House debates

Wednesday, 9 December 2020


Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 2) Bill 2020; Second Reading

4:42 pm

Photo of Katie AllenKatie Allen (Higgins, Liberal Party) Share this | | Hansard source

The Morrison government is committed to supporting older Australians to maintain their independence at home to the maximum possible extent. This is something that senior Australians tell us they want, and we are delivering. This bill is yet another important step towards the delivery of improved home care and the aged-care system more broadly now and into the future.

The purpose of this bill is to improve the administration arrangements of paying home-care subsidies to approved providers. It does so through two key reforms. First the bill will require approved providers to report to the Commonwealth as to the cost of care and services provided to home-care recipients each month. Under existing arrangements, approved providers only have to provide a monthly statement to their home-care recipients that show recipients' available funds, how they are being spent and the amount of the unspent funds. This change will ensure improved financial accountability and allow for better transparency over the use of funds for home care.

Second, the bill will require that the Commonwealth retain on behalf of recipients subsidies that may be in excess of services provided, which can be drawn upon in the future. Currently, approved providers hold and manage accumulated unspent funds, including Commonwealth subsidies. This is quite at odds with many other grant schemes and subsidy schemes. The most recent data suggests that the current pool of funds is around an enormous $750 million of taxpayers' funds. Some providers treat these unspent funds as part of their working capital, when they should in fact be recognised as a liability for unspent and undelivered services. This bill will simply correct that. These measures bring contemporary business practices into home-care subsidy arrangements and align them with other government programs. It's what the taxpayer expects. This bill, importantly, will not affect the eligibility of consumers or the amount of home-care subsidy payable for eligible home-care recipients. This bill builds on the first stage of reforms which change home-care subsidies from being paid in advance to being paid in arrears.

Now, who do these reforms benefit? They benefit our beloved mums and dads, grandpas and grandmas, uncles and aunts wishing to enjoy their twilight years at home. We know that most Australians want to remain in their homes for as long as possible, and the Morrison government supports this choice. As we look to the future, we know that Australia's population is ageing rapidly, and people prefer to stay home longer. This does put pressure on our home-care package system. If there is suboptimal in-home care, this can then accelerate the progression of people moving to the next stage of life, which includes more supportive care in a residential setting. It makes great preventive healthcare sense to support people in their homes. We know from the evidence that this is the best case—for people to stay as long as possible. It keeps them connected to their communities, it keeps them active in their minds and it keeps them comfortable in their homes. In-home care keeps people fitter and better connected to their family, and it's more cost-effective to the taxpayer than residential care.

What's also very exciting about this sector is the ability to embrace new technological advances in home monitoring, and those are coming online very rapidly and making a big difference to the way that we care for people in home. My father developed Alzheimer's in his twilight years, and we kept him at home as long as possible with the support of home-care packages, but, as he grew more and more frail, he then needed to move into a residential care setting.

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 2012-13, when we first came to government, to 185,000 during 2020-21. This is a threefold increase. It's very welcome. The 2020-21 budget includes the delivery of an additional 23,000 home-care packages, at a cost of $1.6 billion, in addition to the 6,000 packages announced in July at a cost of $325 million. This bill is an important step towards helping improve the efficiency and effectiveness of the home-care system and it will enable taxpayers' money to be better spent now and into the future.

I would also like to take the opportunity to talk about the fact that, as the residential aged-care population are ageing even more rapidly than the general population, there is an increased clinical need in that residential aspect of care, and that is actually because the home-care packages the Morrison government is delivering are keeping people home longer and in a more supported environment as a result. Therefore, we need to make sure that we prepare the workforce of the aged-care sector for the future. We need to incentivise clinical leadership through appropriate remuneration packages to ensure that sector leadership is both sufficient and of excellence. We need to make sure that we increase the opportunity for people to take workplace training in regard to aged care, because we know that the aged-care bubble of the baby boomers, as they reach the over-80 age category, is now coming at us at speed.

COVID has also demonstrated the tension between federal aged-care services and state healthcare services. Those facilities that did well provided better in-reach health care, which was provided by local hospitals and GPs. Therefore, I believe that coordination across state and federal jurisdictions is required as we increase the acuity of care in the aged-care sector, and this will help to relieve the state governments' healthcare costs in that sector. But this needs to be achieved without cost-shifting between state and federal governments.

We also need to make sure that standards in aged care are healthcare focused and not just about consumer experience. I'd like to see improving standards with regard to the aged-care sector, to ensure that both consumers' aged care and the health needs of the sector are looked at across home and residential and subacute residential care.

The Morrison government has delivered and will continue to deliver on aged care, now and into the future. It's too important not to care about. We know that older Australians have worked their entire lives to build this great country. This bill will form a part of a suite of aged-care reforms which aim to provide a contemporary, efficient, effective and stable care system for the aged, which they need and deserve. I welcome this bill and look forward to working hard in this place to ensure that the vitality and effectiveness of the aged-care sector more broadly continues now and into the future. I commend this bill to the House.

4:50 pm

Photo of Joanne RyanJoanne Ryan (Lalor, Australian Labor Party) Share this | | Hansard source

It's a pleasure to speak on the amendments moved by the member for Franklin. I want to state a couple of important facts before I get into the gist of the amendment, the first being that this bill was brought into the chamber in February this year—that's before COVID—and seems to have gathered dust for months and months and months. I note in the member for Toorak's contribution she did not reference the royal commission into aged care—which has enormous relevance to this bill—but the 'suite of bills' that will be coming, according to the member for Toorak. Everyone in this place knows that the interim report of the royal commission into aged care in this country has the title Neglect. That pretty much sums up the findings of the interim report into aged care.

Photo of Trent ZimmermanTrent Zimmerman (North Sydney, Liberal Party) Share this | | Hansard source

Order! A point of order?

Photo of Vince ConnellyVince Connelly (Stirling, Liberal Party) Share this | | Hansard source

On a point of order: I believe that the member might have mistakenly called the member for Higgins something other than the member for Higgins, so I would ask her to correct that.

Photo of Trent ZimmermanTrent Zimmerman (North Sydney, Liberal Party) Share this | | Hansard source

I remind the member for Lalor to refer to other members by their proper titles.

Photo of Joanne RyanJoanne Ryan (Lalor, Australian Labor Party) Share this | | Hansard source

Given that the member for Lalor often has to correct people on how to pronounce the name of her own seat, she won't take offence. She will take the point of order, but she will say again that the member of Higgins, who spoke before me on this piece of legislation, failed to reference, even once, the royal commission into aged care or its interim report titled Neglect, and nor did she mention this government's failure to act on any recommendations from that interim report.

The home care package situation is absolutely critical. It's more critical now than it has been because, of course, we've had the pandemic and the enormous frustrations for all in the Victorian community around the residential aged-care system funded by the federal government and regulated by the federal government. And when you compare the federally funded and regulated aged-care sector in Victoria with the state based sector, you can see an absolutely glaring failure in a system—an absolute failure—where we had rampant infection rates. In my electorate, we have six residential aged-care facilities, and four of those aged-care facilities had COVID-19 infections. They weren't all catastrophic; one of the facilities that had infections managed to minimise it fairly quickly, got a very good plan in place and stopped the infections. But, overall, in my electorate there were 472 confirmed cases attached to aged care. There were 220 staff and 188 residents impacted. Of those 188 residents, there were 67 deaths. So I relish the opportunity to speak here on behalf of those families on this piece of legislation to remind those opposite that they have an enormous amount of work to do. I remind them that this suite of policies needs to address both residential aged care and home care packages—where 100,000 Australians are waiting, and where our elderly residents, when given a home care package, are often not given the level of care that they require.

I can speak with some recent experience in this space as someone who has an elderly mother who manages to live independently, and who broke her neck of femur in the middle of the pandemic crisis and spent some time in our public hospital sector. I take the time to thank two public hospitals, the Footscray Hospital and the Werribee Mercy Hospital, for the care that she received in both places under extraordinary circumstances, in a community with high transmission levels. But the point I want to make is that we have an aged-care sector now with lots of reputational damage and there is a lot of fear in the community, and not just from the elderly. My siblings and I—and there are eight of us, seven surviving—are all concerned about what those next steps are. We've got our mum home. She doesn't have a home-care package. She's one of the 100,000 Australians waiting for a home-care package. She does have a new bathroom, which we got fitted while she was in hospital. But our fear about her going into residential aged care is now acute, as is the fear across the community, particularly my community.

There's an enormous amount of work to be done here, and bringing in a piece of legislation that just tweaks a payment process for home-care-package providers is almost an insult to this parliament. It is almost an insult, after the year we've had, the figures we've seen, the numbers we know and the lives that have been damaged—the lives that have literally been limited because of an aged-care system that lacks resilience and because of a government that is ignoring an interim report from its own royal commission. It's ignoring the recommendation that every aged-care facility in this country should have an infection control specialist, after our local experience, where we had aged-care facilities without PPE on the ground to stop those infections and where we saw a facility with a 5½-week infection period. I can't put it more plainly than that. That is an absolute failure of the system. And I know that in Victoria, in my community, people are still anxious. We don't believe—rightly—that we're ready in case there's another outbreak in the other aged-care centres in my community, and that's a failure of this government.

We're here talking about a piece of legislation, brought in in February this year, which does some tweaking to the home-care-package payment system, and this government has failed to do the things the royal commission recommended it do, including transparency around the funding for home-care packages and residential aged care. It has failed to do the things that would lift the community's belief and faith in this sector, which is absolutely critical. We cannot afford for this system not to work; that's the bottom line. We can't afford a failure.

This government has a lot of work to do, and I suggest the members opposite who are going to speak on this bill today make sure they reference the things that they know the royal commission has asked them to take on board. I'm hoping that what I'm going to hear from the contributions of those opposite is a plan to fix the system in both home care and residential care.

4:58 pm

Photo of Vince ConnellyVince Connelly (Stirling, Liberal Party) Share this | | Hansard source

Before I speak directly to the amendments in this bill, the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 2) Bill 2020, I'll first frame some of the context. The Morrison government is steadfastly committed to valuing and supporting ageing Australians, and that is why we're continuously improving our aged-care system. Demonstrating this commitment, we are delivering record investment across the aged-care system. This has grown from $13.3 billion in 2012-13 under Labor to $23.9 billion in 2021 under the Morrison government. It's estimated that funding for aged care will grow to more than $27 billion by 2023-24.

Senior Australians are increasingly choosing to remain in their own homes for longer, and the government is committed to supporting this choice. 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 60,308 in 2012-13, when we came to government, to 185,597, to be precise, in 2020-21. Under this government there was an increase of 38 per cent in a single year in the number of people receiving a home-care package between 31 March 2019 and 31 March 2020.

The government is introducing this bill to improve the way home-care subsidies are paid to providers for care recipients. These changes respond to stakeholder concerns about the rising level of unspent home-care funds, and they also align payment arrangements with other key government programs such as the National Disability Insurance Scheme, NDIS. This bill is the second of two bills changing payment arrangements for approved home-care providers. The first bill changes the payment of home-care subsidy from being paid in advance to being in arrears.

This bill amends the Aged Care Act 1997 and the Aged Care (Transitional Provisions) Act 1997 such that approved home-care providers will only be paid subsidy for care and services rendered to a home-care recipient during a month, with Services Australia retaining the Commonwealth portion of unspent funds for which a home-care recipient is eligible to receive. Services Australia will hold the unspent subsidy until such time as it is drawn down by providers on behalf of the home-care recipient. These changes have been consulted upon with home-care providers and peak bodies by the Department of Health and the Aged Care Financing Authority, ACFA. In 2019, ACFA completed a project assessing the financial impacts of these changes on home-care providers. The government is also making a minor and technical parliamentary amendment to this bill to correct a drafting error in the calculation of the amount of subsidy payable.

By introducing this bill now we will enable the sector sufficient time to make any necessary changes to their payment systems. ACFA's assessment is 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. Financial support for some providers will be available during the transition, taking into account any subsequent impact of COVID-19. Home-care providers are also able to apply the government's free business advisory service for advice on managing their finances.

Let us now reflect on Labor's approach to aged care. Labor is missing in action when it comes to supporting the aged-care sector and the needs of vulnerable and senior Australians. It went to the last election promising $387 billion in new taxes, and not a single additional dollar for home care, aged-care quality or workforce, or mainstream residential care. The opposition leader's budget response offered no commitment to fund home-care, no support for staff and nothing for quality and safety. The opposition leader didn't even mention home care in his recent budget reply speech.

By comparison, the Morrison government's 2020-21 budget includes 23,000 additional home-care packages, at a cost of $1.6 billion, in addition to the 6,105 packages announced in July, at a cost of $325 million; more than $746 million in aged care COVID-19 response measures as part of $1.6 billion in COVID-19 specific support in aged care; and $408½ million for aged-care reform initiatives to improve the quality of care, further respond to the urgent issues raised by the royal commission into aged-care quality and safety and lay the foundations for future reform. Labor's only strength has been its ability to deliver spin, whilst the Morrison government continues to make the quality care of senior Australians an absolute priority.

5:04 pm

Photo of Susan TemplemanSusan Templeman (Macquarie, Australian Labor Party) Share this | | Hansard source

It's disappointing that the debate we're having here about home care and in-home care is not about substantive reform; it's about tweaks of administrative things around the edges. Now, we won't be voting against that; we can see the merit in the measures that are being put forward. They are sensible when you consider that there was something like a billion dollars of unspent home-care funds sitting in different providers' accounts as of 30 June 2020—and possibly more, given some consumers might not have been able to use their funds during COVID. This is a sensible thing to look at, and we haven't opposed it, but I think the disappointment is that this isn't more substantive reform, particularly when the royal commission, more than a year ago, raised issues around home care and the sorts of reforms that we need.

It's all very well to rattle off numbers—we've had this many extra home-care places—but the reality in communities like mine in the Blue Mountains and the Hawkesbury is that there are people waiting for someone to die or go into aged care so that they can access a package, because this is not a demand driven system. It's a system with a certain number of packages at certain levels, and you have to wait for one to become available. In the last two years there have consistently been more than 100,000 people—sometimes more, never less—waiting for their turn to come up. That is not a system about which you can say, 'She'll be right,' because it's not right, and it's causing pain at times.

I've heard members on the other side talk about how important it is to support people in their homes. You can keep them healthier for longer in their homes than you perhaps can in other ways. It's not good enough to say, 'Yes, you'll get one, but you have to wait.' These are the sorts of realities that people are facing, and just hearing members say, 'Oh, we've done lots', is not making a difference. There are more than 100,000 people. Right now, it's 102,000 people. They're the figures we have from the last quarter. We're still waiting for the September quarter figures to come out. Funnily enough, we haven't seen those yet. Consistently, this government has delayed the release of figures that tell us exactly what that number is, and that is a disgrace.

The people waiting for home-care packages are those who want to retain their independence, and they deserve that. They want to be able to have just enough care to be in their own home. I met with a wonderful woman, Joyce, the other day. She does have a home-care package. That gives her access to some gardening that supports her. She wants to knows that, as she gets older, the extra support she'll need is going to be there. I'm sure, Mr Deputy Speaker Wallace, you would also wish that for family members of your constituents. I certainly wish that for mine.

I'm disappointed at the end of this year. I know we've had COVID, but COVID is not an excuse for not acting on a whole lot of things. There has been more than a year of waiting to get a response to the interim report of the royal commission, and we hear suggestions of a suite of packages, which one of the members opposite foreshadowed. Well, let's see it. Show us what's going to come, because right now people don't have a lot of hope that what's going to come is going to do the job.

I think it's particularly pertinent to remind people that, over the past three years, more than 30,000 elderly Australians have died waiting for a home-care package. They've died waiting for help in their home. It just isn't good enough. Over the past two years, more than 32,000 older Australians have entered aged care earlier than they would have hoped because they weren't able to access a home-care package. We all know that providing in-home care is a much more economic premise than is putting people in the position of having no choice but to enter residential care.

Work has been done in relation to this bill, Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 2) Bill 2020, by aged-care accountants StewartBrown. They have looked at how much of the current system is unspent. That's where the billion dollars comes from. They also looked at the average unspent funds per client. They put that at approximately $7,000. Now, these are people who are experts in in-home aged care and aged-care accounting. It's one of the rationales for this bill going ahead and our support for it.

Those same accountants also found that the recipients of home-care packages across Australia are getting, on average, fewer than 10 hours of care each 14 days. That's data from the 2018-19 financial year—data which they presented to the royal commission. Of that time, those 10 hours across 14 days, they found that 6.6 minutes of care was provided by registered nurses in in-home care; 1.8 minutes of care was provided by enrolled or other licensed nurses; and more than seven minutes of care per fortnight was provided by allied health professionals. Even health department First Assistant Secretary Dr Nicholas Hartland said that he found those results unexpected. It is not what anyone should have expected.

So, while we will support this bill going through, we need to see much more change before any of us in this place can have confidence that in-home care packages are available to people who need them when they need them, and that they get a level of care that they require under those packages.

5:11 pm

Photo of Graham PerrettGraham Perrett (Moreton, Australian Labor Party, Shadow Assistant Minister for Education and Training) Share this | | Hansard source

I rise to speak on the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 2) Bill 2020. This bill changes the way that home-care providers are paid for the care and services delivered to a home-care recipient. Labor has a significant number of concerns about this bill—namely, that there may be increased financial risks for some smaller service providers and those in regional and remote areas who don't have adequate cash flows to deal with the payment changes and who are unable to hold unspent funds, which is something that other speakers have touched on—I know that's a concern, particularly for a couple of people in the Liberal Party, so I appreciate their contribution; that services providers who are currently losing money will face significant difficulties changing over to an arrears payment type arrangement; that some service providers may be reluctant to take on new consumers during the transition to the new arrangements; and that the Royal Commission into Aged Care Quality and Safety has not yet handed down its final report, which is due in February next year, and that report may flag some further reform for the home-care payment system.

The Morrison government needs to take urgent action in relation to home-care packages, but changing the funding arrangements is not what would have been my first priority. The Royal Commission into Aged Care Quality and Safety delivered its interim report more than a year ago. I don't imagine that all Australians would have read the report but they would remember that it was called one word and that that one word was Neglect. That interim report identified three areas where immediate action could have been taken. The first of those areas was to provide more home-care packages to reduce the waiting list for higher-level care at home—a recommendation handed down to Prime Minister Morrison over one year ago. Surely that should have been the first priority for this government.

The Morrison government has had 405 days since that report, Neglect, was handed down to make some changes—making some fixes. For some of that time, the Prime Minister was in Hawaii working on his sun tan, but this crucial issue still hasn't been fixed. Over the past three years, more than 30,000 older Australians have actually died while waiting for their approved home-care package, and many then received notices saying that they'd moved up in the queue—moved up in the queue after their friends and family had actually signed their memorial books. As at 30 June this year, 2020, there were 142,436 older people in receipt of a home-care package. That's good news for them. It's great news for those 142,000 people, but there are still 102,000 older Australians on the waiting list for home-care packages. That's like everyone in the city of Toowoomba waiting for a home-care package. Anyone can see that this is completely opposite.

Those opposite keep saying—I have listened to some of their contributions—that the Morrison government is committing record spending, and they keep talking about record numbers. Well, newsflash to the people of Australia: there is a record number of senior Australians. They're called 'baby boomers' because there was a boom in babies after World War II and the Depression. We've known this was coming for about 70 years. There are more elderly Australians. Those in the government keep saying: 'Wow! We're giving more money!' Newsflash: of course you should; you're just doing your day job. Don't give yourselves a pat on the back for doing what the Australian Bureau of Statistics has said you should've been doing for the last 50, 60 or 70 years.

The royal commission interim report, as I said, was called Neglect. It explained in detail the difficult journey that older Australians make as their needs change. They need more help around the home and more help with doing the grocery shopping and getting to medical appointments, and eventually they will need help even in personal care, in things such as showering and caring for wounds, toileting and taking medications.

I've got a father in his 80s, Brian Perrett. He is in this position. He lives a long way from me, in the member for Maranoa's electorate. But with just that little bit of help, he has been able to stay in his home. Between family and some professional carers, he's been able to stay in his home, with all the dignity that comes with that, so that he can spend his time in his shed, making more wooden gifts for his children and grandchildren and great-grandchildren, which I'm sure we'll all appreciate, Dad, come Christmas. Merry Christmas to you, and to all the carers who make it possible for you to stay in your house.

But, when it comes to negotiating a way through the aged-care system, it can be confronting and often very frightening for older Australians. Older Australians who want to stay in their home—and that's completely understandable and commendable—will need to access My Aged Care, on the web page or the phone system, and undergo a face-to-face assessment to determine care needs and to receive a home-care package. Having negotiated this with my father, I have some familiarity with the process that people go through. It is complicated, and it's easy to see how this process for older Australians, who are already frightened, just gets a whole lot worse when they are then faced with long waiting times.

The royal commission heard from those older Australians who are on the waiting list about how they felt, and this is what one of them said:

We are kept in the dark and given false hope. There are many unanswered questions about how the system works. Is the government hoping it all gets too hard and that we drop out of the 'queue'?

Even if that's not the plan, the reality is that 30,000 of those on the waiting list died before receiving their package—a package that they were owed, that their taxes paid for. Some of the carers shared their experience of waiting for home-care packages for their loved ones. One carer said:

Due to me not being able to lift her we had problems, I remember sitting on the bathroom floor with her for hours waiting for an ambulance to come, I have never felt so helpless.

Another said:

My mother is suffering with dementia, she requires 24 hour care and is very fearful of being left on her own for even 5 minutes. She will wander, scream, cry and become overwhelmed easily and suffers from delusions and severe anxiety.

This is distressing reading. For those who have looked at the report entitled Neglect, it is depressing reading.

I'm actually going to recommend another piece of reading for those contemplating aged care who don't want to read the report. It's an article by Sarah Holland-Batt called 'Magical thinking and the aged-care crisis', and it's in Griffith Review No. 68, titled Getting On. It's one of the most gripping bits of reading that I've ever read, and I've got an honours degree in literature. It is incredible writing, and it makes you think about what we're doing as a nation. So a big shout out to the editor, Ashley Hay, and the associate publisher, Jane O'Hara. Keep up that good work.

But for those older Australians who've been approved for a home-care package and are stuck on the waiting list, and for their carers, this is their life, day in and day out. There is no end in sight for them and no help forthcoming, until they reach the top of that very, very, very long queue, of 102,000 people. Just picture how many blocks that queue would stretch for, if all these people were lined up at a My Aged Care office—if one existed. Under the Liberal government, the waitlist for home care has grown from 88,000 to 102,000 older Australians—not something that those opposite mention. This distressing number underscores the failure of the Morrison government's response to this ongoing crisis in aged care. Labor has been calling for action on reducing the wait lists for home-care packages since the first release of data revealed too many older Australians were waiting for care. Aged-care reforms were meant to give older Australians more choice about where they live as they age. Instead, the Liberals' policy chaos has completely failed to care for our older Australians.

The Productivity Commission released in January the median wait time for a home-care package. It has blown out in the last year by more than two months. Many older Australians are waiting for more than 12 months for the package that they've been approved for, and some are waiting for more than two years. Some older Australians are entering residential aged care or even emergency departments instead of receiving their approved home-care package. The aged-care system is broken and, as the royal commission has noted, it suffers from neglect—and that was the title they gave to their interim report: Neglect.

The Liberals have almost been asleep at the wheel for seven years, now in their eighth year. In his first budget as Treasurer, Treasurer Scott Morrison ripped $1.2 billion from aged care. There have been four ministers and the aged-care system has lurched from one crisis to another. It is shameful that, in a relatively wealthy country like Australia, older people can't get the care they need when they need it. The royal commission said it believes that significant additional funding is needed immediately—as I said, 400-plus days ago—and in the future to increase access to home-care packages. The royal commission said that more than a year ago, and yet we still have 102,000 people on the wait list. There's just one word—neglect—that covers what the government is doing. The word 'neglect' should be hung, in shame, around the neck of Prime Minister Scott Morrison like a dead albatross.

5:21 pm

Photo of Peta MurphyPeta Murphy (Dunkley, Australian Labor Party) Share this | | Hansard source

We are almost at the end of a royal commission into aged care in Australia. It has been talked about a lot in this parliament and I have no doubt that it will continue to be talked about a lot in this parliament. Citizens, aged-care providers, academic experts, medical experts—a whole gamut of people—gave evidence to the royal commission, and commissioners examined what should be a system that we are proud of. We should be looking after the people we value—they have lived lives that have contributed to the quality of the lives that we're all living now—with love and care. Before turning to why such a royal commission would have an interim report entitled Neglect, we should all pause and ask ourselves: how did we get to a position in Australia where we needed to have a royal commission into aged care? What does that reflect on us as a society and a community? What does it reflect about the priorities that we have shown as communities, people and governments? Sadly, and to our shame, it reflects very little that is good.

The fact that we have a royal commission reflects positively on the people who pushed for it over and over again and didn't want to see others suffer the way their parents, their loved ones, their husbands or their wives had suffered in aged care, and, disturbingly, their children sometimes had suffered in aged care, because we've seen the number of young people with disability in aged care. It's a good thing that we have a royal commission and that we are coming to the end of it, and it's a very good thing that, in the finest tradition of our democratic system, our aged-care commissioners have been and continue to be fine, upstanding and diligent individuals who are taking their responsibilities incredibly seriously. It is now the responsibility and the privilege of those of us elected to be in this parliament to make sure that the work of that royal commission is implemented and make sure that the effort that people have put in to make submissions and contribute to that royal commission is honoured. It's the right and the privilege of all of us, but it's particularly the responsibility of the current government.

As many people speaking before me have said, this legislation today, the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 2) Bill 2020, brings in some reforms that we are all hoping will assist in the home-care system. But it is fair to say that it's a small change. As the member for Moreton said when he spoke before me, whilst it's a good change and we hope it will free up some money that is being held that should be going into home-care packages, it is arguably not the most urgent reform out of all of the reforms needed. When we have royal commissioners who, a year ago, handed down a report that described our aged-care system as a shocking tale of neglect, a sad and shocking system that diminishes Australia as a nation, it should be the case that any recommendations made by that commission are implemented immediately. It's perhaps intellectually correct to say we'll wait for a final report, but it's not the correct thing to do morally when we know and have evidence that it's a sad and shocking system that diminishes Australia as a nation.

I have no doubt that every other member of this parliament has constituents that have contacted them and has had the experiences that I've had of speaking to families in utter distress, particularly during this year of COVID in 2020, about the experience of their parents in particular, and their grandparents, in aged care. Every single member of this parliament who represents an electorate in Victoria has had the added experience of constituents beside themselves with fear and then with grief about COVID-19 going through the aged-care system and, tragically, taking the lives of people before they were ready. They may have been elderly and they may have been sick, but they weren't ready to go, and their families weren't ready for them to go and certainly weren't ready to lose their loved ones without being able to give them a final hug or touch their hand. It is a shocking tale of neglect that our aged-care system, which is the responsibility of the federal government, wasn't properly prepared to deal with the pandemic. We can never let that happen again. Once is horrific. If it ever happens again, it will be a sad and shocking occurrence that diminishes all of us in this place and, in particular, those who are currently charged with the responsibility of not just funding but regulating the aged-care system.

Is it any surprise then that a growing number of Australians want to age in their home or age in place, and that a growing number of Australians don't want their parents ageing in a residential facility? That is not intended to be any sort of criticism of the amazing people who work in aged-care facilities: the registered nurses, the aged-care workers and the people who work in administration. They are some of the most amazing people, who do a job that is often as much about love as pay, because we know they are overworked and underpaid.

We also know that people who work in aged care in homes are amazing people. Between the ages of about 60 and 72, my mother-in-law was an aged-care worker who cared for people in their homes. She used to describe the women she cared for as her 'old ladies', which always filled us with a little bit of laughter, of course, because Betty wasn't a spring chicken. She would tell me stories about what it took to care for people in their homes, particularly people who were suffering from dementia. A number of the women that my mother-in-law cared for were Holocaust survivors and had been in Auschwitz, and had dementia, and they would often be reliving something that no-one should live once, let alone twice. I don't know how my mother-in-law did that job. I'm so pleased that she did. I want to honour right now everyone that does that job of caring for people in their homes.

But we know that not enough people are able to get the help they need to be cared for in their homes, because of the huge list of people—102,000—waiting for home-care packages. Over three years, 30,000 older Australians have died waiting for their approved home-care packages. Over two years, more than 32,000 older Australians have entered residential aged care prematurely. The Prime Minister, the Treasurer and members of the government like to talk about the number of aged-care packages that have been funded—and they have funded more packages; there were 23,000 packages in the October budget—but the sad reality is that that number doesn't touch the sides. When one of the draft recommendations of counsel assisting the Royal Commission into Aged Care Quality and Safety was to clear out the waiting list for home-care packages and do so by the end of next year, we know it's an urgent priority. So more has to be done and it has to be done now.

If we can't spend the money to do that now—in the global pandemic, with the amount of money that's being spent on various things—then it's hard to know when we could spend the money to make sure that older Australians are able to die at home, having lived their final years in comfort and dignity. We also know that being able to age at home increases your life, is good for you and is good for your family. We need to facilitate more of that. I join others in calling on the federal government to do more, because there are still over 100,000 people waiting.

In conclusion, I want to briefly talk about what is happening in my community. This is incredibly exciting and it is a tribute to some amazing medical practitioners and academics at Peninsula Health and Monash University. This is supported by this federal government; it was supported by me as the candidate and by federal Labor. Had Labor won the election, we would also be putting in the funding that the federal government is to support these projects. When parliament finishes this week, I'm looking forward to being within the next week and a half at Frankston Hospital with the current Minister for Health for a sod-turning for one of the three projects which I want to talk about briefly. These projects are happening in my electorate of Dunkley, based in Frankston, but they are going to benefit the wider bayside and peninsula area as well as the whole country and, we believe, probably the world.

One of the reasons why Peninsula Health and Monash University, which are located very close to each other in Frankston, have joined forces to do some world-breaking research into healthy ageing, mental health and addiction is that, sadly, in some regards we are a community where addiction, mental health, and healthy ageing or not-so-healthy ageing are significant issues. About 32 per cent of our population are aged over 60, compared to Greater Melbourne's average of about 19 per cent. The first project I want to talk about is what was initially going to be called a health futures hub but is now going to be called a Centre for Healthy Ageing. Again, it is a collaboration between Peninsula Health and Monash University, which the health minister has been active in supporting. As I said, I was very proud as a candidate and now as the member for Dunkley to support it.

The centre is going to focus on: designing and delivering new and better integrated models of care for vulnerable people; improving outcomes in aged care; helping people have greater independence so that they can live at home for longer and avoid unnecessary hospitalisations; and looking at how we can help older people to age in their own environments, to live well at home and to live well in residential aged care—for example, how we can help people better recover and rehabilitate from falls or not have falls in the first place. There are going to be living labs. There are going to be academic researchers. There's going to be practical, hands-on work by practitioners to develop models that can be scaled up and rolled out across Australia. It has been my pleasure to have worked with Professor Christina Mitchell, the Academic Vice-President and Dean of the Faculty of Medicine, Nursing and Health Sciences at Monash University, and Felicity Topp, the CEO of Peninsula Health, as they put together this model. This is a great example of institutions collaborating and then going to government to ask for support and absolutely bowling over everyone to whom they present their project.

The second thing that we are very much looking to forward—and I'll be attending the sod-turning with the minister very soon—is the academic centre at Frankston Hospital, which is also going to be a brand-new hospital thanks to half-a-billion dollars from the state government. The academic centre is a collaborative project between Monash University and Peninsula Health that will train medical practitioners and will improve study and teaching. There'll be a sod-turning soon. It is going to be a terrific addition to the health and education hub that all of us in Frankston and the Mornington Peninsula region believe my electorate of Dunkley and Frankston can be.

The third project happening with Peninsula Health that is absolutely going a long way to help people age well in their homes is called MEPACS. It is an alert system which is now both on iPad and a digital alarm with a connection to a call centre in Carrum Downs. Older people, if they don't answer the phone in the morning, will get a call from MEPACS. If they fall and have a problem, they can press the button and they will get a call from MEPACS. It is an amazing service, which Peninsula Health has promoted across the country, and it is staffed by amazing people. We need to do more to help people age better in their homes, and I very much look forward to being part of my community's and the broader national effort to do so.

5:37 pm

Photo of Libby CokerLibby Coker (Corangamite, Australian Labor Party) Share this | | Hansard source

In its interim report, the royal commission into aged care made a specific recommendation to government that it urgently put more home-care packages into the system to address the intolerable waiting list. Put bluntly, the royal commission described the system as cruel, unfair and discriminatory. This urgent call to action was made 405 days ago, and still we have more than 100,000 older Australians waiting for home-care packages. Some, tragically, have passed away before they've received this much-needed support.

I rise to speak on the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 2) Bill 2020 not for what it is but for what it is not. While Labor will be supporting the moving of this amendment to the Selection of Bills Committee, this legislation does not help all those older Australians waiting for home-care packages, nor does it fix the systemic problems underlying our broken aged-care system. After seven years of coalition mismanagement and neglect, problems remain, and they will continue to remain, despite this legislation.

Under this bill, home-care providers will be paid a subsidy for the care and services delivered to a home-care recipient during only a one-month period. This means the government will retain the unspent funds. It should be noted in this House that withholding funds as proposed has the potential to financially stretch service providers. This is especially true for smaller service providers, who are less likely to be holding unspent funds. Regional areas, such as those in my area of Corangamite, are more likely to be covered by smaller providers, so this piece of legislation should be sent to the committee to ensure that we are not disadvantaging older people living outside of large, urban areas.

This draft legislation is more noteworthy for what it excludes than for what it includes. It is no secret that the aged-care sector is failing under this government. 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 the government was brought to light by the royal commission into aged care. The commission's interim report findings have painted a bleak picture of providers who have put commercial profits before vulnerable people. But this federal government knows this well and they knew this before they established the royal commission.

But the surprise of the royal commission the just how terrible things are. The royal commission heard that, every day, 50 Australians living in aged care are sexually assaulted. We should all be very concerned and shocked. We should all want to make a difference in this space. The commission has heard stories about Australians living in aged care with ants crawling over their open wounds. The commission has been told about Australians living in aged care suffering from malnutrition. The commission has been told about the 20 per cent of Australians living in aged care who are receiving substandard care. That only scratches the surface of the issues facing this sector. The royal commission received over 10,000 submissions, and 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.

The first recommendation in the royal commission interim report Neglect was that the government fix the home-care package waiting list. Over the past three years more than 30,000 older Australians have died waiting for their approved home-care package. Over two years more than 32,000 older Australians have entered residential aged care prematurely. This is not acceptable. But, true to form, the federal government has made a stream of announcements but not taken the action necessary to improve the system. I know this because many of my constituents have raised their concerns and their fears with me, and these fears have only been magnified due to the coronavirus pandemic.

Almost 700 older Australians have lost their lives from COVID in residential care. Many of the workforce contracted the disease themselves. That same workforce fought every day to save every life. Residents died because government and some providers failed to regulate and do their jobs. In my own family I have been touched by this, with the loss of someone close: a loved one in aged care at this time. But every one of these deaths is a tragedy. Every one of these deaths is a lesson. We now know that the government and many providers failed to put enough staff in place. They failed to manage the right workforce mix and provide sufficient training in infection control. Insecurity of employment drove further infection spread to other workers and clients.

The royal commission was willing to put pen to paper on some of those lessons, specifically finding that 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 then lives would have been saved. The Prime Minister has boasted about the number of announcements the government has made in aged care, but they have 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 PPE for all aged-care workers, but too many missed out for too long.

A key theme of the royal commission has been repeated testimony from families and loved ones that they've been kept in the dark when it comes to important issues in the lives of their loved ones in aged care. Aged-care facilities get about 75 per cent of their income from the taxpayer, but, despite the heavy reliance on the public purse, there is worryingly little reporting into how that money is spent. Families of our loved ones in care need transparency and they need accountability, but the government has a strong record of shielding some aged-care providers from that accountability.

Now, the interim report from the royal commission makes note of this lack of fundamental transparency across the sector, but today's debate is not about the gross neglect of Australians in the aged-care system. Instead, more than a year after the royal commission first reported some of the most horrendous stories imaginable, this government, sadly but not surprisingly, has prioritised for a second time the timing of invoicing. Today we debate the government holding onto its money for just a little longer before paying providers. 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 hasn't turned its attention sufficiently to the vital issue of workforce planning and management, and we need to change this. The nurses and carers in the aged-care sector deserve this, and they deserve our sincere gratitude. This is especially true in 2020, but it has always been true—and I would like to acknowledge Barwon Health in my region, which has provided amazing leadership to agencies and staff in our local health sector. It has helped to keep people safe.

The royal commission's comments on working in aged care was nothing short of harrowing. Workloads are heavy, and 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. Major change is necessary to deliver the certainty and working environment that staff need to deliver real quality care. To meet 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. Our Labor leader, in his vision statement on ageing, 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.

Labor is listening.

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'm proud to support it.

In closing, I present the Morrison government with a checklist it should not need. There should not be a disastrous over-reliance 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 that are left in soiled incontinence pads. There should not be people living in aged-care facilities 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 mums, our dads, our grandparents and our aged-care workers, and eventually this system will fail us all. It is time for the government to fix this sector or get out of the way and find someone who can.

5:48 pm

Photo of Jason WoodJason Wood (La Trobe, Liberal Party, Assistant Minister for Customs, Community Safety and Multicultural Affairs) Share this | | Hansard source

The Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 2) Bill 2020 amends the way that home-care providers are paid the government subsidy in order 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 measures in the bill improve financial accountability and allow for better transparency over the actual use of the funds for home-care service delivery.

This bill will amend the Aged Care Act 1997 and the Aged Care (Transitional Provisions) Act 1997 such that home-care providers will only be paid the subsidy for care and services rendered to a home-care recipient during a month, with Services Australia retaining the unspent subsidy that a home-care recipient is eligible to receive each month. This unspent subsidy will be available for providers to draw down on behalf of a home-care recipient as care and services are provided in the future. There is no change to a customer's access to their full subsidy. This builds on the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill 2020 that amends the Aged Care Act 1997 and the Aged Care (Transitional Provisions) Act 1997 such that providers of home care will receive a payment not in advance but in arrears. I thank members for their contributions to the debate on this bill.

Photo of Andrew WallaceAndrew Wallace (Fisher, Liberal Party) Share this | | Hansard source

I thank the minister. The original question was that this bill be now read a second time. To this the honourable member for Franklin has moved an amendment that all words after 'That' be omitted with a view to substituting other words. The immediate question is that the words proposed to be omitted stand part of the question.

Question agreed to.

Original question agreed to.

Bill read a second time.

Messages received from the Governor-General recommending appropriations announced.