House debates

Wednesday, 7 September 2022


Aged Care Amendment (Implementing Care Reform) Bill 2022; Second Reading

4:28 pm

Photo of Helen HainesHelen Haines (Indi, Independent) Share this | | Hansard source

I rise today to speak on the Aged Care Amendment (Implementing Care Reform) Bill 2022. It's heartening that this government is moving quickly on the recommendations arising from the royal commission into aged care. The royal commission's findings were a wake-up call to the nation. They called for fundamental and systemic reform, but I was frustrated by the pace of reform from the former coalition government. System reform, I understand, is hard, but it doesn't mean we delay, especially not when so many Australians live in a broken system and in conditions that the royal commission referred to as neglect.

Schedule 1 of the bill will require approved providers of residential aged care and certain kinds of flexible care to have a registered nurse on site and on duty at each residential facility for 24 hours a day, seven days a week, at each facility operated by them. This goes towards implementing recommendation 86 of the royal commission.

A long, long time ago, I was a director of nursing at a bush nursing hospital and aged-care centre. More recently, prior to coming to parliament, I was a volunteer director at a larger aged-care facility. In both places we always had 24/7 registered nurses, and I'm really proud that we did because the quality of the care in those places was greatly enhanced by their presence. We did that because when the bell rings in an aged-care facility in the middle of the night you can't know if the bell is ringing because a resident is thirsty and can't reach their water, because a resident has fallen and needs complex assessment of their needs, because a resident needs their pain relief carefully titrated, or because a resident has a woken confused with unstable blood sugars from their diabetes or, indeed, any number of a multitude of significant health needs. The complexity of care and the unpredictable nature of an acute exacerbation require highly trained professional expertise from a registered nurse.

Having worked as a nurse and a midwife across the north-east of Victoria for decades I know how important it is to respond quickly to calls for help. Aged care is frail care. To respond to that care with a registered nurse prevents unnecessary emergency department admissions, it prevents unnecessary transfers of elderly frail people to other locations and it prevents unnecessary distress to their family and their friends. I know that in the daylight hours, as well as the night-time, how important careful clinical assessment, review and planning are for early intervention in things like urinary tract infections and delirium and to provide evidence based dementia care and palliative care. It prevents not only pain, suffering, distress and ED admissions but also GP call-ins, and we know how precious our GP resources are.

It's unacceptable to leave older Australians in residential care without the highly trained registered nurses that they need. I've been calling for the full implementation of the royal commission recommendation since that report was tabled, because the findings on this aspect were particularly woeful. The statistics speak for themselves: one in three people in residential care have experienced substandard care, nearly one in five have experienced assault and one in two have concerns about understaffing and calls going unanswered.

With Australians living longer and having more complex healthcare needs into old age it is becoming increasingly important to deliver registered nursing care in our aged-care centres. Our aged-care population have increasing co-morbidities and chronic disease. Many aspects of daily care of course don't require a registered nurse—they can be undertaken by well-trained, compassionate personal care attendants—but the round-the-clock supervision of a registered nurse is critical to the quality of that care. Registered nurses provide clinical assessment and decision-making, surveillance, intervention, leadership, education, research and support for personal care attendants, for allied health professionals, for GPs and for families by providing expert and timely advice by bringing together a holistic model of care that caters to the needs of residents in their entirety.

I know that having nurses on site benefits residents, families and staff. I know that it benefits the acute health sector, by avoiding unnecessary admissions. The impacts spread well beyond the front door of the facilities. As I said before, we have an overstretched, overworked and stressed GP workforce. To have 24/7 nurses in our residential aged-care facilities prevents out-of-hours GP calls.

When I talk to providers about this change many of them ask me, 'Where are we going to find the staff?' We have a workforce crisis in my electorate and it's very difficult to fill the vacant spots that already exist, let alone the ones to come. Last night I spoke to an aged-care provider CEO who told me exactly this and recently I visited a small aged-care facility in Alexandra who told me exactly this. 'We're running really short on registered nurses,' they told me. So we need to see more detail from this government about how the legislation will impact small providers in rural, regional and remote locations. I know my colleagues in this House from across rural and regional Australia have similar concerns. My residential aged-care centres already have registered nurses constantly on call, but for many this isn't just an issue of rostering staff. Our aged-care health workforce is overworked and underpaid, and aged-care centres often don't roster registered nurses to work into the night; they simply keep them on call. So finding the workforce to fulfil this requirement will not come easy, because of the long-term erosion of the sector and I'm fearful that some small providers simply may not be able to find a registered nurse workforce by the time the requirement comes into force, and this could mean that they have to close. So we need to be really careful about this. We can't let there be the unintended consequences of small aged-care facilities closing in the regions when there already is a thin market. We don't want to have a situation where our elderly rural residents have to move to another town for their care, so we need to be pulling out all stops to train and retrain registered nurses in regional areas.

We need to be thinking about things like HECS forgiveness and scholarships. We need to be taking action to support our regional universities. We need to make sure that in rural and regional towns we have the child care available to enable our workforce to train or retrain. And we need to make sure that we have the availability of housing to enable clinical placements—to name but some of the barriers we're facing in the regions.

The legislation says that there will be exemptions to this requirement, and the Minister for Aged Care is currently consulting with providers, advocates and people in care about exactly when those exemptions will be granted. However, this doesn't give much peace of mind right now to small providers, who may support the intent of the policy wholeheartedly, as I do, but who simply can't recruit in time. I would urge the government to act expeditiously to bring these recommendations forward so that we know with certainty in the regions how we're going to manage this.

I will be supporting the second reading amendment tabled by the member for Farrer, which said:

… notes that, of the aged care providers who do not currently have a registered nurse on site, and on duty, at all times, 53% are based in regional and remote areas and 86% are small providers.

This second reading amendment requires the draft subordinate legislation setting out the exemptions to these requirements to be provided by the government to the parliament so that they can be scrutinised by members and senators. I hope that the minister also sees fit to bring the subordinate legislation setting out the minutes of care part of recommendation 86 to the parliament as well, as this will have a similar effect.

In supporting this amendment I acknowledge the minister's desire to get this legislation through and to get on with reform. I also note that I don't want to see rural, regional or remote registered nurses having a second-rate quality of care caused by long, long delays in implementing this change. What I want to see is support to the regions to get these nurses into our aged care. There are some terrific examples of how we're doing this in Indi, and I specifically want to call out the Alpine Institute, which is run by Alpine Health, a multipurpose service in my electorate. They've been growing their own aged-care workforce for some time, but they need investment, particularly in student accommodation so that they can upskill their personal care attendants and division 2 nurses up into division 1.

I want to briefly touch on nurse practitioners. This is the most untapped resource in aged care, and I spoke to Minister Butler about this recently. We need to look carefully at the skill mix more broadly, and we need to be looking at nurse practitioners. The expertise of these highly skilled nurses could completely transform our aged-care sector. I've had considerable experience with older persons nurse practitioners and with mental health nurse practitioners. They're an incredible resource and they could be mobilised across our aged-care sector if policy levers were shifted now to allow them to operate to their full scope of practice. Their access to Medicare items needs addressing urgently, and I brought this to the former government. I want to see action on this, and I call on the government to work closely with the College of Nurse Practitioners to get this happening.

Nurse practitioners get better symptom management in a timely way; they avoid complications; they take pressure away from our public health system; and they, too, take pressure off our overstretched GP workforce. That's a lost opportunity, but it's one we could fix. So I really call on the government to get on with this. The other thing that nurse practitioners do, of course, is provide expert medication management, and anyone who's worked in aged care knows the challenges of polypharmacy with elderly people. Our nurse practitioners are experts with this.

The second schedule will require the secretary to publish information in relation to aged-care services. These services will be specified in subordinate legislation and can include information about how much providers spend on care, nursing, food, maintenance, cleaning, administration and profits. This will allow consumers to make an informed decision. This information is already provided to the department from aged-care services, and it makes sense that it's also made public so that families and people considering entering aged care can evaluate their options. I have long called for this and a star rating system for aged-care providers, and this data is a crucial building block in creating an honest, transparent system for consumers to learn what applies. This is sensible reform, and I am pleased to support it today.

The third schedule will enable the government to cap the management and administration fees that approved providers can apply to home-care package recipients, and remove the ability of approved providers to charge the care recipient an exit amount. Up to 45 to 50 per cent of the costs of home-care packages go to management and administration fees. There's no way to tell if the reasonable fees that providers are allowed to charge bear any relationship to the actual costs involved. It's time these costs were properly regulated. In the area of Hume, which closely mirrors my electorate, there were 2,224 people on home-care packages earlier this year. Ageing at a home is clearly the preference of many of my constituents, so this change will be welcome news to them and their families and will hopefully stop them getting ripped off. They will know that the fees they are paying are going directly to their care, rather than other administrative purposes.

I want to take a moment here to acknowledge the work of the member for Mayo, who has been a dogged advocate on behalf of older Australians. I was honoured to second her private member's bill, the Aged Care Amendment (Making Aged Care Fees Fairer) Bill 2021, last year. Like the member for Mayo, I'm concerned that a lot of the details of this reform will be set out in subordinate legislation, which does not allow us as a parliament to scrutinise whether they go far enough to prevent the risk of cost shifting and gold plating of other services and equipment charges. I will be pleased to support her amendments when the time comes.

There is still so much to be fixed within the home-care package system. The wait still gets longer and longer, tens of thousands of people long. In north-east Victoria the number of people on the waiting list is getting larger, not smaller, and that's unacceptable. I call on the government to commit to meeting that standard too, set by the royal commission. Immediately deliver home-care packages for all who need them and cap waiting times for home-care packages at one month.

In conclusion, right now, all around the nation, aged-care workers are providing care to older Australians, whether that be home-based care or residential aged care. When we go to sleep at night, aged-care workers will be continuing that care, and when we wake up in the morning they'll be there still, and I thank them.

4:43 pm

Photo of Tony ZappiaTony Zappia (Makin, Australian Labor Party) Share this | | Hansard source

Nothing highlights the failures and incompetence of the Morrison government more so than its handling, or should I say mishandling, of aged-care services, a sector that has been in crisis for years. The sector has been the subject of some 20 aged-care reviews in the past 20 years, including a review by a committee of this parliament. Indeed, the Standing Committee on Health, Aged Care and Sport held an inquiry into the quality of care in residential aged-care facilities in Australia, and it was only some three years ago that we handed down our report. The report had 14 recommendations, which in turn had many other parts to them. Mr Deputy Speaker Freelander, you would be very familiar with them because you were on the committee, as was I. Many of the issues that have subsequently been raised by the royal commission and others were matters that the committee closely looked at and reported back to government about, yet we saw little from it in terms of any real action from the Morrison government.

The problems with aged care were not only well known because of so many of those reports; in particular, the Oakden inquiry in South Australia lifted the lid on much of the practices that were then subsequently exposed both by our committee inquiry and the royal commission. Indeed, Oakden was not an isolated case. There were so many other examples of similar bad practice. Perhaps we'll never get to them all, because the truth of the matter is I suspect many of them went unreported and were covered up in different ways and were never fully exposed, as they should have been.

Finally, when the Morrison government reluctantly implemented a royal commission, it used the royal commission, in my view, as an excuse to defer action it could have implemented at the time. There were many things that could have been done, as a result of the previous inquiries and what the government was aware of, that would have changed and improved the system, even if it was as interim measures at the time; in other words, allow the royal commission to proceed but carry out interim measures that would have helped people much more than what the government actually did. Instead, we saw not only the royal commission be used to defer any real action from the government; from memory we had about 100,000 people still on waiting lists for appropriate home-care packages, and too many people in aged-care facilities poorly cared for.

The poor care was through no fault of the people who work within the sector. Those staff who work within the sector do an extraordinary job under very difficult conditions. As you would know, Deputy Speaker Freelander, they are underpaid, overworked and under-resourced, and, at times, they have to do work which they are unqualified to do. If they were given the support they need, they would be able to deliver much better services. I know that most of them—in fact, all the ones I've spoken to—are people that are very passionate about their work, love doing the work they do and have a genuine care for the residents they look after. But the reality is they have not been given the support they need. I say to all those workers in the aged-care sector, particularly with the last two or three years when we went through the COVID pandemic, when there were additional restrictions which prevented family members and visitors going into those centres and providing a little bit of extra support as well: the aged-care workforce did a magnificent job in caring for the people under their care.

We have around 277,000 people who work in aged-care facilities. They deserve our gratitude and recognition for what they do, but they also deserve the increased support that this legislation begins the process of delivering for them. The requirement for providers to provide transparency about how much is spent on care, nursing, food, maintenance, cleaning, administration and profits will make providers accountable. As the member for Indi quite rightly pointed out, it will also give families important information when making choices about which facility best suits their needs. The accountability process, I believe, will also add to ensuring providers of aged care lift their own standards in order to be competitive because they know potential residents will look around before they sign up with a particular provider.

With respect to that, I note the member for Indi touched on the star rating system. In 2019 there was a study by the Centre for Health Service Development which used a five-star rating method to define adequacy of staffing care in facilities. That study found that more than half of all Australian aged-care residents are in homes that have, in their view, a one- or two-star rating level for staffing. In a five-star system, that, to me, indicates it's a pretty poor level of service. Twenty-seven per cent of residents were in homes that had a three-star rating, and only 15 per cent were in homes with a four- or five-star rating. In fact, only 1.3 per cent were in homes with a five-star rating. It just shows that, yes, there is a difference, and there are some very good homes out there, but the overwhelming majority of residents within those homes simply were not being provided the care that this study suggests they should have been provided. Transparency will bring competitiveness and accountability back to the system and, in my view, that can only lift the standard of care that is being provided.

The bill will also ensure that a registered nurse will be on site and on duty 24 hours a day, seven days a week at each residential facility. That responsibility will apply from 1 July 2023. It's just under a year away and it provides providers some time to get the additional staff that they need. I accept that that in itself will be a challenge, but I don't believe that the shortage of staff is solely because there are not enough nurses out there. Indeed, referring back to the study from the Centre for Health Service Development, I also note that, when it came to their assessment of registered nurses in aged-care facilities, they found that between 2003 and 2016 the number of registered nurses in residential aged-care facilities fell from 21.4 per cent to 14. 9 per cent—by a third. The number of enrolled nurses fell from 14.4 per cent to 9. 3 per cent—again by about a third. Those reductions in nursing staff over that period didn't result from a shortage of nurses available; they resulted from cost-cutting measures that were implemented by many of the providers.

Again, as others have quite rightly pointed out, enrolled or registered nurses within these facilities actually save communities and governments a lot of money. If you have a nurse on site at all times, it will very likely prevent a hospital admission. It may well prevent even a doctor's attendance, because there might be medical needs that can be provided by a qualified and experienced nurse. As such, not only will the patient benefit, because they will get immediate service; it will mean that there will be a savings at the other end that would otherwise be a cost if the person is admitted to hospital or if a GP has to come out.

Indeed, on the subject of the GPs coming out, Deputy Speaker Freelander, you would be well aware that it was becoming increasingly difficult for GPs to attend aged-care facilities, because the remuneration they were receiving for their service was also becoming inadequate for the time that they were spending out there. That in itself became a problem whereby having an enrolled or registered nurse on deck would have made a difference to the wellbeing and care of the resident.

The bill also caps the amount that home-care providers can charge for administration and management. That is an issue that has been brought to my attention as a member of parliament and perhaps has been brought to other members in this place on many occasions. It seems to me that an issue of providing funds for packages and services to people that require aged-care services is that much of the funds are used up in administration fees. Just as badly, if residents try to switch provider, they are charged a fairly exorbitant exit fee, which makes it almost impossible for them to switch, because they would lose much of the funding that was provided to them. That has to come to an end. Quite frankly, the funds were provided for services, not for admin costs. I believe there were at least some providers who were exploiting the system, making good money out of the admin costs and providing little in the way of services. I'm pleased to see that, again, this matter is being addressed.

All three of the matters I have touched on were recommendations of the royal commission. It is not surprising; they were matters that I think many of us were aware of, should have been addressed and could have been addressed much earlier.

I will wrap up by saying this. Many of the residents who enter aged-care facilities today do so towards the end of their life, when they are in a situation where they need much greater care. Many prefer to stay at home for as long as they can and, with the support of government services, have been able to do so. So they enter these aged-care facilities at a time of very high need. That is the time when the staff in those centres need to be able to spend more time with them in order to support them. And yet, what we're seeing is the reverse. Staff are run off their feet, not having time to look after them in the way that they should, and, in turn, the level of care diminishes. Again, that is not through any fault of the staff, but simply through the pressures that are put on them to provide the services that they would like to otherwise provide. As higher care needs more time and more skills, in my view that also means that we need to appropriately pay and remunerate those people who work in the aged-care system for the services that they are providing, because, if we don't, as we have already seen, many of them will exit that particular sector because the remuneration simply isn't there. And nobody can blame them for that.

This legislation picks up on some of the recommendations of the royal commission. Yes, there is a lot more to do. And, yes, delivering on even the requirements within this legislation can be challenging. But it's a start in the right direction. I'm pleased to see that the government is making it their priority and I'm more than happy to say: 'Let's work through these issues one at a time so that we can ensure that the Australians that ultimately end up in aged-care facilities get the services and the support they need.' In this country, we have over a million people today that are over the age of 80 years. Many of them will end up in one of these facilities and many of them, unless they are given the care that they need, will also spend their last three years living in a way that I don't think any one of us would want for ourselves or for our own parents.

4:56 pm

Kate Chaney (Curtin, Independent) Share this | | Hansard source

I welcome early implementation of some of the royal commission recommendations. It's a step in the right direction to protect our most vulnerable. However, I note that this bill, the Aged Care Amendment (Implementing Care Reform) Bill 2022, is introducing only a few of the 148 recommendations made by the royal commission. Even within the limited scope of this bill, there are many substantive issues that are likely to inspire differing views that are intended to be addressed in delegated legislation and so will not be subject to rigorous debate and scrutiny in this House.

This bill sets out some good changes. The government's commitment to 24/7 nursing is welcome. We need to ensure that the elderly in our community have access to immediate medical assistance if required. However, my electorate and I are concerned about how this commitment will be fulfilled. In this climate of severe skills shortages, where will all these nurses be found? How will the compliance of providers be enforced? How do we ensure that smaller providers can comply? What does it mean for the training levels of other staff? I understand that exemptions may need to be granted, given the current staffing challenges, especially in rural and regional areas, but there's no visibility of how exemptions will be given.

The amendments to the bill proposed today by the Deputy Leader of the Opposition and the member for Mayo require greater detail on these potential exemptions, which would allow appropriate scrutiny and discussion. I will be supporting these amendments. It is important that the implementation of these changes not be delayed, but proper scrutiny of the proposed exemptions is required to ensure a balance between access to better care and practical and geographical constraints.

The issues addressed in this bill are a good start, but just a start. I look forward to seeing the government respond to the rest of the recommendations as soon as possible. In my electorate, both experts and those with lived experience of aged care are looking forward to the broader review of the aged-care legislation. They've asked me to advocate for a better system. For example, I've had multiple aged-care advocates contact me expressing concern about related clauses in the recent Aged Care and Other Legislation Amendment (Royal Commission Response) Bill 2022. Constituents have told me they were particularly worried about schedule 9 of the royal commission bill, which legislates on restrictive practices in aged care.

The question of consent—for example, for chemical restraint—needs to be aligned nationally. In Western Australia, facilities can give consent for chemical restraint even if a family member has guardianship. A constituent told me of her mother, who was made to take tablets that caused nausea and a number of falls. The facility told the family the pills were required, as the woman was aggressive, but this seemed unlikely to the woman's daughter. They were concerned to arrive in the middle of the day to find their mother asleep.

In the lead-up to the drafting of the new Aged Care Act, my constituents want to know that there will be a robust and extensive consultation. They want to be informed as soon as possible of the community engagement process that will be undertaken to ensure that the new legislation is written with a human rights lens and consumer focus, to ensure the inclusion of a range of issues such as mandatory reporting of sexual assault.

Another area of reform needed is cultural safety. Recommendation 3 of the royal commission was that the act should incorporate this principle. Aboriginal and Torres Strait Islander people are entitled to receive support and care that is culturally safe and recognises the importance of their personal connection to community and country. Neither of the recent aged-care amendment bills address this principle.

Accepting this principle would require three things: firstly, the use of culturally appropriate assessment tools to understand needs; secondly, supporting Aboriginal and Torres Strait Islander people to use aged-care funding through home-care packages to maintain their connection to country; and, thirdly, supporting Aboriginal and Torres Strait Islander people to access aged-care support from Aboriginal and Torres Strait Islander aged-care providers. There are few of these and many providers are church based, with whom Aboriginal and Torres Strait Islander people may have difficult histories of forcible institutionalisation.

It's worth noting that the aged-care access rate for Aboriginal and Torres Strait Islander people in Perth is half the national average, for capital cities, at 8.5 per cent. This goes to a fundamental principle that needs to inform the broader review of the aged-care legislation of ensuring that service development is informed by the people affected by it.

There's also work to be done on the public reporting of complaints and incidents. One story brought to my attention was of an elderly lady assaulted by a staff member. The incident was reported to police, and the staff member consequently resigned. But as there's no public reporting or record, the family fears that the worker could go on to be employed by another aged-care facility.

While this bill is a start, I look forward to these recommendations and others from the royal commission being adopted in further legislation.

Photo of Mike FreelanderMike Freelander (Macarthur, Australian Labor Party) Share this | | Hansard source

The immediate question is that the amendment moved by the honourable member for Mayo be disagreed to. I call the member for Lyons.

5:02 pm

Photo of Brian MitchellBrian Mitchell (Lyons, Australian Labor Party) Share this | | Hansard source

) ( ): Can I say from the outset how proud I am to be standing here, on this side of the chamber, as a member of the Albanese Labor government. During the 2022 federal election, Labor took strong aged-care policies to the people that would ensure we are able to support our older Australians. The people gave us a mandate, and we are wasting no time in fulfilling it.

Labor understands the need to reform the aged-care sector. The royal commission into aged care provided a sobering insight into the flaws in the aged-care system, flaws that had been allowed to continue for far too long. Too many older Australians have been suffering due to issues in the aged-care system, a lack of care and attention by people who are charged with providing care and support, and a lack of standards and accountability to prevent the lack of care we have witnessed and, sadly, our older Australians have experienced all too often.

The report acknowledged neglect in a system where it should not exist. It uncovered severe problems that need response from a strong government, and that's what we are providing. Labor is that government. We are working as quickly as we can, with the aged-care sector, to rectify the issues that have been identified and to fulfil the recommendations of the final report of the royal commission into aged care.

The passage of this bill will ensure the implementation of several important and urgent aged-care reforms. These reforms were pledged by Labor at the 2022 federal election, and, as I said, the Albanese Labor government is wasting no time in delivering on the promises it made to the Australian people. Importantly, this bill responds to key recommendations of the royal commission's final report, recommendations which this government is committed to adhering to, to ensure a better, safer and more fair aged-care sector.

The bill will lift care and quality standards in aged care and, importantly, will create the mandatory standard to have a registered nurse on site at all times in residential aged-care facilities. This was a core recommendation of the commission report, a core pledge from Labor at the election, and, as a government, we are delivering on this pledge. The significance of this change cannot be overstated. This will immensely improve health outcomes in aged-care facilities. A 24/7 RN presence in our aged-care homes means more people can receive qualified medical assistance when they need it no matter what time of the day or night that support is needed. It will save thousands upon thousands of stressful, expensive and often unnecessary trips to hospital and emergency departments, ensuring that there is less pressure on our hospitals and that older Australians are able to get support when they need it and, critically, where they live.

I note concerns have been shared with me about the ability to recruit and retain RNs, particularly in the regions. The Albanese Labor government, through the Department of Health and Aged Care and the Aged Care Quality and Safety Commission, will work with providers to ensure they are able to meet this obligation. The government has established a wide range of programs to attract and retain nursing staff to aged-care homes. This includes 1,300 transition-to-practise programs for nursing graduates, 1,900 scholarships, support for 5,250 clinical placements and an annual retention payment of up to $6,000. The government is working to address the issues that we currently face, and the issues that we may face into the future.

I must note also that this bill will provide a mechanism in extenuating circumstances for an exemption framework to apply, which will be further specified in consultation with experts and the aged-care sector. This exemption, in extraordinary circumstances, is particularly important for facilities in rural and regional Australia, like in my electorate, that are justifiably concerned about obtaining and retaining staff. The last thing they want to do is to fall foul of the new standards and the new law, but this government will work with them to meet the requirements they need to. We won't leave them behind.

The bill will also place a cap on the amount that home-care providers can charge for administration and management, as well as prevent providers being able to charge exit fees for their services. Time after time, I've spoken with constituents in my electorate who have provided me with bills from their aged-care provider that include absolutely huge administrative fees that are completely out of touch with the care that they are provided with but that's incorporated into those bills. It's completely out of whack. No sensible person could look at those invoices and think this makes any sense at all.

The rorting of the system is affecting older Australians who are trying to remain in their homes for longer, and it is limiting the services that they can achieve from the home-care package system. The government is about giving power to the people and ending the rorts and extortions that we saw far too often under the previous government. Labor is ensuring that home-care packages are able to be used to their maximum, to support people at home and enable them to remain in their homes for as long as they can. Home-care packages should not be sucked up by unnecessary and overbearing administrative fees. This change that is about ensuring bang for buck and service being delivered under those packages. This bill ensures that happens. It makes another strong commitment from the federal election into a reality.

Finally, this bill will fulfil the desire that all Australians want more of: transparency and accountability. This government pledged to the people that, if elected, we would be a more transparent and accountable government, and we are. We pledged to implement a federal anti-corruption commission. We heard from the Attorney-General today that that will be next week. That will ensure transparency and accountability; we are doing that. And we pledge more accountability and transparency in aged care.

The Albanese Labor government is today delivering on this pledge with the passage of this bill. This bill will require the department secretary to publish certain information about aged-care providers and their services. This will improve transparency by ensuring information is available to the public on how much providers are spending on care, nursing, food, maintenance, cleaning, administration, and how much profit they're making. This will help rebuild trust in the sector and ensure that providers are publicly held to account for the funds they spend on caring for their residents.

This bill also ensures that those living in rural and regional aged-care facilities are not left behind. People in our regions—like those in my electorate of Lyons—deserve the same standard of care as those living in aged-care facilities in our major cities.

In my electorate, I have been meeting with aged-care providers about Labor's plan for the aged-care system and what the changes might mean for them. From the outset I must say: I'm incredibly proud of the level of care that is being given across the board to aged-care residents in my electorate. Most of the providers in Lyons are community based, with volunteer boards. They're not-for-profit providers who pride themselves on offering a high level of care to their residents and ensuring a safe and enjoyable workplace for staff. They have an enviable record for staff retention and for care of residents. They have a high reputation in their community and they're well-sought-after places to live. These aged-care facilities will often go the extra mile for residents, families and staff alike, and they do not hesitate to forgo higher returns if it means a higher quality of care can be achieved. I'm pleased to say that none of the aged-care homes in my electorate were named in the royal commission—none of them were named. So the royal commission isn't targeting them.

But of course the new compliance measures that we're introducing will have an effect on them because they increase their costs. I'm dealing with the aged-care minister and her office at the moment about that, because we all want to make sure that compliance is stringent—we absolutely back that in—but we don't want to see the good providers being unnecessarily burdened when of course the target is those who have not been providing the appropriate level of care over the years.

The staff of the providers in my electorate work hard, and they're dedicated to their jobs and the residents of their facilities. It's quite opportune that I'm standing here this afternoon on the national aged-care workers' day, and I shout out to all those aged-care workers—many of them women; many of them in their 30s, 40s and 50s, and doing very physical work—who are absolutely dedicated to their residents and workplaces. I give a big shout-out to them. But of course, this government is also committed to not just thanking them but making sure that they get the pay they deserve, because they do extremely hard work for relatively low pay. And we are going to back in a wage case for them soon.

I acknowledge the work of aged-care facilities in my electorate, such as Medea Park in St Helens, Toosey in Longford, Kanangra and Grenoch in Deloraine, and of course Corumbene in New Norfolk, as well as a few others. They all go above and beyond for their residents. They are well-respected institutions within their local communities. They have the respect of the people, and, in turn, they show respect to their people. It's a good model of care. I'd love to see it rolled out across the country.

Over the past month, I've been meeting the CEOs, board members and staff at each of these facilities, talking to them about the challenges they face and the changes that are being implemented by the government. From the outset, Labor has been committed to working with the aged-care sector to ensure that the changes that are implemented in this place, and through the recommendations of the aged-care royal commission, can be achieved, and that no facility is left behind and no good facility, no good provider, is unfairly or adversely impacted.

Aged-care facilities in Lyons have done it tough, especially over the past few years of COVID. They've borne the brunt of the increased costs, of immense changes to circumstances and of staffing insecurity and lockdowns, as the pandemic continued to take its toll. They have been weathering the storm, however, and I remain committed to them—to fighting in their corner with them and working with them, to ensure that they can succeed in our joint aim of providing world-class care for our older Australians.

I do not pretend for a second that challenges do not lie ahead. Change always brings challenges. Aged-care providers in my electorate have shared their views with me, on Labor's reforms; their anxieties, as to the varying levels of change and what it may mean for them; and their thoughts on how government can best work with them to ensure that the recommendations of the royal commission are fulfilled and that providers can continue to provide the best possible care for our loved ones. And we have a shared, joint vision about that: that at the heart of everything we do is the welfare and care of people who live in these facilities.

The Albanese Labor government will keep having these important conversations and working with aged-care facilities to ensure that the changes to the sector are implemented efficiently, effectively and fairly. It's a big job but one that we are up for, and, I know, one that will be well-orchestrated by our very dedicated new Minister for Aged Care, Minister Wells.

This bill before the House today is a keystone in Labor's plan to fix the aged-care system. It ensures that some of the most significant changes to the aged-care structure can be implemented, thereby adhering to the recommendations of the aged-care royal commission and ensuring that Labor uphold the commitments we made to the people at the election. Importantly, this bill has been brought forward in communication with the aged-care sector. The requirement for 24/7 RN staffing will not come into effect until 1 July 2023 so facilities have time to make the appropriate staffing and budgetary changes and prepare for this significant change. Labor is assisting the aged-care sector with this change and ensuring that our older Australians living in aged-care homes are given the respect, dignity and care that they deserve so that we can put behind us that word 'neglect' and hope it ever again surfaces with respect to aged care. I commend the bill to the House.

5:16 pm

Photo of Anne WebsterAnne Webster (Mallee, National Party, Shadow Assistant Minister for Regional Development) Share this | | Hansard source

Australians want and expect that our older Australians are well supported and cared for in a way that brings dignity and respect to them. They want to stay in their communities. That is why the coalition when in government called the Royal Commission into Aged Care Quality and Safety to ensure our senior and most vulnerable Australians receive the care that supports and respects their dignity, which recognises the important contribution they have made to society.

The final report of the royal commission makes 148 recommendations, which the coalition supported and continues to support. Twenty-three public hearings and over 10,000 public submissions produced a report which is the product of wise and compassionate scrutiny of Australia's aged-care system. In response to the royal commission the coalition committed $19.1 billion to a five-year plan to improve aged care, with new home-care packages, respite services, training places, retention bonuses and infrastructure upgrades. We in the opposition remain committed to supporting the health, safety and wellbeing of older Australians and understand the important role that aged-care providers, care workers and nurses play in ensuring this support is provided in residential aged-care settings.

Paragraph 5 of recommendation 86 of the royal commission's final report calls for:

… from 1 July 2024, the minimum staff time standard should require at least one registered nurse on site per residential aged care facility at all times.

That is 24/7 registered nurse, or RN, care. I am regularly contacted by aged-care service providers in Mallee and I meet with them. They tell me how desperate they are for workers and how impossible it is to find nurses. This is called having a thin market. Those of us who live in regional communities are very familiar with what that means. They also talk to me about the issues with the current and proposed funding models—workforce issues, thin markets. I wrote to the Minister for Aged Care raising concerns of the funding shortfalls that will occur because of the government's indexation rate. I have also written to her regarding the challenges aged-care providers in my electorate, some of which are the only ones in a town, have in finding staff to meet their compliance obligations. While I thank the minister for her reply, it does not solve the ongoing crisis occurring in regional Australia.

I've spoken to many aged-care providers in Mallee. This is some of the feedback they have provided:

There are no floating RNs in Mallee ready or able to supply the workforce required. There are simply not enough RNs to fill shifts in smaller regional town settings.

The CEO of Sunnyside Lutheran Retirement Village in Horsham, Denise Hooper, told me that they have an RN on morning and afternoon shifts and have been advertising for four months for an RN and have not been able to attract one. That's four months. Horsham is not a small town. I know Sunnyside. It is a large establishment and employer, and while they have concerns about attracting staff, it is nigh-on impossible for towns such as Nhill, Warracknabeal or Ouyen to find any. As Denise said, it is challenging enough finding RNs for the hospital, let alone for aged care, where conditions and salaries cannot be matched.

Denise told me that aged care is becoming a subacute care facility, as people are entering facilities older and with more complex needs than they did several years ago. Yet they are not funded for that level of care. While the royal commission recommended that a registered nurse must be on site 24 hours a day, seven days a week, by 2024, schedule 1 of this legislation establishes a new time frame for providers to do this by July 2023. Make no mistake: our nurses have worked tirelessly on the frontline through the COVID-19 pandemic, protecting lives and keeping Australians safe. I recognise the amazing support that nurses provide our older Australians, particularly their critical work in aged-care homes since the outbreak of the pandemic. These were not easy times, yet our nurses stood up when it mattered most to protect so many older Australians—and I am grateful for their work. I note today, even speaking with another aged-care provider, that we have yet another COVID outbreak in one of our facilities. However, we've come a long way, and the vaccination rate and the care rate have increased so that the conditions of older people are absolutely so much more improved.

This legislation will seek to ensure that every aged-care home in Australia has a registered nurse on site 24/7 by July 2023. However, this time frame is not consistent with the royal commission's final report, which recommended this occur in 2024, with an accompanied minimum care minutes requirement under recommendation 86. The minimum care must be provided by RNs, not ENs. The royal commission took into account a range of factors when recommending the July 2024 time line, recognising the current workforce shortages and the time required to train or access the necessary additional workforce. Given the government has brought the start date of this recommendation forward by a year, it must specifically outline what support will be provided to regional and rural providers, and to other providers already struggling with viability and workforce challenges.

The opposition notes the unique challenges faced by our aged-care providers in rural and regional Australia, particularly regarding access to the RN workforce. Does the Labor government? The government must outline how they plan to get additional nurses into aged-care homes following their talkfest jobs summit. The opposition supports the royal commission's recommendation on 24/7 RNs, but there are realities that must be faced. Regional and rural communities struggle to get a basic workforce. What is the government planning to do to assist these vital local services? I note that 53 per cent of aged-care providers are based in regional and remote areas, and 86 per cent are small providers. However, the fact that exemptions will be required for rural settings but will not be known until the legislation is passed, and will be a delegated legislation, means that the government can decide, without scrutiny and without any transparency, to make the exemptions as narrow and short lived as they wish. This is concerning. It provides no stability nor security to our small providers.

The other concern I have is that to give exemptions in regional settings while demanding urban aged-care facilities provide that 24/7 RN capability will make a two-tier aged-care system. If the bar is lower in regional and rural settings, what is that saying about the dignity and the quality of care required for aged-care residents in regional settings? I find it troubling.

The opposition calls on the government to provide oversight of the delegated legislation that puts in place the mechanism and details of possible exemptions. The government has not been transparent with any of the details of this exemption clause, with significant questions still to be answered, such as: What is the exemption mechanism that will be contained in the delegated legislation?

Who will be eligible for an exemption? For how long will they be eligible? What will be the penalties for non-compliance with schedule 1? Will there be provisions that seek to prevent providers from using the exemption process as an excuse not to fulfil the royal commission's recommendations to provide high quality care to support its residents? Who is the decision-maker?

This lack of transparency creates uncertainty for providers who are already under stress from the COVID-19 pandemic. This information is particularly critical for rural and regional providers, who will likely be subject to significant difficulties in finding the additional workforce to meet the requirement within the timeframe. I have spoken to other aged-care providers in Mallee who have expressed their thoughts and concerns, Darren Midgley, from Chaffey Aged Care in Merbein, while agreeing that exemptions are warranted, argues that the current legislation fails to endorse current highly trained ENs—enrolled nurses—in the care minutes that are now going to be required. He also states that the modified Monash 4 centres such as his, which are 15 kilometres outside the buffer zone of MM3, which receives more funding, is unfair and does not comprehend the higher costs for delivering quality aged-care services a great distance from urban centres such as Melbourne, 550 kilometres away.

One of the key challenges, he acknowledges, is that regional services have zero access to agency nurses. Even if they managed to find the staff required, when a nurse calls in sick, there is no agency nurse around the corner to replace them, unlike in Melbourne or Sydney—or Bendigo or Ballarat. There are 90 aged-care services in Mallee, with just over 4,000 nurses and midwives in the whole of outer regional and remote Victoria. No-one—not the federal government, not the state government, not the universities, not the aged-care service providers themselves—has been able to explain to me how they will meet the requirement for these extra nurses in the time frame Labor wants.

Labor should stick to the previous government's time line for the implementation of 24-7 nurses as recommended by the royal commission for 2024 and put in place incentives for training the needed RNs for regional settings in a regional setting. Labor should reveal the details of its proposed delegated legislation so it can be scrutinised by parliament and the parliament can determine if it's suitable for aged-care providers, especially rural ones. Labor needs to state its plan to get more nurses into the regions so regional aged-care providers can provide this quality care.

5:28 pm

Photo of Steve GeorganasSteve Georganas (Adelaide, Australian Labor Party) Share this | | Hansard source

I too rise to speak on the Aged Care Amendment (Implementing Care Reform) Bill 2022. I'm very proud that the government has brought this bill forward and honoured its commitment to older Australians and to implementing the royal commission. I think the government is taking the right steps in ensuring that we implement all practical measures to guarantee older Australians get the aged care that they deserve. For too long we've seen neglect in this area—neglect from the previous government, neglect from a whole range of media attention that aged-care homes were getting and neglect for our older Australians, which is shameful in a nation such as Australia, where we don't have the proper care to look after people who have worked all their lives. They've paid their taxes. Some have fought in wars. In years to come, we will be measured for what sort of a nation we were by the treatment of our older Australians.

As I said, older Australians have worked hard all their lives. They've contributed to our society, our communities and our economy. They deserve nothing short of being supported with dignity and humanity in their frailer years. That's the least that governments can offer. This bill will ensure that we are able to do that. This goes hand in hand with our commitment to fight not only for a better system for our older Australians but also for a pay rise for Australia's aged-care workers. We know that a lot of the problems stem from not giving dignity, as well, to people who work in the aged-care sector. We recently made a submission to the Fair Work Commission that supports a wage increase for aged-care workers.

The Royal Commission into Aged Care Quality and Safety was clear that one of the problems was the undervalued, underpaid and highly casualised workforce in aged care, and the previous government ignored that recommendation. On this side of the House, we won't. We will fight for a better future for those aged-care workers, the carers, and the most important people, the residents of aged-care facilities. If we don't start paying aged-care workers properly, we won't be able to attract and retain enough staff to care for our loved ones as our population ages.

The government's committed to stopping the neglect in the aged-care sector. We want to ensure that older Australians are cared for with security, dignity and humanity. We acknowledge the hard work of dedicated staff in aged care and a lot of aged-care facilities that are doing great work. We know that the pandemic made it even harder, and we saw some of those horrific pictures on our TV of people dying from COVID-19 in many of the aged-care facilities around the country. I think that increasing wages and job security and encouraging more people to work in aged care will give nurses and carers more time to care.

This is more important than ever, given the sector shortages that were created over the last few years by the pandemic and, of course, by the inattention to this area by the previous government. This problem is also contributing to the gender pay gap—to low pay and poor conditions in care sectors like aged care, where the majority of workers are female. This is a serious problem, as we heard again during the recent Jobs and Skills Summit. So increasing wages in aged care is essential to ensuring that men and women are paid equally and continue to contribute equally to Australia's productivity.

As I said at the beginning of my speech, we're also delivering on our election commitment to improve this sector. One way we're doing that is through transparency in the aged-care system. This bill will introduce measures to monitor the costs associated with aged care. Providers will have greater responsibility to be transparent and fair; they will need to publish more information about their operations, including what they're spending money on. We will also be delivering on our election commitment to stop the rorting of home-care fees. This will be done by placing a cap on how much can be charged in admin and management fees. In addition, we'll remove the exit amounts altogether. This is very important.

In my electorate, I—like all of us in this chamber—have heard from many older Australians who are receiving home-care packages. One of the things that comes up time and time again is that they don't understand where the fees are going when they're not getting the service that they signed up for. They find the system confusing and fear that a big chunk of what they're paying is not actually going to the services that they require for assistance and help in their homes and not going to the services that they are receiving.

This measure will enable the government to cap these charges and maximise available funding to address the care needs of more than 210,000 older Australians currently receiving home-care packages. We want to ensure that there is pricing transparency for consumers and providers and greater clarity about direct and indirect costs. In short, home-care users need to be confident that the money is going directly to care, not to the bottom line of providers.

Other measures that we're introducing include the star rating system. This means that the Department of Health and Aged Care will, in future, publish a comparison rating for all residential aged-care services by the end of 2022, giving users and their families more peace of mind. In addition, the secretary of the department will make information on residential aged-care services and provider expenditure publicly available. This includes what is spent on labour, workers, care, food, nutrition, cleaning, admin, maintenance, and profit or loss. The information will be published online and will help inform consumers' choice of residential aged-care services and providers.

In addition, from 1 December 2022, approved providers and their governing bodies will be required to meet new responsibilities that will improve governance. They will need to notify the Aged Care Quality and Safety Commission of changes to key personnel. The current disqualified-individual arrangements will also be replaced with a broader suitability test. We're also extending the Serious Incident Response Scheme to all in-home care providers from 1 December 2022. This is because of the horror stories we heard during the royal commission. We need to increase protection for older Australians from preventable incidents, from abuse, from neglect and from those horrible things that were reported in the royal commission. We'll improve information sharing between care and support sector regulators, as well—in other words, streamlining so that they both have the information. This will enable proactive monitoring of risks across the sectors and better protection of the participants from harm. That was one of the issues that came up—that people who had been disqualified from one particular aged-care provider could quite easily move into another one without these checks and balances. We're also introducing a new code of conduct for approved providers, their workforce and governing persons.

We take this responsibility very seriously, and I think each and every one of us in this chamber has a duty to do so. As I said, we must fix the aged-care system and we must provide the care that elderly Australians require so they can live with dignity in their frail years, whether it be in home care or whether it be in a facility that looks after them. We must fix this system.

This bill goes a long way to protecting the safety, dignity and wellbeing of every older Australian accessing aged-care services, and it demonstrates that there is a willingness from this government, a commitment to ensure a fair, transparent system for older Australians, their families and their carers and a commitment to the welfare and conditions of these incredible people who care for older Australians. In short, we're putting security, dignity and humanity back into aged care. I'm proud to be speaking on this bill and to be part of a government that takes the care of older Australians very seriously, because all Australians need to have trust in the system that looks after some of our most vulnerable people. They deserve nothing less.

This bill also goes on to include many measures that will provide additional protections directly to older Australians. These protections are long overdue. The bill implements three of our government's urgent election commitments, as well—to put security, dignity, quality and humanity back into aged care.

As of 1 July 2023, the bill will introduce the requirement to have a registered nurse, for example, on site and on duty at each facility 24 hours a day, seven days a week. It is incredible that at this point there is no requirement for a registered nurse to be available to administer particular medicines or drugs in a nursing home. What happens if there is a requirement to administer a drug or a medicine, or some of the care that's required that has to be done by a registered nurse, and there isn't one onsite at 1 am, 2 am or 3 am? Normally, they may ring a doctor if they can get one. If they can't, the residents are put into an ambulance and sent off to the public hospital. This would help clear two angles: (1) waiting times at public hospitals and (2) giving the care that's required right then and there for those residents in the aged-care facility. The royal commission made this a clear recommendation because it recognised the value of having on-site nursing care. It will save thousands of stressful, expensive and ultimately unnecessary trips to emergency departments all around the country.

Consistent with recommendation 86 of the royal commission, the bill will also provide a mechanism for some exemptions. These will be finalised once experts in the residential aged-care sector have been consulted. However, it's important to note that any exemption framework will provide for tightly targeted exemptions. They could perhaps be in rural and remote areas. They could be in areas where the workforce is very hard to find. They could be in towns where it is the only aged-care facility for a radius of many kilometres. There will be many very important and strict conditions to the framework.

We must recognise that older Australians have contributed to this nation. They've worked, they've paid taxes and, as I've said many, many times in this place, they have built the foundations that we stand on today to enjoy a wonderful life in this wonderful country. If we have got a great country, it's because of those that came before us, those that fought in wars, those that did hard labour and those that had the foresight to build those foundations for the next generation of Australians. We have a duty to those people that they will live out their last few years with dignity, humanity and respect.

5:41 pm

Photo of Gavin PearceGavin Pearce (Braddon, Liberal Party, Shadow Assistant Minister for Health, Aged Care and Indigenous Health Services) Share this | | Hansard source

The responsibility to ensure every older Australian receives the care that they need falls upon us all. It's our duty. It's our duty as sons, as daughters, as caring citizens and as local communities. It's absolutely our responsibility as lawmakers in this place. Whether you live in the city or in one of the thousands of rural communities across Australia, like mine, everyone deserves the right to live their senior years connected to family, loved ones and local community. Our seniors deserve to stay in the communities where they have lived and built their lives. That's what they wish to do. Our senior Australians have the right to feel safe. Our seniors have the right to live their lives with dignity. And our seniors should know that, when it's needed, their care will be of the highest quality possible.

On the back of the royal commission, it was our government that started the journey to make aged care better. It was the Liberal-National government that implemented the largest investment in aged care in Australian history. The core principles of our response were founded in the pillars of respect, care and dignity. Our investment provided an additional $17.7 billion to deliver generational change in the aged-care sector. That was absolutely the right thing to do.

But our government wasn't solely focused on implementing the recommendations of the aged care royal commission. As well as implementing a once-in-a-generation improvement to the aged-care sector, the Liberal-National government focused on the specific aged-care needs within local communities and rural and regional local communities at that.

A great example is within my electorate of Braddon, on the west coast of Tasmania. It's a rugged and great part of the world. It's the resource and economic heart of Tasmania. It's rugged and isolated. In the lead-up to the 2019 federal election, I secured $1 million in order to invest in aged care in a place called Queenstown, a mining town on our west coast. During my time as the federal member, it became apparent that there remained an unmet need in aged care across the west coast of Tasmania. So I worked with the West Coast Council and on behalf of their local community to secure that funding. In the lead-up to the 2022 election, the federal Liberal government pledged to address the shortfall of aged-care beds in Queenstown on our rugged west coast. Our $3 million commitment would have funded the extra beds in the region that are so desperately needed.

Regrettably, this important commitment to aged care on the west coast of Tasmania was not matched by the Albanese, and this decision has left the west coast community without certainty around the provision of these desperately needed services. I promised the west coast community that I would continue to fight for them, and they know that. The aged-care service in their region is important to them. The Minister for Aged Care has repeatedly promised that the safety and wellbeing of older Australians, who rely on these aged-care services, is the No. 1 priority of the Albanese government. If that is the case, I look forward to the Labor federal government matching that $3 million commitment to ensure the west coast receives these desperately needed aged-care services.

The current government's commitment to aged care must continue the once-in-a-generation reform that was undertaken by the former Liberal-National government. Their program must continue the important work of implementing the recommendations of the royal commission. The Aged Care Amendment (Implementing Aged Care Reform) Bill 2022 is part of that process. The first reform under this bill is to legislate that every aged-care centre have a registered nurse on site 24 hours a day, seven days a week, by July 2023. This is a key Labor election commitment. It should be noted that the scheduling brings forward by a full calendar year the royal commission's recommendation No. 86, which was that 24/7 registered nurses be provided in all aged-care centres by July 2024.

Mr Deputy Speaker, I do have concerns. Firstly, I'm concerned around workforce. The aged-care minister has said that she will need just 900 more registered nurses to meet this important election commitment. However, the CEO of the Aged & Community Care Providers Association, Mr Paul Sadler, says it's his belief that it could be double that. Everywhere I go in my electorate, the most urgent need of employers is workforce. It's across all sectors—no exception. It's across hospitality, agriculture, mining, trucking, tourism, public service, health and, yes, aged care as well. No sector can find the workers it needs to do the work that is set in front of it, let alone meet a legislated requirement in 11 months to increase the workforce. If you live in a regional or rural community, that concern is amplified and exacerbated many times over. Where is this workforce going to come from? How will these regional communities across the north-west, the west coast and King Island—in the middle of Bass Strait—find, train and attract these RNs in a 10-month window?

Mr Sadler also calls out the Albanese government's lack of transparency with regard to the workforce numbers that they're quoting. 'I don't have visibility of how the department advised that number,' Mr Sadler said. 'It would be good if they shared that with the nursing colleges and unions and providers.'

My second concern is the lack of detail around the exemption clause contained within the schedule. Again, the minister talks about the necessity for transparency in the aged-care sector, and yet the Labor government is expecting us to vote on an exemption clause about which there is no detail. It's important to note that most of the 34 submissions received by the recent Community Affairs Legislation Committee inquiry raised concerns about the lack of transparency in the drafting of these exemption clauses. The scope of the exemption forms a crucial part of the schedule, so it makes sense that we must see the detail prior to voting on it. If not, it appears that the government is seeking to retrofit an exemption clause to their election commitment because they know that the commitment is undeliverable without it.

Implementing reform to cap the fees approved home-care providers can charge and the removal of exit fees were matters considered by the royal commission. This schedule is widely supported by the sector and is also supported by the opposition. Schedule 3 of the bill responds to the royal commission's recommendation 88 in order to improve provider governance. This was a recommendation fully accepted by the previous Liberal coalition government and was being processed through a $27 million investment. Again I call for greater transparency in this schedule. The need for better public reporting of data in the aged-care sector is crucial—it's vital—however, at this point we don't know what information will be reported and made public. They haven't said. If transparency is to be the hallmark of this government—and they claim this every day—then these details must be made clear before we vote on the bill.

In conclusion, this bill contains the work commenced by the Liberal-National government and our delivery in response to the recommendations of the aged-care royal commission. There are, however, many questions clearly left unanswered. There is the need for more information, the need for more detail and the need for more costings around schedules 1 and 3 of the bill. How is it going to work? How much is it going to cost? When does it need to happen? There are eligibility concerns relating to the discretionary considerations provided before an instrument of exclusion is granted. What about the hardships regional and rural communities have in order to source, retain and train RNs in their regions? The government hasn't taken into account the discrepancy between the large aged-care providers in the leafy green suburbs of the big capital cities and the small rural aged-care facilities in the bush that still require one RN.

I'd like these questions answered before we vote on this bill. I can guarantee you that there are a lot of caring providers out there that would like to see exactly the same information provided.

Photo of Scott BuchholzScott Buchholz (Wright, Liberal Party) Share this | | Hansard source

I thank the honourable member for his contribution. I remind him of the procedures of the House. The consideration in detail stage provides the environment to ask those questions.

5:51 pm

Louise Miller-Frost (Boothby, Australian Labor Party) Share this | | Hansard source

I rise to speak to the Aged Care Amendment (Implementing Care Reform) Bill 2022. As a society and a community we have a duty and a responsibility to care for those vulnerable amongst us. Over a long period of time we have failed one particular group of vulnerable Australians to an unacceptable degree. Like all Australians, I was shocked and appalled by what I saw in the Four Corners special that aired in 2018 titled 'Who cares?' and I welcomed the announcement of the Royal Commission into Aged Care Quality and Safety. The final report handed down in April 2021 detailed 148 recommendations. I was proud to run as a candidate for a party that made election commitments on aged-care reform designed, in line with the royal commission recommendations, to address the shameful neglect of our older Australians.

This bill implements three of the commitments that were made in response to the royal commission. They are, firstly, to lift care and quality standards and ultimately health outcomes by making it mandatory to have a registered nurse on site at all times in residential aged care. The fact that this is controversial boggles the mind, given that aged-care facilities were once referred to as nursing homes. This commitment, if this bill is passed, will take effect from 1 July 2023 and will introduce a new responsibility for approved providers of residential care and of specified kinds of flexible care to have a registered nurse not only on site but also on duty at each residential facility 24 hours a day seven days a week.

This policy is designed to raise the standard of care to a level that our older Australians deserve and that I think we as a community expect. Having a registered nurse on site and on duty 24/7 is expected to save thousands of unnecessary trips to hospital emergency departments. For instance, a urinary tract infection is extremely distressing and can quickly escalate to delirium, and older people can rapidly become very unwell, deteriorate and become disordered. You wouldn't want to go to hospital for a UTI and you certainly wouldn't want to be hanging around waiting to be seen. You need rapid diagnosis and treatment. A nurse on site can facilitate that. Likewise, a nurse on site would be able to triage residents after a fall or an illness, again preventing unnecessary ambulance trips and hospital visits. These trips can, of course, be extremely unsettling and disruptive for patients, particularly for those with cognitive decline. Any step that can be taken to assist in dealing with minor ailments within the aged-care setting is to be welcomed.

This is also part of the solution to addressing the very serious issue of ambulance ramping and bed block in hospitals that we're seeing across the country. I note that there are going to be some exemptions to that on a case-by-case basis, I understand. Certainly I have heard from local providers who have facilities in rural and remote areas that they will be seeking that. They understand that, while we have to have the right level of care, there are some areas where workforce shortages will be a considerable issue. In particular I'll note one that was mentioned to me: Booleroo Centre, which is in very remote South Australia—and certainly not in Boothby.

Secondly, this bill ensures that government funds going to aged care are directed towards their real purpose: providing a better standard of care for residents. The bill introduces a power that will enable the government to cap the amount that home-care providers can charge in administration and management, as well as remove the ability for providers to charge exit amounts. In practice, this means that the government has committed to capping the amount that can be charged for admin and management to people who receive home-care packages. Given that over 210,000 older residents currently receive home-care packages, this measure ensures that government funds go towards improving quality of care, rather than being chewed up by additional and unnecessary administration fees.

Of course, we recognise that organisations providing home-care services do need funding for administration functions, and most services do the right thing. However, I hear from many older people about their distress at being unable to access or fund the services they need, despite what they consider to be very generous aged-care packages. As a government, we have a responsibility to ensure that our funding goes to the outcomes that we have designed it to reach, and they are the actual services to our residents in the community.

Thirdly, this legislation implements our commitment for greater integrity and accountability in aged care. Specifically, it fulfils the government's election commitment to increase transparency about how much providers spend on care, nursing, food, maintenance, cleaning, administration, and profits. This amounts to much greater transparency and insight into what aged-care providers are spending government money, taxpayer money, on, and this is a crucial step in improving public trust in our aged-care system. Again, many providers are doing the right thing, but, as the royal commission highlighted, some are not, and this has a significant effect on the quality of life and the health of our aged-care residence.

During the campaign I had from a local man, Salvatore, about his mother's, Maddalena, terrible last month in an aged-care facility. Sal had been horrified at the bland, unhealthy, innutritious and inadequate food she was provided—and he actually gave me some photographs, which were pretty horrific—as well as the poor quality of her room. The family ended up helping out with minor maintenance and cleaning, including mould removal. In a nursing home situation, where we have people who are, in many instances, already of poor health, to actually have mould in their rooms is unacceptable. Sal was very distressed that, despite his very best efforts, despite being a frequent visitor, along with other family members, to his mother, he was still not able to ensure that her care was even adequate, let alone what he wanted for her last months. This is for you, Salvatore, and for your mother, Maddalena. I'm so sorry for your experience and your mother's experience.

The electorate I represent, Boothby, is the home of many major aged-care centres. Indeed, my husband is the chair of the advisory committee to one, Alwyndor Aged Care, which was founded by his stepgrandmother. Many of them perform well and provide excellent care that is of the standard that residents and their families rightly expect. I certainly heard some fantastic stories of people finding that what their relatives were being offered was exactly what they had wanted and what they would have wanted to do if they could have kept their relatives at home. But, as with the rest of the country, when you visit aged-care sites or talk to aged-care workers, a core theme of exhaustion and frustration comes through. It's no wonder workers are leaving the sector in droves.

During the campaign, I also welcomed the then shadow minister for aged care, Clare O'Neil, to a forum on aged care held in Marino, in the south of Boothby. We had a large number of local residents come, many of whom had family in aged care, but we also had a lot of workers come and tell us their stories. We heard harrowing stories from aged-care workers from the United Workers Union, who were sick with guilt and worry at not having the time or the resources to provide the care that they wanted to provide to residents. We heard from exasperated and often desperate family members just like Salvatore—relatives of older Australians who could not navigate the system or find practical solutions to the need to find affordable care.

We note that aged care has changed very much over the past decade. A decade or so ago, people would stay in aged care for five or six years, maybe longer, and we're now in a situation where aged care is often more of a palliative service. The average stay is often around the six- to eight-month mark. That's changed things significantly. It does mean that we have a higher need for care. We do need to have a nurse on site so that people are getting the care they need in their final months and so that we can ensure that they're getting the pain relief they need. We need to ensure that when something happens—when there's a fall, when they're deteriorating or when they're ill—they get the care they need, whether that's something that happens in the nursing home or whether they do in fact need to go to hospital via ambulance. Obviously, that's a very important part of palliative care. A very important part of living in a nursing home is that you can access that care when you need it. This aims just to ensure that people are not going unnecessarily to hospital, both because of the trauma and the distress that that causes the residents themselves and because it often results in long waits at the emergency department or in ambulance ramping.

These are some of the first steps in what is going to be a long journey to fixing aged care in this country. We know that older Australians have worked hard all their lives. We know they deserve a better situation than what was found by the royal commission, which was summed up in the title of its interim report as, simply, Neglect. The previous government presided over this neglect of older Australians and the aged-care system. There were multiple reports into aged care before, finally, a royal commission following that Four Corners report. The royal commission's report was handed down in April 2021, and the recommendations have still not been implemented. This government, the Albanese Labor government, is determined, under the fine leadership of our Minister for Aged Care, Anika Wells, to leave no stone unturned in helping implement all possible practical measures to guarantee older Australians get the care that they deserve—the care that we, as their family, as their friends and as a community, expect that they can have.

I don't know anyone who isn't impacted by aged-care at some point in their lives, whether they be residents themselves; those in middle age who are facing the daunting task of figuring out how to get adequate and affordable care for their ageing parents; or those now looking at their own future in aged care, either through home-care services or in residential aged care. The aged-care system and the aged-care services that we provide our community impact us all. Even beyond that, the current situation in aged care that we have inherited should outrage us all.

All Australians deserve to be supported with dignity and humanity in their twilight years. This bill is a strong start towards making that a reality for all older Australians, their friends and their loved ones. We understand that aged care is a system, from home care to residential care, the intensive services provided for dementia and palliative care, but it needs to be a system that can be navigated easily. When people are putting their loved ones either through services at home or into aged-care facilities, they should feel confident they are getting the care they need, they are getting the food they need and that they'll have quality of life in those last years. That is what we all expect for ourselves and our loved ones. I commend this bill.

6:05 pm

Sam Birrell (Nicholls, National Party) Share this | | Hansard source

I support the amendment proposed by the member for Farrer. The concerns the opposition have about the Aged Care Amendment (Implementing Care Reform) Bill 2022 are shared by providers in my electorate of Nicholls. The bill does not contain adequate detail or an acknowledgement of the complexity of the many issues. It fails to outline an exemption framework that would give comfort to small aged-care providers, ensuring that they won't be unfairly impacted by the changes. This is a loose legislative framework, and there are aged-care providers that have tried and failed to find out from this government what their fate will be when the full regulations are finally implemented.

Here's a practical example of the challenges and uncertainty faced by small regional aged-care facilities predominantly in regional Australia. Nathalia is in my electorate of Nicholls, a beautiful township of 2,000 people with a long history of taking care of its own. Barwo Homestead is a community-run aged-care facility reflecting the desire of residents from the district to remain in the district when they can no longer look after themselves at home. I recently visited Barwo Homestead and spoke with Lynda Walker, the CEO.

The Royal Commission into Aged Care Quality and Safety was a landmark commission, and the Morrison government responded to the recommendations in May 2021, announcing a $17.7 billion aged-care reform package to respond to the 148 recommendations and deliver sustainable quality care and safety in the home and in residential aged-care services.

One of the measures recommended by the royal commission was for an Australian National Aged Care Classification—which people are calling AN-ACC—care funding model to replace the aged care funding instrument from 1 October 2022. This measure, AN-ACC, includes a mandatory care-minute standard for residential aged care. The royal commission identified staffing levels as vital to the quality of care that older Australians receive and recommended that the care minutes be introduced to drive increased care time. Consistent with the royal commission recommendations, from 1 October 2023, the initial care-minute requirements will be set at a sector-wide average of 200 minutes per day, including a minimum of 40 minutes of registered nurse time. This will be based on care provided by registered nurses, enrolled nurses and personal care workers. The 200-minute overall target and the 40 minutes of registered nurse time will be an average target across the sector. In practice, each residential aged-care facility will have its own care-minute target reflecting the AN-ACC case mix of residents.

In relation to aged care, the goal of dignity, quality and safety in aged care is one that we in this place should all share. The issues I raise are not a criticism of the response to the royal commission or the goal of providing quality care nationally, but there is, as I will outline, a need for a nuanced response given the specific circumstances we find ourselves in as we emerge from the disruption of the global pandemic, particularly in rural and regional Australia, such as in places like my electorate of Nicholls.

In the case of Barwo Homestead, there are currently 17 residents in a 20-bed facility. All are low care, and the absence of chronic care needs means they are adequately cared for by personal care staff, with the support of two registered nurses. The transition to a formula of minimum care minutes poses a significant challenge for small, low-care facilities, as does the requirement for 24/7 registered nurse cover addressed in this legislation. They will need to provide 40 minutes of registered nurse time from 1 October, but in the current environment a place like that just cannot recruit registered nurses. Nathalia has a wonderful environment; it's a beautiful place. But registered nurses don't grow on trees. For a small facility like Barwo Homestead, currently at less than 70 per cent occupation, there is also a serious issue with affordability of additional registered nurse hours and the additional administrative burden placed on a small number of staff who would otherwise be engaged with residents.

There is also the issue of reporting on care minutes, which will be one of the measurable indicators used to inform a new star rating system on the My Aged Care website, which will be introduced from December 2022. Given the difficulties faced by small, low-care facilities—and Barwo Homestead is just one of these—they are unable to respond as efficiently or as comprehensively as larger facilities, especially those in the big population centres with larger pools of qualified labour. What smaller facilities want is time to adjust and, in particular, to be exempted from the star system in the interim so that they are not tarred with the stigma of a low rating through no fault of their own—one that isn't reflective of the wonderful care that they provide.

The longer-term issue is one of financial viability for small community providers in our rural towns. Mr Paul Sadler, the interim Chief Executive Officer of the Aged & Community Care Providers Association, said the following to the Community Affairs Legislation Committee on 25 August 2022:

… we would say that, until we know the detail of how exemptions are going to operate, we do run a risk that we could end up with unintended consequences, even up to the closure of aged-care services across regional Australia if they cannot obtain the staff that are going to be required.

I'll repeat that line: 'even up to the closure of aged-care services'.

The Nationals understand rural communities and how important it is that residents remain connected and cared for in their twilight years. We don't want to see important community based facilities gobbled up by big operators or, worse, disappearing altogether simply because of the financial burden of minimum requirements. We don't want aged-care residents who are happily being cared for in the communities they love being forced into care in larger towns where they lose that connection to family, friends and the community.

The opposition supports the royal commission's recommendation on the 24/7 RNs in aged-care facilities, where it is possible, by 2024 and in line with the recommendation. This government wants to legislate much earlier but has not been transparent with any of the details of any exemption clause. Significant questions are still to be answered, such as: What is the exemption mechanism that will be contained in the delegated legislation? Who will be eligible for an exemption? How long will they be eligible? What will the penalties be for noncompliance?

The Nationals and our coalition partners have a longstanding commitment to aged care. In government, our total investment in response to the final report of the royal commission amounted to $19.1 billion. Our 2022-23 budget responded to 10 recommendations of the royal commission and built on our existing five pillars of aged-care reform. We delivered record investment across the aged-care system over the forward estimates. It went from $13.3 billion in 2012-13, under Labor, to $30.1 billion in 2022-23—growth of 126 per cent under the coalition.

The government must continue our generational reform of the aged-care system for the benefit of all Australians and stop playing political games with older Australians and their families, particularly in small regional communities such as those in my electorate of Nicholls. I urge the government to ensure that places like Barwo Homestead in Nathalia—and there are many of them—whilst still held to account for the quality of their care, are provided the flexibility to continue to operate as they always have and provide the quality of care in small regional communities that is so valued.

6:15 pm

Photo of Shayne NeumannShayne Neumann (Blair, Australian Labor Party) Share this | | Hansard source

I rise to speak in support of the Aged Care Amendment (Implementing Care Reform) Bill 2022. I will give a bit of advice to those opposite: you know you're not going well and your government hasn't handled an area well when the interim report of a royal commission you initiate is titled Neglect. You want to have a read of the foreword of that report. You don't even need to read the final report titled Care, dignity and respect, which called for far-reaching and fundamental reform, to know the coalition, in nine long years, failed abysmally in terms of the aged care of our people, whether in residential aged care or in home care or of those people getting the Commonwealth Home Support Program.

This was a government that went through aged-care ministers like throwing confetti. I think it's important to look at where we've come from. One of the first acts of the former government—they think they're now a government in exile but they're actually in opposition—was to get rid of the Aged Care Workforce Development Fund, which we brought in as part of our Living Longer, Living Better package. It was a $40.2 million fund. I heard the previous member talking about developing aged-care workers and people who can work in regional areas. Well, you don't get rid of the fund that was there to assist as one of the first acts of your new government back in 2013. This is a Liberal Party and National Party grouping that decided they would demote aged care out of Health and Ageing and put it into the mega portfolio of Social Services. Eventually, after Labor campaigned for years—the stakeholders did—to bring it back into a DOHA situation, they finally did so.

One of the first acts of the coalition government back in September 2013 was to get rid of the workforce supplements. To those opposite: we're crying out for workers in aged care. In none of their speeches do they talk about what they really did. They didn't develop an aged-care workforce strategy. They abolished the panel for positive ageing, which was led by Everald Compton, Susan Ryan and Brian Howe, which went ahead and did its report anyway. If you're interested in positive ageing, you don't abolish that panel. They got rid of $1.2 billion straightaway. That was funding to go to residential aged care to assist in increased wages, training and workforce development. That was one of the first acts of the Abbott government in 2013—$1.2 billion of funding cut. When Labor opposed that, it took them 32 minutes in this chamber—I was the shadow minister for ageing, in the opposition—to cut $1.2 billion in funding in aged-care workforce development. That's all it took them. Then, in June the next year, they cut the dementia supplement and the veterans supplement to help people stay in their homes and get the care they needed. That was to help providers support people living with dementia and veterans staying in their homes.

So don't come into this place and give us sermons about aged care as if the last nine years didn't happen. They certainly happened. That's why there was a royal commission. That's why the interim report was titled Neglect. That's why the final report talks about far-reaching and almost traumatic changes that need to happen in the sector, because those opposite neglected it again and again and again. They can barely find a budget or a MYEFO where they didn't cut funding again and again. This is what the 2016-17 budget papers said.

This is the coalition government: 'The government will achieve efficiencies of $1.2 billion over four years'. That's not the $1.2 billion I was referring to before; that's additional cuts of $1.2 billion over four years through changes to the scoring matrix of the aged-care funding instrument that determines the level of funding paid to aged-care providers. So they cut $1.2 billion directly from the sector and they wondered why there was neglect. They wondered why people were leaving the sector when they weren't being paid enough and didn't have career development, training or opportunity. People were malnourished. There were maggots. They were literally starving in soiled bedsheets and soiled clothing under the Liberal and National parties' watch. Those two royal commissions are damning.

This Labor government is trying to correct the failures, the follies and the foibles of those opposite, who failed the aged-care sector and failed those people who were going before us who needed care. They were vulnerable, living with dementia. More than half the people living in residential aged care are living with dementia, and those opposite failed them monumentally. They shuffle money around all the time. We saw situations where, for example, they would take money off 26,000 packages from residential aged care and they would give it to home care for 10,000 packages. There was no new money; it was sleight of hand. That's why the sector was crying out for reform. Only this Labor government is taking reform and taking seriously the recommendations of the royal commission.

If the recommendations were taken seriously by the former coalition government, they should have had a look at the fact that the interim report, titled Neglect, was handed down in October 2019. And what did they do? They continued to use sleight of hand to cut funding. And they did things just before the interim report was handed down to see if they could provide a bit more money in the sector to satiate the aged-care providers and, effectively, to con people. We're putting more money—billions of dollars extra—in aged care because those opposite failed the sector and failed our senior Australians. Care, dignity and respect is the title of the final report. That's what those opposite failed to do—provide the care, dignity and respect that those older Australians deserve.

This government is taking steps and acting on the recommendations of the royal commission. We know that it's backed by the sector. I noticed those opposite not quoting the sector. COTA, the Council on the Ageing, suggested to the Senate inquiry looking into this bill that it welcomes the commitments made in this legislation and supports its intentions. 'We warmly welcome priorities which the Albanese government and the minister for Aged Care has given this bill in the legislative program. This is unprecedented.' That what COTA said. National Seniors Australia commented to the Senate inquiry:

The peak consumer body for older Australians, National seniors Australia, as long advocated for improvements to aged-care services and, as such, we support the intent of proposed amendments.' The HSU, the Health Services Union, supports the bill in its quick passage through the Senate, welcomes the new government's prompt and decisive action in aged care in making it a first order of business for their members. I praise the members who work in aged care: the nurses, the personal carers, the administrators. The 'heroes of the pandemic' those opposite called them but never supported them. The HSU said, 'This bill addresses the deepening workforce crisis, and the public's trust deficit in the sector is long overdue and therefore most welcome in terms of this legislation.'

The coalition has no good track record. John Howard in 1997 produced the Aged Care Act, which governs this particular sector, and those coalition members opposite who were in the dregs of the previous government should hang their heads in shame for what they've done to the aged-care sector in this country. They never saw a budget or a MYEFO where they wouldn't cut funding. This bill goes a long way, but it is a first step for transparency and accountability. It makes sure that those in the sector know they have to deliver the care that they espouse in their propaganda and their advertising.

This is about committing extra support. We're making sure that, from 1 July 2023, approved providers of residential aged care and the specified kinds of flexible care have a new responsibility to have a registered nurse on site. This will help alleviate pressures on public hospitals and GP clinics. The sector has been crying out for 24/7 care for years, and the coalition refused to listen to them. Again and again, people from the sector would come to this place and speak to Labor and coalition members, and the coalition government would refuse to act on it. The member for Cook, the former Prime Minister, was the Minister for Social Services for a long time. He cut billions of dollars out of the sector when he was the Treasurer and also when he was the Minister for Social Services. The previous government neglected older Australians.

What about clarity? There was virtually no clarity at all in the sector in terms of where they spent money. At one stage, the previous coalition government, knowing full well that they'd failed the sector, decided to throw some money at it. There were no conditions on workforce development training and no conditions on how the money would be spent in terms of food, standards of nutrition or quality of care. Nothing like that was done. It was just, 'We'll throw some money here and there, because we know we've got a political problem.' Aged care was a political problem for the previous coalition government. They knew it—they had a royal commission. They didn't act on the recommendations quickly enough. They got the interim report in October 2019, and they didn't do what they needed to do.

We're going to cap the amount that can be charged to people receiving home-care packages for administration and management. We're going to make sure that we cap these charges and maximise the funding available to address the care needs of the 210,000 people currently receiving home-care packages. I can't count the number of times I've stood in this place or up in the Federation Chamber giving example after example of people who had to wait for assessments, then, when they got an assessment that they needed a level 4 home-care package, they could only get a level 2 and then only eight to nine months—sometimes even 12 months—later. People were dying before they got the care they deserved. Families were in distress. It wasn't just Labor MPs; I guarantee coalition MPs got the same entreaties and urgings for help that we used to get. I gave example after example in speeches I made in this place. I think I've spoken more on aged care than I have on just about any other topic, but the coalition government failed.

For 14 years before I came to this place in 2007, I sat on the board of Carinity, an aged-care provider in Queensland. As a lawyer working in private practice, I and my colleagues at Neumann & Turnour Lawyers acted for many, many aged-care providers. I worked with and for the sector. After I became Parliamentary Secretary for Health and Ageing, I remember going to a conference and speaking on aged-care reform and what we were doing. I saw so many of my clients in Queensland—in Brisbane, at the time—sitting there. They urged reform.

I want to commend the current Minister for Health and Aged Care, because he was the architect of Living Longer Living Better, which was prostituted and abolished, effectively, by the previous coalition government when they came to power in 2013. I'm so glad to see him as the minister now in this place, along with the member for Lilley as the Minister for Aged Care and the Minister for Sport, to make sure that we can do it better.

We need people to live longer and live better in this country, and we need to make sure that the recommendations of the Advisory Panel on Positive Ageing and the things that people like Everald Compton, the late great Susan Ryan and Brian Howe said about turning grey into gold are taken up. I want to commend the former member for Lilley, Wayne Swan, who had the vision to put forward that panel on positive ageing, and I'm pleased that the current member for Lilley is now the Minister for Aged Care, taking up that step.

This government is absolutely committed to remedying the failings of the previous government. They should have a look at themselves and what they've done. It's no good coming into this place and acting as if the last nine years didn't happen. They were there; they were on the treasury bench. It's no good being in office and in power if you're not doing things.

This government will act. We will act on aged care. We will give people the dignity, the security and the humanity that they deserve. I'm pleased to support this legislation. It's part of the first steps that the Albanese Labor government is taking to address the myriad failings of those opposite on aged care.

6:30 pm

Sophie Scamps (Mackellar, Independent) Share this | | Hansard source

I would like to start by praising our aged-care workers and thanking them for the work that they do in often very difficult circumstances. Due to recurrent cuts to investment in our aged-care system for too long, Australians in our aged-care system have been neglected and not treated with the care they deserve. As a society, we now need to decide how we want to treat our older Australians. I believe that, if implemented, the Aged Care Amendment (Implementing Care Reform) Bill 2022 will play a role in ensuring older Australians are treated with dignity and respect and that they will get the care they need when they need it.

As we stand here today, the aged-care system is in crisis. It is a crisis that has been developing for many decades because of poor policy. Back in 2018, the ABC's Four Corners program shone a light on the neglect and abuse in our aged-care system. As a consequence, a royal commission was instigated. The royal commission's final report is sobering reading. There has been a systemic failure. Over the last few years, the crisis in our aged-care system has been further compounded by the pandemic and ongoing staff shortages. As Peter Rozen QC told the Royal Commission into Aged Care Quality and Safety:

… the aged care system we have in 2020 is not a system that is failing. It is the system operating as it was designed to operate.

That is to say, our aged-care system has evolved over time so that its primary purpose is profit. Older Australians are viewed as a commodity to be monetised, as opposed to respected citizens who deserve our care.

This bill focuses on three key areas and implements recommendations 86 and 88 of the royal commission. It requires a registered nurse to be on site 24 hours a day, seven days a week, at every aged-care facility. It limits the amount of money that can be charged on administration for home-care packages and requires greater transparency through greater public reporting standards. It also requires the capping of fees by home-care providers. These changes will lead to greater fairness and transparency and help our older Australians receive better care.

Thousands of my constituents in Mackellar live in aged-care facilities, and I want to ensure that they are well cared for. As a doctor, I know that aged-care facilities house people who have high rates of health complexities and comorbidities—people who, at any time of day or night, may need the medical assistance of a registered nurse. A 24-hour, seven-days-a-week onsite registered nurse will not only give aged-care residents the care they require but also support an overrun health system by reducing the need for ambulances and hospital visits.

Improved aged-care services is a major issue for my community. Concern about aged-care services is something that I heard voiced repeatedly throughout the 2022 election campaign. One of those people I recently spoke to is an aged-care nurse who has worked across multiple aged-care facilities and has provided home assistance in the Mackellar electorate for the last six years. She recently wrote to me, stating:

Even after the Royal Commission I still see people in appalling unhygienic and undesirable living conditions. Clients who are left unattended for long periods of time, even after pressing their call buttons for help and clients who are overmedicated as a way to manage.

Today I'm speaking on behalf of the thousands of Mackellar residents in aged care, on behalf of their families and on behalf of all the aged-care workers who care for and love their residents, and who want to see them live a life of dignity and respect—and also to help them in their last days. I'm also speaking on behalf of every Australian who believes that we can and should treat our older Australians better. I hear and understand the concerns that some aged-care providers have in relation to the lack of available registered nurses and the financial implications of mandating a 24/7 on-site registered nurse. We do have a skills shortage; we are in crisis. Just in the aged-care sector alone there is a deficit of 14,000 nurses. Fixing this skills gap will require the new government to increase wages and improve training opportunities for aged-care workers at an economy-wide level. I am satisfied, however, that the legislation provides sufficient support to assist with the transition. I do agree, however, with Senator Pocock's concerns outlined in the Senate report that there needs to be further rigour around exemptions.

This bill goes to the very heart of what it means to be a caring society. Of course we all want to see our older Australians living with dignity and respect, and enjoying their golden years. Let's bring care back into our aged care. I commend the bill to the House.

6:36 pm

Photo of Rob MitchellRob Mitchell (McEwen, Australian Labor Party) Share this | | Hansard source

It's great to hear a member for Mackellar speak in a positive light! It's been a long time since we've had that, so I welcome that and appreciate the words that she said because I think she has actually got to the core of it. This Aged Care Amendment (Implementing Care Reform) Bill 2022 is about how we treat our older Australians.

I, for one, know that as I get older I have a closer look at aged-care facilities. Which ones are good, which ones are not so good? Which ones have the best opportunities! It's something that's so important to all of us—for our loved ones, for our friends, our families and our communities. I guess this goes back to how we as a nation stand up and say, 'The way you judge a nation is in the way it treats its most vulnerable.' People who are living in aged-care homes do deserve the respect and dignity that they've earned.

I think about the time of my journey in this place and of going to the different aged-care facilities across my electorate, where you see some amazing people doing amazing work and getting very little credit. I think about what we learnt through the royal commission report—and it had that awful title, Neglect. It's one simple word but it summed up everything that was happening. It was neglect of the people living there. As the member for Blair pointed out, we heard the horror stories of people with maggots in their rooms and people not getting fed. We'd see pictures of an aged-care resident getting a hotdog without bread and a little dob of potato, and that was their lunch. That's just not fair; it's not right and it's not what we should be about.

I think about the time I spent at Goonawarra during the pandemic—during the lockdown. They had 170 cases of COVID and 20 Australians lost their lives. And there was silence from the then government in supporting these people who were doing it extremely hard. Anyone who has spent time wearing full PPE knows just how uncomfortable it is and how difficult it is to work in—and how easy it is to make a mistake. I know I did it myself—I had to scratch my nose and bang! You have to go straight off and redo it. These aged care workers don't get paid a lot of money—and I'm also talking about the kitchen staff and the cleaners—but they're the ones who are out there, day in, day out, dealing with families. Many people who they deal with are from migrant backgrounds; they didn't have a lot of friends and family and didn't have an understanding of what was going on. Suddenly they were locked in their rooms 24/7, couldn't see their families and couldn't see their friends. But each and every day those aged-care workers turned up and did their jobs, and did them exceptionally well.

They put everything they had on the line. They were kept away from their own families; they went through and did that. And they copped the feigned praise from those opposite, calling them 'heroes'. But when it came to the crunch, when they needed help and support, the former government went missing. We know that that because we learned through the royal commission what was going on and the difficulties that were being faced, yet the former government still just stood there and kept kicking back against it, not wanting to support the royal commission and, in effect, not wanting to support our older Australians.

What this bill today is doing is putting in place three of the government's urgent election commitments. It will put security, dignity, quality and humanity back into aged care. I'm proud to rise and support that, because it's so important. There is more than a great urgency. This is an absolute need. It has to happen very quickly.

I am on the record in this place raising the issues of aged care and the issues that we were left with by the previous government. During the election campaign, we ran hard on the fact that Labor would reform the aged-care system, mainly focusing on the dignity and health of residents. I remember having the then shadow minister, now the Minister for Home Affairs, in my electorate to speak with residents and staff firsthand about what we had planned for aged care and what we were committed to do, and it was very well received. I think they appreciated that someone was listening.

We went to one place in Kilmore, a beautiful spot. We sat around and had a chat to the residents—no fanfare, no nothing. That's what the minister is like. She's just a wonderful, warm person. We got to meet a lady there. If you ever get the chance to go through an aged-care home, talk to the residents. You find wonderful stories about the things that people have done over their lives. I remember I went to one in Healesville back when that was in McEwen. One of President Eisenhower's secretaries was in that home. I just wish I'd had a tape recorder to record some of those stories. At the one in Kilmore, we met a lady who was related to someone who's probably a little bit less well known but in my circle was a bit of a legend. That was Burt Munro, who Anthony Hopkins played in the movie The World's Fastest Indian. When we sat there and listened to her stories, we could see her eyes light up because someone was talking to her about her history and what she'd been through. I asked her specifically, 'Was Burt as cheeky as what the movie portrayed?' She said they were very kind to Burt in the movie! He was a legend in New Zealand, a man who rode around the world. He rode a 1938 Indian and became the world's fastest on a motorbike of that class. It is an amazing story, and an amazing story by someone who is in our community, someone who came here and spent her life here.

These are people who have worked hard, paid taxes, helped build our communities and generally been the foundation of the great country that we have today. We should respect them and give them every ounce of dignity, because they have earned it. It's not something they are putting their hands out for as some sort of entitlement. They've actually earned it from the work they've done and the opportunities they have given us. We only have to think back to people like our war veterans and their families. We often talk about the men and women of our ADF over the years but also their families and what they went through. These people did it hard, they did it tough and they built what we've got. All of us should say, 'Aged care is so important, and we should make sure that people are looked after and given dignity.'

This bill is about delivering on what we promised. Think about having a registered nurse in an aged-care home 24 hours a day, seven days a week. Most of us would think that that should be in place. It's a no-brainer, really. Why hasn't it happened? Why did we go through years of cuts to aged-care budgets, cuts to staff and cuts to the treatment of the workforce there? From July next year the legislation will introduce a new responsibility for providers of residential aged care and specific kinds of flexible care to have a registered nurse on site and on duty at each home 24 hours a day, seven days a week.

You will hear cries from the leftover former government members about the cost. They always talk in terms of cost, but they never talk in terms of investment. What does having a nurse available 24/7 mean? It means less stress on our ambulance system, doctors, nurses, hospitals and emergency departments. We know that they are getting overrun at the moment right across the country. Despite what some newspapers say, Victoria's not alone in this. New South Wales, Western Australia, South Australia—everyone is dealing with the same thing. They're dealing with COVID and the effects of that. So emergency departments are being overrun. Having access to 24-hour nursing at an aged-care home means taking pressure off our ambulances and the emergency staff at our hospitals. This investment in putting nurses in place saves us money at the other end—at our emergency services. It saves our ambulances from being ramped. Victoria proudly—

Well, this is the idiocy of the argument that gets put by those opposite. I'll gladly take that interjection, because Victoria has the highest number of paramedics in the country. The whole issue that we're dealing with is the result of a pandemic. If you lot had invested money in aged care instead of cutting it in every budget, maybe we wouldn't have had a royal commission report that was simply titled, Neglect. You might be funny and cheeky and thinking, 'Ha ha! Look at me! I'm going stick my nose in and carry on,' but you're making a goose of yourself, because—

Photo of Maria VamvakinouMaria Vamvakinou (Calwell, Australian Labor Party) Share this | | Hansard source

Order. Through the chair.

Photo of Rob MitchellRob Mitchell (McEwen, Australian Labor Party) Share this | | Hansard source

this legislation and what we're putting through is addressing the nine years of what your mob did when you were in government, and it's something that you should be ashamed about.

Photo of Julian HillJulian Hill (Bruce, Australian Labor Party) Share this | | Hansard source

He's the goose, not you, Chair!

Photo of Maria VamvakinouMaria Vamvakinou (Calwell, Australian Labor Party) Share this | | Hansard source


Photo of Rob MitchellRob Mitchell (McEwen, Australian Labor Party) Share this | | Hansard source

Absolutely! No, no. I'm never going to—

Photo of Maria VamvakinouMaria Vamvakinou (Calwell, Australian Labor Party) Share this | | Hansard source

I think the honourable member knows that he needs to go through the chair, without a doubt. Thank you.

Photo of Rob MitchellRob Mitchell (McEwen, Australian Labor Party) Share this | | Hansard source

I think we know that the chair has my absolute respect. It just shows the ignorance from those opposite on what this is about and their seriousness about aged care. I think he's the member for Casey. Healesville is in Casey. We actually went to those places to look after them—to actually go and see what was going on and see what they were dealing with. It's interesting that you find the ability to laugh about the idea of having nurses back in hospitals and trying to take pressure off ambulance systems—that's a really intelligent thing to do! But it's not unexpected, I guess, because, when we talk about investing in health and aged care and bringing people together, the only people who sit in this place who don't want to do that are those sitting in the leftovers of the LAP.

The 2020 Aged Care Workforce Census reported 80 per cent of residential facilities having registered nurses, but we need to get those numbers up, and to recognise the difficulties, as mentioned by previous speakers, about the shortages. These are not people you can just turn a tap to get—'Do a four week course and away you go.' These are people who have very special talents and the ability to work in a very tough area. It's not easy to find people with the compassion and the ability to work in aged care. I know. When I see them doing it every day, I'm in awe of it. The ability to do the things they do is just something special.

Today I met with workers from the ASU about what's happening there, and in my area we've seen a lot of growth in the aged-care facilities but what we also see now in our communities is councils walking away from this. Victoria has the best community care sector in the country, and councils are walking away from that. It's easy to sit there and say, 'Oh, we'll just get an outside provider to come in.' But I'll tell you what: it doesn't happen. Outside providers focus on one thing: profit. As to the idea that people are going to drive an hour and a half out of Melbourne to go to a regional area to give people care—it just doesn't happen. You can absolutely go to private providers, but they are not there in the regions, in the small towns, in the country communities where we need them. And that's not something new. It has been happening for a long time. And it's harder and harder to get people. We use this analogy about people working in aged care: they get paid less than someone working at Bunnings on a Sunday. That's not right.

It goes back to what I said at the start: this is about how we, as a country, see ourselves. It's about how we treat and respect the most vulnerable in our community.

This is an issue that has been developing for a long time, and this House should be supporting every opportunity to help this government deliver its promises and help deliver better aged care for our communities, because it's one thing that we are all going to face one day. We're all going to get there, hopefully, or our families are going to be in aged care. And what we need to be able to do is stand back and say, 'We've done everything we can do to help make it better, safer and more dignified.' If that means making sure that they get proper food and proper care and that they have face-to-face contact with people, then that's the least we can do for the generations of people that have built this country and made it what it is. With those remarks, I commend this bill to the House and wish it a very, very speedy passage.

6:49 pm

Monique Ryan (Kooyong, Independent) Share this | | Hansard source

I wish to begin with a message to the residents in aged care across the country—the seniors of our nation, who deserve our deepest respect. At times the political debate about the many issues in aged care, so brutally exposed by the recent royal commission, is necessarily focused on the very important issues of funding, regulations and the workforce, all of which I will speak about today.

In this building, aged care can sometimes be talked about like it's a burden, a budget blowout, a massive red tape, the work of staff who are deemed unskilled. Aged care is not a burden. The treatment of our elders is how we should measure the greatness of our nation. In this political forum, the people at the heart of what we're talking about are often left out of the conversation.

So, on the off-chance that there are some folks watching the live proceedings of the House of Representatives from their aged-care home, I want to say that your care, your happiness, your wellbeing and your dignity matter. I want to extend my deepest respect to you and the contributions that you've made to this country in your lives.

The royal commission's report on the state of aged care in Australia was simply titled Neglect. It spoke of neglect in federal funding, neglect in regulatory oversight, neglect of the workplace conditions and remuneration of aged-care workers—who provide highly skilled, crucially important work—neglect of care for the people who raised all of us.

When the former Liberal government deregulated aged care, to the extent where aged-care providers did not need to have anyone onsite with nursing qualifications, nurses and specialist geriatric doctors spoke out in alarm. They knew that people living in care facilities were some of the most vulnerable in our communities and that, without the oversight of a dedicated, qualified nurse, their health, wellbeing and lives would be put at risk. We've seen the full dangers of this during the COVID pandemic in the last two years and the dreadful things that have happened in aged-care facilities around this country.

The royal commission into aged care heard testimony after testimony that laid bare the worst of their warnings, horrors that no-one could wish upon their worst enemy let alone their sick, elderly mother or father, their uncle or their aunt. That report titled Neglect is a national shame but is also an opportunity. The full suite of recommendations from the royal commission must be implemented, and I'm pleased today to support the Aged Care Amendment (Implementing Care Reform) Bill 2022 to get started on doing just that.

We have to mandate that residential aged care and care approved providers provide a registered nurse onsite in appropriate facilities, and that nurse needs to be on duty 24/7 from as soon as possible—from 23 July as mandated. It's important that we cap home care. It's important that we limit the prices of aged-care packages. It's important that we limit the ability of approved providers to charge exit amounts. Older people, vulnerable people, need to understand the cost of the care that they're committing to when they enter a facility. Transparency of information regarding the provision of aged-care facilities is extremely important.

I'm particularly proud to support my colleague from Mayo's amendment to this bill. Subordinate legislation is important. We know that legislation at the discretion of the minister has its advantages and opportunities. It's important, though, that parliamentarians are provided with an opportunity to review their subordinate principles. The community deserves transparency over what the government is providing for us.

The framers of the Constitution vested legislative power in the Australian parliament because they felt: 'The people's elected representatives are particularly well-suited to the exercise of the open-ended discretion to choose ends, which is the essence of the legislative task.' The process of executive lawmaking by subordinate legislation lacks transparency. It lacks the publicity of the parliamentary process. It therefore reduces the accountability of the exercise of legislative power. We need to have greater transparency of the legislation that we see and, on those grounds, I'm very proud to support the amendment of my colleague from Mayo.

6:55 pm

Photo of Fiona PhillipsFiona Phillips (Gilmore, Australian Labor Party) Share this | | Hansard source

It's a real pleasure to speak today on this Aged Care Amendment (Implementing Care Reform) Bill 2022. I've got to say that today is' thank an aged-care worker day', so I think it can be no more an applicable time for this to come through than today. As I said, it's a real honour to speak on this today.

I would like to take this opportunity to thank all our aged-care workers. Everyone who works in our aged-care homes, whether they're our aged-care workers, our cooks, our cleaners, our nurses, our people working in admin: you are all important. I want to thank the Health Services Union also for raising this as well—in terms of 'thank an aged-care worker day'—and for all the work that you do every day to support aged-care workers and raise awareness of what's happening. I also want to thank the many aged-care workers who have raised these issues in this bill today. They have been tireless and fearless over many years. They've never given up. I am really, really proud to be here today to talk on this because it is so essential, not only for our aged-care workers but of course, most importantly, for our aged-care residents.

I come from one of the oldest age demographics in Australia, the electorate of Gilmore. Our aged-care residents are much loved, and they deserve that dignity and respect that they should have. I think that's why there is so much passion from our aged-care workers to reform the system and to make it better. As I said, it is about our aged-care residents. I also want to thank our aged-care nursing homes as well. I meet with a variety of nursing home representatives across my electorate, and we've had many a roundtable discussion about how we can improve the system. It is really good to see people working together.

Of course, I was absolutely devastated and heartbroken at the revelations of the aged-care royal commission, although it shouldn't come as any surprise because of those many discussions with aged-care workers. I know that many people in my electorate of Gilmore were also devastated by what came out of the aged-care royal commission and the harm particularly for our residents. 'Neglect': a powerful word and a truly devastating one. That was, of course, the summation of the royal commission. Older Australians deserve better than neglect. They deserve a system that is there for them as they age, to give them dignity and to care, to really care. That's what aged care should be: care, not neglect.

I have heard so many heart-wrenching stories over my time as the member for Gilmore, both in aged care and in home care. I hear lot of stories and a lot of people contact my office. As I said, my electorate has one of the oldest populations in the country. There are a lot of people who have come up to me, particularly people who might have their parent in an aged-care nursing home; they're worried about them, for their care. Sometimes they're children who might be in another state, but they just want to know that their parents are being looked after. It is a really huge issue that impacts so many people.

Of course, we know the electorate of Gilmore, on the beautiful New South Wales South Coast, is a place that many people want to retire to, and I can completely understand that. It is a beautiful place. It's a beautiful coastline. It's made up of around 100 individual villages, each with their own personality. Of course, we have many aged-care homes that are truly beautiful and really well loved in their communities. But it also means that there are a lot of people that have firsthand experience of our deteriorating aged-care system.

Since I was elected, one of the most common complaints I've heard is about the home-care system. In a regional area like ours there are limited providers, and it's really hard to find the right services. I just want to talk about some of the most recent examples. Patricia from Berry contacted my office just yesterday. She was receiving cleaning services but, without explanation, they have all of a sudden stopped. My office is working with her to find out what's happening. But complaints about access to providers and the fees they are charging are complaints I hear often.

In another example, a 95-year-old lady from Ulladulla had been waiting since January for her level 4 package, which she really needed. Her daughter told me that she's been on a level 2 package but her mobility is failing and she needs more equipment to help with her quality of life. The good news is that my office helped get that package through, finally, but this, unfortunately, is such a common story.

Sadly, many people have also told me they simply couldn't afford the prices charged under the package. Some home-care providers were charging incredible amounts in administration charges. A Burrill Lake resident told me one provider was taking 46 per cent of their package. They tried to find one that was cheaper, but there simply weren't any. Too many people are waiting too long, struggling to find services and being charged too much when they do find them. The system is broken.

This bill will place a cap on the amount that home-care providers can charge for administration and management, as well as removing the ability for providers to charge exit amounts. That is good news in our community. I know it will be very well received. Local people should feel confident that their money is going directly to care. After all, that is what it's for.

All up, this bill implements three key changes to fix our aged-care system. The second change this bill will make is to ensure that residential aged-care facilities have a registered nurse on site and on duty 24 hours a day, seven days a week. This is in response to another of the key recommendations of the royal commission.

We need to stop unnecessary hospital trips for our older Australians. We have a hospital system buckling under the pressure of COVID-19, combined with a GP crisis and a health system that has been mismanaged at a state and federal level for years. Just last week I attended the nurses rally at Shoalhaven Hospital. I note that there were many rallies across my electorate, and we had many nurses from Milton, Moruya and Batemans Bay as well. Many of those nurses came up to me to thank me and Labor for the changes we are making to aged care. It's given them hope for their future and hope for their patients. I wished them well in their fight for better pay and conditions from the state government.

I just want to take this moment, as well, to say that the hospitals in my area—the nurses, the hospital workers—are absolutely brilliant. They do a fantastic job, and I think there's general consensus right across the community in our region that that is the case. But they need more support from their state system; they absolutely do. I've lost track of the number of times I've been called about the bed block outside Shoalhaven Hospital. I say this as well because the nurses and the healthcare workers want a better system. Everybody wants a better system, and that's why nurses were rallying in a state system—because they want better for their patients. They want ratios. When we look at what we've achieved through this bill in implementing recommendations from the royal commission, we're actually moving forward, and I think there's great frustration that the New South Wales state Liberal government are just not providing that support or those ratios for their nurses. At the federal level we have taken leadership in that, and I'm proud of that.

I'll tell you who else was at that rally at Shoalhaven hospital: Katelin McInerney, the Labor candidate for Kiama. She's a mum, and she will absolutely stand with nurses, and she was there. There was no sighting of the Liberal state member for Kiama—or for South Coast—and that really disappoints me. We need to be supporting our nurses, just like we, federally, are supporting our aged-care workers. Everyone—our nurses and our workers—deserve better. I do want to say thank you to all our nurses across the health system for everything they do. We will absolutely keep working hard for you.

We need to make sure that, if there is a way that we can stop older Australians ending up in hospital unnecessarily, we support that to happen. So I'm really pleased about these changes. I know that registered nurses won't fix everything; they won't solve everything. In many cases, they certainly do need the support of good GPs. I'm also having the conversations with local GPs, like Dr Kay, who are delivering great GP services in our local aged-care homes. But she also needs support to keep doing this. We need to support our GPs more to do that important work in nursing homes to support our registered nurses. But this bill is a really good place to start.

We need to make sure that, when people living in aged-care homes have a problem that can be dealt with quickly and easily, there is someone there to do it. It just makes sense, and it is what the royal commission said needs to happen. We are doing it and we are doing it quickly. There is no time to waste. I know that this means we need to find the nurses—amazing, wonderful, beloved nurses. We need to upskill our workforce and we need to get the nurses we lost during COVID-19 back into the industry.

How do we do that? We start with a pay rise. Our nurses shouldn't be moving to other industries because they pay more for easier work. They should be paid fairly for the work they do, and that's a key part of Labor's aged-care plan: making sure that happens. We've also announced fee-free TAFE as part of the outcomes of the jobs summit, targeted at skill shortage areas, starting with nurses. Fantastic news. It will help, absolutely. It's one more step, one more piece of the puzzle, in fixing a system left to disintegrate for too long.

The third change this bill will make is to help ensure greater transparency on what aged-care providers are spending their money on. Once again, local people in my electorate of Gilmore want to know that their money—and aged care isn't cheap!—is going to care. That's what residents moving into care want to know. It's what their families want to know. This bill will ensure that this is transparent and that there is accountability in aged care.

I'm proud to be part of a government that is working every step of the way to ensuring that every Australian has dignity, humanity and support as they age. The families of older Australians in my electorate deserve to have confidence in the facilities that they entrust to look after their loved ones. They shouldn't have to worry about whether their mum, dad, auntie, uncle is getting fed, is having their bed changed, is getting help to go to the toilet, if they need it. Not one single person should lose someone they care about because they didn't get the care they needed when they needed it. So I am delighted to support this bill. I support it wholeheartedly. I want us to get on with putting the care back into aged care. I am proud to be part of a government finally delivering dignity and humanity for our older Australians. I commend the bill to the House.

7:09 pm

Photo of Mark CoultonMark Coulton (Parkes, Deputy-Speaker) Share this | | Hansard source

I rise today to speak on the Aged Care Amendment (Implementing Care Reform) Bill 2022 and support the amendment that was introduced by the member for Farrer. I want to make it very clear right from the start that I support the concept of as much highly-qualified professional support in aged care as possible, and the idea of 24/7 nursing care is an honourable goal to aim for.

My concern, though, is: if it's legislated, particularly in some of my more regional smaller communities, and the aged-care provider can't find the staff, and if they are then in breach of legislated conditions, what happens then? Are they going to be closed down?

I watched very closely the Royal Commission into Aged Care Quality and Safety and there were some tragic stories. But I've got to say that, in my part of the world, I didn't see too much of that. A lot of the providers in the Parkes electorate are smaller and they're community owned or maybe run by the local council. We have seen some amalgamation of late. McLean Care, for instance, have come in and taken over the Alkira and the nursing home in Gunnedah. We've seen Whiddon homes that are servicing Narrabri and Wee Waa and out at Burke, and they've just taken over Fairview in Moree. But my experience from visiting these places is that the folks that are residents there are getting great service from very dedicated staff. They're doing the best that they can to attract the staff that are available. Quite frankly, they should take, and recognise, the people who have come from overseas to work in aged care. Just out of interest, the second language that's spoken at home in the Parkes electorate, that's not English, is Nepalese. We've got people from Nepal, the Philippines and the subcontinent countries who are doing a great job filling in that workforce gap.

We are also doing a lot of work locally, and I want to give a shout-out to my home town and the Gwydir Learning Region, an organisation that I used to be chair of, that is training people in a cert III in aged care at the local school, because there are no tertiary facilities in Gwydir Shire. Over the last 15 to 20 years, maybe a couple of hundred people have been trained up and are now working in aged care. They are fantastic. When my father was a resident at Naroo—a facility that he was actually instrumental in building, and he was chairman of the committee, and ultimately became a resident—the local people who had had a career change later in life, as mature people, did an amazing job.

The most important thing is that there are services within local communities. A lot of my towns are more than 100 kilometres apart. I've been working with the Lake Cargelligo all-care committee now for probably more than a decade. It was started by a couple of gentlemen whose wives had dementia and there weren't any services locally. They'd been married to their wives for over 60 years, and their wives were in facilities 120 kilometres away. These chaps, who were in their 80s, couldn't be there every day, as you need to be if you've got a family member with dementia, to help with the feeding and just the continuation of being in the life of someone who's going through the terrible experience of dementia, and it was just terrible. All those years together and, in the final years of their lives, they're separated. My concern for other towns that I have is what happens if they have to provide nurses 24/7 and they can't.

Over the years I've worked very closely with many of the aged-care facilities in my electorate. There is Cooinda at Coonabarabran; I've been helping them by working with some capital grants to upgrade their facilities so that they can do what's necessary. Another great example is Cooee Lodge at Gilgandra. The community of Gilgandra has actually made aged care and disability care an industry that actually droughtproofs the community. They've constructed duplex villas for people to go into for retirement, there is a hostel nursing home and then dementia care. So people are actually moving to Gilgandra because of the care that's offered in that community.

But over the last, probably, 15 to 20 years we've seen a change—we've seen more aged-care packages delivered at home. A lot of these facilities were built basically as hostels, where people might go and spend five or 10 of the later years of their lives, but they're now going in as high-care patients. The funding model allowed for a bond—and the low interest rates have also impacted on aged-care facilities' viability, because the return on those bonds hasn't been as high over the last few years—and now that people are mainly there for end-of-life care that model has broken down. So most of the facilities in my electorate now are in financial difficulties. We're going to have to look at that funding model because it's just not working the way it did. Also, a lot of my communities have a higher proportion of older folk who are on pensions. They don't have a house that's worth $500,000 or $600,000 which they can sell to pay for the bond. Many of the homes in these small country towns are not worth anything like that. So funding is particularly difficult.

Despite all of this, I believe that the people in my electorate are getting good care through the dedication of the staff involved. Obviously, in the bigger centres like Dubbo we have some great facilities. Basically, there are retirement suburbs. There are nursing homes supported there—three or four of those. A lot of people are actually coming into Dubbo now to retire. But the ones I'm particularly concerned about are these smaller towns of 1,000 or 2,000 people and that are a hundred kilometres apart—places like Bourke, where Whiddon provide the services now. Cobar has Lilliane Brady Village, which was driven by the local council and named after the very determined and famous hardworking mayor, Lilliane Brady, who, sadly, passed away in her 91st year. These communities have banded together to build facilities so that they can care for their loved ones at home. That's what we've got to do.

I do recognise and understand the reasons for the legislation in the way that it has been presented; I just don't think the government understands that there could be unforeseen consequences in this. I'm hoping that the government will support the member for Farrer's amendment so that the exemptions mean these smaller regional facilities can continue.

This is seriously one of the biggest issues we're facing as a country. By the time baby boomers, like me, need that higher care, not only is the expense going to be higher for the government; we're also going to need a workforce. That's the other side of it. I am supportive of reform now because the issues around aged care are only going to multiply as baby boomers need that higher level of care. I am just expressing extreme caution on putting legislation that may ultimately lead to some facilities having to close. That would be a complete disaster.

7:20 pm

Photo of Emma McBrideEmma McBride (Dobell, Australian Labor Party, Assistant Minister for Mental Health and Suicide Prevention) Share this | | Hansard source

Aged care matters. It matters in communities like mine on the Central Coast of New South Wales, where one in five people are aged over 65, and it matters in every suburb, town and city across the country, where old Australians and those who love them deserve better. That's why it's crucial this legislation, the Aged Care Amendment (Implementing Care Reform) Bill 2022, is supported and urgently implemented.

I want to start by saying to the many people in my community who live in residential aged care, are receiving home care or know someone in aged care: you deserve better. As a government we're acting on the recommendations handed down by the Royal Commission into Aged Care Quality and Safety. In doing so I acknowledge those who shared their experiences with the royal commission and the people of my community who encouraged me to share their stories in this place—stories which are familiar to so many of us, which are often heartbreaking, disturbing and deeply personal. I also acknowledge the members of the Health Services Union, who stood up for older Australians and those who care for them.

Nicole, from Chittaway Bay, in the electorate I represent, contacted my office earlier this year to talk about her experience with aged care. She told me that we need urgent change to fix our broken aged-care system. Nicole said that aged care is overstretched and older people are paying the price. She told me: 'My mother is currently in a nursing home, and every time I visit her I can see quite clearly that there is a shortage of staff available to help her. I often search around for someone to assist me if help is needed. It worries me, and I often worry she is being neglected.' Elizabeth, from Bateau Bay, also contacted me, in July this year, about her husband, who is living with dementia and is in residential aged care. Elizabeth told me she has to spend hours a day caring for him herself because there aren't enough staff to give him the care he needs. She said she's desperate for aged-care reform. And that's what the Albanese government is doing. This legislation is a big step forward in fixing our broken aged-care system. It will respond to recommendations from the royal commission's final report and will help us as a nation to put security, dignity and humanity back into aged care.

This bill introduces a responsibility for approved aged-care providers to have a registered nurse on site and on duty at every aged-care home across Australia 24 hours a day, seven days a week. This will give older Australians the care they need and their families the comfort and assurance they need. It will also prevent thousands of avoidable and distressing trips to the hospital emergency department.

I've spoken often in this House about my father and his experience living with younger onset Alzheimer's. The particular situation was this: my father was at a cottage having some respite so that my mum, his full-time carer, could have the break she needed. Dad had a history of kidney stones, and he had an episode whilst he was in respite care. He wasn't able to communicate his distress or the pain he was in. The staff there were capable and dedicated, but it was beyond their experience and what they were able to do. I had to rush and collect my dad from respite and take him to the emergency department at Gosford Hospital, where we spent hours in a busy emergency department. It's not a place that any older person, particularly someone living with dementia, should be in. It was very unsettling for my dad, it was very difficult for my mum and it is something that happens to so many older people and their families every single day. That's why it's so important that we have the right care at the right time—so that people can get the support that they need and so they don't end up in distress and with complications, where their situation progresses, they become worse and they end up in emergency departments or having long stays in geriatric or rehabilitation wards in hospitals.

This bill also introduces a cap on charges for the administration and management of people receiving home-care packages, and it removes exit fees altogether. There are currently more than 210,000 Australians receiving home-care packages, and they deserve quality care. They need to know that the care will be of a standard that they can rely on. Their families need that reassurance and that comfort. In capping these charges, the Albanese government will make sure providers are spending more of their funding on care, making sure that that investment from all of us goes into supporting staff and providing quality care.

The last measure of this bill is the government's commitment to improving integrity and accountability in aged care and providing greater transparency. We know that aged-care staff, the many capable and dedicated people who are working within our aged-care system, are as much the victims of aged care as the people that they're trying to support. So that integrity and accountability is absolutely integral in underpinning the reform to aged care, which is so desperately needed and which our government is determined to achieve.

This bill requires the secretary of the department to make information on residential aged-care services and provider expenditure publicly available, including information on labour, care, food and nutrition, cleaning, administration, maintenance and profit or loss. This information will be published online and will help older Australians make more informed choices about residential aged-care services and providers. These measures respond to increasing public concern about the aged-care system, and they'll improve transparency for those living in residential aged care, for those who love them and for the providers. This is an important step in making sure that older Australians get the care they deserve and that, as a community, we are determined to provide.

These measures build on legislation passed by the House in the previous sitting fortnight. For me, personally and as a local MP, I'm so pleased to say that that legislation, the Aged Care and Other Legislation Amendment (Royal Commission Response) Bill 2022, has now passed the Senate. This was the first bill—and I think this is not just symbolic but practical—passed by the 47th Parliament, and it addresses a series of urgent funding, quality and safety issues as recommended by the royal commission. It will provide additional protections for older Australians living in residential aged care and a series of measures to increase transparency and accountability, something which all Australians have called for. The royal commission's interim report into aged care was titled Neglect, and, after close to a decade of inaction under the previous government, Australia's aged-care system has fallen into crisis. We need to act, and we need to act with urgency because people's lives depend on it.

Another one of my constituents, Frank, from Mardi, wrote to me last year saying—and this reflects the former speaker: 'Every baby boomer we know dreads the thought of having to go into a nursing home. Just look back at the issues uncovered by the royal commission and, more recently, the shocking handling of infection control with COVID-19. We have all had experience with parents and relatives experiencing substandard care in nursing homes, so, absolutely, everybody plans to stay home for as long as possible.'

We need to make sure that older people, and those who love them, aren't fearful about the prospect of being forced into aged care; that they know with confidence that, if they enter aged care, they will get quality care; and that they will get the care that we all want for our parents, for our grandparents, for every older Australian.

I'd also like to reflect that later this month we'll be marking Dementia Action Week. In doing so, I recognise the work of Dementia Australia and, locally, the Central Coast Dementia Alliance. As many of you in this House know, dementia impacts close to half a million Australians, and almost 1.6 million Australians are involved in their care. People living with dementia are some of the most vulnerable Australians. They have been tragically let down by our broken aged-care system. Older Australians who have worked hard their whole lives—raised families, supported communities, run businesses, contributed, had meaningful lives—deserve to be treated with dignity. They deserve respect.