Rachel Siewert (WA, Australian Greens) Share this | Hansard source

I rise to make a contribution to this debate on aged care. If we had a plan in January, it has now failed. I dispute that we had a plan, but, if we did have a plan, I don't know that the government should be shouting about it from the rooftop, given that it has failed. We have had so many people—older Australians—die in aged care, we've had healthcare workers become extremely ill from COVID and we have not prepared adequately. This comes to an aged-care sector which, I would strongly argue, was in crisis even before COVID got here. We were not well set up to deal with it.

I want to go through one of the later reports into aged care. This report was looking particularly at clinical care in aged care. For me, it underlines what the problems are in aged care and one of the reasons we are in the position we are in now. The introduction to the last chapter of the report, in which the report made a number of recommendations, states:

5.1 Residential aged care is a hybrid model of service delivery, awkwardly straddling the divide between being a health facility and support accommodation. The problem with this approach is that it is people who fall in the gap: people who are vulnerable, frail and aged, and who often lack an advocate who is both aware of their needs and is in a position to ensure their rights.

5.2 There is a lack of clarity about where the dividing line is between personal and clinical care, who should be responsible for delivering those different types of care, and who should be responsible for the standards of care. Until we solve the fundamental problem of defining what we want from residential aged care facilities (RACFs), no regulatory framework will be able to resolve these issues.

5.3 This lack of definition is not only felt at the service level, it is evident within policies, operational guidelines and funding frameworks within the Department of Health (Department) itself, which lack clarity and are often contradictory in how aged care is defined.

5.4 There has been a move to make RACFs more comfortable for residents, reflecting that RACFs are, for all intents and purposes, their home. However, it appears that this has been conflated with a move to reduce the clinical rigor of services in that 'home'. … a lack of formality in appearance should not result in any lack of formality in clinical services.

5.5 This inquiry has demonstrated to the committee that gaps exist in the current framework for the delivery of clinical services in RACFs and that poor clinical care for older Australians … has too often been the result. … the Single Aged Care Quality Framework … is a positive step forward… much more needs to be done to promote a higher quality of care for people living in RACFs.

5.6 The committee considers that aged care stands at a crossroad.

The committee was right. Aged care did stand at a crossroad. I would argue that it has gone across the crossroad into a disaster when you consider COVID.

The government 'noted' most of the recommendations from this committee, and we were discussing that in this place last Thursday when we were talking about the government's response to those recommendations. If the government had implemented those recommendations—instead of just taken note—and moved on clinical care, I argue that we'd be in a much better position now. We'd have a plan to actually deal with COVID and stop it getting into aged care.

Really, can we stop using the argument that just because it has been rampant in other places means it's okay for it to be rampant here? It's not okay. It's not okay for so many people to have passed away due to COVID in our aged-care facilities. It's not okay that we have so many healthcare workers who have caught COVID. We put paid to that notion of, 'They're bringing it in'. No, they're catching it in aged-care facilities. It has been demonstrated that it could be kept out of aged-care facilities if appropriate measures are taken and if people have a plan. But there is no plan to keep it out of aged-care facilities.

While I welcome any expenditure going into aged care, I consider the $563.3 million committed today to be a down payment on what is needed to address these very significant issues. We heard just last week that around $3.5 billion is needed to address the issue, and that money is basically extending current initiatives. It's not addressing one of the fundamental flaws in the system by making sure we have a workforce that is, firstly, funded to the level needed to deliver the care, which is at least four hours and 18 minutes.

So from the start we're behind the eight ball, because we don't have a workforce that is of sufficient size to actually meet the need, let alone be able to do surge workforce when people unfortunately do get sick. So we need the funding, for a start, to go into the proper level of care. And we need a minimum level of care in terms of staffing ratios. We are still having an argument in this country that we might need a nurse on 24/7, for crying out loud. Honestly, that is the level of debate we were having. We were still trying to argue that, let alone get proper ratios to enable proper care, let alone getting the four hours and 18 minutes.

Then we've got to make sure that we have adequate training. I remember providers coming to our hearing—and I'm sure Senator Polley does, too—saying, 'The staff we are hiring are insufficiently trained.' You could go and get a cert III or IV off the internet, for crying out loud, without putting your hands on a patient or a resident. That needs to change. We need to be making sure infectious disease control is mandatory. And how about making sure the retention bonus—additional funding was provided for that—extends not just to direct-care workers? Don't get me wrong: direct-care workers are absolutely essential, but so are the people who keep the place running and so are the people who are working in the kitchen, who are gardening, who are providing auxiliary support services; they are also important and absolutely essential for the good running of good aged-care facilities.

And let's start having a look at the level of profit being made from providing care to older vulnerable Australians. If you look at some of the work that came out of UQ just last week, looking at the quality of care, only 11 per cent of facilities were found to have the best quality of care, and that was based on consumer experience, compliance with official standards and use of medications; 78 per cent were in the middle and 11 per cent provided poorer care. Smaller and government aged-care facilities were more likely to have high-quality services. So, I think we need to have a good hard look at aged care in this country. It's not as if the government hasn't had so many recommendations. You've got the Pollaers report on workforce that has very good recommendations about how to improve the workforce. Where are we in implementing that? We are not very far along the road.

Not only do we need to make sure we are providing funding for the sorts of things the government outlined today but also we need a massive level of funding injected into our workforce, and we need to be training that workforce. And we need to agree that in aged-care facilities these days we are providing clinical care. They are sub-acute facilities, and we need to make sure we hold these providers to account on clinical care, because the argument of whether these facilities provide clinical care was still being had during the inquiry. Well, we know right now that yes, they do. We need to substantially shake up the game here, and we can't wait for the aged-care royal commission to provide its recommendations. While they are going to be very, very important, it doesn't take Einstein to work out that we need a significant investment in our workforce. We need to increase care substantially, so let's get on with doing that right now—cough up the $3.5 billion now. Do not wait for the aged-care royal commission; you can start on it now.