Monday, 10 September 2018
Aged Care (Single Quality Framework) Reform Bill 2018; In Committee
I did indicate in my second reading contribution that I had a couple of questions around the transition funding—the $50 million for residential services to help them transition to the new standards. I indicated that I'd like a bit more information about how that's rolling out and why it's only for residential services. Perhaps we could deal with that issue first and then move to the amendments.
Senator Siewert, I'd be happy to answer those questions and get some more information for you. Perhaps we could go to Senator Hinch first and I'll come back with the answers to those questions.
The TEMPORARY CHAIR: That's great; we have a nod. Thank you, Minister. Senator Hinch?
My apologies for not being here. By leave—I move amendments (1), (2) and (3) on sheet 8448 together:
(1) Clause 2, page 2 (table item 1), omit the table item, substitute:
(2) Schedule 1, item 10, page 4 (line 19), omit "Act", substitute "Schedule".
(3) Page 4 (after line 28), at the end of the Bill, add:
Schedule 2—Further amendments
Aged Care Act 1997
1 Paragraph 54 -1(1 ) ( b)
Repeal the paragraph, substitute:
(b) to maintain an adequate and safe ratio of appropriately skilled staff to care recipients, to ensure that the care needs of care recipients are met;
2 At the end of section 54 -1
(3) For the purposes of paragraph (1) (b), the ratio of appropriately skilled staff to care recipients is an adequate and safe ratio if, for aged care provided by an approved provider at a particular time, the ratio of appropriately skilled staff to care recipients is equal to or greater than the minimum ratio required to be provided by the Quality of Care Principles for:
(a) the number of care recipients receiving care through the aged care service at that time; and
(b) the type of care and level of care provided.
3 At the end of Division 54 of Part 4.1
54 -6 Staff to Care Recipient Ratio Standards
(1) The Quality of Care Principles must set out Staff to Care Recipient Ratio Standards. Staff to Care Recipient Ratio Standards are standards for quality of care and quality of life for the provision of aged care.
(2) The Staff to Care Recipient Ratio Standards mustset out the minimum ratio of appropriately skilled staff to care recipients required to provide care at an aged care service at a particular time taking into account:
(a) the number of recipients receiving care at that time; and
(b) the type of care provided; and
(c) the level of care provided.
The TEMPORARY CHAIR: The question is that the three amendments on sheet 8448 be agreed to. Those of that opinion say aye; against, no. The noes have it.
Senator Hinch interjecting—
The TEMPORARY CHAIR: I didn't hear a second voice, I'm sorry. I'm happy to put it again if we need to. Sorry, Senator Polley, did you wish to make a contribution?
The TEMPORARY CHAIR: Okay. Then I'll come back to you, Senator Hinch, and recommit it.
I want to make some comments in relation to the amendments put forward by Senator Hinch. The intent of this legislation is to make provisions for a single set of aged-care quality standards. This is not an appropriate bill to deal with these issues. We will not be supporting these amendments. With regard to staffing arrangements in residential aged-care facilities, the roles of nurses and personal care workers in the care of older Australians is critical and will only become increasingly important. Labor also understands the importance that other health professionals, such as GPs, occupational therapists, physiotherapists and dietitians have on the overall wellbeing of older Australians.
The number of people aged 85 is rapidly increasing compared with younger age groups and is projected to double by 2032. We will need to see a tripling of the aged-care workforce in the next 30 years to provide a high standard of living and care for this growing proportion of older Australians. Given the government dumped Labor's $1.5 billion workforce compact and the supplement after the 2013 election, we have consistently called for the development of a comprehensive aged-care workforce development strategy to address issues of training, staffing levels and an ageing workforce.
The government's finally addressed workforce issues by announcing $1.9 billion for the Aged Care Workforce Strategy Taskforce in the 2017-18 budget. However, when the government made its task force membership public six months later, it failed to include any representatives of the aged-care workforce. This task force report has been with the government for nearly three months. We urge the government to give its full attention to this report and respond now with some urgency. Labor also takes this opportunity to thank the chair of the task force, John Pollaers, for his important work.
We believe that the government must work with unions and aged-care providers to implement this strategy to meet growing demands. This strategy must consider things such as the proposal for 24-hour registered nurse coverage in residential aged-care facilities. Labor also successfully pushed for the reconstitution of the Senate inquiry into the future of Australia's aged-care workforce. The Senate Standing Committees on Community Affairs report tabled in parliament in June this year was adopted unanimously by all political parties and made a series of recommendations in relation to workforce development. The Senate report also provided valuable analysis of the issues confronting the aged-care workforce.
Whether it is aged-care providers, workers or consumers the message has to be consistent. The government must take action to ensure we have an adequately skilled and equipped aged-care workforce to care for our rapidly ageing population.
I indicate the Greens will be supporting these amendments. They're not very prescriptive. They also don't adopt some of the more intense set ratios. We have indicated that we do think, broadly, ratios need to be a part of the process because of the problems that we've seen, but we don't want them to be too prescriptive. We want a process for being able to establish them, depending on the situation and the acuity of residents, the types of residents we're talking about, the ratio of allied nurses to people with professional qualifications and, of course, care workers, who provide so much of the care that's essential when you think about the fact that this is a person's home. It is not a hospital; it is a person's home. And care workers—who will, in fact, be visiting this place again on Wednesday—play an absolutely essential role in the provision of care. I'm so sick of hearing from both nurses and care workers that there are just not enough staff on the floor to provide the medical attention that's needed but also the personal care.
I've also seen some very excellent examples of residential aged-care facilities where they have excellent staff-resident ratios and the care provided is excellent. So we support the concept of ratios, but we're not endorsing any particular ratio at this stage. We also recognise that you have to be careful that it's not too prescriptive because circumstances are different in many of the residences. As I said, we're talking about a person's home. We're also talking about their care, and we need to make sure that we've got that balance right. So we will be supporting these amendments to register our support for the concept of ratios, bearing in mind that we don't think that they should be too prescriptive and restrict the ability to make sure we have that balance of care and staff present in the home right.
I chaired the workforce inquiry, as Senator Polley just articulated. I'm deeply disappointed that we haven't seen an outcome from the task force to date. I think that we were pretty clear in that report that it's absolutely essential that we get on top of that workforce issue because we have an ageing population. We have people going into residential care who are older and frailer. They're staying in homes longer, which is really strongly supported by the community. So it is really important that we get these workforce issues dealt with now.
Having been involved in the discussions over Living Longer Living Better, I was similarly disappointed when the previous workforce arrangements were abolished by the incoming government. There were some amendments made and some concessions made when that was being negotiated at the time. I think that we've unfortunately stagnated, despite having the task force. I acknowledge that action was taken to get that task force in place, but basically progress on a lot of the workforce issues has stalled and it is absolutely essential that we have a skilled workforce of personal care providers, allied health professionals, RNs and ENs on the floor of these places. But it is also absolutely essential that we have a plan in place. Otherwise, we will not be able to provide the care that is needed for our ageing population because we just won't have the workforce ready.
I have some concerns with the proposed amendment, but before I deal with those can I just take a couple of seconds to congratulate the minister, Mr Wyatt, on doing what I think is a magnificent job in the aged-care area. I've seen a lot of aged-care ministers over my time here—some of them have been very good and some of them ordinary. But Mr Ken Wyatt has really demonstrated an understanding of aged care and, particularly, of the facilities that look after the elderly in our society. I'm delighted to say that Mr Wyatt particularly understands the need for aged care and the problems associated with looking after the aged in rural and regional Australia.
The amendment that we're dealing with may well be appropriate in the capital cities. I'm not quite sure that it's appropriate in a small community. Just last week, the Lower Burdekin Home for the Aged Society called to see me. That operates in the town where I live, Ayr, in North Queensland, about 100 kays south of Townsville. It has facilities both in Ayr and in the twin town, Home Hill, across the Burdekin River.
I know the facility quite well. More than 40 years ago I was a member of the Apex services club when we were invited to a meeting to set up a community aged-care facility in the Lower Burdekin—that's Ayr and Home Hill. My club sent someone along. I was president of the club at the time and I still remember promising the person we sent: 'Can you go along to this meeting? It's only one meeting. It won't take you very long. You can go along and hear what's being proposed.' It turned out that he then became the chairman of the society for about 20 years and did a wonderful job there.
But this was a community aged-care facility built, at the time, as I recall—and this was confirmed to me just last week—entirely by donations from the community. There was no government assistance back in those days. Obviously, the daily payments of the inmates—the patients; the people cared for—make a contribution, and the government contributes to them. But after almost 40 years of operating on the basis of community support, the home is now finding that it's having some difficulty in continuing to operate. They're applying for a capital grant. It's the first time, I might say, they've ever done this in the 40 years that they've been operating.
Their issue is that the home is now 40, 30 or 20 years old, as they built extensions. A lot of the accommodation was appropriate 40 years ago, but is not quite so acceptable today. Of course, with the changes that we've seen in aged care over time, nowadays, those who used to be low-care patients are now being encouraged to stay in their own homes. The government is providing very considerable support to people who want to live in their own homes. They really can't look after themselves in their own homes, but they're getting support coming in. I've had experience of this; my brother-in-law is now a recipient of that. I know the aged persons homes in my home community; my mother was there 20 or 30 years ago. My mother-in-law was there and my sister was there relatively recently. I've seen what happens.
Why I'm concerned about the amendment is that what might work in a unionised workforce in Melbourne, Sydney or Canberra may not work in country areas. I think that the Lower Burdekin Home for the Aged is the second-biggest employer in my community. It's a country town—I say it's a small country town, but by Australian standards it's a country town of about 10,000 or 12,000 people. The district is about 20,000, so it's a big small country town—and it's one of the big employers there. A relative of my wife actually works there. She provides care and does that not as a professional but as one who helps in the various things that need to be done.
The important issue, particularly for community-run facilities, is that they are able to balance the books and make things pay and it sometimes means that the staff have to be multiskilled. They have to be prepared to enhance the productivity to make sure that the home keeps operating, because if the home is experiencing some difficulties it means that for the first time in 40 years it might have to be taken over by one of the corporate aged-care places, who, appropriately, I guess, run these things for profit—otherwise, often, why would they be involved? But this is a community that is local; it's done by local money and local people. It's part of the community. I'm concerned about ratios and particular prescriptions of staffing ratios, because whilst they may be appropriate in one area they may not be in another area. I think Senator Siewert was alluding to the same thing in her, might I say, mild support for the amendments.
I don't want to delay the Senate too long except to say that there are a number of these community run aged-care facilities in the north of Queensland, where I basically operate. I give a shout out to the Bowen aged care operations, situated around the community of Bowen, which is an hour south of Ayr—where I live—which is two hours south of Townsville. They have a wonderful reputation. They've done enormously significant work for their local community. They've operated the books very well. I'm hopeful that the government will be able to support them in some of the very significant capital works they're undertaking.
I mentioned also the Warrina Innisfail aged-care facility, a bit north of Townsville, who've done a wonderful job. They were the recipients of some significant Commonwealth grant money in the last round. They are able to put in place a whole new facility that will be very significant in the community of Innisfail. It's about the same sort of size and atmospherics as the community I live in. It's a sugar town. It's in north Queensland, about four hours north of Townsville. There are about 20,000 people in the surrounding areas. They do a wonderful job. It enables long-term residents of those areas—in Innisfail, Ingham, Ayr, Home Hill, Bowen and every community facility—who in the past might have had to leave the place they've lived all their lives and go to one of the capital cities to get good aged care, to stay in these towns that I've mentioned.
The significant thing about all the towns I've mentioned is that they're community-run facilities. I don't know, but my guess would be that the union has very little influence there, which means that people are paid well but they work harder. They work that extra mile where it needs to be done. That's what a community facility is about. I'd hate to see this approach in these smaller country towns—and I mentioned some towns in North Queensland that I'm aware of but I'm sure a similar situation applies in many, many parts of Australia—so we have to take this into account. I'm delighted that Mr Wyatt understands the importance of aged care in remote communities.
I go even remoter than the towns I've mentioned, to talk about Hughenden and Richmond—west of Townsville—which are much smaller towns, but even there the local councils are doing their own bit for aged care and getting assistance from the Commonwealth government. I look forward to having Mr Wyatt come north again, as he indicated he would do, when he was up in the north about six or eight months ago. He does a wonderful job. He is caring. He understands the issue. Whilst, of course, he doesn't have a bottomless pocket of money, he does understand that all parts of Australia need to be looked after, and I'm delighted that he does that wonderful job.
On the amendments before the chair, I have my concerns, for the reasons I have mentioned, so I probably won't be supporting them at this time.
Temporary Chair Bernardi, just before you changed over with your predecessor as chair, Senator Sterle, he indicated that he would submit the vote again, and I request that you do that. Could you check with the Clerk?
I'll just take some advice. Senator Hinch, I understand there was some confusion. I'm not confused. I understand exactly what's going on. The amendments, by leave, are being moved together, and they will be put to the chamber at the conclusion of this debate, which will be in just a moment—unless you are seeking the call again?
Sorry—your predecessor had actually called the vote and there was some confusion about whether there were enough ayes to force a division or not. That was all it was about.
The TEMPORARY CHAIR: It's okay, Senator Hinch; it's underway. The committee is considering amendments (1), (2) and (3) on sheet 8448 together. Minister?
The government does not support the amendments to this bill as proposed by Senator Hinch. I would say, personally—and, I know, on behalf of all on my side—Senator Hinch, we have no doubt about your compassion and your support for the most vulnerable in our society. But, for the reasons I will go through, we again take a similar position to Labor and do not support these amendments because we believe that, while they are well intended, they do have unintended consequences. I would remind those in this chamber of the Oakden situation in Adelaide, where in fact they had the highest ratios of staffing—higher, I think, than just about any other aged-care facility in this country—and we are still all very much aware of what happened in that facility, despite the high staffing numbers.
The government also doesn't support the amendments to this bill because all Commonwealth-subsidised aged-care homes are required to have adequate numbers of appropriately skilled staff to meet individual care recipients' needs. There is, however, no Commonwealth legislation that prescribes minimum numbers of staff on duty at any given time. This is because there is actually no single optimum number of staff or combination of staff qualifications that will result in quality aged care in all circumstances, as I think Senator Macdonald has just so eloquently described with regard to regional Australia. Rather, the number of staff required to look after care recipients will change according to the varying needs of the individuals under their care, the facilities' size and design and the way work is organised, including the extent to which services are outsourced. It is the responsibility of individual aged-care homes to use government subsidies to ensure they have the staffing mix and numbers they require for their care recipients to receive the highest quality care required.
In addition, opinions presented at the Senate Community Affairs References Committee inquiry in 2016 into the future of Australia's aged-care workforce were mixed regarding the merits of staff ratios. A number of submitters were not supportive of mandating staffing ratios, mostly because they considered it would not resolve issues and would impose an unnecessary regulatory burden and, of course, cost, which inevitably would be passed on to the residents or their families. So, for all of these reasons, the government does not support these amendments.
I understand your question was in relation to the $50 million provided to residential care. Is that correct? Yes. The advice I have is that it was provided to assist them in transferring to the new standards and that the Australian Aged Care Quality Agency is providing education, guidance and material on the quality agency website for all aged-care providers, regardless of the type of care.
Perhaps you could take on notice, if you don't have it there already, the breakdown of the funding. I thought it was specifically allocated to residential care. Could you take on notice or give us the breakdown of what went to residential care and what was available for the other providers?