House debates

Thursday, 8 September 2022


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

10:10 am

Photo of Michelle LandryMichelle Landry (Capricornia, National Party, Shadow Assistant Minister for Manufacturing) Share this | | Hansard source

All Australians want and expect our older Australians to be well supported and catered for in our community, including in residential aged-care homes. That is why in government the coalition called the Royal Commission into Aged Care Quality and Safety: to ensure our oldest and most vulnerable Australians receive care that supports and respects their dignity and recognises the important contribution they make to society. The final report of the royal commission makes 148 recommendations following 23 public hearings over 99 days, 641 witnesses and over 10,000 public submissions. They are 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. The opposition remains committed to supporting the health, safety and wellbeing of older Australians and understands the important role that aged-care providers, care workers and nurses play in ensuring this support is provided in residential aged-care settings.

Speaking to this bill hits very close to home for me. My father, who is 86 years old, is in the aged-care system at the moment, and I understand what the families are going through when it comes to aged care. I want to thank all the aged-care staff that are looking after him for their tireless work in making him comfortable. While I'm visiting him, families of other residents and patients grab me in the hallways to share their experiences, telling me about their own dire situations. They ask me for help to find doctors for their parents or elderly loved ones. Tragically, some are telling me about their mums and dads dying in agony waiting for a visit from a doctor. In some cases they are given Panadol for pain they're experiencing while they wait, and then they pass away.

I recently met with the CEO of Benevolent Living aged care, Alison Moss, about the issues they are facing delivering aged-care services in Rockhampton. They are struggling to provide quality care due to a lack of staff. They have 22 beds available in their newly built and state-of-the-art facility, but, due to struggles with staff and shortages of doctors and nurses, these beds are unable to be filled. I have also recently been notified that Access Aged Care, a provider offering clinical services to residents in residential aged-care facilities, will soon be withdrawing its services from Rockhampton. Despite intense recruitment efforts, Access Aged Care has been unable to secure the services of GPs in Rockhampton to support its care model and, as a result, will no longer be providing services. This has the potential to impact emergency departments as residents can no longer be treated on site at their facility and will be taken to the emergency department for treatment. This will affect approximately 170 residents in the local area.

A&E at Rockhampton Hospital faces constant ambulance ramping at a rate of 45 per cent, one of the worst ambulance ramping rates in Queensland. Shortages of doctors and nursing homes mean the elderly are being sent to A&E for scripts or check-ups, which could be done by a GP in a nursing home. This is clogging up the system.

We were told this government was going to listen, they were going to consult and they were going to care. I heard the slogans constantly during the election. They recited over and over again 'Medicare, aged care, we care.' Unfortunately, on multiple occasions I have sent correspondence to the Minister for Aged Care, Anika Wells, about the terrible state of aged care in Capricornia, about Access Aged Care pulling out of the PHN and to make her aware of a bipartisan aged-care forum I hope to host in Rockhampton and that she would be more than welcome to attend. To date I have not received a single response. This is shameful behaviour of the minister, and I implore her to stop playing politics with this important issue. The minister would be well served to remember that aged care is too important for politics.

The Aged Care Amendment (Implementing Care Reform) Bill 2022 contains three schedules amending the Aged Care Act 1997. Schedule 1 establishes a new responsibility for providers of residential aged care to ensure that a registered nurse is on site 24 hours a day, seven days a week, by July 2023. Schedule 2 of the bill introduces a new power to enable the government to cap fees that approved home-care providers may charge care recipients and removes the home-care providers' ability to charge exit amounts. Schedule 3 of the bill introduces a new requirement for the Secretary of the Department of Health and Aged Care to publish additional information in relation to aged-care providers and their costs, with the aim of allowing older Australians and their families to make more informed care decisions.

The opposition urges the Labor government to continue generational reform of the aged-care system for the benefit of all Australians, and to stop playing political games with older Australians and their families. Our nurses have worked tirelessly on the front line through the COVID-19 pandemic, protecting lives and keeping Australians safe. We especially recognise the amazing support that nurses provide our older Australians, particularly their critical work in aged-care homes since the outbreak of the pandemic. We know these were not easy times, yet our nurses stood up when it mattered most to protect so many older Australians, and we are grateful for their work.

The opposition have grave concerns regarding the extreme use of unreleased subordinate legislation by the government. Instead of containing adequate complexity and information, this bill does not actually outline the necessary details on how it will impact aged-care providers in practice. The opposition considers this bill more of a legislative framework than detailed legislation. The lack of detail within the legislation and the lack of ability for parliamentary scrutiny of its subordinate legislation are serious concerns for the parliament and for the aged-care sector. These concerns were echoed by many stakeholders and witnesses who appeared at the Community Affairs Legislation Committee inquiry into the bill. The government must listen to the concerns raised by the witnesses at the inquiry and the stakeholders who will affected by this legislation.

Schedule 1 of this bill allows the government to implement the employment of registered nurses in residential aged-care facilities on a 24-hour basis by July 2023; however, this time line is not consistent with the royal commission's final report, which recommended making it mandatory to have a registered nurse on site 24 hours a day from July 2024, with an accompanying minimum care minutes requirement. The opposition notes the unique challenges faced by aged-care providers in rural and regional Australia, particularly regarding access to the registered nurse workforce. The royal commission considered a range of factors when recommending that time line, recognising the current workforce shortages and the time required to train or access the necessary additional workforce.

Given the government have brought the start date of this recommendation forward by a year, they must specifically outline what support will be provided to regional and rural providers and other providers already struggling with viability and workforce challenges. The government must outline how they plan to get the additional nurses into aged-care homes in regional and rural aged-care facilities, following their jobs summit. The opposition supports the royal commission's recommendation on 24/7 RNs in aged-care facilities where it is possible by 2024 and in line with the royal commission recommendation.

The opposition also 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. 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 are likely to be subject to significant difficulties in finding the additional workforce to meet the requirement within the time frame set by this bill.

I'll now speak to schedule 2. The former Minister for Health, Greg Hunt, and the former Minister for Senior Australians and Aged Care Services, Senator Colbeck, required, for the first time, that information be published relating to the median prices charged for home-care services, increasing the transparency on home-care prices. This bill now enables the government to cap charges that approved home-care providers can charge care recipients and removes home-care providers' ability to charge exit amounts. The opposition supports these reforms, as they are sensible amendments broadly supported by the sector. We remain committed to ensuring downward pressure on home-care prices and older Australians being able to make informed decisions about aged-care services.

Speaking on schedule 3, the opposition agrees that we need more transparency in the aged-care sector to ensure older Australians and their families are able to make informed care decisions. That is why in government we introduced substantial reforms to increase transparency, including from 1 July 2019 requiring all home-care providers to publish their pricing information in a standardised schedule published on the My Aged Care website, providing greater visibility of median prices, and investing in the My Aged Care website to ensure that older Australians and their families are able to easily access and compare information about aged-care providers. The publication of additional information to increase sector transparency and to increase consumer understanding of this sector is supported by the opposition. I believe that more information assists in making more-informed choices.

The coalition has a proud and constructive history of delivering for the aged-care sector. The coalition's 2022-23 budget delivered funding for aged-care reform of $522 million, which built on the funding contained in the previous budget. This brought our total investment in response to the final report of the royal commission to more than $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—from $13.3 billion in 2012-13 under Labor to $30.1 billion in 2022-23 under the coalition. By 2025-26, funding in aged care was estimated to grow to $34.7 billion per year under the coalition.

We also remain committed to providing our older Australians support to live in their own homes for longer. That is why we increased new home-care packages from 60,308 under Labor in 2012-13 to 275,597 in 2024-25, an increase of 357 per cent. We are currently in the second year of the five-year plan and it is imperative that the government now continue our work to support the aged-care sector. I also implore the Labor government again not to play politics with aged care. People like my father and the families I meet deserve better.

10:22 am

Photo of Peter KhalilPeter Khalil (Wills, Australian Labor Party) Share this | | Hansard source

Like others in this place, I've reflected a number of times on the importance of respecting Australians in their senior years. It's not just about good manners, although that's a big part of it; it's about recognition of their hard work and the contribution that they have made to their communities, to broader society and to their country. Older Australians really deserve dignity as they age and they deserve a government that will actually look out for them. Our value as a society is found in how we actually treat each other, but there is little pride to be found in the treatment of people in aged care and the hardworking staff as well in that industry.

'Neglect' is probably the best single word that can be used to describe how they have been treated, or not treated. That is a simple yet poignant way this issue has been described by others. That is why the Albanese government have committed to putting the care back into aged care. We want to rewrite that, reverse that neglect and actually care. It's what we promised at the last election and it is what we are delivering with the Aged Care Amendment (Implementing Care Reform) Bill 2022, which will implement three of our urgent reforms to aged care.

It will require approved providers of residential aged care to have a registered nurse on duty 24 hours a day seven days a week from 1 July 2023. This will extend to specified kinds of flexible care. This is something we will work closely with state and territory governments to implement. For aged-care residents and their families in my electorate of Wills, in the northern suburbs of Melbourne, this is incredibly important. It will mean fewer unnecessary trips to the hospital simply because a nurse is unavailable. That will take pressure off our health system. These trips, usually at all hours of the night, cause a great deal of stress to residents, and their families, and add to the already significant workload of the people who care for them.

Fewer unnecessary trips to the hospital will also reduce exposure to illnesses—a risk of which we have been acutely aware, of course, during the pandemic. We are also particularly conscious of this in my electorate of Wills, where significant outbreaks have occurred across aged-care homes. For the families whose relatives contracted COVID-19 in aged care, I know how important this reform is. It's critical. I've spoken to dozens of them—family members and people in aged care—including those who lost loved ones, tragically. They have all told me about the greater investment in care hours required to improve the living conditions in these aged-care facilities. It was a constant theme, a constant refrain.

Affordability is another challenge that the Albanese Labor government is committed to addressing. This bill will cap the amount recipients can be charged for the administration and management of home-care packages and remove exit amounts entirely. More than 210,000 Australians currently receive home-care packages, and I know, from the dozens of stories that have been shared with my electorate office, just how much cost remains—an ongoing stress for recipients and their carers. By capping these fees, we will make it more affordable for people receiving home-care packages and we will make it clearer, providing a better picture of expected costs—which can be exceptionally difficult to fully grasp when navigating what is a very complicated system.

So improving transparency in the sector is a priority for the Albanese Labor government. Australians across the country have been rightly shocked about the secrecy of and scandals arising in this sector. It has been shocking—shocking to ordinary Australians, to people who have family members in aged-care facilities. There have been all the front-page reports of the lavish lifestyles of aged-care home executives and the owners of those facilities—just shocking! I think it's been a direct hit to that sense of fairness that Australians hold so dear. All this was happening while residents were slapped with increasing fees and aged-care workers remained some of the lowest-paid workers in our economy.

So the final part of this bill will give Australians a greater picture of the operations of aged-care providers, including where they are directing their money. It will shine a light and give transparency. It's very important. It will require the secretary of the department of health to publicly provide information about the expenditure of aged-care providers. This will include information on the expenditure directed towards staffing and care hours, food and nutrition, cleaning, administration and maintenance, as well as the profit and loss—the bottom line. This information will be made easily available to the Australian public, to those family members, providing them with the information they need to make decisions about the care for themselves or for their family members.

Now, this is what real action looks like, from a government that is actually committed to respecting older Australians and to putting their care back into aged care. It's not rhetoric. It's not grandstanding. It's not talking about it. It's actually doing something about it.

As a government, we will also continue to seek further reforms, including working with the sector to implement mandatory nutrition standards, to ensure that all people in care receive high-quality, nutritious food. We will mandate an average of 215 minutes of care per day, as recommended by the royal commission into the sector. Just like providing more nursing hours, this will reduce the workload of staff and provide more time for the provision of basic standards of care—which, frankly, we should all expect as a baseline, a minimum.

Now, I know how important this is for the hardworking staff who care for our older Australians. It's a tough job—probably one of the toughest jobs out there. The care, the commitment that they make, is really incredible. It is really giving of yourself; it's highly stressful but it's also very, very difficult work, and it requires a lot of skill and a lot of compassion. A lot of hard work goes into caring for our older Australians. It has to be acknowledged how difficult that job is.

And it's often a thankless job. That's something that we're trying to redress here by acknowledging the hard work of age-care sector workers. We know how insufficient their pay is for the level of work they do, for that type of commitment. That's why it's so important that we address these issues and put the care back into aged care—acknowledge and reward, through their better pay, the aged-care workers who do that thankless job to look after older Australians. We can make a real difference to the lives of older Australians and give them the dignity that they deserve, given the commitment and contribution that they have made to this nation over their working lives.

10:31 am

Photo of Rowan RamseyRowan Ramsey (Grey, Liberal Party) Share this | | Hansard source

I rise to support the amendments to the Aged Care Amendment (Implementing Care Reform) Bill 2022. Aged care of course is a very important issue within all of our communities. As I often say in this place, I come from one of the most rural and regional electorates in Australia. It is a great concern to me how these individual units are affected by any changes we make in this place. We are all very aware that staffing issues are a problem right across the industry, but they're more acute in rural and regional Australia than they are in the cities.

We've had some difficulties in the recent past. I've had a major—for us, let's say a major—sized unit of around 80 beds having some real difficulty meeting standards. It's fair to say that we absolutely need our facilities to meet those standards but, given the degree of difficulty that's evolving at the moment, sometimes I think it needs a little bit of a soft touch to make sure we don't run the risk of closing these beds. In another case, in the City of Whyalla, we've had a community owned service which operates all of the residential care spaces in Whyalla under extreme pressure and forced to close one of their three facilities.

In that space, I'm very pleased that the former government stepped into the breach and assisted Helping Hand to come to Whyalla and provided around $3 million worth of assistance to actually keep the facility going—to get their management systems in place and to make sure that we have a seamless change in managing and ownership in Whyalla. Helping Hand have been there for most of this year—a little more than that—and they need to make a decision in the very near future about whether they are going to go past the 12-month point and actually purchase the facility and stay in Whyalla permanently.

In the lead-up to the election, I secured an electoral commitment from the coalition to advance $10 million for capital works in Whyalla. I don't make any bones about this, and I've spoken to the health minister, Mark Butler about this: it was not matched by Labor, but it was a very welcome offer from the coalition. I've spoken to the minister since, just saying how important it is that we secure this support, even though I understand it wasn't a Labor commitment. I believe there is a funding round coming up in November. I've also spoken to the local state member there, Eddie Hughes, who is a Labor member, and we are as one on this issue. We just simply need to get capital investment into Whyalla to secure the long-term management of a larger organisation which has the efficiencies which actually come with being able to run that type of organisation.

One of the problems we had, of course, was with Kindred Living at the facility that was closing; we just could not get enough registered nurses. In fact—it is one of those paradoxes, I suppose—the hospital, too, was struggling for registered nurses and so it set up a modus operandi, if you like, which led to the raiding of registered nurses out of Kindred Living, which only exacerbated the problem. People have asked me, 'Why couldn't we stop the hospital raiding that staff?' But you are going to have a shortage of nurses somewhere. The problem is that we have a shortage of nurses, whether that's in the hospitals or in the aged-care sector. So we know that we have to address that as a matter of urgency.

I am confident the Minister for Health and Aged Care is listening and that we will reach a position where we can secure that long ongoing service from Helping Hand. I know it would be difficult for him to sign off on some kind of grant in front of the process. I think that is right, and he is holding his ground in the right manner. But as long as the government, the Labor Party, are committed to making sure that we have long-term, classy operators in Whyalla and that we achieve some reinvestment to get rid of the shared rooms and shared bathrooms I'll be pleased. If we know anything after COVID it's that we don't want shared bathrooms in aged-care facilities. So we will move the dial forward, and I give my assurance to the people of Whyalla that I will not rest until we have nailed down that long-term commitment from Helping Hand and that we have a commitment to build new facilities and upgraded and expanded facilities at Whyalla.

10:36 am

Photo of Lisa ChestersLisa Chesters (Bendigo, Australian Labor Party) Share this | | Hansard source

It gives me great pleasure to rise to speak in favour of the legislation that is before us, the Aged Care Amendment (Implementing Care Reform) Bill 2022. These reforms to aged care are long overdue, and one of the key commitments of the Labor government is to rebuild the aged-care sector to restore dignity, quality and humanity back into aged care.

The royal commission broke many hearts. It exposed the true crisis there is in aged care. But, for many of us, many of the residents living in aged care and many of the families of residents, they were stories that we had heard before. For far too long, the sector had been let fall into the crisis that it is in today. The bill before us introduces a number of key reforms that will help get the sector back on track.

Just by way of example, I want to share with the House some of the conversations that my team and I have been having with people in the Bendigo electorate. So serious were the challenges in our electorate when it came to aged care that we actually ran our own survey and our own consultation work around the same time as the royal commission to share the experiences of local people. We also organised our own rally to give family members and workers an opportunity to speak out and to try and get the former government's attention about what was happening in our region.

I can remember being at the rally and inviting some family members up to speak. I had to do the mental health check and say: 'What we're talking about is quite confronting. If this is a trigger for you, please reach out.' There were lots of tears. There were lots of stories being shared that triggered some really traumatic memories for many of the people that were there because they had lost loved ones in aged care who hadn't received the appropriate support that was needed because the sector is in crisis.

One example of that was Bernadette, who was a primary carer for a friend. Her friend Leonie was in aged care. She contacted us to say that there wasn't enough qualified staff. Leonie had reported that staff did not know what medication she had to take and they were often trying to give her the wrong medication. She said she was unable to walk and reliant upon stuff for toileting but felt really embarrassed and was concerned about pressing the call button for them because she knew how overworked they were. The food was inadequate. Recently Leonie had just been given a party pie and a sausage roll. Her GP recommended that multivitamins be provided to Leonie to compensate for the poor quality of food. This is Leonie's experience. Leonie is one of the people in my electorate that really welcomed Labor's commitment and the reforms that are before us. The 24/7 registered nurse, for example, would ensure that Leonie wouldn't be in that situation going forward; she would actually have a nurse on site to help ensure that she was receiving the right medication and not trying to be given the wrong medication.

Another example: Kylie contacted my office. She is a nurse in residential aged care, and she said that she was heartbroken to be leaving the sector but that she's burnt out. She worked extremely hard. She worked overtime every week and weekends, double shifts when they asked, because she didn't want to leave the residence in the situation that Leonie is in. Years of doing this had taken its toll, and she was burnt out. When asked if she supports the reform for a 24/7 registered nurse to be a requirement, she said yes because it would mean that her employer would have to have a replacement nurse for when someone called in sick. Quite often that isn't the case; it is left up to the facility, and, if they can't get somebody, they are left short staffed.

We acknowledge that there's a lot of training we need to do and a lot of work we need to do to encourage nurses back into the sector, but, if we are able to improve and support registered nurses, like Kylie, then Kylie may come back; she may come back into the sector. They're the kinds of people we need to encourage back in.

I also wanted to share the example of Robert. Robert is a 97-year-old World War II veteran, one of the last remaining World War II veterans that we have in our country. He's living in Bendigo and he does not miss an ANZAC Day. He's in the home-care support system. He fears going into aged care because of the examples that I've shared and that others have shared. So he still lives at home with his 90-year-old wife. They've been together for a while. She's now in a wheelchair on a level 4 package. Robert is on a level 3 package. My Aged Care home care is the only support they receive—there's no family—but it's complex to navigate.

They have a private provider who helps to manage their package, very limited in detail. Robert thought he had been doing the right thing by saving funds for OT work and assisted equipment needed for his wife, but it wasn't right to be doing it that way. He was unaware that his funds could be used to help his wife, which, in turn, then denied him being eligible for a level 4 package and therefore more support for himself. Because he wasn't quite aware of the complexity of managing the case and because he had a private administrator based in Melbourne, he couldn't get the information that he needed. He was going without the extra support to help his wife toilet. Here he is, a 97-year-old World War II veteran, living at home, trying to live longer and live better at home, supporting his wife to toilet because he wasn't aware of how his package work properly. He ended up coming to my office, asking if we could move him from a level 3 to a level 4 package. We contacted My Aged Care to find out that he couldn't move to a level 4 because he hadn't spent all of the level 3. We had to unpack the miscommunication.

Also, so much of their packages had been lost in an administration fees, and that speaks to one of the other reforms before the parliament today: capping home-care charges. This bill reflects our commitment to cap the amount that can be charged by administration and management for people receiving home-care packages, and it removes exit amounts altogether.

That has definitely been the experience of Robert, and that's part of the problem we have with this sector. Private managers, private providers and private organisations are also not very good at sharing with their clients or customers how best to use their packages. So a year and a half down the track, this very kind, very gentle and very strong World War II veteran is calling my office to find out what can be done to support his wife. It shouldn't be this hard. A veteran should not have to come to their MP's office to get support to help toilet his wife. That is why the capping of home-care charges is important. It will encourage more not-for-profits to be in the sector and it will probably see the exiting of many that are in the sector to make a profit and not to deliver a service. These proposed changes provide pricing transparency for people like Robert and for providers, and creates greater clarity about direction and direct and indirect costs. All of these changes are necessary.

Robert isn't the only one who has raised home-care changes with me. There's a group in Castlemaine, and this is one of the key issues that they spoke to me about in the lead-up to the election: the frustration that they're looking at, with their money dwindling and not actually going on support for them but going in administration fees. Then there's the cost of exiting, so they feel trapped with a dodgy provider and they can't move to the next without paying an exit fee. So they welcome these changes that are before us today.

The other key change that is really being welcomed by people in my electorate is transparency of information. In this bill we are committing to improving integrity and accountability in aged care, providing greater transparency about what aged-care providers are spending money on. That goes to the food example that I used in the case of Leonie. Part of the frustration that Leonie and her friends spoke to my office about was that it is expensive for a lot of our older residents to be living in aged care. They've had to sell their homes or the money has gone into a bond. They are paying a lot to be in these facilities and yet all they get served is a sausage roll and a party pie. It's not good enough, when they feel they're paying a lot from their income. Having transparency of information will hold the sector accountable and will keep it honest. It allows residents and family members to know exactly where the money is spent. It also allows our parliament and our government to really understand where the money is going in aged care. If all the money is being spent on staff and we need more, then we can look at that. But if the money is going into mega profits for non-for-profits or for individuals then we need to know that.

These things are why these changes that are before us are so necessary. The legislation that we have is a part; together with the other legislation that was moved through in the first sitting fortnight this is our demonstration as a government that we're getting on with the reform that the sector requires. We do not want to be here in three to four years time and still have family members coming into our electorate offices crying because their loved one has passed away in pain, or were in a position where they didn't get the help that they needed. We want everybody to live their best life and, when they exit this life, to go with peace and dignity, and in humanity. We want to see that return to our age-care sector.

In the few moments I have left, I do want to thank everybody who continues to work in aged care—who has just hung on. The last few years have been really tough: the short-staffing and the pressure on the sector. But it's been particularly tough in states like my state of Victoria, where we've had the longer lockdowns and longer exclusions not allowing family members and friends in because of the risk of COVID in aged care. It was done for health reasons—aged-care is quite susceptible to COVID, and we've lost a lot of older Australians to COVID—and a lot of the residents understand that, but it has taken its toll, not just on the residents but also on the staff. They are burnt out. To those who've hung on and are still there, all I can say is that it will get better. These reforms that Labor is moving on in government will improve the aged-care sector. We are committed to seeing wages lifted for these aged-care workers, these angels who have hung on to make sure that residents have the support they need. I say to them: we understand things have happened that have broken your hearts, but thank you for sticking it out, because it will get better.

These reforms are a step in the right direction, but we acknowledge there's a lot more to do. I look forward to being able to go back out to these facilities when they do have a 24/7 nurse on and there is a replacement if that person is not able to be there. I look forward to activities officers being genuine activities officers and not having to drop activities to double up as a PSA because someone has called in sick.

The transparency—making sure we know where the money goes, whether it's taxpayers' money or whether it's individuals' money—is critical.

Finally, on home-care packages: there's a lot of work we need to do to clean up this sector, and the capping of home-care charges is just the beginning.

Older people deserve our respect and support, and I'm proud to be part of a government that is moving on implementing many of the recommendations of the royal commission.

10:51 am

Photo of James StevensJames Stevens (Sturt, Liberal Party) Share this | | Hansard source

It's been very interesting to listen to the contributions from other members on this, because there are obviously some clear commonalities that we, as members of parliament, experience in our interactions with the aged-care sector in dealing directly with constituents. I can tell from the previous contributions that we all have very similar issues that are brought to us as local members of parliament. They're not all bad experiences, by the way. Naturally, a disproportionate number of people who reach out to their MP do so because they've got an issue that they need support in overcoming—I accept that—but I want to make a few comments about the inherently fantastic people who work in our aged-care system and the fantastic work that they do, and I'll do that in a moment.

The second thing to say, following on from that, is that I don't think any of us as human beings, not just members of parliament—I don't think there'd be any Australian—has not had a direct personal experience or interaction with the aged-care system in this country either at the moment or in the past. Of course, all of us will in the future. My last surviving grandparent is now in a residential aged-care facility, two of my three deceased grandparents came to the end of their lives in aged-care facilities, and many other members of my family have need of, or will in the future have need of, the aged-care system, hopefully for a brief period and not for a very long time. It's very important to all of us that we have an excellent aged-care system that provides the highest standard of care and support in the most flexible way to people needing that care in the last moments of their life.

My grandmother not only spent the last period of her life in an aged-care facility but spent most of her career working in the aged-care sector. She was an aged-care nurse for many decades. She had become a nurse during the Second World War and served in the Army, as a nurse at the Heidelberg hospital in Melbourne, nursing returned soldiers. Many of them were POWs who'd had traumatic experiences and had challenges insofar as the care they needed. Then she came back home to Adelaide and worked at the repatriation hospital for a reasonable amount of time doing similar work caring for veterans, and then became an aged-care nurse for the remainder of her career as a nurse. She was someone who absolutely loved that work. She loved caring for vulnerable people. At times it was very difficult because the sorts of care, with the circumstances people are in, are very challenging and emotionally draining. But she absolutely loved it and found doing that work so fulfilling. I think she is the same as almost everyone that works in the aged-care sector.

We all, as members of parliament, have the opportunity, I'm sure, if you're anything like me, to regularly visit our facilities and talk to management and staff as well as the residents about what their issues are and the challenges they've got. My observation is that, inherently, the people working in the sector—whilst we need to do better in the support they've got—very much get an enormous amount of fulfilment from doing the work they do. They are great heroes in our society, and I'd like to pay tribute to everyone that works in the aged-care sector. We are very lucky to have your dedication.

The royal commission brought to light some, in some cases, quite shocking examples of unacceptable circumstances in our aged-care sector. I've got no dispute with any commentary of the royal commission around that. But I think we've got to remember that, whilst there are some bad circumstances, there will always unfortunately be bad operators with bad faith. My personal experience, and I think it's the case across the sector, is that most operators are inherently doing excellent work with the resources they've got. The aged-care facilities I visit in my electorate are doing fantastic things, and the aged-care facilities I've experienced when members of my family have been cared for by them are doing fantastic things. There are people that need to lift their game but it is important that we don't let the zeitgeist become some sort of sense that we've got an aged-care sector—particularly a residential aged-care sector—that is on the whole providing very low-quality, poor care; that's not the case, certainly in my experience. I want to be a constructive participant in this place in doing more wherever we've got the opportunity to improve things.

The reality is that the demand on aged-care services will only grow exponentially into the future. A large part of that is for inherently good reasons. People are living longer. Modern medicine is changing our life expectancy and is allowing people to have longer lives and a lot more options around treatment for things that would have ended their lives much sooner. My own grandfather's circumstance, which is very common—he is very lucky to be alive at almost 93 years old—is of significant mental deterioration through having dementia. He is physically fit as a fiddle, which is great, but he is in a circumstance where, because of his dementia, he needs very significant care in a residential circumstance. Prior to him going into that circumstance, he had, I have to say, really good community care support. My grandma was in the same situation before she passed away. They had good support and access to community care packages that allowed them to stay at home for much longer than they otherwise would have been able to.

That's another thing that's really important as we look at addressing aged-care reform and how the system will change into the future—that we make sure we are helping people to stay in their homes for as long as they can, provided they want to and it's safe to do so. That's a difficult circumstance to confront for any family. In my family's case, my grandparents had to go into residential aged care. Of course they didn't want to, and we did the best we could as a family to support them to stay out of residential care for as long as it was safe to do so. But it will always get to a point where that's not tenable.

It is important that we have a good, flexible system that can, for as long as possible, have people in a circumstance where they are able to stay in a home-care situation where supports can be funded, as we do through community aged-care packages. They've changed a lot over the years, but the principle of helping people to age in place, in their home, is one that's very important for them. And of course it is important that we make sure that, particularly if they want to, we can keep them out of the residential system for longer, in a safe way. It takes the burden off the explosive growth we would have in residential care if we weren't doing as much as we could to further support people in that circumstance to stay in home care.

This bill has been well commented on through a very long list of speeches and contributions in the second reading debate, and I do note, in particular, my colleagues who have talked about being in other electorates. I'm in a metropolitan electorate and I understand the issues that are acute in the sector in my electorate. But it has been quite valuable to hear contributions from members whose constituents, particularly on the residential aged-care side of things, have very different circumstances and challenges because of those circumstances. Smaller communities have much smaller facilities that are more commonly community developed and run, and they have very difficult challenges around viability. I don't have that challenge in my electorate, but I have to say that I recognise and back to the hilt people who represent electorates where they do have those facilities and how vital it is that we support those facilities to stay operating and open.

It is very traumatic for people to go into residential aged care. Some have lived their entire lives in a particular community, compounding the trauma which happens at times when people are taken from their home into a residential facility because it's not tenable for them to stay in their home anymore. To then also remove them from their community—adding that additional burden of having many people that are part of their family and their social circle at a long distance from them and, therefore, clearly not able to provide that nourishment they need of regular visitations et cetera—would be a very distressing and disappointing outcome.

So I commend the comments of the many members who have talked about some of the challenges that are associated with mandating certain requirements on operators which will be near impossible for some existing operating residential facilities to meet. I hope the government is very much attuned to and concerned by this, and that they make sure they think through how they structure exemptions for facilities that could have their viability dramatically impacted if we're not careful. I think that point has been made comprehensively by a lot of my colleagues, and I add my weight to those comments to make sure that it is really reinforced to the minister and the government. I hope that in good faith they are able to structure exemptions that ensure those facilities can be viable.

I've talked about community care, and, in concluding, I make the point that I want to see the community care side of this sector very much focused on, and being about people accessing care and support and not about becoming some huge profit-centre industry. The aged-care sector is not there to make people extremely wealthy; it's there to support that greatest generation of people who have served our nation and built this nation, and who need us, as a government and as a society, to give them the highest standard of support and care.

When it comes to community care, a lot of my constituents' experiences have been very disappointing. I won't go into the specifics of those details publicly in this debate, but I think that every member of parliament would have similar experiences of certain providers of community care clearly making a lot of money rather than necessarily delivering an excellent outcome for the people that the system is there to support. I am certainly a happy participant and supporter in this place wherever I get the opportunity to support further change if it's necessary to make sure that's the outcome we're getting around community-care provision.

With that, I'd like to reiterate my thanks to everyone in this sector. It's been a very difficult few years with the compounding challenges of COVID and the workforce in aged care. We know that what they have had to struggle through, in some states in particular, was extremely taxing, brutal and draining, so thank you very much to the people that work in the sector. I hope that we as a parliament will continue to deliver change for you that improves the quality of care to people that need it and also ensures that the great heroes of the workforce of our aged-care system are properly valued for the work they do. I thank the House for the opportunity to contribute on the second reading.

11:06 am

Photo of Zali SteggallZali Steggall (Warringah, Independent) Share this | | Hansard source

I rise to speak on the introduction of the Aged Care Amendment (Implementing Care Reform) Bill 2022. This is a bill I welcome following the dire revelation of the royal commission in aged care. I would like first to thank the many who work incredibly hard in this sector. They do their job well, and the revelations of the royal commission would have been incredibly distressing for those in the sector who are endeavouring to give the best of care to loved ones and to our older Australians as they go into residential care.

It's vitally important that this parliament work to improve the standards of our aged-care system. The recommendations of the royal commission were clear—that much-needed improvements to the way we care for our older loved ones must be implemented as a matter of urgency—so I urge the minister to accelerate implementing all the recommendations of the royal commission.

Locally in Warringah, some 15 per cent of residents are now over the age of 65. As Australia's population continues to age, the systems we currently have in place will need to be ready to cope with increasing demand. We must approach the issue with an unwavering compassion and acknowledgement that there are some systemic flaws in the past that weren't acceptable and that need to be changed. Underresourcing and lack of preparedness have rendered many aged-care facilities ill-equipped to adequately care for their patients and residents, and I think that was made all the harder during COVID, obviously, where additional requirements were imposed upon aged-care centres. We have to remember they are not hospitals; they don't have the level of care that is available in emergency departments, so the balance between the resourcing and where the best care can be provided always needs to be front of mind.

I have spoken with many local residents, nurses and aged-care workers, and they all believe strongly that having registered nurses on duty will absolutely improve the quality of care and reduce the burden on the health system generally. Registered nurses have the skills and training to treat many more incidents and prevent them from happening in the first place. This will reduce the number of residents being taken to hospital, with care able to be provided at the facility, reducing strain on our stretched ambulance and hospital services. The implementing care bill clearly seeks to improve the system, and I urge the government to ensure these measures succeed.

Costings of the bill are not insignificant. We know this is an issue. An accumulated $460 million over the forward estimates is substantial; however, it's an investment absolutely worth applying to appease this shocking crisis. As many have highlighted in this debate so far, it may still not be enough to truly cover the implementation of the measure.

The three schedules in the bill will improve safety and access to care rights as outlined in the Australian Charter of Healthcare Rights. The implementation of a mandated posting of a registered nurse 24/7 in aged-care facilities is a welcome improvement. It's an improvement I strongly advocated during the last parliament, and I spoke in support of the member for Indi's motion in 2021.

I have done some extensive consultation with stakeholders and residents in Warringah. I seek assurance on their behalf that any exemption criteria for schedule 1 will be reasonable and that it will be consistent with the royal commission's recommendations. I echo the concerns of the member for Mayo and in the coalition's second reading amendments about the lack of detail in the primary legislation and the extensive use of delegated legislation. It's critical that the exemption criteria be made known so that we can be assured that reasonable provisions will be in place to protect providers who are unable to obtain a registered nurse. In that sense, I have listened to the contributions of other members of this place in relation to the difficulties in regional and more remote areas. Nevertheless, we also need to ensure that this exemption process is not used by providers to avoid providing better care and having registered nurses.

The department estimates that there is a shortfall of some 850 nurses at present to meet the needs of this bill. We cannot penalise the ratings of these centres for not obtaining staff if they simply doesn't exist. We need to ensure there are exemptions where reasonable steps have been taken to recruit staff but have been prevented by lack of availability amidst the skills shortage crisis. Gaps in individual shifts due to sudden illness or injury of staff and difficulties for employers in abruptly sourcing casual staff should also qualify for a reasonable exemption. The onus should be on the federal government to appease the skills shortage that we are facing and help ensure these exemptions are minimised.

The bill also seeks to cap home-care costs specifically pertaining to service providers no longer charging for cessation of care. I support this in principle as we need to target and prevent unreasonable outlier prices in home care. Some stakeholders in my electorate hold concerns that this schedule will grant the government an unlimited power to regulate all home-care prices. So I call on the government to always be transparent and consultative if they are to implement discretionary regulatory powers.

There are still some issues relating to the crossover between aged care and NDIS. That does not pertain to this bill, but an issue that I would urge the government to address is the gap and the age discrimination that exists in the NDIS system as people then transfer to the aged-care system.

The third schedule seeks to mandate public disclosure pertaining to aged-care services. I support this in principle because we need transparency. But I find it to be broadly written. A general power to disclose information without parliamentary scrutiny could be problematic. So I trust the government will consider reasonable privacy with regard to important information if it's published.

When the royal commission's report was released last year, Australians were collectively horrified to learn of the extent of the real human tragedy in a deeply fractured system. The malpractice and underresourcing were a clear violation of the right to access adequate health care. I'm pleased to see this bill introduced so early on the government's parliamentary agenda. The bill will aim to rectify the three serious gaps in the aged-care industry that were outlined by the royal commission. These are important to fix, but we must remember the commission produced 140 recommendations to fix the system. So we must ensure progress is continual. There is significant pressure to reform the sector ahead of the impending jump in demand. To remain ill prepared for this would be catastrophic. We can't allow this sector to underdeliver quality care.

In consultation with the aged-care workers in my community in Warringah, further fractures have been identified. One aged-care worker I met with identified that there is a significant gap between some aged-care participants receiving access to great support and others who are not. One aged-care worker has alerted me to instances whereby she witnessed dangerously poor hygiene in facilities and in homes and long wait times for support and assistance, even if an emergency button had been pressed. Alarmingly, she had seen staff administering medication to control behaviour and believes that it may have been unethical and unnecessary sedation. We know these were the types of issues that were raised during the royal commission.

Reporting these serious issues through the appropriate channels can prove challenging for some aged-care workers. I note that these complaints are not always acknowledged. So we need to ensure enough streamlined reporting systems are in place so that quality care can be monitored and applied consistently across Australia.

In my community, there are also concerns that some providers have too many people on their books and so they are not resourced enough to provide substantial care for all of them, with fears that a profit-over-people mentality still exists within the sector following the revelations of the royal commission. In particular the concern is for older people without family or close relations or those under public guardianship. They're often left behind with inadequate support. The disparity in quality of care needs to be addressed in those circumstances.

It has to be acknowledged that navigating the aged-care system can be daunting for families and for older Australians. The sector can be quite complex, and many older people rely on family and friends to help guide them through the processes of application, assessment and engagement with service providers. Sadly, people who struggle to navigate the system find themselves being left behind.

As we age, our circumstances can change rapidly. This heightens my concern that underinvestment in My Aged Care has seen waiting lists explode. It can take upwards of 12 months on a waiting list to access home-care packages. In that time one injury, a fall or sudden cognitive decline can see an older Australian completely without access to the level of care they need to stay in their home. I urge the government to eliminate the home-care waitlist, as per the royal commission recommendations, and reform the system to make sure it is sustainable and fit for the ageing population we're dealing with.

Keeping people in their own home longer should be a core goal of the aged-care sector. This is again where we do see age discrimination between the interaction of the NDIS, which finishes at 65, and aged care, which does not provide the same level of support. Again, those without family or community assistance find themselves dangerously undersupported as their needs grow. Without ease of access to adequate supports, older people may be forced into aged-care facilities. This is not of benefit to the government, the economy or the community. For those who live in residential aged-care facilities, care needs to be equitable and consistent. The best way to ensure this is to ensure that we have well-trained, well-resourced staff.

There are profound opportunities to stimulate the economic benefits of a well-functioning aged-care sector. We know this is where the megatrends in employment opportunities are. We know this is where the skill shortages are. The reforms recommended by the royal commission could create around 30,000 additional full-time jobs in aged care by 2030. This excludes the additional 50,000 extra full-time workers that will be needed because of population trends. So now is the time to capitalise on the opportunities afforded by reforming this sector. Of course, we also need to make sure they are properly valued. We cannot expect people to work in these sectors, which we know are so incredibly essential to the ongoing standards we expect in our community, without them being properly remunerated and valued in our society.

This bill brings forward good measures to address three key gaps that were revealed by the royal commission into aged care. It's vital the implementation of these schedules is done thoughtfully and carefully so that meaningful changes can succeed. I again wish to thank those who work so hard to provide quality care within this sector. Their contributions are vital to our older Australians in our communities. It's time we ensure that the unacceptable standards of the past are amended. I look forward to continued action from the government and the minister and to seeing this happen.

11:18 am

Photo of Dai LeDai Le (Fowler, Independent) Share this | | Hansard source

Like all Australians, I want to see care for our elderly improved where possible and considered deeply. After all, it is something that affects us all. Yesterday in the House I had the privilege of seconding the amendment moved by the member for Mayo, Rebekha Sharkie. She's a strong advocate for regional Australia, and I trust that her amendment will ensure senior Australians receive better quality care for what they pay, and it will make it more difficult for vultures who wish to take advantage of our most vulnerable.

My contention is not with the government's proposal to cap fees, making aged care more affordable for Australian families, or to improve the availability of information for senior Australians to make informed decisions. However, I do take issue with schedule 1 of the Aged Care Amendment (Implementing Care Reform) Bill 2022, which proposes to establish a responsibility for providers of residential aged care to ensure that a registered nurse is on site 24 hours a day seven days a week by July 2023.

Our nurses have worked tirelessly on the front line through the COVID-19 pandemic, protecting lives and keeping Australians safe. I would especially like to recognise the incredible care given by our nurses in Fowler in supporting a particularly vulnerable elderly population. Some of the people they cared for did not speak English as a first language and others did not speak English at all, adding to the complexity and stress already being experienced during the pandemic. We will never be able to thank these nurses enough.

Despite nurses having been immensely overworked during the last few years, the government proposes to have skilled nurses on call 24 hours a day, seven days a week. I do not harbour concerns over the validity of this proposal. Rather, I'm worried that not enough consideration has been put into how we will support these nurses and how we will expand the number of nurses available for this demanding job. This government needs to be careful to not simply throw money at situations. Detailed planning needs to be put in place as to how new nurses will be brought into the industry, how they will be trained and how these skilled workers will be retained.

Currently, the proposed staffing standards are pitched well above what can be provided by aged-care facilities. The government has stated that nearly 900 new registered nurses will be required to meet the new standards. However, the Aged and Community Care Providers Association has estimated that the sector will instead need 1,440 registered nurses to meet the new staffing requirements. The government's proposal, therefore, considers the minimum requirements and does not take into account the COVID fatigue of a large portion of our nursing workforce.

My constituents, like many around the country, struggle to find and afford care, either for themselves or their parents. Recently I had a constituent write to me, outlining the struggles she had in finding a home-care nurse for her father, Anthony Best. Anthony is 90 years old and suffers from macular degeneration. He was assessed for the Commonwealth Home Support Program through the My Aged Care framework; however, he received no further assistance. His daughter Louise managed to find an at-home nurse; however, the standard of care was not what was expected. Due to shortages of quality nurses, the care provider was sometimes unable to provide a nurse at all, and at other times the level of care was not what was required. In Louise's words, 'The system is broken.' While the government proposes to increase the workload of nurses in our communities, they have failed to outline how these nurses will be supported so that stories like Anthony's can be avoided.

Additionally, regional electorates have already raised concerns around staffing and the lack thereof. My community of Fowler is similar in that sense. We will see a skills shortage, as we need aged-care providers who are not only qualified but also can cater to our non-English-speaking residents.

There is a cultural and language barrier that needs to be overcome. Knowledge is often disseminated by community groups, friends and family, as opposed to formal channels. This was evident during the COVID testing challenges, in which misinformation was rife among non-English-speaking communities. Our healthcare system can and should do better for CALD communities.

Our community of Fowler is a very diverse electorate with a growing population in the south-west corridor and a low expectation of the aged-care system. The widening of capacity constraints in the aged-care system is being compounded in Fowler. Many view aged care as having only one option—choosing to place their elderly family members in aged-care facilities—without understanding that there are other options to support the elderly and keep them at home as long as possible.

The CALD community have strong family ties, evident through family compositions that are of multiple generations—for example, having grandparents, parents and children in the same household. They are also generally reluctant to move their elderly away from the home. Services such as shopping trips or GP visits would go a long way towards supporting these families, without the need to relocate their elderly fully. Matching these offerings would alleviate demand on full-time aged-care facilities.

I also point to another of my constituents, Mr Thang from St Johns Park. Mr Thang currently lives with his wife and daughter. He came to our office recently, inquiring after nursing-home places for when he is unwell and immobile. He is worried he will not have the funds to secure a place in the nursing home that speaks his language. He says it will cost him $200,000 to move into an aged-care home and fears this could cripple his family. Therefore, I support the home-care package program, which supports older people with complex care needs at home so they can be closer to their families.

Providing alternative aged-care options will alleviate pressures on aged-care homes and ensure families can stay together as a unit. But families that have tried to care for their elderly, if possible, at home do not have enough access to resources or financial support available to our electorate. Fowler constituents face challenges in the understanding of certain aged-care services offered and how to access them.

Beds available in aged-care facilities that cater to the CALD community are very limited, such as those that cater for cultural dietary requirements and multilingual staff. Recognition of overseas qualifications could alleviate this pressure on our aged-care facilities that will now have to provide 24/7 care.

Refugees and migrants are more than just their harrowing stories of escaping war-torn countries. There are skilled professionals. There are also qualified nurses and doctors. While the government looks to bringing in a further 35,000 skilled migrants to our country, to tackle the skills shortage, I ask: why not look in our own backyard first? In my electorate of Fowler we have many migrants and refugees who have skilled qualifications from their homelands. Unfortunately, many do not have the paperwork or evidence to back up their qualifications. Speaking from experience, when you are fleeing persecution, violence or war you are not thinking about the university degree paperwork or your qualification documents; you are thinking about how to save your life and the lives of your loved ones.

According to the Asylum Seeker Resource Centre, current recognition of the prior-learning process is complex and lengthy, which can be difficult for someone who has no knowledge of how our government works. They recommend a new skills assessment system, for people without evidence of qualifications, against an established benchmark, which should be combined with tailored courses and employment placements to identify their gaps in knowledge.

We are wasting the potential of a huge group of people who are ready and willing to work. I commend upskilling our community, and offering more government funded courses at TAFE would be a good alternative to just university courses. I point to countries like Canada, which fast tracked visas for refugee nurses in the pandemic. They hope to expand their Foreign Credential Recognition Program, with the aim of employing an extra 11,000 overseas-trained healthcare workers a year.

Furthermore, those who are seeking asylum could wait up to five years for their applications to be processed. During this time they are kept on punitive bridging visas, which leave them in purgatory, unable to work or study. I appreciate that the Labor government has committed to reducing this delay in visa processing; however, more action is needed to tackle the crisis at our doorstep. Over 100,000 people are currently seeking asylum. While they wait for their visas to be processed, many cannot access social services, do not have the right to work or do not have the right to study. There is no access to higher education and all are excluded from subsidised funding for apprenticeships, training and certifications. If we are to look at reforming TAFE as part of Jobs and Skills Australia, we must also acknowledge that shorter and more practical technical courses could open opportunities to a wider cohort of staff and accelerate the supply to industry.

Age pensioners who are alone and take care of themselves are reluctant to seek medical treatment, due to financial constraints. The recent increase in GPs not bulk-billing is accelerating this, which leads to their health deteriorating and adds to the demands on aged-care services. With cost-of-living pressures, we cannot expect our elderly and vulnerable to break the budget just to get simple healthcare services.

We have also received many phone calls from age pensioners who have had concerns regarding having to pay out of pocket to see their local GPs. While I commend the government for acting in aged care and continuing the reform by the previous government, this cannot become a tokenistic gesture to stop the cries for help from senior Australians, nurses and the families that just want affordable and quality care for their loved ones.

For too long, in this House, have grand spectacles been the way of government after government to ease the pressure on them from the Australian people. Now is the time to act. Now is the time to create long-lasting and meaningful change in a sector that has been neglected and forgotten for far too long. I will continue to hold the government to account beyond the implementation of this bill, and I will continue to fight for senior Australians and the frontline workers who wake up every day and put on their scrubs to look after our most vulnerable.

When I came to Australia I was told of the Australian dream. I was told you could achieve the dream to own a home and raise a family if you contributed to your country and worked hard. Part of that dream is that when you get older you will be cared for. I will not let Australians who have spent the entirety of their lives working to be robbed of that dream.

11:30 am

Photo of Anika WellsAnika Wells (Lilley, Australian Labor Party, Minister for Aged Care) Share this | | Hansard source

The Albanese Labor government is taking a different approach to governing to the previous government. We are not afraid to tackle the big challenges facing our country and we are not afraid to do it at the earliest possible opportunity. And we're not afraid to consult or to reach across the aisle and work with our parliamentary colleagues, regardless of political stripe, to face those challenges. Even if sometimes we disagree on how to do it or how fast do it, I think it's fair to say that everybody in this parliament wants to see a better future for older Australians and for the aged-care sector. I want to thank all members for their contributions to the debate on the Aged Care Amendment (Implementing Care Reform) Bill 2022, all of which has been thoughtful and many of which have been based on their or their loved ones' lived experience with aged care.

I'd also like to acknowledge and thank everybody who has either contributed to the Senate inquiry or to the ongoing consultation around the delegated legislation. I want to reassure those who have taken the time to participate in these processes so far that we have heard you and the issues you have raised, and that we are moving government amendments to this bill today as a result of your contributions to this consultation.

The royal commission told us that we need to do better, and this bill is our earliest opportunity to take steps on that journey. The bill makes important practical changes to the delivery of aged-care services and it provides greater oversight of what funds are being used for. Importantly, this bill also introduces limits on amounts that can be spent on administration costs as opposed to direct care. These measures put the quality and safety of older Australians first.

The bill introduces a new responsibility for approved providers of residential aged care and of specified kinds of flexible care to have a registered nurse on site and on duty at every residential facility 24 hours a day, seven days a week, from 1 July 2023. This will save thousands of unnecessary trips to hospital emergency departments and will ensure that older Australians living in residential aged care have access to the nursing care that they deserve. From 1 January 2023, the bill also introduces powers to enable the government to cap administration and management charges for older Australians receiving a home-care package and removes the ability to charge care recipients for ceasing care. This will maximise funding that is available to address care needs.

There is currently little transparency in how providers set their prices for care and package management, and there is no cap on how much they can charge. The royal commission heard that some providers were charging up to 50 per cent of home-care package funding for administration and management. I know I have heard that in my electorate and I know that the member for Mayo has heard that in her electorate, and it's something that we seek to address as soon as possible. This bill will provide the means to ensure high levels of administration and management charges are reduced, and that money goes instead directly to meeting care needs.

Lastly, this bill will include amendments relating to the transparency of providers' financial information and other valuable information about providers' operations to empower older Australians to make more informed choices about their care and to shine a light on providers not doing the right thing.

I'd like to take a moment to acknowledge and respond to some of the feedback that we have received regarding this bill. During the Senate inquiry process, some concerns have been raised regarding regional and rural aged-care homes and the impact that the new nursing requirement will have on their ability to operate. We are aware of the issues facing these facilities and this is exactly the reason why there will be sensible and limited exemptions available while we move to this new 24/7 nursing standard. These exemptions will be designed in consultation with these providers and other stakeholders to ensure that we get them right. It is also why, under the new AN-ACC funding model, which will start on 1 October, remote and very remote facilities are forecast to receive, on average, approximately $290 per bed per day, which is $83 more than the average funding for the current ACFI system.

Some people have also raised the question of how the 24/7 nurse standard will be enforced and whether there will be consequences for those without an exemption. As with any situation where an aged-care provider fails to meet their responsibilities around care standards, the Aged Care Quality and Safety Commission can undertake regulatory responses that include education, monitoring provider performance, directing a provider to take specific action and enforcement action such as sanctions. Ensuring best practice and the safety of older Australians is a priority for the Albanese Labor government.

We also acknowledge comments raised during the Senate inquiry process around ensuring appropriate levels of consultation for the delegated legislation. We agree there should be consultation around the detail, and there will be. On top of hours and hours of royal commission hearings that formed the basis of its important recommendations that this bill will help address, consultation on the delegated legislation is continuing and will be undertaken to determine policy parameters and, where timing permits, on exposure drafts of the proposed delegated legislation. Specifically, the delegated legislation for the exemptions to 24/7 nurses will go through an exposure draft process. I'd also note that all amendments to delegated legislation will be subjected to disallowance and therefore continue to be subject to parliamentary scrutiny.

Before I finish I want to acknowledge the proposed amendment by the member for Mayo. We do not support the amendment to the bill. We are concerned that there is a real lack of certainty about what a schedule of reasonable charges would look like and the responsibility that such a schedule would place on approved providers. I'll hop into that in a moment. However, I really do appreciate the intent of the amendment.

The government will not tolerate providers cost-shifting when we can cut administration and management fees. The bill already allows us to manage charges if unscrupulous providers try to get around the new caps. We will be watching this closely and we will respond and identify those providers who are doing the wrong thing.

Setting reasonable fees for aged-care services is not straightforward. If we set the fees too high, providers that can deliver effectively at lower prices will get a benefit at a cost to taxpayers. If we set them too low, providers who cannot deliver for the national price—for example, a small provider delivering personal care in a rural area—might just stop offering that service altogether. The cost of providing services isn't the same across the country or for all providers, and the last thing that we want for providers in rural and remote areas already struggling is to stop offering critical personal-care services to people in the community because we have legislated a charge that does not meet the real cost of providing that service.

However, I thank the member for Mayo for her engagement on the bill and for her longstanding dedication to better aged-care policy and real outcomes for older Australians in need of care. I look forward to working with her and all my colleagues to deliver better outcomes for older Australians in sessions to come. I thank all members for their contribution to the debate on this bill, and I commend the bill to the House.

Photo of Milton DickMilton Dick (Speaker) Share this | | Hansard source

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

11:47 am

Photo of Milton DickMilton Dick (Speaker) Share this | | Hansard source

The question now is that the amendment moved by the honourable Deputy Leader of the Opposition be disagreed to.