is a tripling of home-care packages. The 2020-21 budget includes the delivery of 23,000 home-care packages, at a cost of $1.6 million, in addition to the 6,105 packages already announced in July at a cost of $325 million.

As a government, we want to ensure the long-term sustainability of the aged-care sector. This is why we are introducing this change. Moving to payment in arrears backs our commitment to continuing to ensure that more Australians have access to home care, and that those who need it are able to access support quickly, and it prepares the system for important future reforms. This bill is an important step towards the delivery of an improved home-care system into the future to support our senior citizens.

The Morrison government is cognisant that these changes may impact the cash flows of some providers. We plan to assist this to ensure a smooth transition. In fact, the change was initially due to start in June 2020. However, in March, when COVID-19 hit, we announced that the implementation of improvements to payment arrangements for home-care packages would be placed on hold during the crisis. This was to ensure that the key focus of the aged-care sector was to help combat this virus and support older Australians. With COVID-19 now under control, it's time to introduce this important change.

The Aged Care Financing Authority has assessed that the vast majority of providers would be able to accommodate the cash-flow impact of the change in payment arrangements due to either unspent funds on hand or access to capital. The change is now set to come into effect in February 2021. At the same time, financial support will be on offer to some providers during the transition. We want to make sure that we help providers get to the other side of this crisis as well as get to the other side of the transition to a modernised payment system. Home-care providers will also be able to apply to the government's free business advisory service for advice on managing their finances.

Improving aged care for all Australians continues to be one of the government's key priorities. We are delivering a record investment across the aged-care sector—growing from $13.3 billion in 2012-13 under Labor to $23 billion in 2020-21 under the Morrison government. It is estimated that funding for aged care will grow by a further $4 billion, to $27 billion, by 2023-24. Every Australian knows that we have an ageing population. Every Australian knows that, as the baby boomers get older, we are going to need to provide more support for them. Australia is certainly not alone in that regard; every developed country has an ageing population. Senior Australians are increasingly choose to remain in their own homes for longer. The government is committed to supporting this choice—and even more so through the COVID crisis, with more than $746 million committed to aged care through the COVID response measures as part of the $1.6 billion in COVID-specific support in aged care.

I'd like to make a few remarks about the government's response to the COVID crisis and our support for the aged-care sector through this period. Although no country has been able to prevent aged-care communities from bearing the brunt of COVID deaths, Australia has done better than most—despite the community outbreak in Victoria, which now, I'm proud to say, is fully under control. Compared to other countries, our fatality rate for those in aged care is one of the lowest in the world, at around 0.1 per cent. By comparison, Canada's aged-care sector reports a death rate that is 15 times higher, Ireland's and Italy's 30 times higher and the UK's 53 times higher. We should also take solace from the fact that the vast majority of facilities in Australia have had no deaths from COVID and over 90 per cent in Victoria have had no cases of COVID. Compared to the international experience, it appears that, for the most part, we've kept COVID out of aged care.

It's also important to know that, when community transmission took hold in Victoria, there was a very rapid pivot to resources being sent directly to Victoria. We already had a national plan for aged care that had been in place and constantly updated as the COVID crisis hit Australia. But I'm proud to say that the Victorian Aged Care Response Centre was rapidly deployed to ensure that there was a person in charge in every aged-care centre that was connected back to the federal government and that our resources were made available. In particular, significant amounts of resources in the form of PPE were made available at a very rapid rate. Knowing that COVID had a predilection for the aged and infirm, the federal government acted swiftly and early to implement the world's best practices, to keep our senior citizens safe. Locally, aged-care providers in Higgins were aware a community outbreak may have devastating consequences for their residents. They acted early. And I spoke to many, if not all, of my CEOs in the seat of Higgins.

We know that locals were finding it very difficult because the local aged-care providers knew that they had to change visitation rules to minimise contact of residents with outside visitors. This was actually incredibly heartbreaking for families. I heard so many stories of residents who were suffering from dementia who were unable to see their families, and many people wrote to me about their fear that their parents may die without seeing people they'd loved and known in the previous weeks. It has been a very, very difficult period over the last few weeks and months during this lockdown period. I know that my constituents understood that these measures were necessary to keep their loved ones safe, but that is not to underestimate how significant that was. If you had a mother or a father who had dementia whom you were unable to visit, the lack of stimulation from the lack of family visits may have had a very significant impact, with a decrease in their cognitive ability over that period of time. It was heartbreaking to hear these stories and for families to know that they may not see their loved ones again as they were ageing and perhaps dying—not necessarily because of COVID—without seeing their families in those critical weeks and months at the end of their lives.

Unlike the Morrison government, delivering quality care for senior citizens does not appear to be a priority for Labor. In fact, the opposition leader's budget in-reply speech made no mention of or commitment to funding home care. There was no support for staff and nothing on quality and safety. It was quite surprising to me that that wasn't in the budget in-reply speech. Perhaps there's more to be heard.

The Morrison government has delivered and will continue to deliver on aged care. We had done so before COVID, we are now delivering during COVID and we will deliver as we move out of COVID. This bill aligns home-care payments with other government payments and ensures a sustainable system as more home-care packages are released in readiness for future reforms.

I would just like to say a few words, now that Victoria has managed to contain COVID. I know that my constituents are looking forward to being able to see their loved ones again. I know they are looking forward to being able to join in family celebrations, to return to having weddings and funerals, to visit their loved ones in hospital—to get back to life again. And I know that businesses are celebrating the opportunities to open up again.

It's been an incredibly tough and long winter. It's been an incredibly tough and long lockdown in Victoria. But I know that each and every Victorian has done the right thing in order to keep other citizens, as well as their families and their loved ones, safe. I thank them, particularly the constituents of Higgins who have written to me and rung me and provided their stories to explain to me how hard it has been for them, so that I can provide practical support and pragmatic and strong advocacy for them, to make sure that their voices are heard here in parliament but also across the Victorian government response as well.

Tony Zappia (Makin, Australian Labor Party) Share this | Link to this | Hansard source

The aged care sector is in crisis, and it has been for several years. That's why I speak in support of the amendment moved to the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill 2020 by the member for Franklin. When the royal commission was called by this government in to the aged-care sector, the previous aged care minister, the member for Hasluck quite rightly said, 'We don't need a royal commission; we know what the problems are.' When I say 'quite rightly', he was absolutely right with his comments about the fact that with know what the problems are. We knew what the problems were because there have been, in recent decades, over 30 different inquiries into the aged-care sector. Amongst those 30 inquiries there was an inquiry into the Productivity Commission in 2011 and there was an inquiry by the parliamentary Standing Committee on Health, Aged Care and Sport that reported to the House in 2018. Both of those inquiries carefully looked into the needs of the aged care sector.

Indeed, I was a member of the health, aged care and sport committee of the parliament that handed down its report with its 14 recommendations in 2018, and I can recall the hearings of that committee throughout the course of the inquiry. A number of people from every sector of society, from the health professionals to the staff within the centres, to residents' families and even to resident operators, highlighted the flaws, the problems and the needs of that sector. And so, when I say the sector is in crisis, it was absolutely clear to me then that it was in need of complete overhaul, or at least of a great deal more support than it was getting. And yet, this government, which has now been in office for seven years, simply fiddles on the edges with respect to the decisions that need to be made.

Indeed, the royal commission for all of its value, is highlighting to date the matters that were already brought to the attention of governments. I see the royal commission as an excuse by this government to simply defer making the necessary commitments that need to be made to the sector. Whilst the royal commission is in progress, the government continuously says that we need to wait for the findings of the commission. I accept that we do, but I also accept that what matters are known to government need to be addressed right now.

Not surprisingly, the royal commission handed down an interim report 12 months ago which called for a number of changes to be made. It was an interim report entitled Neglect. That term alone highlights and says it all with respect to the sector. Regrettably that neglect has continued over the last 12 months since that interim report was handed down. When we look at the number of people who have died as a result of COVID-19—the total deaths around Australia as of the last figure I saw was 905—683 of those were from within the aged care sector. It's a sector where people would have thought there was a level of care going above and beyond what is possible, even at home, and yet it was quite the opposite. For those who were in aged care—and I stress the word 'care', unfortunately, that wasn't to be the case. Some 2,000 of them contracted COVID-19 and, as I said, 683 died. That highlights that not only is the sector in crisis but also that, even since the interim report, very little has been done to change it.

This legislation makes three key changes to the process of making payments with respect to both home support and homecare packages. The first is that the payments will go from advance payments to payments in arrears. The second is that any unspent money will be held by the department and not by the providers of the service, as was previously the case. The third is, if there is unspent funds for a particular package, clearly that package will be reassessed and then the new package will be based on the expenditure incurred. All three appear to be fairly sensible cases, but I do note that as at June 2019 to date, homecare packages, in terms of the money that's been set aside or unspent as a result of payments not being made, was $750 million. I understand that by June 2020, when the figures are released, the figure is more likely to be about a billion dollars.

As other members have pointed out, home-care packages come in four different levels. Yes, it is true that there are over 100,000 people waiting for packages, but some of those people are on lower packages than they have been classified for. The fact that they are on lower packages still means that they have unmet needs. It means that the packages they have been approved for are not being provided to them. So 103,000 people, as I understand it, are still waiting for their approved package. I note the government made a budget announcement of an additional 23,000 packages. What I don't know is over what period of time they will be allocated, how many of those packages have already been added to this year's allocations, how soon they will be rolled out and what level of packages they are. Will they simply be packages that give level 1 support, which for most people is nowhere near adequate, or will they address the real shortage of packages that people are waiting for? Time will tell when the statistics are assessed. Perhaps in 12 months time we'll know just how committed this government is to those 23,000 packages.

It has been rightly pointed out that we live in an ageing society. Indeed, my understanding is that, by the year 2056, 22 per cent of the population will be over 65 years old. Currently the figure is about 15 per cent. Effectively, there will have been a 50 per cent increase in the number of Australians proportionally who will be over 65. Therefore, the need for age services will undoubtedly increase. It's also the case that people are not only living longer but, because of that, are entering residential aged-care facilities at an older age, which means that they enter those facilities at a time in their life when they have greater need. Indeed, my understanding is that of those people in aged care right now over 50 per cent suffer from dementia or dementia related illnesses. That means that the level of care that is needed for them is much greater than it might have been in the past. So for the 220,000-odd people who are in aged care right now, when more than half of them are at a high level of care, it obviously means that the centres providing that care will require more staff and more support services for them. Yet, from the parliamentary inquiry that I participated in, it's clear that the level of allied medical services in particular for many centres is declining—it's not getting higher. It's not improving or getting better; it's declining. Indeed, for many of those centres I understand even GP services are starting to fall back, because GPs find that it is not viable for them to continue to provide the services that they have been providing, so some of them have stopped going into those centres. That creates another problem, because as soon as someone in aged care requires medical support the aged-care operators immediately transfer them to a public hospital, and that in turn clogs up public hospital beds when the level of care could actually have been provided in the aged-care facility had there been access to a GP and to qualified nurses to provide the medical support that was required.

The interim report from the royal commission highlights not only the things that we knew but some of the things that urgently need to be done. I note that counsel assisting the commission has released another 124 recommendations embracing a whole range of human rights principles and an independent process for oversight of the aged-care sector. Both of those matters go to the heart of the issues that were exposed by the committee of this parliament. In particular the aged-care principles and the rights of people within those centres were a real concern to members of the committee, as, I might say, were the oversight principles. In my view, there was insufficient government oversight of many of those facilities. I know that legislation has gone through this parliament to try and improve that, but, again, it appears from the royal commission's reports to date that not much has changed.

There are some 2,700 aged-care providers across Australia, and 1,000 providers—less than 50 per cent of the total providers—responded to the royal commission's service provider survey. They self-reported 274,409 instances of substandard care over a five-year period to the year June 2018. That is 50,000 instances of substandard care being reported per year. I don't know what the total numbers would be if all providers had responded to that survey, but 274,000 suggests to me that the figure would well and truly be close to, perhaps, a million instances of substandard care being reported. And this is voluntary reports. I can only guess at what the number would be if every operator was prepared to honestly report all of the issues that were raised with them. Those issues include things like: physical abuse; dreadful food and malnutrition; poor continence management—and I understand something like 75 to 80 per cent of residents in these centres have an incontinence problem; dehydration; patchy and fragmented palliative care; inadequate prevention and management of wounds, sometimes leading to septicaemia and even deaths; maggots in open wounds, as we've heard in this place many times; falls that have not been attended to and ultimately lead to death; overprescribing without consent of sedative drugs and physical restraints; inadequate allied health support; and then we have the figure of some 50 sexual assaults each week being reported. Those stats alone highlight the woeful state of the aged-care sector in this country. In a very recent report, only one in four aged-care clients of home and residential care believed that their care needs were always being met—one in four. Those figures alone should be of concern to this government.

Why are there these problems? It's because the sector is underfunded, there are inadequate staff within the sector—often insufficiently trained—and the sector is essentially driven by profit. Since 1997, when the laws were changed, the sector has become one where profit now seems to be the motivator for many of the people within the sector. While the government provides some $25 billion in funding, and that represents about 80 per cent of all of the funding that goes into the sector, the reality is that a good deal of the operators—something like 41 per cent of the operators, and that doesn't mean 41 per cent of the beds but 41 per cent of the operators—are private operators who clearly put profit before service.

The issue with this legislation, as others have highlighted, is that some of the smaller and regional providers might find it more difficult as a result of getting payments in arrears, and that is a genuine concern. And for the regional and smaller operators—again, this was made very clear to the parliamentary committee's inquiry—it is much more difficult to remain as viable operators. My concern about all that is that if viability goes out the window for them, then people in country and regional Australia will be left without any service whatsoever, unless the government steps in and provides additional support to those smaller operators. That's not where the private operators want to go, because they can't make profit out there. But the people out there need the aged-care services, just as they do right across Australia.

Bert Van Manen (Forde, Liberal Party) Share this | Link to this | Hansard source

I agree with much of what the member for Makin had to say, particularly his outlining of some of the disgraceful treatment of those elderly Australians who have been put into residential aged care because they need that level of care and their families are not in a position to look after them anymore. I think it's disgraceful that those people have been treated in the manner. We should as a society recognise that one of the important measures of our civilisation is how we take care of our elderly. When we hear stories as the member for Makin has outlined and as we've seen told at the aged-care royal commission, we should be very disappointed and reflective on what we need to do as a society to improve the level and quality of care that our senior Australians get when they need it.

Someone else in an earlier contribution in this debate made the reflection that it's these senior Australians who built the country that we have today and that we have the opportunity and the blessings that we have in life because of their hard work, effort and contribution to our society and that, in reflection of that, we should ensure that the level of care that they receive is first class and the best it can be.

In line with the recommendations from the commission's report handed down in 2019, the government has outlined that it would establish a single unified system of care for our elderly in the home to deliver a seamless system of care tailoring services to the needs of the individual. These bills are a step in that direction. Obviously, the final changes will be guided by the final recommendations of the royal commission and will have the ultimate goal of improving care and ending the wait for home-care packages.

As an example of the level of investment that the Morrison government is making into aged care, funding has grown from $13.3 billion in 2012-13, under the previous Labor government, to nearly $24 billion in 2021-22. This investment includes $4.6 billion for additional home-care packages since the 2018-19 budget, and the government estimates that home-care packages will continue to grow, from 60,300, where they were in 2012-13, to nearly 185,600 in 2020-21.

These huge numbers also allow me to drill down into the electorate of Forde, where we have over 10,000 senior citizens and a number of organisations that support seniors, including Jimbelunga Nursing Centre at Eagleby, and the Beenleigh and Districts Senior Citizens Centre Inc, the largest senior citizens centre in south-east Queensland. But I also want to take this opportunity to reflect on a number of other aged-care service providers in the electorate. I know there is rightly condemnation for those residential aged-care service providers that don't look after their residents, but I'm pleased to say that I have some very good residential aged-care service providers in my electorate of Forde who do an outstanding job. There is, as I've already mentioned, Jimbelunga aged-care facility at Eagleby, which looks predominantly after the Indigenous community in a culturally sensitive and appropriate way. But what's important at Jimbelunga is that they also take other residents who don't have an Indigenous background or cultural background, and those residents get to enjoy the same care that the Indigenous residents do. But the important part, particularly for the Indigenous residents there, the cultural aspect of their care.

I know the member for Oxley in his earlier contribution mentioned the importance of culturally appropriate settings for the Vietnamese community in his electorate. Jeta Gardens in my electorate also does that for the Malaysian and Chinese community in a culturally sensitive and appropriate way as well. Other aged-care facilities in my electorate who do an outstanding job include: palm lake aged care at Eagleby and at Bethania; Oxford Crest at Eagleby; Infinite Care at Cornubia; St Paul de Chartes, who I visited recently over at Boronia Heights. They're just some of the great aged-care facilities across the electorate of Forde who do an outstanding job each and every day. I forgot to mention Seasons Waterford West. Seasons' model is very interesting in that they have a mix of over 50s retirement village units. It is designed such that if one of the partners requires aged care and high care they can transition from their normal unit into a high-care unit within the same facility, but their husband or wife is still close by, so they can still catch up for lunch and dinner, go and spend time in each other's rooms and socialise together, which I think is a tremendous model and works very, very well.

I want to take this opportunity to thank all of those who work in these services around the electorate of Forde and all of those who work to support our senior citizens. It's a vitally important job. I know from the many that I speak to that they thoroughly enjoy the job, and they are very appreciative of the opportunity they have to look after our senior Australians. I want to give my gratitude to all of those staff, the nurses that work in the various facilities around the electorate, for the work they do each and every day.

As I'm sure others in this chamber do, I hold a seniors expo every year. Unfortunately this year, due to COVID-19, that wasn't to be the case. I get to speak with hundreds of seniors who attend. They tell me they would much rather have home care than go into residential aged care. They feel that that's because they will have more autonomy and freedom at home and feel more in control of their own affairs. I have seen that firsthand over the last 12 or 18 months with a family situation. As my father-in-law's dementia got worse he made it very clear that he didn't want to go into residential aged care. My wife, Judi, and her sisters took on the task of looking after him at his home, in particular Judi's sister and her husband who moved in to give him full-time care. They were also able to get assistance with a home-care package. I have seen the time and effort that is required by families to look after a loved one who is in that situation where they require a high level of care. It is an important message, because until you actually live that experience and go through it I don't think you can say you can fully understand the time commitment and effort required.

This bill is about changing the way that payments are made to the home service package providers. The current system of home care allows for packages between $8,900 and up to $51,900, depending on your level of package that you've been assessed for. This funding has historically been provided in advance to providers. This means that the money often sits untouched in providers' bank accounts. It has created a rising level of unspent home-care funds. This particular way of funding differs from how the Australian government ordinarily pays for programs and services. The discrepancy in payment arrangements has been highlighted by the Aged Care Financing Authority and several aged-care stakeholders.

In the 2019-20 budget the Australian government announced improvements to the payment arrangements for home-care packages to pay for services as they are delivered. This bill will allow home-care payments to providers in arrears from February 2021—the initial changes requiring minimal systems or operational changes. The home-care providers will receive the January 2021 advanced payment in mid-December, as per normal for that time of year, and this will be the final advanced payment. The providers will not receive a February advanced payment in early February, but instead will receive the full payment for February when they lodge their February claim in March. The providers will continue to lodge their claims as per normal with the same information that is currently required.

I think it's important to reflect on one of the areas that I get feedback on. I think it is still an area that needs to be dealt with in due course. I get comments from constituents who have home-care packages on the level of administration fees that some of these home-care service providers charge in comparison to the services they actually provide. I have made a representation to the minister on behalf of a number of constituents for that to be an area we look at to ensure that the constituents who are receiving a home-care package actually get proper value for money and that a large sum of those packages isn't being eaten up in administration fees charged by the home-care service providers.

We all agree, I think, that having unspent funds sitting in the aged-care providers' accounts is not the optimal situation. We need to ensure that we get bang for our buck when it comes to aged-care funding. One concern that has been raised on these changes is the question: can home-care package service providers manage the change? The government asked the Aged Care Financing Authority to assess providers and determine if they can accommodate the change to cashflow arrangements. The determination is they can and, for those who need transitional support, there is financial support to assist with that transition.

In conclusion, the Morrison government has a record of funding the aged-care sector, including a huge funding boost for home-care packages. We know that ageing in the home is, in most cases, a better option for seniors than residential aged care and potentially saves more in the long term from seniors going into hospital. We have heard the voices of our senior citizens and we will continue to provide record funding for the aged-care sector and, in particular, for home-care packages. I am proud of our government's record in this area over the past seven years. When I speak with seniors at the Seniors Expo they tell me that they are generally happy with the services the government provides and covers financially.

Obviously with the establishment of the royal commission we are seeking to rectify the issues that have been raised through various means and avenues, as I outlined at the start of my contribution and has been outlined by many in this debate today, about practices which are not acceptable. We eagerly await the final report of the royal commission. In terms of the payment model for aged-care funding and in particular how we fund providers of home-care packages, I want to see and we as a government want to see and ensure that the unutilised funds are used to support those for whom the funding is provided. We are determined to ensure that providers are supported through the transition process, but we are more determined to ensure that our senior citizens, who have contributed so much to this country throughout their lifetimes, have the best quality of care, which they deserve. I commend this bill to the House.

Zali Steggall (Warringah, Independent) Share this | Link to this | Hansard source

I rise to speak on the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill 2020. I welcome this legislation. This amendment seeks to bring the payment mechanism for home care in the aged-care sector into alignment with business leading practice and the NDIS. This bill will assist in preventing the accumulation of unspent home-care packages. Currently, there is nearly $800 million in unspent home-care packages in Australia. Under current arrangements, if a home-care package of $40,000, for example, is provided to a person and only $30,000 is spend, the remaining $10,000 is not reallocated and these funds build up in a person's individualised budget.

There are more than 100,000 people waiting for approval of their home-care packages. This is not a good outcome. Figures from the Department of Health released last month show that, in the last two years, 28,000 people died while on the waiting list. Government needs to urgently enable the reallocation of funding where allotments are underspent. The government missed the opportunity to fix the backlog problem. It announced—and I welcomed it—the additional 23,000 places, but, in a situation where the waiting list is still over 75,000, clearly more should have been done. While this bill will help, I encourage the government to consider how they can assist providers who may need support through the transition to this new payment measures.

The submission made by Leading Age Services Australia to the Aged Care Financing Authority was an important one and highlighted that consideration of the financial impact on home-care providers is a result of changes in payment arrangements whose report is included in this bill. The submission notes that 40 per cent of surveyed home-care providers would find the implementation of these measures financially challenging to manage their cashflows. So phase 1 of the implementation of this bill was initially due to commence in June 2020, but was delayed for at least six months due to the COVID-19 outbreak, and I think that's a good thing because, clearly, managing that transition will be important.

Aged-care provider peak bodies—the Aged & Community Services Australia, Leading Age Services Australia and Catholic Health Australia—all stated that they supported the proposed changes in principle, but they raised a number of concerns that they identified as needing to be addressed prior to the implementation of the proposed amendments. And so I urge the government to listen to those peak organisations, resolving outstanding payment issues prior to transitioning to new arrangements, resolving potential cashflow issues for providers and resolving the need for flexible and responsive payment systems—for example, providers receiving funds within 48 hours of submitting a claim. The announcement of a delay in implementation in March this year was welcomed by these peak bodies, allowing them to focus on the health of their clients.

Locally in Warringah, aged care is a key issue, as 15.7 per cent of the total population is aged over 65. This proportion is growing. I have spoken with the CEOs of several aged-care facilities in the electorate, including Anglicare, Allambie Village and Twilight Aged Care. They've told me that families are very emotional and frustrated, because they've taken the right steps but are not getting the help they need. Families feel guilt, because they can't supply the care their loved ones require.

The wait for home-care packages can be long and often with dire consequences. Families wait up to two years for their home-care package following the assessment. By this time their parent's condition has deteriorated and the family can no longer cope in caring for them. The elderly deserve respectful, affordable, accessible and safe aged-care options that are offered in a timely manner. We want aged care that promotes independence and wellbeing with choices so that people can stay at home longer while being healthy and connected. We need more options for a suitable mix of home help and medical support.

We can't talk about aged care without talking about carers in the system. It's really important to understand the needs carers also have. Residential respite is a key issue for those who provide full-time care to their loved ones. Two weeks ago we celebrated carers week, and I'd like to thank all of those who continue to dedicate their lives to the care of others and use this opportunity to highlight some of their needs. Carers, of all people, need to be able to plan ahead. The logistics involved in preparing for an absence are huge.

I've received many, many letters requesting clarification on the government's policy on residential respite. I ask that the government consider the proposal that the subsidy for residential respite be allowed to be used towards a resident carer in the patient's home. In the words of many of my constituents, 'Imagine not being able to plan or look forward to your next break from work, which is not just nine to five, five days a week, but is actually 24/7 for 365 days a year with no weekends and is both physically and emotionally draining to the point of desperation.' Respite has become a key issue during the COVID pandemic, with carers feeling even greater pressure than before. The stress of working with vulnerable people and the constant strain on carers, not wanting to be the one who brings COVID into the homes of those their care for, has been enormous.

The inability of carers to get together to share their stories and debrief their experiences has been very much curtailed. So I urge all of those working in home care to look out for one another and to engage with mental health providers and support as and when you need them.

I've met with Anglicare, Twilight and Allambie village. All these facilities are also feeling the strain, but they are very pleased and so proud—and we are proud as well—of their staff and residents and how they responded to the pandemic.

Those who offer home care are feeling the pinch as well. We should not forget that, like child care, the burden of this unpaid and unrecognised labour falls disproportionately to women, and, in this regard, I continue to call for greater gender equality and balance in caring arrangements. There's no doubt that, for so many women, time is taken out of the workforce not just for child-rearing duties but also for caring duties for elderly parents, and this is something that's simply not addressed.

There are still many issues with the sector. There's an inherent unfairness in the age cut-off for NDIS eligibility. Once someone hits 65, they're no longer eligible for the NDIS but only for aged-care plans. But the support provided under My Aged Care plans does not come even close to that provided under the NDIS in meeting the costs incurred by people and their families. Last year, I presented a petition to parliament calling for an end to the age discrimination in the NDIS. So I urge the government to address this issue as a priority, for all those older Australians who continue to suffer from a lack of adequate care. They are not many, but they do fall between the cracks of these two systems.

The aged-care royal commission is ongoing and of course continues to raise horrific stories of neglect. The concerns and recommendations are many, emanating from over 10,000 submissions received to date. The interim report, which was presented nearly a year ago already, highlighted three areas where immediate action could be taken: to provide home-care packages to reduce the waiting list for higher-level care at home; to respond to the significant overreliance on chemical restraints in aged care, including through the 7th Community Pharmacy Agreement; and to stop the flow of younger people with a disability going into aged care and speed up the process of getting those young people who are already in aged care out of that system.

I support this bill and its efforts to more efficiently allocate the limited funding that is available to home-care providers for our elderly population. We need to look after our ageing population and those who look after them, including both paid and unpaid carers.

Julie Owens (Parramatta, Australian Labor Party) Share this | Link to this | Hansard source

If you sit in this House for even a short period of time, you notice something about the Morrison government: they seem to wait until things have got really bad, so everybody knows there's a problem, then they rush forward with their silver announcement, and they make an announcement. But when you dig underneath it, you find there's nothing there. And there is no area where this is more true than in aged care.

We in Australia have known that we had an aged-care crisis coming for decades. We had the Hawke and Keating government writing papers on the ageing of the population. Peter Costello went on and on and on about the ageing of the population and the changes we needed to make to ensure that this country was able to care for its people as they aged. We knew about the needs of the workforce. We knew all about it. We've known about it for decades. We've also known for quite a few years now that the crisis had well and truly hit and that the standards in our aged-care facilities were not up to it. We've had stories of extraordinary numbers of people malnourished, of people lying in beds unable to get out of them, of people with maggots in wounds—we've had some dreadful stories. But we've also had some really across-the-board assessments that up to a third of people were simply not getting the care that they needed, with enormous numbers malnourished. So we have known for a long time that the crisis was well and truly here.

Two years ago, this government finally called a royal commission into aged care, after nearly a year or more of being begged for it—by the community, by the people who worked in aged care, by the opposition, by people whose parents were suffering and by people whose partners, who they loved, were being left lying in urine. We heard dreadful stories for months and months and months. Finally the government said, 'Okay, royal commission', and they've done nothing but brag about it ever since. The Prime Minister gets up and says, 'I called the royal commission.' Well, it was two years ago. Two years ago we knew the situation was so bad that even the Prime Minister knew we needed a royal commission and finally called one. That was two years ago. A year ago now we had an interim report that was entitled Neglect. How often do you see a royal commission put out an interim report with such a totally outrageous title? Neglectit says everything about what it found.

Meanwhile, we had the government saying over and over again, 'We can't do anything, because there's a royal commission happening; we have to wait for the findings,' even though what we were hearing through that royal commission was stories of appalling neglect. Every day this government did nothing, someone—in fact, hundreds and thousands of people—lay in bed, unable to get out, sometimes all day. Those of us who have struggled through lockdown in the last six months know how dreadful it is not to be able to leave your house. But for these people there is no out, there is no end. It doesn't stop when we get a vaccine; they're there for the rest of their life, living in circumstances that most of us wouldn't wish on our worst enemy, let alone people that we love and people that we care about. Yet this government, dragged kicking and screaming to the royal commission itself, ignored all the evidence, ignored the interim report and kept saying, 'Nothing we can do here; we have to wait until the royal commission is over.'

The report is due in November, and today we're looking at a bill. Apparently the government can do some things while the royal commission is going on. It's hard to imagine why this bill was so urgent that it had to be done before November. The final report will be there in November. They've been saying they couldn't do anything until that time, and now, suddenly, 'Oops, must do this!' The bill does three things. It triggers a change to the way providers are paid. Providers are currently paid one month in advance. After this bill passes the Senate, they'll be paid one month in arrears. Again, it's hard to imagine why they couldn't wait another month to read the full recommendations of the royal commission, which they said was so important to wait for, before they did this. The second phase of the reforms, which commences in April 21, means that providers will only be paid the subsidy for what they actually provided to consumers, and the third phase will mean that subsidy payments to providers will be reduced by a portion.

In some ways these are quite minor changes, relative to the kind of effort that is needed right now, and has been needed for several years, in the aged-care system, and given the aged-care system that we know we're going to need as the population ages. We're living longer. We're healthy for longer. The number of people with dementia is going up. As we live longer, more and more really high-needs care is required. We're stuffing around at the moment with this sort of stuff, when really there is major work to be done.

I want to talk specifically about home care at this point. For all that we've seen of the problems within the aged-care system and for all of the major changes that are going to be needed in terms of the quality of the workforce, the way the funding works and the whole funding system, there's another part of the aged-care system which is probably much easier to fix, and it's called home care. It's an incredibly good policy, home care. It was introduced a number of years ago now, before the Abbott-Turnbull-Morrison government was elected, and it's particularly important because it allows people to stay in their homes longer. One of the great interesting things about health care, generally, is that in the vast majority of cases what's best for the person is actually cheaper for the taxpayer. The person can stay home longer if their bathroom is renovated so they can't slip. If they can make minor changes to make their home safe, if they can have someone coming in and checking that they're okay and that they've taken their medication—all those small things can be done and people can stay at home longer.

For communities like mine, where large numbers are born overseas and putting a parent or partner into an aged-care facility is something they would not even consider, home care becomes even more important. A lot of these families will work tirelessly to keep their loved ones home for as long as possible, because that's what they do. So home care is incredibly important. And yet, according to the government's own Productivity Commission report this year, the waiting time for people with high care needs is up to three years. So you are assessed and, if you are found to need the care, you wait three years. Before the royal commission was even called, there was a waiting list of over 100,000 people for home care. There is still a waiting list of over 100,000 people for home care. The list has not changed. The number of people waiting has not changed.

And you can see why that is when you look at how the money has been allocated. The government is really good at making announcements but, when you look at it a little bit, the money is not there anymore. In the 2017-18 budget, they announced 14,000 home-care packages—that's over a number of years, by the way, so it's not a lot—but they were funded entirely by a reduction of 26,000 residential care places between 2017-18 and 2020-21. They took the money out of aged care and stuck it into home care. But they still didn't put enough places in home care to affect that queue of 100,000 people. And now there are lengthy waits for people to get into residential aged care as well.

In MYEFO in 2018—there was still lots of criticism; there were still 100,000 people waiting to get into home care—they put in $287.3 million. But all they did was bring it forward from a later year. Again, that was no additional money and no real effort to solve it. In February 2019, on the eve of the royal commission into aged care hearings, they announced another couple of hundred million dollars over five years. But it was actually a re-announcement of the 2018-19 budget. Again, there is nothing new here. And do you know what? Even if there was new money, the nature of being a government is that you don't get to stand in this place, or out there in front of the media, and make wonderful announcements about how fantastic you are if you are failing in this way. This is serious and it needs to be solved. You can get up here and brag that the government called the royal commission and claim that you put new money in. But even if the government did put new money in, if it doesn't fix the problem, they are responsible for the problem.

The Abbott-Turnbull-Morrison government has been in this place for seven years, and this problem has been growing and getting worse every year they've been here. In spite of all their announcements, they have not made a difference. If they didn't understand it, if they weren't aware of just how bad things were, if they hadn't been listening to the evidence to the royal commission, if they hadn't been listening to people telling them in the electorates of all the members over there—just as all of us over here are told every day—if they weren't aware of how bad it was then COVID should have shown them. The COVID pandemic exposed, in the bright light of day, just how under-resourced our aged-care system is. My mum was in hospital last year. I went in there and showered her and took her to the toilet. I went in there every day and spent two or three hours with her. If I didn't, she wouldn't have had the care. But a lot of people in aged care do not have family. COVID exposed just how under-resourced aged care is. It exposed the issues with a casualised workforce. It exposed the issue of workers going from one centre to another because they only have a few hours here and a few hours there. It pulled apart the curtain and showed us what has been going wrong in our aged -are system for years. We have a huge budget, we are billions and billions of dollars in debt, and there is not a single extra dollar for aged care in the budget. Given what we've just seen, given that we've got the report of the royal commission into aged care coming down the pipeline in just a minute and given all that we know about the disaster that is aged care and the growing problem with home care delays—there's a three-year delay for getting urgent assistance at home—you would expect the government to say: 'We're spending all this extra money. We can spend it. This is a great way to create jobs, a great way to help our ailing aged-care system.' But, no, there's not another dollar in the budget.

The home-care packages announced by the Morrison government recently won't even come close. The 23,000 additional packages are just a drop in the ocean, because they're not all in one year but spread out over a number of years. They're not even going to touch the sides, when it comes to it. Again, you need to look behind the figures and announcements, because there's always nothing there. Documents tendered at the aged-care royal commission recently revealed that the Morrison government will deliver just 300 new home-care packages by 2024. That is, royal commission evidence revealed just 300 new home-care packages by 2024. There are 103,000-odd people waiting in the queue now, people getting older every day. The entire population is getting older. In spite of all of the announcements, the home-care packages haven't touched the sides, and there'll only be 300 new ones by 2024.

In my electorate I hear from people every day about this. One woman came to me about her mum, who'd been approved for a level 3 home-care package. Her mum is in her 80s. She had a heart attack and a stroke last year. Owing to her condition, she was assessed as needing bathroom and home modifications and domestic assistance, which would have allowed her to stay at home. Then this woman found out her mum might need to wait two years for the modifications—two years! One of two things happens there: her mum goes into aged care or someone gives up a bit of work to care for her. Neither of those is the best solution. The best solution is proper funding of home care by this government right now.

Another one: a local man in his 70s contacted me about the long wait for services. He'd been approved for a home-care package and assessed as being in need of domestic help with cleaning—not particularly heavy help, by the way. None of the local service providers have the capacity to provide this service, so he's just waiting and waiting and waiting. He hasn't even been given a time frame; he's been told just that nobody can help. Again, this is easy to fix, yet we've got a government that year after year makes announcements that it is, and fails miserably. There's been no change over several years: 100,000 before the royal commission and still 100,000 waiting in the queue now.

Brian Mitchell (Lyons, Australian Labor Party) Share this | Link to this | Hansard source

I thank my good friend the member for Parramatta for her excellent speech pointing out the shortcomings of this government on aged care. It's been some time since this bill, the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill 2020, was before the House, so I'm very pleased to have the opportunity to speak to it. One of its key purposes is to change the payment of Australian government subsidies for home-care packages from payment in advance to payment in arrears. This change is part of intended reform to the home-care payment arrangements to move towards an NDIS-like system where home-care providers are paid a fee for service for the older Australians they are caring for. This does raise some concerns as to the potential risks to the financial viability of service providers, especially smaller rural and regional service providers, such as those in my electorate, which may struggle with the cash flow to deal with payment changes with the change to an arrears payment system. Some service providers have indicated that if the new payment arrangements increase their administrative costs then those costs will end up being passed on to consumers, which in turn, of course, reduces the level of services available to a consumer under their package.

As the member for Parramatta pointed out, it may be somewhat premature that we're dealing with this now, given that the final report of the aged-care royal commission is to be handed down imminently. It may well be the case that the royal commission makes a recommendation around home-care payments and unspent funds, which have been part of the evidence presented in hearings. These are issues that need to be looked at in more detail, and Labor will move to have this bill referred to a Senate committee for that reason.

More broadly, I'd like to speak in support of the amendment moved by the member for Franklin, the shadow minister, which notes this government's piecemeal approach to aged-care reform. I recently received an email from my constituent Anna. Anna is in her late 70s. She lives in one of the small rural towns in Tasmania's north-east, in my electorate. After a lengthy wait and difficulties with her service provider, Anna is now receiving two home-care hours a week to help with housework and that sort of thing. Unfortunately, the process of getting this support in place was so drawn out that these two hours are no longer enough to meet Anna's needs. She is dependent on a walker, needs help with her shopping and getting to and from appointments. Most urgently, she requires modifications to her bathroom, as the current configuration is entirely unsuitable and unsafe. Despite these urgent needs, Anna is essentially right back at the start of the process, with no idea about how long she might be waiting to get the support she needs to remain in her home.

You can see the vicious cycle that is going on here. Somebody makes an application for a home-care package based on their needs at that time—these are older people already—and they wait so long for the package to come through that their needs have increased. They make a further application based on their new needs, and they've got to wait for that. By the time that comes in their needs have increased again and they may well be on their way into a home, which could have been avoided if they'd had the payment when they needed it. You can really see what happens there.

Despite her urgent needs, Anna is essentially right back to where she started. In her email to me, Anna wrote: 'I'm still having trouble with my provider and administrator of my home-care package. My bathroom renovation has flown into an uncertain future. I was approved for a level 3 package, but, thanks to the infinite national queue, I have now joined the many unfortunates that have to wait, regardless that I need help now. But one cannot be selfish.' Isn't that what we hear all the time from older people in our community. They put other needs before their own: 'One cannot be selfish.' She continues: 'Thanks to the inadequate funding for the release of more packages and the lack of available packages, we will wait in limbo until we either finally give up waiting or die.' It's not right that an elderly woman like Anna has to feel that she's in such a terrible state that she has to either give up or die for a home-care package that she's perfectly entitled to.

Anna's frustration is clear, and she has good reason to be frustrated. She is just one of 103,000 older Australians who are waiting for home care. As the member for Parramatta pointed out, it was 100,000 before the royal commission, and all these years later it's still 100,000. Despite all the evidence that we've heard over the years—all the stories and the incident reports of neglect—we still have 100,000 people on that waiting list. In Tasmania there are 2,000 people waiting for a home-care package, and the waiting list for that is about three years long. My office has a veritable laundry list of constituents struggling with wait items and issues with the aged-care system more generally, as I suspect most members in this place would have. David, for example, is in his 80s and lives alone in Devon Hills in the north of my electorate. For several months, David has been receiving two hours a fortnight of support through a home-care package. It's a minimal amount but essential to supporting David to remain in his own home. That is the best solution not just for David but also for the economy. If David doesn't get the minimal support he receives to stay in his own home, he will have go to an aged-care home, with all of the expense and inconvenience to the Commonwealth that that entails. It makes good economic sense to keep David in his home. In March the visits for those two hours a fortnight of support stopped with no contact from his service provider. It turns out that the service provider had expended all the funds from David's package, but instead of notifying David, they simply stopped showing up.

My office also has assisted Marie from Sorell, in the south-east of my electorate, to try to navigate the aged-care system. Anybody who is familiar with the computer systems of this government would know that navigating the aged-care system is no easy task, despite years of experience with such things. Marie cares for her husband, and he receives 19 hours a week under his home-care package. Marie applied for home-care help in her own right and was offered a level 2 package. If Marie had accepted this package it would have meant fewer hours overall for her and her husband but at a much higher cost. So Marie rejected this package, as any sensible person would, and as a result was placed on a non-priority waitlist, meaning a wait of up to three years for the support that she needs. I could go on, but I think the point has been made loud and clear that the wait times for home-care support are simply unacceptable.

The government did announce, in the recent budget, an additional 23,000 home-care packages, but that is just a drop in the ocean for what is needed. Stakeholders have described the budget measures as merely tinkering with the aged-care system, an aged-care system in severe distress. Patricia Sparrow, CEO of Aged & Community Services Australia, argues:

The kind of financing and budget reform that is necessary to set up Australia for our ageing population means a total rethink - not just a series of announcements that prop up the current system.

That really gets to the heart of what we are talking about here. As has been touched on by the member for Parramatta and many others, this is a government that is addicted to announcements. It confuses announcements with action. It thinks a slogan is a solution. It's not good enough. There is more to governing than putting out a press release, getting your head on the telly, putting out a meme on Facebook that you are down at Bunnings having a snag. There is more to governing than that. There's actually looking after people and making sure you are doing the right thing, not just getting good press to try and win an election.

Grant Corderoy, senior partner at aged-care accountants StewartBrown, shared a similar sentiment to that of Ms Sparrow, noting:

…it's a holding-the-fort type budget. It's waiting for the royal commission and I believe that some reforms really need to be introduced prior to the royal commission's recommendations.

Clearly this recent budget announcement is insufficient. Once again the government's announcements of new home-care packages have consistently failed to address the true scale of the aged-care crises in this country. Documents recently presented at the aged-care royal commission revealed that the government would deliver just 300 new home-care packages by 2024, despite a series of announcements promising thousands more.

It is important to note that the aged-care workers who are on the frontline working under tough conditions, and particularly over the last few months, for relatively low pay are not in the gun here. They are just working like Trojans. I've been on the floor with some of these guys when I've done 'a day in the life of an aged-care worker', and I can't even pretend to know the conditions that they really work under. They work extremely hard for relatively low pay. They are not in it for the money. They are dedicated people who want to do the best for the residents in these places. It is really important to make that distinction. What we are concerned about is the state of the system. This is nowhere near an attack on the people who work in a broken system. Labor will not allow workers to be used as a scapegoat.

The interim report of the royal commission called for action on the unacceptable number of Australians waiting for care, referring to the current wait list as 'neglect'. That is the title of the report: Neglect. You would think that would spur the government into action. You get a royal commission interim report titled Neglect, that's something that you act on immediately. You don't wait months and down the line and say, 'We will get and to it when we get around to it.' In the words of the interim report:

Many people receiving aged care services have their basic human rights denied. Their dignity is not respected and their identity is ignored. It is a shocking tale of neglect.

This is royal commissioners saying this. Royal commissioners have said this is 'a shocking tale of neglect'. Yet months later we have tinkering from the government. No real call to action from those opposite other than, 'We are going to wait for the final report before we maybe get around to doing something.' It is nothing short of heartbreaking when neglect is a word used to describe, by royal commissioners, the aged-care system in Australia, but that is the legacy of this government on aged care. Just last week, there were devastating revelations of more than 100 reports of assault and sexual assault in Australian aged-care homes each week. That is something else to confront. So, despite completely unacceptable figures and reports, the Morrison government is still yet to introduce a Serious Incident Response Scheme that would respond to cases of assault and abuse in Australia's aged-care system.

The Morrison government does not have a plan for aged care. It does not have a plan, despite everything, but Labor does. Labor has an eight-point plan that the government can consider to immediately address known issues in the aged-care sector, which has been pushed to the brink by the impacts of the coronavirus pandemic. First, set minimum staffing levels in aged care. Second, reduce the home-care package waiting list so more people can stay in their homes for longer. Three, ensure transparency and accountability of funding to support high-quality care. Four, have independent and public reporting as recommended by the royal commission. Five, ensure every residential aged-care facility has adequate personal protective equipment. Six, have better training for staff, including on infection control. Seven, have a better surge workforce strategy. Eight, provide additional resources so the aged-care royal commission can inquire specifically into COVID-19 across the sector while not impacting or delaying the handing down of the final report. I would like to commend here my colleague and friend the member for Franklin, the shadow minister, who has done a magnificent job holding this government and particularly the failed minister to over this diabolical situation facing aged care. The member for Franklin has done a superb job.

Labor knows that older Australians deserve dignity and respect in their later years of life. Those opposite have presided over an aged-care crisis in this country, robbing people of that opportunity. With that in mind, I will leave you to ponder this recent statement from the royal commission:

Had the Australian Government acted upon previous reviews of aged care, the persistent problems in aged care would have been known much earlier and the suffering of many people could have been avoided.

That says it all.

Fiona Phillips (Gilmore, Australian Labor Party) Share this | Link to this | Hansard source

I'm pleased to rise tonight to speak on the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill 2020. This bill speaks to some very important issues, but in many ways it is the issues it doesn't speak to that are even more critical. The administrative changes it makes will have consequences, but the changes it isn't making have consequences as well. My electorate on the New South Wales South Coast has the second-highest number of people over the age of 65 in Australia. We have more than 40,000 people over the age of 65, nearly 27 per cent of my total electorate size. People come to our coast for many reasons, but many come to retire and live a good, relaxed life by the sea, so it is no surprise that legislation like this is extremely important to many people in our community—not only those who want to access homecare now but also those who may need to in the near future, their families and friends.

As our population continues to age, we need to make sure we are supporting older Australians to live in their homes for as long as possible. We know, now with agonising detail thanks to the aged-care royal commission, many of the problems that are facing our aged-care system. We have seen the tragedy that Covid-19 has wreaked throughout aged-care homes across Australia because the government was not repaired. What we need to be doing now more than ever is making sure people are supported to stay at home for as long as possible. Staying in your home for longer has so many benefits not just for the person receiving care but for their family, for our aged-care system as a whole, for our economy and for everyone, and the truth is that we need to be doing better. Across every aspect of aged care, that is true, but today I want to focus on home care.

We need to do better on home care. The interim report from the aged care royal commission, which was titled Neglectand doesn't that just say at all—and which we received a year ago highlighted that urgent action was needed now to ensure older Australians are getting care at home when they need it most. It is no secret that the waitlist for home-care packages is out of control. More than 102,000 older Australians are waiting for home-care packages. Wait times have blown out, with older Australians in our community waiting almost three years for the high-level packages they have been approved for.

In this year's budget, the Morrison government announced 23,000 'additional' packages. But documents tendered at the aged-care royal commission showed that the government will deliver just 300 new home-care packages by 2024, despite their promises in the tens of thousands—only 300. What a disappointing response to a huge problem. Three hundred new packages are simply not enough, and that much is just glaringly obvious. We need urgent action on a huge scale, and it has to start now.

I want to share the stories of some of the people in my electorate who are struggling under the current home-care system. Perhaps this will finally help to put a human face on that figure I mentioned of 102,000 people, because it seems that the government keeps forgetting. These are people's mothers and fathers. They are aunties, uncles, friends and loved ones. They are people, and they deserve better than a three-year wait for help.

Aunty Joyce is a beloved Aboriginal elder from Gerringong. She is well known on the South Coast and has spent her life working hard to help other people and contribute to our community. But now Aunty Joyce is the one asking for help. She has applied for a home-care package and been approved for a level 2 package. But she has been told it will be at least two years before she is able to access one. Aunty Joyce has emphysema and she has sadly had a couple of recent falls. She wants some help with home services, like someone to mow her lawn and help her get out and about to visit friends in the local area. She's been told that, while she waits for a level 2 package, she can access a level 1 package—after she waits up to three months. We know that Indigenous people in our community have a unique set of challenges and we also know we need to be doing more to help close the gap. Aunty Joyce has told me how she just wants to make sure local Aboriginal people like her can access the aged-care services they need, when they need it.

I have spoken before in this place about the innovative home care program being run in the south of my electorate, the Illawarra Retirement Trust's Booraja Home Care program. This is a home-care program delivered by Aboriginal people for Aboriginal people, and it is exactly the type of program people like Aunty Joyce need. Unfortunately, Booraja is based in Moruya and doesn't extend up to the Gerringong area. But, as some people might remember from the many times I have raised it in this place, I have had to fight and fight to help Booraja continue to receive funding from this government, funding that would allow it to stay open. They wanted to extend the program to more local Aboriginal people, but the government had to be dragged kicking and screaming to support it. I could never understand why, when it is so clearly a no-brainer. I was so delighted when some funding did eventually come through. Common sense did prevail eventually.

I would like to thank all of the workers at Booraja and IRT who advocated for this funding: Booraja Home Care Manager Uncle Bunja Smith, and IRT Foundation Manager Toby Dawson, to name just two. Without their advocacy, I know that even more Aboriginal elders in the Batemans Bay area would be struggling to access services. But this is the type of pilot program we should be encouraging and replicating so that people like Aunty Joyce can access culturally appropriate services in an appropriate time frame that doesn't leave them languishing without adequate help for years. Years—sadly, that is no exaggeration.

Then there is Warren from St Georges Basin. Warren is in his 90s and he had hip surgery 12 months ago. He was told by My Aged Care at the time that the home modifications to his bathroom would be completed before he was discharged from hospital. But, here we are, 12 months later, and Warren is still waiting. Warren told me how he has paid $170 for the plans for the bathroom, but they have heard nothing back. It is not just this though; Warren was also assessed as needing a level 2 home-care package but is only receiving a level 1. Why, 12 months after it was promised, is Warren still waiting for help?

Adriana from Ulladulla was approved for a level 3 package almost a year ago. Since then, sadly, she has had a stroke and her needs have only increased. But Adriana and her husband are being told it will be at least another six to nine months before she can get a plan appropriate for her needs. In the meantime, Adriana is receiving a level 1 package, but it is simply not enough. She needs more help and she needs it now.

I could go on. Sadly, I hear the same story over and over again, and I am left asking the same question: why is the Morrison government forcing people like Aunty Joyce, Warren and Adriana to struggle without the support we know they need? It is simply unfair and it is tragic.

The purpose of this bill is to change the payment of the home-care subsidy to approved providers from being paid in advance to being paid in arrears, but it doesn't impact the overall amount available to the home-care package recipient. According to the Aged Care Financing Authority, this legislation will be the first of three phases to reform the home-care payment arrangements. But even the explanatory memorandum for this bill acknowledges, as it states:

Some of the submissions suggested that the new payment arrangements would be a risk to the viability of some providers.

…   …   …

Many of those submissions specifically reference providers in rural and remote locations.

As is so often the case, country areas, the hardest hit, are being left behind once again by this government, when the truth is that our community is already struggling with the availability of local providers. It's another story I am hearing too often—local people approved for packages but no-one to deliver them. Service providers are also concerned that, if the new payment arrangements increase administrative costs, then these costs would be passed onto consumers. This in turn would reduce the level of goods and services available to a consumer under a package.

Tracy from Burrill Lake has been assessed as needing a level 3 package, but his provider was taking 46 per cent of the pool provided to him. Tracy's wife was finding it difficult to navigate the system and understand the fine print. She tried to find a provider that wouldn't charge so much but realised that there were really only two options in the local area. But what would happen if those providers couldn't afford the changes in this bill and were forced to close? Or what if they were forced to pass along even more costs to Tracy, leaving him with even fewer services? I don't want to see the changes in this bill making things even harder for people like Tracy and his wife. I don't want to see fewer providers—and of course that would also mean fewer jobs in our local community. Local people have had to deal with so much. We need to make sure we are supporting them now more than ever.

The truth is that the government have not detailed the savings associated with the change in these payment arrangements or what the funds will be used for. That is a big concern of mine, because we have seen their track record. Counsel assisting the royal commission released their final submission on 22 October. That includes a number of recommendations directly related to home care. This includes the government clearing the waiting list by December 2021 and making home care a demand driven system rather than one that is rationed. That is real reform. We need to be overhauling the system, not tinkering around the edges and making changes that could actually make things worse.

This government's record on aged care is nothing short of appalling. 'Neglect' was the word the royal commission used, and it is an apt word for it—neglect. We have heard how, in the last year, 10,000 older Australians have died waiting for a home-care package. Perhaps the most heartbreaking case of all was that of the poor gentleman in my electorate who tried to get some help for his wife. She had been approved for a level 4 package but was only receiving an interim level 2. She was terminally ill, but she waited six months for her home-care package. Devastatingly, she passed away before that assistance arrived.

This isn't about statistics. It isn't about numbers. It is about people—real people who are struggling. In the aftermath of COVID-19, I had a strong army of volunteers who were helping me call older Australians in my electorate to check in on them. Many of these calls centred around aged care and home care. Many of the stories I have told tonight come from these calls. They weren't people looking to complain or to get ahead; they were just getting on with it, struggling through on their own. What concerns me is all the people suffering in silence, all those people in my electorate whose story doesn't get to be told tonight—because we know they are out there.

The royal commission has been a heartbreaking and confronting exercise. We have seen so many experts stand up and give a bleak picture of a broken system that needs major reform now. We have heard heartbreaking and traumatic accounts from loved ones who have endured what no-one should have to. At the end of the day, our aged-care system is failing our community. It is failing our families. It is failing our mothers, fathers, grandparents, aunts and uncles. It is failing people like Aunty Joyce, Warren, Adriana and Tracy. It is failing Australia.

But the Morrison government just does not seem to be listening. Instead, the Treasurer made a flashy announcement during the budget of 23,000 home-care packages, but the reality was much different, with only 300 of those actually being new packages. We saw the interim report released a year ago, but here we are still talking about the same mess, still without any real policy plan to fix it. The commissioner described the waiting list for home care as cruel, unfair and discriminatory, but the government simply released an additional 10,000 packages to fix a waiting list that at the time consisted of 119,000 people. What we need is real reform, because the consequences of nonaction are too high. They are certainly too high for me. I will not accept it—not now, not ever. People in my electorate deserve better, and I will always be here standing up for them.

Peta Murphy (Dunkley, Australian Labor Party) Share this | Link to this | Hansard source

I feel privileged to have been in this chamber to hear my friend and colleague the member for Gilmore give that speech on behalf of her community and be the voice for the people she represents. They chose very well at the last election. She's an amazing advocate. You can't help but be moved by those stories.

I want to start my contribution on the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill 2020 with the quote that the member for Lyons finished his contribution on, a recent statement from the royal commission:

Had the Australian Government acted upon previous reviews of aged care, the persistent problems in aged care would have been known much earlier and the suffering of many people could have been avoided.

As the representative of a community with loved ones in aged care who suffered through the spread of COVID-19 I, too, regret that action wasn't taken earlier to avoid the suffering. I also regret that when this House moved a motion of congratulations and thanks to the people of Victoria today for what they have done to get through the second wave of coronavirus, which has been nothing short of magnificent, there wasn't appropriate acknowledgement from either the Prime Minister or the Treasurer about the role that inadequacies in preparation in aged care played in so many of those tragic deaths.

Perhaps it's that failure to acknowledge mistakes and lack of action that is partly the impediment to taking action. We won't get anywhere until we acknowledge what is wrong and then fix it. We have to acknowledge that, over the last three years, 30,000 Australians who loved and were loved died waiting for care that they had been approved for, that Australians assessed as needing high-level packages for residential home care are waiting three years to get that care. There surely isn't a person in this place privileged to represent their community who hasn't received a phone call, an email or a visit from a distraught person not understanding why they have been approved for a home-care package that they desperately need but they can't get it or from their families who are beside themselves to get the care for their parents or their loved ones so that they can continue to live a life of dignity in their home. They have been approved for that care, but they are waiting three years to get it. Surely it moves everyone who has the privilege of serving in this place the way it moves the member for Gilmore, the member for Lyons and everyone else who I have heard speak today about people in their communities. There are 100,000 Australians waiting for a home-care package. Announcements don't deliver home-care packages. We have draft recommendations from council assisting the royal commission recommending that the government clear the waiting list, not because it is a number of 100,000, but because it is 100,000 people waiting to get that care that they need to end their lives in dignity and comfort. Surely, as human beings, that's what we owe the other citizens of our country.

It was a year ago that the interim report was titled Neglect, and I know that other contributors to this debate have mentioned it, and that is because it has to be mentioned. A title of a report into our aged-care system in this country that we are so proud of titled Neglect is shameful. The first recommendation of that interim report, over a year ago, was to fix the home-care package waiting list. There were 100,000 older Australians waiting then and there are 100,000 older Australians waiting now for home care. The government doesn't need to wait for February next year for that recommendation to know that it should have acted before, and it needs to act now.

The people who have been brave enough to give evidence to that royal commission are amazing, and we all owe them a debt of gratitude. There have been more than 10,000 submissions and experts after experts backing in the experience of individuals to say that this is a system that is broken. This is a system where apparently 50 sexual assaults a week happen in residential aged care—50 sexual assaults a week. We can't stand for that. How could we stand for that?

It's just extraordinary that under this government there was no COVID plan specifically for aged care, and there's been no acknowledgement of that failure. So it's no wonder that there are so many people—too many people—who don't believe this government when it says that it will fix the problems. It is no surprise that there are so many people—too many people—who just don't believe this government at all and don't have any trust in politics or politicians. That has to change. There are 1.2 million Australians and their families who rely on us here in this place making that change—the people on those benches over there making that change and those of us on this side of the parliament pushing them to make that change. It has to happen.

We shouldn't have to rely on the families of people in aged care to make that happen, but so often we do. We saw the second recommendation of the interim report of the royal commission directed towards chemical restraints in aged care. One of the reasons that occurred is because of brave people like my constituent Edgard Proy and his parents, who he loves so dearly. When you hear him talk about them, you just know that they are, along with his children and his wife, the most important people in his life. Monica Proy is a woman who spent her entire life working as an advocate for the elderly and as a carer in aged-care homes. But, cruelly, as happens to so many older people in our community now, as she aged she began to suffer the symptoms of dementia. Her loving husband Silvio and the family tried all they could to keep her at home. They didn't want her to go into aged care—you might suspect they knew a bit about what happens in aged care—but when Silvio had a stroke the family had to make that decision. Last year, Edgard spoke to SBS and participated with Human Rights Watch in a documentary to try to stop what then happened to Monica happening to other people.

They had no choice but to put Monica into an aged-care facility and put Silvio with her, but Monica's dementia got worse. She would wander around away from her room and vocalise loudly. Those behaviours led to her nursing home heavily medicating her and trying to reduce her frustration. They chemically restrained her. It took the family quite a time, not surprisingly, to realise what was being done to their beloved mother and grandmother. Edgard is absolutely clear that the cocktail of drugs his mother was being given made things worse. Not having a great grasp of the English language didn't make things any easier. Edgard knew something was wrong, because, even with dementia, she hugged him, she laughed and she giggled, but the medication meant she just couldn't be consoled. As he said to me in an email, the medication took the life out of her. She'd lost her power with the dementia, and then the drugs took away her capacity to deal with the dementia. Human Rights Watch said last year that a third of people of people in nursing homes are on sedatives and 32 per cent are on antipsychotic drugs. We know that Monica's story is not unique, but it was powerfully unique to her family.

Do you know what the Proys did? To some extent they're lucky that they were able to do this, but it was a sacrifice. They had to employ a carer to go and help care for their mother while she was in aged care and had to detox from those drugs. It took two years for those drugs to get out of her system with the support of her family, her wonderful carer and the workers at the new facility in Mount Eliza where she now lives. Edgard knows that the people who were prescribing the medication were doing the best they could with the knowledge they had, but, as he said to SBS, if they're not trained in looking after the elderly, specifically people living with dementia, what hope do those people have? Is it any surprise that draft recommendation 71 of counsel assisting the royal commission is that antipsychotic drugs need to be prescribed by appropriately qualified medical practitioners?

If anyone is reading this speech or watching this speech, I encourage you to google 'Edgard Proy', and you will find the video and see his mother now. Edgard says that his mother has been medication free for over a year. She and Silvio are together in a new nursing home—the family are still paying extra for her to have a carer—and the sparkle is back in her eyes. Edgard says his mum's emotions are heightened: 'She's not giving up. When I hug her today she's at peace.' Edgard's now an advocate with Dementia Australia, and clearly a very effective one.

Of course, after the interim report the government brought in some regulations. There were negotiations with the shadow minister about those regulations to deal with the use of chemical restraints. I'm pleased that that happened, but, given that the draft recommendations of counsel assisting the royal commission include recommendations about chemical restraints, it is clear that there is still an issue. They include recommendations about introducing new requirements regulating the use of chemical and physical restraints—comprehensively regulating them—informed by reviews of quality-care principles, reports of the parliamentary joint committees on human rights and on the operation of the NDIS:

A person receiving aged care who is the subject of a restraint should be readily able to seek an independent review of the lawfulness of the conduct.

I couldn't agree more.

We know, because of the royal commission looking into the absolutely inadequate and failed preparation and response of this government at the time into COVID in nursing homes, that the government need to come back to this parliament by 1 December to report on what they have done. I am calling on the government and the minister, when they do that, to report about how often chemical restraints are now being used. That information should be available to the public. We should know whether or not the reforms that were introduced are working and what else needs to be done. We owe it to Monica, we owe it to Edgard and we owe it to every other person in aged-care facilities, because we all have parents and we're all going to that age one day. It's not a problem of numbers and dollars; it's a problem of what we value in this society. Do we value older Australians or don't we? I know what my answer to that question is, and I'm pretty sure it's everyone's answer. So we need to match those words with action.

I just want to conclude my contribution today by saying how amazing people that work in aged care are. They don't do it for money; they do it for love. They are people who do a job that can be without reward, apart from the fact that they are loved and are loving others. We don't do enough in Australia to value people who work in our care economy, from the start of life to the end of life. As the royal commission has said, we need to do more for the staff in aged care. I look forward to being part of doing more and bringing in those reforms.

Helen Haines (Indi, Independent) Share this | Link to this | Hansard source

I rise to support this bill, the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill 2020 because it makes a straightforward, positive change to Australia's home-care system. Right now, home-care providers are provided the full amount of their clients' home-care packages in advance. This means that any unspent funds, which are often substantial, sit on the books of the provider.

Last week, in the wake of the federal budget, I held a roundtable with home-care providers in my electorate to understand their priorities and challenges. And addressing this issue of holding unspent funds was one of their key concerns. I'd like to thank Leanne Christie, Leonie Painter, Nicola Burns, Jane Archibald and Tracey Hooper, who participated in this roundtable. As a former director of a residential aged-care facility, I know how hard so many providers work on behalf of their clients. I can tell you that these women who I spoke to work very hard every day to do their best for the older people in Indi. I add to the words of the member for Dunkley to say that aged-care providers and aged-care workers right across this nation are the most undervalued people in our society. Only last night, we heard, on ABC's Q&A, from the ethicist Simon Longstaff, who spoke to this as well. When we speak in this place of highly paid professionals in the corporate world and we think about our aged-care providers, we can only hang our heads in shame, quite frankly.

My discussion last week at the roundtable reinforced the broader point that the issues in the home-care sector are substantial, widespread and urgent. This bill is a good bill, but really it's a drop in the ocean of the reform that needs to take place in home care. Let's just consider the state of the home-care system right now. The government's latest data from March shows that more than 103,000 Australians are waiting for a home-care package, the same as a city the size of Ballarat. That figure includes 22,000 people waiting for a level 4 package—that is, people who've been assessed by the government as needing around $50,000 a year in order to take care of their basic needs. And they're getting nothing at all. What's worse, these figures are from March. The government has not yet released data from the June quarter, which will reveal the impact of the pandemic, which has exacerbated these issues even further.

On top of that, these figures are projected to go up enormously by 2024 as our population ages. And, on top of that, we know that more and more people are choosing to stay home rather than go into residential aged care. And aged-care providers are telling me that, because of the negative perception of residential aged care, because of the absolutely devastating findings of the royal commission and because of the pandemic, people are scared and increasingly trying to stay at home. So the demand for home-based care is rising significantly. We need to be adding thousands of packages every year just to stay afloat, and we need to add vastly more than that if we are to work through the backlog of people waiting for packages.

The current waiting time for a home-care package is over 12 months. I've heard from constituents that they've been waiting for over two years. Indeed, tragically, some 30,000 Australians have died in the last two years while waiting for the care they need. Before the budget, the Council on the Ageing called for 60,000 additional care packages to be released in the October budget. But what did the budget deliver? Just over a third of that. Twenty three thousand home-care packages is woefully inadequate for the problem that we face. It's also fiscally reckless. We know from studies undertaken very recently from Victoria University that investing in jobs in aged care or, for that matter, child care—the full spectrum of caring—would lead to a dramatic multiplier effect in our economy and have a huge effect on GDP.

But, while it is fiscally reckless because of this, the whole point of the home-care system is to ensure people can stay in their homes as they age. When people don't get the support they need to stay at home, the alternative is that they move into residential aged care, which, on a per resident basis, is four times more expensive for the government than even the most expensive home-care package. So, from an economic perspective, it simply doesn't add up. Yet 50,000 Australians are in residential aged care because they couldn't get the support they needed at home. These are people who wanted to stay home—50,000! The failure to stump up enough home-care packages and fix the other blockages in the system is not only heartless and cruel, it actually ends up costing the government more. So it really doesn't make any sense to me.

The home-care sector also called for the budget to signal significant reform in the sector. It's not just about the lack of packages; there are other bottlenecks that simply adding more packages does not solve. For instance, providers are telling me that there are also significant delays in the assessment of people, largely due to the lack of a trained workforce for aged care assessment teams, particularly in rural and regional Australia—in places like where I live—and it's even worse in remote areas.

There's also a fundamental mismatch between the package a person receives and the care they need. For instance, imagine an individual assessed as needing a level 3 package whose health actually improves once they receive that package 12 months after they are assessed. That person, in our current system, can't go down to a level 2 package, and has no incentive to either because, if their health deteriorates again, they will need to go through the full assessment process before they can be bumped up to a level 3 package. So people hang onto these things even if they don't actually need them at that point in time. Imagine if we had a more flexible system that allowed us to move people through. It would save us a lot of money and it would be a much higher quality level of care. Bringing us back to this example: that person would have $34,000 a year for their level 3 package sent to their home-care provider but they'd only be spending, say, $15,000. That means possibly $20,000 a year would sit with their home-care provider doing absolutely nothing. And $20,000 is enough for a whole level 2 package, and then some. But, because of a badly designed system, it sits in an account doing nothing. And because of a badly designed system, whilst 100,000 people languish in the queue, there are substantial amounts of money sitting in the accounts of providers going to waste.

The point is that the problems in the home-care system are not just about a lack of funds; it's also about a gross misallocation of funds and a total failure, over many years, to fix these gaping issues in the home-care system. Moreover, home-care providers in Indi tell me that the process for actually delivering packages is incredibly confusing for many people and causes huge problems for them and for providers alike. When a person gets assessed by an aged-care assessment team they subsequently receive a letter notifying them that they've been allocated a package, but being allocated a package does not mean that your package will actually be delivered anytime soon. I think I've demonstrated pretty clearly that it certainly doesn't mean that. When people get this letter it actually means they face a 12-, 18- or possibly 24-month wait to be assigned that package, but they don't realise that. The providers I speak to tell me heartbreaking stories of people who call them up excitedly saying they've been assigned a package, after which the provider sends somebody out to meet them, only to have to explain to them that they'll have wait another year or two before anything arrives. That's not only devastating for the person involved but time-consuming, costly and a very difficult conversation for the provider.

Fast forward a year or two, and that person gets a second letter saying they've finally been assigned their home-care package. They then have 28 days to choose a home-care provider. If they don't do that in 28 days, their package, possibly after they've waited years for it, gets cancelled. The providers I speak to tell me there are people who actually don't understand what this second letter is about, and that many people, after waiting months or years with no support and already having received a letter that really didn't deliver them anything, simply throw this second letter in the bin and, without knowing, forfeit their right to a package. Clearly that's a travesty, and it's not the fault of the vulnerable older Australians who are bamboozled by the labyrinth of the system that we have. It's the fault of a government that has failed for years to design a system that actually works for the people who need it.

Over recent weeks, in addition to my roundtable with home-care providers, I've asked my community what they think of the budget and of the government's plans for recovery. So far I've had 1,200 responses to this survey, and better quality aged care is the second most important issue for people. Just nine per cent of those 1,200 respondents think the government is doing enough on aged care. Eighty-four per cent think it needs to do more. But the numbers don't say nearly as much as the words do. Here is just a tiny portion of what my constituents told me about the home-care system. These are anonymised, and they are direct quotes. From respondent No. 14: 'My mother died waiting for a level 4 package. She was on level 1. My cousin and I had to put her into a nursing home for the last week of her life because my dad couldn't look after her and we couldn't access nursing care in the home.' From respondent No. 112: 'My mother waited almost two years to receive her package. The money came through when she was 91.' From respondent No. 142: 'As a 74-year-old, I find myself visiting more and more of my friends in residential care. Many of them would like to stay at home but, with no live-in care or assistance, it's simply not possible.' Respondent No. 128: 'I had to find an aged-care facility for my dad and his wife earlier this year. They'd both been assessed for a home-care package, but this was going to take at least 12 months to come through, so we just had no option, as they could no longer live at home.' Finally, from respondent No. 96: 'My neighbour died of neglect in a system that should have cared for him. He was found unwell by some other neighbours, who took him to hospital, but he was sent home too soon, with not enough home support, and he was left to the care of the neighbours. And then the neighbours found him for the second time, but this time they were too late; he'd died. This man had no family to care for him. He relied on the system, a system that had let him down. And there was no funeral; there were no answers. His body was just taken away, just gone.'

These are not my words; these are the words of everyday Australians who either are themselves trapped in a cruel system or have watched their loved ones die, as the royal commission described, of neglect. I wanted to quote my constituents verbatim today because I want this House to hear, loud and clear, the anguish that so many people feel. So many Australians are crying out for help, and I want this House to hear that cry. As a former nurse, these stories devastate me but they do not shock me. Anyone who's seen the system up close knows that it's broken. Older Australians built so much of the prosperity that we here enjoy. They raised us. They helped build this wonderful country of ours. Yet we condemn so many of them to live out their final years in the indignity and suffering of cruel neglect.

The ongoing crisis in our aged-care system is a blight on this government, and so, while this bill is an important one and a good one and I commend it to the House, I implore the government: hear the voices of my constituents; hear the voices of everyday Australians around our country. We need you to hear them, but we need you to respond.

Andrew Wilkie (Clark, Independent) Share this | Link to 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.