Senate debates

Thursday, 10 December 2020


Aged Care Amendment (Aged Care Recipient Classification) Bill 2020; Second Reading

11:19 am

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

I rise to make a contribution in the second reading debate on the Aged Care Amendment (Aged Care Recipient Classification) Bill 2020, which allows for the introduction of a new classification system of older Australians accessing residential aged care and some types of flexible care.

It marks an important step towards a new funding model for residential aged care by allowing the Australian government to undertake shadow assessments using the Australian National Aged Care Classification or AN-ACC tool, to enable that to occur. We all know that this is desperately needed, because our system is desperately broken. We know that the current tool, the Aged Care Funding Instrument, commonly known as ACFI, is no longer fit for purpose and it hasn't in fact been fit for purpose for a long time.

This bill allows for 12 months of shadow assessments to be undertaken to collect information about how the AN-ACC tool operates. We know that ACFI in fact enables perverse outcomes and incentives within its model. Older Australians who experience greater pain, disability and fragility gain additional funding. Of course, we know that they need additional supports. But the perversity is that you get more funding for that, but, once you get somebody well, the funding falls away. In other words, our aged-care providers are not enabled and supported around ensuring the continual wellbeing and enablement of a person in residential aged care. That is a ridiculous situation. The incentive there is perverse: you want to keep people unwell or claim that they are unwell so you can get more funding to look after them. It's absolutely ridiculous, and that's been the case for a long time.

We do need to have a tool and a funding process that supports aged-care providers who focus on reablement and wellbeing of older Australians. There is so much evidence and research around now around the importance of that and what can be done. But that also costs money. It costs money to support somebody who, for example, has chronic pain or disability or who is frail. It does cost money to provide the level of support and care to improve their wellbeing and, importantly, to maintain that wellbeing.

The Australian Greens are broadly supportive of the measures in this bill but we have a number of issues, which I am about to raise. I also want to let the minister know that we will be asking a series of questions in committee to ensure that we have on record in this place the responses to some of the issues I'm going to be raising.

As part of this measure, the government will need to recruit and train a new workforce to undertake the shadow assessments. I understand that the assessment workforce will be independent from providers and assessors, and assessors will need to meet strict qualification criteria. Of course, that's important and we welcome that. However, I urge the government to ensure that assessors are well trained and are offered permanent positions to have the capacity and capability to undertake the shadow assessments. That's just so important in getting this right. I also echo the concerns raised by the Federation of Ethnic Communities Councils of Australia, who have recommended that assessments of older people from CALD backgrounds are guided by a diversity advisory. This would help enable training of assessors—including cultural competency, cultural safety and trauma informed approaches.

During the short inquiry into this bill several submitters raised issues around the use of section 29C of the bill, which enables the secretary to arrange computer programs to make decisions on the classification of care recipients. Several stakeholders raised warning bells about the use of computer programs to classify care recipients in light of the failures of the robodebt program. I won't take long to remind the chamber of the very significant problems that eventuated from relying on computer programs and taking out the human beings in this process.

The Australian Greens have strong concerns about how computer programs will be used to make concessions in classified care recipients under the ANACC tool. We don't want to see older Australians fall prey to a repeat of the errors that were made under the illegal robodebt program. We want to make sure that safeguards are put in place. We are not necessarily tech phobic; we just want to make sure there is a human element built into the system so that the computer programs are not making decisions that have long-term consequences for human beings. I have raised that I want to clarify some of the issues around that with the government.

There are also concerns about what information the government needs to gather to make future decisions about the new classification system after 12 months of shadow assessments. At the end of 12 months, the ACSA has suggested we need to understand: whether the alternate resident classification delivers the required support for an individual resident; the financial impacts at both the aggregate and provider level from a change from the current funding instrument, ACFI, to the alternative funding instrument—in this case, it is the ANACC; whether the proposed five per cent stop loss is adequate in all circumstances; and the potential values assigned to the national weighted activity unit of the ANACC.

I am hoping the government will do its due diligence and properly collate and evaluate information received during the shadow assessment period. We need to have all the information possible to ensure we do not repeat the mistakes of the ACFI model. Counsel assisting the Royal Commission into Aged Care Quality and Safety recommended that ongoing evidence based reviews should be conducted thereafter to refine the models for the purpose of ensuring that they model accurate classification and funding to meet assessed needs. We will be monitoring the further refinement of this process to ensure that the new classification model meets the needs of older Australians. It is very important that this process is undertaken, but we want to make sure that we get it right.

This bill marks an important step towards a new funding model for residential aged care that is so desperately needed. It is part of the overall reform that is needed in residential aged care that we have spoken about at length in this place. The royal commission is going to be, in the very near future, handing down its recommendations. We think it is important that this process does get underway. We know very well that the funding process needs to change. We know it is part of the reform process. We want to make sure that older Australians get the best care that they can, which comes from an approach of enablement and of ensuring their wellbeing.

I am not saying all providers, but we know very well that some providers are not up to scratch; they are not providing quality care. They can say it is about funding, and, yes, funding is part of that. But my argument is that there are some providers who are not doing their job. They are not doing a proper job. We heard about them during the royal commission. I'm sure everybody in this chamber has had emails from people around the poor quality of care of their loved ones. I am sure my colleagues have also had emails around the complexity of the process of accessing care. We need to fix that process. We need to make sure that providers are also held to account, that there is transparency and accountability. Looking at this process very carefully is one of the things that I and, I am sure, others are going to be doing, to make sure that the transparency and accountability of providers who provide the level of care that they are funded for are there so that the community knows what the providers are spending their money on. We know from the royal commission, and, in fact, how some providers responded to the pandemic, that some did a really good job and some did a very poor job. My argument is that, in some instances, the coronavirus took hold because there were not good infection control processes there from the beginning, which enabled the virus to spread more rapidly in these facilities.

This is a good step. We need to start this, we need to do the shadow assessment, but we need to watch it very carefully to make sure that we do get this new process right. The Greens will be supporting this legislation, but I want to seek some reassurances and clarifications from the minister, as I indicated in those questions.


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