Michelle Ananda-Rajah (Victoria, Australian Labor Party) Share this | Hansard source

We are at a watershed moment for aged care in our country. After four years of work across the first term of our government and this term, we are at a point where we are about to usher in a historic new aged-care act, the first in a generation. It will be a generational reform for not only millions of Australians now but also our future selves. This work has incorporated the voices of older Australians, peak bodies, aged-care providers and unions representing those precious workers, those people who are at the front line, up close and personal, providing that care to older Australians in both residential aged-care facilities and their homes. We pay tribute to those workers.

The coalition claims that we did not co-design this. They put in the caveat that we should have co-designed this with them. In fact, they did provide support for this work. There is bipartisan agreement that we need major reform, a complete overhaul, to aged care in this country, and we thank them for their support. But, on the notion of co-design, co-design actually happens with stakeholders. It happens with the people the act is meant to support. At the heart of this act is a statement of rights, a statement of principles, that recognises that older Australians have a voice and autonomy and that they should have a say, and we absolutely should prioritise their preferences because this is about them. This is a key piece of information, a value, that was missing from the previous act.

This reform cannot happen a moment too soon. We have in the rear-view mirror, looming large with a long shadow over this work, the royal commission into aged care, which in 2019 released its interim report. Do you know what the title of that interim report was? It was Neglectneglect writ large. It was an indictment on the aged-care system that we inherited when we came to government. A quote from that interim report was that our aged-care system spoke of a shocking tale of neglect. It had 'designed neglect into the system'. Can you believe this? Such an important safety net for all Australians, underpinned by the principles of care, had neglect designed into the system. It spoke to systemic failings throughout the system—chronic underinvestment, a lack of standardisation of care and the complete disregard of the importance of that workforce.

I spent my whole career before coming into politics in medicine—a 30-year-long career. There is no care, whether it be in health care, disability care, aged care or child care, without the workers. The workers are everything. That care workforce is mission critical. It's mission critical not only to these important service sectors but also to the functioning of our country. That was evident during the pandemic. While I was wrapped up in PPE from head to toe, working at the Alfred on the front line, how do you think my colleagues—the nurses, the allied-health professionals, physios, OTs, pharmacists, junior doctors, senior doctors—and I felt when the then aged-care minister, Senator Colbeck, was found at the Ashes watching cricket when he should have been fronting up to a COVID inquiry? Meanwhile, we had a flood of older Australians coming through the door, gasping for air and drowning in the secretions in their lungs. They were delirious. They were completely disconnected from their families. You can imagine how much trauma those patients experienced and how much trauma we all experienced.

I can barely speak about this time because it was so traumatic. I have pretty much buried it and concreted over it. There's a real moral injury for a lot of those healthcare workers who worked during that time. But, as awful as it was for us on the front line in hospitals, it was much, much worse for those aged-care workers who were dealing with this in the aged-care facilities. In Victoria, we even had to send the Army in to support the workforce. There was a complete collapse of residential age care.

You can imagine that the first bill we passed as a Labor government in 2022 was actually on aged care. We had to do that because the system was in crisis. The word 'crisis' is overused. It is thrown around in this place far too casually. But this was a real crisis. People's lives were hanging in the balance. Families were shattered, unable to reach their parents and their loved ones. We had a workforce that was leaving in droves, decimated. I don't think we speak enough about the workforce, but I do. Standing up for that workforce is how I ended up in politics. They were a group of people that I fought for, and that's how I ended up here.

My experience as a general physician at the Alfred was a daily ward round, which started in the emergency department and then worked its way up through every level of the hospital. In train was an entourage of junior doctors, a pharmacist and allied-health professionals. Health care is provided not by an individual—it's not just by me; I was the boss and made the tough calls. It's provided by a team of high-performance individuals. We started in the emergency department, and the majority of that workload was older Australians with a whole catalogue of problems. These included frailty, as you don't get into hospital unless you've got major problems with frailty. Social isolation was common. Many were grappling with the loss of independence due to overlapping morbidities, comorbidities. Multimorbidity is the norm, where you have multiple health problems. It's not just one anymore; it's many. It might be heart failure, COPD, which is a type of emphysema, diabetes, cognitive decline, dementia. All of these things interact so that by the time a person comes to hospital—particularly during that COVID period—they may even have delirium. Delirium is not just confusion. Delirium is a lethal condition which is a predictor of mortality. The longer it goes on, the higher your mortality. It's very difficult in a hospital to manage delirium because hospitals are chaotic places.

I also experienced a lot of interactions with families, and what was evident was carer stress. Carer stress was writ large. It was an issue that was very much gendered. The burden was borne disproportionately by women, often spouses or partners but sometimes daughters. During the pandemic, from 2019 to 2022, I have to say that this was all turbocharged. Our time was spent on the ward round, seeing patients, but then getting on the phones and trying to reach loved ones to convey to them what was going on with their families and their parents.

Another observation I would make is that the decision to enter residential aged care is not an easy one for anyone. It's not easy for the patient, even if they have lost their faculties. It's certainly not easy for the families, because the families carry a great deal of guilt. They feel guilty that somehow their parent has to enter aged care. What I found was that people will generally go through a fairly long phase of recurrent admissions to hospital before the penny drops that they aren't coping and that they need to go into residential aged care—falls, delirium, sepsis, and so on and so forth, until it is evidence that coping at home is no longer possible. There's a very long period, a precontemplative phase, that people will go through before that decision is made.

So one of the first things we did when we came into government in 2022 was to try and lift standards in residential aged care and rescue that workforce. What we did was pump $18 billion into the aged-care workforce, with successive wage rises. It does mean that now registered nurses are $430 better off per week and carers around $320 better off per week. In some cases that's a $17,000 per year wage rise. It's phenomenal. It's arrested that egress of workers from the sector. We're now also seeing much lower vacancy rates for these sorts of positions in aged care.

Honestly, aged care is a profession. It should be seen as a profession. The staff in the aged-care facilities that I visited when I was in the lower house, in my own community in inner Melbourne, were very much a tribe. There was a sense of camaraderie and pride in the work that they were doing. That's exactly what we want to see, because when people have pride in their work quality follows.

What we also did was introduce food standards to try to make the food in residential aged care more appetising for people, noting that many of them will have swallowing difficulties or other such issues. So that can be a challenge. We mandated 24/7 nursing, and now a registered nurse is on site in aged-care facilities 99 per cent of the time. What does that mean? It means that a nurse is there to basically call up a doctor if there's a problem, prescribe medications and sometimes even manage the palliation of a patient, without loading them onto an ambulance, sending them to hospital, where they endure a busy, chaotic emergency department and then go up to a ward for more chaos.

Hospitals are chaotic places. People get shuffled around like chess pieces from bed to bed. Alarms are constantly going off. Emergency calls are constantly going off. This is extremely overstimulating and bad for elderly Australians. It actually leads to delirium—not to mention the fact they end up basically stuck in a bed, and then they decondition. It's called 'PJ paralysis'. That's not a medical term. PJ paralysis refers to pyjama paralysis. As much as possible, we try to keep people and manage them in their residential aged-care facilities. There are mobile teams that are often deployed from hospitals to do that. We certainly had a dedicated team. Other major health networks in Victoria have these.

We're now going a step further. We're trying to actually fulfil the wishes of older Australians to remain at home. So, on 1 November, a new act will begin that will usher in support at home. With that will come an additional 83,000 or so home-care packages, on top of the around 300,000 home-care packages that are distributed. This is double the number of home-care packages we had five years ago. There has been a steady uplift. We know there is a waiting list of around 120,000 people awaiting an assessment. Looking at the data, which I had a look at from the Department of Health, Disability and Ageing during the inquiry last week, the median waiting time until you are assessed to get a home-care package is around a month. In Victoria, the median time in some places is about a week. It's not a prolonged period. That timeline is coming down. I thank those assessors. They are often aged-care teams that are positioned in the community and go out and do home visits. Sometimes it's done by phone or telehealth.

We know that the need is urgent, and it's not acceptable to have older Australians dying at home, as we heard last week, while waiting for a care package. We know that. It is not acceptable. It reflects how broken this system is and why it is so urgent that this parliament and the Senate pass the Aged Care and Other Legislation Amendment Bill 2025. We are completely overhauling this system. At the heart of it is the wishes of older Australians. It is a generational reform that we will reap the benefits of for years to come.