Tuesday, 5 December 2017
Government Response to Report
I take note of the government's response to the Care and management of younger and older Australians living with dementia and behavioural and psychiatric symptoms of dementia (BPSD)report. Senator Polley has just articulated that this report was tabled on 26 March 2014. This was a very significant and very important report because we found that people were being poorly treated, that people with complex behavioural issues and psychiatric issues associated with dementia were living with restraints, both physical and chemical, that they were in poorly designed facilities that did not accommodate them and that there were poorly trained staff who did not meet their needs. It was a very distressing, unsatisfactory situation.
I chaired this inquiry. For a while after we tabled this report some aged-care providers actually rang me and said: 'How can we fix this? What can we do? Where would you suggest we go to get some help?' There are places where people can get support for addressing issues around dementia, particularly for people who are living in residential care, but it requires training, for a start. We actually visited the excellent training facility in Melbourne of Dementia Australia—it's not Alzheimer's Australia anymore. They took the senators on that site visit through as near a lived experience as you could get. They use technology that gives you a feeling of a cognitive impairment so that a carer, a paid staff member or a loved one can gain a sense of what somebody with dementia is living with when they have a cognitive impairment. You can't pretend that it's anywhere near what somebody with dementia would feel, but it at least gives an understanding of certain behaviours. How, in 2017, could we have circumstances where people living with dementia are living in care and in a situation where somebody has not been through at least that training? That's what we still have in 2017, 3½ years later. It is simply not good enough. It is simply not good enough that we have not moved far enough along with training and support to address people's needs.
Senator Polley, I'm wondering how long you think it's going to take before we get a response to the inquiry into the aged-care workforce. Senator Polley's just indicated that she thinks it's going to be a while. We have seen the government's announcement of the aged-care taskforce, which is a step. It doesn't have worker representation, but it's a step. An aged-care workforce that looks after and supports somebody with a cognitive impairment or somebody with dementia requires particular training. The inquiry into the aged-care workforce also highlighted the absolute flaws in the training, supports and preparation of the aged-care workforce. It shows just how understaffed our aged-care services and supports are going to be into the future. So I certainly hope that the government responds in a more fulsome way and in a much quicker way to a workforce inquiry to ensure that we have a workforce that is trained to support people living with dementia, that we have residences that meet the needs of people living with dementia and that we address issues around both chemical and physical restraints.
During this inquiry, we also visited a number of excellent care facilities where they are providing—at no extra cost, folks, because they have to live within the means of the ACFI payments—a caring environment where they have almost eliminated the use of chemical restraints and do not use physical restraints. People are cared for in a non-clinical environment where they have access to the outdoors, access to chickens and caring for animals, access to sensory gardens and access to a workshop. There's no nursing station. This is within an aged-care facility—there's no nursing station. The nurses don't wear uniforms.
Some of the residents there are ex-nurses and they go around and make everybody's beds every day, because in the past, before they adopted the new techniques, they had had problems with people going into other people's rooms. Then they very intelligently worked out that the residents were ex-nurses and they wanted to tidy up people's rooms and make their beds. So that's what they do every day. Other residents with past experience arrange flowers.
That was the only aged-care facility where, when we had our hearing, we didn't have the relatives of the people in care, who were their former carers, complaining. They were glowing in the experiences of their loved ones in aged care. So it is doable. There is no excuse for these facilities not providing the sort of care that we would expect to receive if we were in those facilities or that we would expect our loved ones would receive in those facilities.
I'm extremely disappointed that it has taken so long to respond to this report. Many of the recommendations, as Senator Polley has just articulated, are supported in principle. The report said:
The committee recommends that the use of antipsychotic medication should be reviewed by the prescribing doctor after the first three months to assess the ongoing need.
That was supported in principle, but then the government go on to talk about what they've been doing et cetera and don't actually support this fully or make sure it's implemented. It's just one example of the fact that we aren't seeing a strong enough response from the government to address this very significant issue, which, as was highlighted just a moment earlier by Senator Polley, is only going to grow. If we don't nail this issue now and make sure that we have a workforce that is properly trained to understand the complex needs and the complex behaviours of people living with dementia, this situation is only going to get worse.
We need to address the issues about restrictive practices, about the overuse of antipsychotic drugs and the overuse of restraints—the similar situation to what we've reported before on restrictive practices being applied to people living with disability. We have people with disability—particularly those living in residential institutions—who have also been subject to both physical and chemical restraints. If we don't start taking this issue seriously, we are going to have a very serious problem into the future. It's hugely disappointing that this wasn't addressed much earlier and that our recommendations weren't supported. We will continue to review very closely what the government does do about these recommendations. I seek leave to continue my remarks.
Leave granted; debate adjourned.