Wednesday, 28 October 2020
Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill 2020; Second Reading
I rise to speak on the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill. While Labor will be supporting this amendment, this legislation does nothing to help more than 100,000 older Australians waiting for home-care packages, nor does it fix the systemic problems undermining our broken aged-care system and which the federal government is responsible for. Instead, this legislation tinkers at the edges. It is of some value, but ultimately it fails to deliver the home-care packages that will help to keep older Australians at home longer, keeping them connected to their communities and families.
This bill is designed to move the payment of the home-care subsidy to approved providers from an advance payment to an afterpayment. This will place home-care payment packages on the same model used for providers of the NDIS—a model that I'm regularly told places real pressure on providers' ability to do their work. Now, the issue that needs to be appreciated by this government and this House is that post-payment cycles can financially stretch service providers. This is particularly true for smaller service providers. Regional areas like my electorate of Corangamite are more likely to be covered by smaller providers and therefore will be harder hit.
This legislation is more noteworthy for what it excludes than what it includes. The amendment before the House does not implement the wholesale reform needed to protect the safety and dignity of older Australians. The neglect of the sector by this government was brought to light in the royal commission into aged care. The commissions interim findings have painted a bleak picture of many providers which put commercial profits before vulnerable people, and this callous behaviour is only made possible because we have a federal government that has not in its seven years of governing put in place the stringent guidelines needed. It was Labor that pushed for the royal commission and dragged the Morrison government, kicking and screaming, to act, despite the fact that they already knew there was serious misconduct in the aged-care system.
It must be said we owe a debt of gratitude to every loved one, provider and staff member who took the time to provide evidence on the failure of the sector to the royal commission. The first recommendation of the royal commission's interim report entitled Neglect,and what a shameful title, was for the Morrison government to fix the home-care package waiting list. When the interim report was released we had 100,000 Australians waiting on the list for a package. Today, 12 months later, we have 102,000 Australians still waiting on the list for a package and the government's response is to introduce 300 more home-care packages.
It's absolutely tragic that in the past three years more than 30,000 older Australians have died waiting for their approved home-care package. Over the past two years more than 32,000 older Australians have entered residential aged care prematurely. This is simply unacceptable. But true to form the Morrison government has made a stream of announcements without any real action. I know this because many of my constituents have raised their aged-care issues with me. They have experienced firsthand that the announcement never matches the delivery. Many talk to me about their anxiety when forced to place a loved one in an aged-care home. They know there are serious flaws in the system and fear their loved one will receive substandard care. I do understand the pain of losing a loved one in aged care during COVID. This happened to me. It is tragic. It is traumatic. It was awful not to be able to say goodbye. But it makes me even more determined to push for an overhaul of our aged-care system.
The coronavirus pandemic has only magnified the entrenched problems facing the aged-care sector. Almost 700 older Australians have lost their lives to COVID in residential care. Many of the workforce contracted the disease themselves—the same workforce has fought every day to keep residents in aged care safe. Tragically too many vulnerable people have died in aged care, because the federal government and the providers they regulate failed to do their jobs. Every one of these deaths is a tragedy and every one of these deaths is a lesson.
We now know the federal government, and many providers, failed to put enough staff on in place. They also failed to manage the right workforce mix. Training has been insufficient under this government, so knowledge of infectious control was, and remains, far too rare. Insecurity of employment and a casualised workforce drove further infection spread to other workers and clients.
The royal commission was willing to put pen to paper on some of these lessons, specifically finding there was no COVID-19 plan for the aged-care sector. Officials have very plainly said that if the government had moved more quickly to establish better resourced aged-care response centres lives would have been saved. The Prime Minister has boasted about the number of announcements his government has made in aged care, but they've failed to deliver the policies and resources our aged-care sector needs to survive this pandemic. The federal government promised an effective surge workforce for Victoria but didn't deliver. They promised protective equipment for all aged-care workers but too many missed out for too long. And even when our most vulnerable are at risk, even when the pandemic took hold, even when the country demands answers, this government is all photo op and no follow-up.
A key theme of the royal commission has been the repeated testimony of families that have been kept in the dark when it comes to important issues in the lives of their loved ones in aged care. Aged-care facilities receive about 75 per cent of their income from the taxpayer. Despite the heavy reliance on the public purse there is worryingly little reporting of how the money is spent. Families of our loved ones in care need transparency and accountability. When considering reform it's crucial that transparency and accountability of the aged-care sector are at the top of the list. Sunlight is a powerful tool in making sure organisations are behaving in line with community expectations. But this government has a strong track record of shielding dodgy aged-care providers from accountability. Such actions by this government are a disservice to those aged-care providers, like those in my electorate of Corangamite, who are doing their absolute best to put quality care at the forefront of everything they do.
The interim report from the royal commission does make note of the lack of fundamental transparency across the sector. It should be noted the report was handed to the government 12 months ago, but with little consequence. However, the debate we're having today is not about the gross neglect of Australians receiving aged care. Instead, more than a year after the royal commission first reported some of the most horrendous stories imaginable, this government has prioritised the timing of invoicing. Is this the crucial step we need to take for our aged-care system? The house is burning to the ground, and this government is talking about what colour hats the firefighters should be wearing!
We know this government has not turned its attention to the vital issue of workplace planning and management. The nurses and carers in the aged-care sector do deserve our sincere gratitude. This is especially true in 2020, but it has always been true. The royal commission's comments on working in aged care were nothing short of harrowing—in the words of the commission:
Workloads are heavy. Pay and conditions are poor, signalling that working in aged care is not a valued occupation. Innovation is stymied. Education and training are patchy and there is no defined career path for staff. Leadership is lacking.
The commission report went on to say:
Major change is necessary to deliver the certainty and working environment that staff need to deliver great quality care.
The conditions of the workforce described here cut to the very heart of the sector. The sector is nothing without the workers, the carers, who dedicate themselves to looking after our most vulnerable. We must show aged-care workers our appreciation. We need them now more than ever, and, on behalf of my constituents of Corangamite, I say thank you.
To meet the ever-increasing demand for aged-care services and support, the workforce will need to be three times its current size by 2050. That's a threefold increase in three decades. In Anthony Albanese's vision speech on ageing, he said:
Part of the answer to this crisis must lie in our aged care workforce. Those we trust to care for our most vulnerable, our parents, our grandparents, eventually ourselves.
There are too few aged-care workers, and they are paid too little. They have begged the Government to do something.
He said, 'But it is Labor—Labor—who is listening.' He went on:
Our aged care workers need proper pay and proper training.
The aged care workforce must also be able to provide culturally and linguistically appropriate care.
Staffing numbers, qualifications, skills mix and experience, all affect the ability of aged care workers to provide safe, quality care.
Under a Labor Government, solving this will be one of the priority tasks for Jobs and Skills Australia.
I believe in this vision outlined by our Labor leader and I am proud to support it.
This is a third-term government that wants applause for being dragged kicking and screaming to acknowledge the existence of these most serious problems. Well, no—seven years in, there are no accolades, no points, for identifying the catastrophe. So here is a checklist the Morrison government should not need. There should not be a disastrous overreliance on chemical restraints in our aged-care sector. There should not be aged-care workers who have to choose between meeting the medical needs of one patient over another because of inadequate resourcing. There should not be 50 sexual assaults in aged-care facilities every day. There should not be people living in aged-care facilities who are left in soiled continence pads. There should not be people living in an aged-care facility with ants crawling on their wounds. There should not be people living in aged care who are suffering from malnutrition. We should not have a residential aged-care system that fails one in five residents.
This government is failing our mothers and our fathers, our grandparents and our aged-care workers, and eventually the government's failure will affect us all.
In closing, it is important to remind all in this House that government must be judged by how it treats its most vulnerable. It's time the Morrison government fixed the aged-care sector or got out of the way for someone who can.
I rise to speak on the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill 2020. Why this bill? More specifically, why now? There is nothing in this bill that needs to be done now before the royal commission hands down its final report in February 2021. This bill was introduced back in February this year, so we've waited eight months already. It seems far more responsible to wait until after the royal commissioners have handed down their final report. I think it's fair to assume there are serious recommendations coming for major reform to aged care. This legislation seems to be tweaking a system that's failing older Australians. They're tweaks to adjust how or when we pay service providers. They're tweaks that will do nothing to provide better services or release new packages.
Two years ago, when the Prime Minister announced the royal commission, he admitted it was likely to be a bruising outcome. Let's face it, he called the royal commission to get ahead of the bruising reports by the ABC's Four Corners program—a program on which his own minister appeared saying there was no need for a royal commission—how embarrassing.
The royal commission has been far more than bruising. The response of this royal commission was referred to as an opportunity of a lifetime. The stories we have heard from older Australians and their families have been appalling and heartbreaking. When senior counsel assisting, Peter Rozen QC, wrapped up last week he labelled this the most in-depth and thorough examination of Australia's aged-care systems that has ever been undertaken.
The senior counsel presented 124 suggested recommendations to the royal commissioners. There are no guarantees that all the suggested recommendations will be accepted. The fact is they deal with issues that will make this legislation before the chamber either redundant or irrelevant. Regardless of what the commissioners agree upon, there are changes coming and there will be many.
Let's look at a few of the suggested recommendations by senior counsel. Recommendation No. 8 suggested a new aged-care program combining all the existing aged-care programs into a more comprehensive continuum of care of older people. Why tweak a system that may be completely overhauled after the recommendations are handed down?
Suggested recommendation No. 9 is about meeting preferences to age and place. This suggested recommendation includes a requirement to clear the home-care package waiting list and immediately increase the home-care packages available, allocating a package to all those on waiting lists by 31 December 2021. Why tweak a payment system when what we really need is to clear the backlog?
Suggested recommendation No. 14 is about approved providers responsibility for care management. This would see an approved care provider assign a care manager to each individual. In the instance where there are more than one provider, the leading provider must assign a care manager. Why make life harder for aged-care providers when an overhaul is on the way?
Suggested recommendation No. 16 is about assistive technology and the home modifications category. This would provide aids, appliances and services to promote independence in daily living and reduce risks to live safely at home. Why tweak the system when what people need is more than what's being offered anyway? Older Australians simply want to age well, safely and securely at home.
The Darling Downs and West Moreton Primary Health Network, so ably led by CEO Merrilyn Strohfeldt, asked older residents in my community what they thought about services that provided care for older Australians. Among the things they wanted to see was more support to continue living at home as they aged. They wanted: more focus on prevention, such as exercise, balance and nutrition; more help to manage their health needs; and more services closer to home, such as visiting professionals and telehealth options. This is exactly what the royal commissioners found in their interim report so infamously called Neglect, and that's what the evidence that has been adduced before the royal commission shows since the interim report. It's what we want for our parents, our grandparents and for ourselves as we age. It's what home care is all about, or, rather, it's what home care should be all about.
Given there are more than 100,000 Australians still waiting for home-care packages, given we are just four months away from the final report of the aged-care royal commission and given there's a strong likelihood of major reform to aged care coming, why are we debating this legislation now? Is this the time to be tweaking a system, which isn't working, about how the government pays providers of aged care—tweaks that would put pressure on smaller providers? When we know we need more packages, is this the time that this legislation before the chamber is so important? If people are not being supported to live independently at home then they are more likely to require more expansive and expensive health and residential aged-care services. Do we want the see more Australians languishing and dying while waiting for home-care packages?
This legislation does nothing to address the current crisis. The legislation does nothing to address the challenges, the blessings and the burdens of our ageing population. The government hasn't even considered the issues of an ageing population. This is a government with a track record of ignoring the ageing population and the impact of longevity on our economy and our lifestyles and on jobs and on services.
I hear backbenchers in the government waxing on about their proud record on ageing. They must have political amnesia. A bit of history is really important. Back in November 2013—this is a third-term government—one of the first acts of this government was to scrap the Advisory Panel on Positive Ageing, just six months away from delivering their final report, their blueprint. But it shouldn't have come as a surprise to anyone, because the coalition parties, going into the 2013 election, had a seven-page pamphlet—seven pages in total—that they devoted to aged care. That was their total policy commitment on the area of aged care. They said things like they were going to get rid of antiquated regulatory processes. How's that going? They thought this would put at risk standards in the industry. If they got rid of regulations, they thought it would also help, because people would be less susceptible to potential abuse and neglect. That's really gone down fantastically well, hasn't it? Honestly, what a joke that policy was.
'Ageing' wasn't a dirty word to former Treasurer Wayne Swan, who established this panel of pre-eminent Australians to lead the nation forward. At the same time this government was sacking Everald Compton and his panel, they axed the Aged Care Workforce Supplement—$1.2 billion designed in accordance with the sector to assist aged-care providers to pay and train their staff appropriately. Then, a few months later, in June 2014, they axed the dementia supplement. That was just fantastic! As we know, ACFI, the Aged Care Funding Instrument, doesn't cover severe behavioural issues and issues for those people suffering from severe dementia. It doesn't fully catch them, so the funding doesn't cover everything.
The previous Labor government designed a dementia supplement, providing 10 per cent extra, and a veterans supplement, also providing 10 per cent extra, for home-care packages and a daily payment for people living in residential premises who were living with dementia and severe behaviours. But what did this government do? One of its first acts was to get rid of dementia supplement, which was affecting, at that time, 330,000 Australians. So don't come into this place and tell us about your proud record. There's barely been a MYEFO and a budget that this government has brought forward that hasn't resulted in a mismanagement of the aged-care sector or a cut, particularly in their first three years under Prime Minister Abbott and Prime Minister Turnbull, to funding in the aged-care sector. I might add, the current Prime Minister was the Treasurer during a lot of that period.
Because those opposite are so excited and happy about what their record is, let's have a bit of a look at what they've done. On September 2017, there were 6,000 home-care packages. This was their first relief. They were all exhausted by December 2017, so, in the budget in 2017-18, there was no funding for 14,000 home-care places. They took them all away by reducing the 26,000 residential aged-care places. That was really a brilliant move! In the MYEFO in 2018, there was supposedly another 10,000 places. They brought forward some funding. That's all they did. They didn't put forward new funding; they just brought it forward.
In February 2019, they announced another 10,000 places on the eve of the royal commission hearings beginning over five years. It was because they wanted a little bit of an accounting trick. They are really good at it if you watch Senate estimates. They also reannounced that in the budget in 2018-19. Then in November 2019, prior to MYEFO and in response to the royal commission's interim report titled Neglect, they announced for one year from 1 December another 5,500 places. You can't really work out when you look at it whether that was new money or just rehashed or recycled money. So don't give us lectures about how good you are in terms of aged care when you have a royal commission damning you at the moment and you can't find a budget or MYEFO you don't want to cut the funding for. The government are obsessed with aged-care funding cuts.
This government has moved 'ageing' out of the departments of health and human services. It stuck it initially in the department of social security, where it got lost. Ageing became a government service without any consideration of how to address the ongoing health and active ageing policy agenda. Eventually aged care was moved back to the Department of Health after Labor campaigned for that to happen, and so many people in the sector did also. But the government remains focused on aged-care services rather than ageing policies. There is a distinction, but you wouldn't know it. I remember a former coalition minister for rural health telling a Senate estimates inquiry she considered 'ageing' and 'aged care' to be precisely the same thing. I can assure you they are not. I encourage anyone to have a look at the Department of Health website and look at it's 'health topics'. There's 'aged care' but no topic for 'ageing'.
Come to think of it, 'dementia' doesn't rate as a topic either. Dementia is the second leading cause of death for men and the leading cause of death for women. In 2016 it became the leading cause of death for women and the greatest cause of disability for older Australians. Dementia Australia tells us there are close to 500,000 Australians living with dementia at this moment and a further 1.6 million Australians are involved in the care of someone living with dementia. We recently buried my mother-in-law, who was living with dementia for many years. In the next 30 to 40 years, there will over one million Australians living with dementia. How does dementia not rate as a major health topic on the Department of Health's website? Dementia isn't an ageing issue. It is true that over half of the residents in residential aged-care facilities are living with dementia, but it is a disease that affects young people as well as older. Almost 30,000 younger Australians are living with dementia.
The research is vital. But where is the government's agenda on active ageing and dementia-friendly communities? We hear nothing from the government about positive ageing or age-friendly communities. A large part of the demographics of our country is getting older. The community that plans for this with appropriate infrastructure and public places, safe and stable walking services, plenty of seating and conveniently located restrooms is the community I want to live in and that Australians want to live in. It is a community that appreciates playgrounds are not just for kids but to provide exercise and recreational facilities as well. It is a community that employs older people and utilises their wisdom and their experience to mentor and train young people. It is a community that values and appreciates older people, rather than isolating and neglecting them. It is a community informed about dementia and aging, respecting and caring for those people living with those challenges. It's a community that provides appropriate housing options, age-friendly transport options and health, consumer and social services. This is a community that provides services and support for carers.
Labor took these policies to the last election, and I anticipate that we will do so again. On this side of the chamber, we want to wrestle with these options and develop comprehensive plans with stakeholders. We're a party that believe that the ageing of our population can be a positive thing, a blessing rather than a burden. It is a tremendous achievement in Australia that our population is ageing. It is something that we should celebrate. It is a good outcome for our health services and an achievement we can take pride in.
When I see all the challenges we face in the health and ageing sectors in terms of dementia and getting our communities ready for the demographic changes that will happen and I see legislation that tweaks things like this, I see that the government have utterly failed older Australians. They are languishing at home. This is an unacceptable performance by the government, and they should be ashamed of themselves.
The Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill 2020 amends the way that home-care providers are paid a government subsidy so as to address stakeholder concerns regarding unspent funds and to align home-care arrangements with other government programs, such as the National Disability Insurance Scheme. The bill will amend the legislation such that an approved provider of home care will not receive a payment in advance but will be paid a monthly subsidy for a home-care recipient upon lodgement of a claim with Services Australia at the end of each month. The government has introduced a second bill, which will amend the legislation such that home-care providers will only be paid a subsidy for services rendered to a care recipient during a month, with Services Australia retaining the unsent subsidy for which a care recipient is eligible in each month. This unspent subsidy will be available for a provider to draw down on behalf of the care recipient as services are provided in future. I thank all members for their contributions to the debate on this bill and commend the bill to the House.