Senate debates

Thursday, 5 December 2019


Aged Care Legislation Amendment (New Commissioner Functions) Bill 2019; Second Reading

9:31 am

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

As senators will recall, I am speaking in continuance on the Aged Care Legislation Amendment (New Commissioner Functions) Bill 2019, which is phase 2 of transitioning powers and functions to the Aged Care Quality and Safety Commission and the commissioner. I was talking about the issues we need to be looking at, including a continuous quality improvement framework. As mentioned last year, the Australian Greens want to see a quality improvement framework being adopted to ensure that near misses are reported and work is done to continuously improve care for older Australians.

Last year I chaired the Senate Community Affairs References Committee inquiry into the effectiveness of the aged-care quality assessment and accreditation framework for protecting residents from abuse and poor practices and for ensuring proper clinical and medical care standards are maintained and practised. The committee recommended that the government work to expand the role of the commission to drive continuous improvement in quality and safety in aged care. Unfortunately, this bill has not touched the issue of continuous quality improvement, and we still have questions around the status of the framework. I will be asking about the status of the Serious Incident Response Scheme and the quality framework during the committee stage later this morning.

We have other concerns about the scope of the commissioner's complaints function. There is a significant lack of complaints and resolution of complaints about aged-care services being published. This is possibly driven by the reluctance of the secretary and the commissioner to use their respective powers to make information publicly available. It could also be due to the interpretation of the definition of 'protected information', as raised by COTA during the inquiry into the Aged Care Quality and Safety Commission Bill last year.

Today I will put forward an amendment that seeks to remedy this problem, by placing an obligation on the commissioner to publish information relating to complaints that have been made. The amendment requires the commissioner to publish a report at the end of each month on the number of complaints received about each approved provider or service provider, the number of complaints received about approved providers or service providers that were not resolved, and the type and number of actions taken by the commissioner to address the complaints. This amendment will lead to greater transparency and accountability regarding decision-making around aged care. Families want to know that their complaints are being heard, answered and responded to.

Aged-care advocates play an important role in supporting older people to address and exercise their rights and have their voice heard on the issues that are important to them. Under the current User Rights Principles, advocates and community visitors are granted access to enter aged-care facilities to assist older people. However, advocates still face a number of barriers to doing their job. For example, some advocates are still being refused entry and access into aged-care facilities. There are also issues around information being withheld from advocates where aged-care providers are blocking access to information. Advocates are reporting that it often takes time to resolve these issues with providers refusing entry. The commission is now responsible for enforcing provider responsibilities, including sanctions against providers refusing access to advocates. Today I will also be moving amendments that provide advocates with access to information relating to residential care, home care and flexible care.

The establishment of the new commission has made important steps towards a more holistic approach and better oversight of the aged-care sector as a whole. While some progress has been made, there is still significant work that needs to be done to ensure older people have access to safe and high-quality aged care. The royal commission's interim report made alarming observations about our current regulatory system in aged care. They said:

We have heard evidence which suggests that the regulatory regime that is intended to ensure safety and quality of services is unfit for purpose and does not adequately deter poor practices. Indeed, it often fails to detect them. When it does so, remedial action is frequently ineffective.

The regulatory regime appears to do little to encourage better practice beyond a minimum standard.

We believe we should be striving for an effective regulatory system that deters, detects and responds to actions that could cause older people harm. Regulation should be about enhancing health and wellbeing of people receiving care. Sadly, our broken aged-care system is not achieving these goals. While the royal commission has flagged its intent to recommend a fundamental overhaul of the aged-care system, including regulation, there are many changes that can be made to the regulatory system now so that older people do not have to wait for better care. We need action to ensure that we have a robust regulatory system that is fit for purpose and supports the kind of transformational change needed in our aged-care system.

I understand that the government is looking into the third phase of reforms relating to the commissioner's powers and functions. This presents a valuable opportunity to further strengthen the commissioner's set of powers and regulatory tools. In the meantime, I hope that the government will consider our proposed amendments that seek to strengthen the commissioner's powers and functions now. Older people deserve better quality care that is respectful and upholds their wellbeing, dignity and human rights, and we must do everything we can to ensure this happens as soon as possible.

There are many issues that still need to be addressed—restraints; the issues around viability of the sector; and rural and regional aged care, particularly rural and regional aged care for First Nations people. We do need to look at a total restructure of aged care. The Greens are aware that this will take time. But, because it will take time, we need to act now on the things that we know are wrong so that we can fix those while we develop a truly transformative approach to the way aged care is provided to older Australians.

As I indicated earlier, we will be supporting this bill, but I will be moving amendments, because I think the government hasn't gone far enough in this second phase of developing the role of the commission and the commissioner.

9:38 am

Photo of Stirling GriffStirling Griff (SA, Centre Alliance) Share this | | Hansard source

People were shocked by the extent of the abuse and poor care exposed in the interim report by the Royal Commission into Aged Care Quality and Safety. It was a scathing report and an indictment on an industry that is meant to deliver respectful, good-quality care during an aged person's final years. The interim report showed that the government has deep systemic work to do to fix the aged-care system. It also needs to increase its investment. But it cannot simply pour money into the system without asking for a more accountable and transparent situation from providers. It cannot continue to tinker around the edges.

Centre Alliance supports the Aged Care Legislation Amendment (New Commissioner Functions) Bill 2019, as I'm sure every senator here does. The bill completes the process of handing responsibilities for aged care from the department to the Aged Care Quality and Safety Commissioner and its independent commissioner. It will put responsibility for approval of aged-care providers, plus complaints handling, accreditation, auditing, compliance and sanctions, under one body. This will certainly help streamline and strengthen oversight, as these roles will no longer be split between the department, the former Aged Care Complaints Commissioner and the Aged Care Quality Agency. But, as we all recognise, that's just one important step on a long road of necessary reform.

There are just so many problems in this sector. For instance, I started asking, over many estimates sessions, about what happened to unspent home-care package funds once a person passed away and was no longer receiving in-home assistance. What I discovered was that the department did not audit unspent funds. The department pretty much ran an honour system, where the onus was on providers to return unspent funds to the Department of Health. The department has since conducted a pilot audit of the program, which found a number of areas for improvement, but even then it did not look at the evidence of undisclosed outstanding unspent funds—incredible! That's just one example of the many problems in the mammoth aged-care sector.

The proper training of aged-care workers is another ongoing failure which the government knows about but seems to be doing nothing to tackle. Aged-care training for personal care workers is an absolute basket case. It needs to be better regulated and nationally consistent. For example, at the moment there are over 80 providers offering Certificate III in Individual Support. Some of them offer a course that runs for just 10 weeks, and others run that very same course for a year, which is actually the recommended minimum. It's patently clear that 10 weeks of study is not enough to learn and cement what a worker needs to know to deliver quality care. How can we improve the aged-care system if we don't massively improve training first?

Without a doubt, the sector also needs substantially more funding to ensure quality of residential care and faster ACAT assessments of care needs. The government needs to get assessment wait times, especially for home-care packages, down to one to three months instead of well over 12 months. Government is taking steps in this direction by making 10,000 more places available. But, as other speakers have noted, this is nowhere near enough to address the unmet needs in our communities. The health minister has also recently responded to the problem of chemical restraints by announcing that doctors will have to apply for permission to prescribe the antipsychotic drug risperidone for more than three months. However, it needs to be said that the overuse and inappropriate use of chemical restrains are a symptom of much larger problems in residential aged care, such as understaffing and poor staff training. These two measures are only small fixes that respond to the primary symptom and not the underlying causes.

The royal commission's interim report sounded a warning note on quick-fix responses. It noted that government policy in this area was beset by short-term solutions, which will:

… at best temporarily stave off the worst problems and, at worst, produce another set of unintended outcomes requiring further inquiries and reviews and further injections of public funds, without addressing the underlying causal factors.

Academic Juanita Breen, a dementia care researcher from the University of Tasmania, pointed out something similar in a piece in The Conversation last month. She cautioned that tightening access to risperidone may only serve to shift prescriptions to other sedatives. She also said GPs report feeling pressured by staff to prescribe these medications due to a lack of staff training on other ways to deal with these types of symptoms. Importantly, she made the point that we need to address training and the care environment, among other things, before we can properly address overprescribing of chemical restraints.

It's good the government is trying to act, but it needs to go deeper, to the root cause of the problems, which almost always go back to not having enough adequately skilled staff. Funding is a big part of the equation; we won't fix the system without better investment. But we can't be throwing more money at the problem without asking for more accountability and transparency from aged-care providers in return. That is what my amendments are all about.

Approved providers will have to provide annual financial statements to the Quality and Safety Commission, which will then make them public. The financial statements will detail the amount spent on the provision of care—things like food and medication—as well as the amount spent on staff and staff training, accommodation, administration and the amounts paid out to parent bodies. At the moment, there is no clear way to know how much a provider is spending on the provision of care. Is it 30 per cent of their income? Is it 50 per cent or 70 per cent? We just do not know how much a provider is pocketing as profit at the expense of the people in their care. At the moment, providers can spend their taxpayer subsidies pretty much as they choose. But, in an environment where our elderly are being subjected to systemic neglect, they very much must be held to account.

My office has heard firsthand accounts from people who work with and for aged-care providers highlighting that dodgy financial decisions and profiteering takes place. For instance, there is a hundred-bed provider that has made $2.5 million in profit three years running, but this profit is only shown as $500,000 on its financials, because they pay $2 million in rent to the parent company which already owns the building. And there is a 50-bed not-for-profit facility where the salaries for three managers exceeded $500,000 at a time when the home could not meet basic minimum standards and was also, as it turns out, sanctioned. And there are other providers using subsidies to help send senior staff to overseas award ceremonies and lavish conferences.

This amendment has the support of the Australian Nursing and Midwifery Federation, whose members are at the coalface. They and many other stakeholders want financial transparency so that it is finally clear how much facilities actually spend on delivering care and how much is pocketed or wasted.

The same day I circulated my amendment, I saw a story on the ABC about the royal commission's Hobart hearing which emphasised why these amendments are needed. That story detailed how Bupa South Hobart was so understaffed that, according to the daughter of two residents, her 90-year-old mother had been forced to clean up after her incontinent father and at times help a blind elderly resident go to the toilet because the woman's calls for help had gone unanswered. According to the ABC story, a former Bupa regional director said there was pressure on the facility to spend less on staffing. Part of her responsibility was to 'improve the commercial operation in South Hobart'. In other words, her job was to increase profits.

My amendments are all about transparency and accountability—and, boy, do we need more of this! For this reason, we also intend to support the Greens amendments, as they deal with disclosure of information. The Centre Alliance amendments also reflect a private member's bill introduced by my colleague Rebekha Sharkie, which would simply require aged-care providers to disclose their staff ratios.

Knowledge is power, as they say. All of these amendments seek factual information from providers so we will have a clearer picture of how their facilities are resourced. This will be crucial if we are to engage in sustainable reforms to the sector that will improve the experience and treatment of vulnerable elderly people living in residential aged care. I urge all senators to support these important amendments.

9:48 am

Photo of Richard ColbeckRichard Colbeck (Tasmania, Liberal Party, Minister for Aged Care and Senior Australians) Share this | | Hansard source

I thank all senators for their contribution to the legislation. This is an important piece of legislation which fulfils the recommendations of the Carnell-Paterson review, reinforced in the Earle Haven review, and I commend the bill to the Senate.

Question agreed to.

Bill read a second time.