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Monday, 3 March 1997
Page: 1733


Mr ANDREN(5.18 p.m.) —I would like to draw the government's attention to the problems emerging for rural Australia from the changes in federal funding for aged care, both in the nursing home sector and in delivery of dementia care. The five-year national plan for dementia care is due to end on 30 June. This effectively means the end of the plan that has been hailed by the New South Wales Alzheimers Association and other aged care services as perhaps the most successful program yet devised to support dementing illness sufferers and their carers to remain in their own homes.

In its own review of the five-year plan released in July last year, the reference group stated that `the balance of aged care has shifted from nursing home care towards support for people living in their own homes or in hostels.' Despite this, the rural areas of New South Wales stand to lose five counsellors from the dementia counselling service as the department of family services heads down a path of mainstreaming these services through the over taxed and under resourced home and community care structure.

The New South Wales Information and Counselling Service, which employs two counsellors in my region—in Orange and Dubbo—is the only dementia-specific counselling service in the state. It has been fully funded by the Commonwealth under the national action plan for dementia care at a cost of $533,000. The service is delivered in Dubbo and Orange under the co-ordination of the Alzheimers Association and the New South Wales Health Department aged care assessment teams. The mid-plan report on the action plan states:

there appear to be significant advantages to the co-location of counsellors with Aged Care assessment teams.

The message I am getting from the aged care experts in my electorate is that it is essential to maintain the counselling service as it stands. Mainstreaming it through home and community care staff or transferring counselling responsibilities to nursing home staff will not work.

I held a meeting with dementia carers in my electorate in Orange the week before last. These are mostly elderly partners of Alzheimer's or dementia sufferers who are prepared to sacrifice their time for the care of someone they love. All they ask is a continuation of the help line and the face-to-face service that a person like counsellor Marnie Mason has been providing to her clients in the central west. Defunding of the New South Wales Information and Counselling Service would mean the end to a 24-hour help line, no face-to-face counselling and an end to the free family therapy sessions for people with dementia and their carers—who are in crisis, especially at the time of diagnosis. From January to October last year, the service responded to 4,300 help line calls and 2,300 counselling sessions state wide. One lady told me she would have suffered a breakdown without the calm and supportive help of the counsellor, who has a specific understanding of each client.

The concept of mainstreaming these services may be a possibility in the city, where there may be more extensive resources, but that is not the case in regional and rural New South Wales. The Orange aged care services, including representatives of the aged care assessment team, Orange City Council ageing and disabilities services and the local nursing home industry, all tell me that the national action plan for dementia has met significant gaps in service provision. They feel strongly it should be maintained indefinitely as part of ongoing aged care strategy.

We have heard so much about the $8 billion black hole, later $11 billion, now supplemented by $3 billion which we missed in tax receipts, and another $1½ billion because Treasury got its sums wrong. All of this arithmetic gymnastics for what? As Bob Ellis so eloquently says, for what has this expenditure pain on the aged been imposed? In his words, `To impress four sadomonetarists in Moody's with our economic correctness'. It may come as a surprise to Treasury that carers in our community save this country not $1, $2, $3 or $5 billion but $8 billion a year. Yet we dismantle this valuable counselling service and substitute a less than satisfactory alternative arrangement through the home and community care structure whose services help carers with housework such as house cleaning, washing, ironing, shopping, transport, bathing, toileting, dressing, feeding and personal grooming—all very important, but in no way providing the very professional and targeted counselling that the dementia counselling service has delivered through these five rural officers.

There are aspects of the government's aged care bill exposure draft which I would also like to draw to the attention of the House. I did not receive a copy of the draft until the week before last. I could have sought a copy earlier had I known of its existence, but I chased it up in response to concerns from these aged care services in my electorate that had not seen a copy. The problem is, they were supposed to have made their comments on the draft by Friday, 21 February—the day after I received my copy. As far as I know, my copy is the only copy west of the sandstone curtain, the Blue Mountains.

I notice the minister's office told a local paper that peak groups in aged care had had copies for some time and they should have transmitted the information down to their colleagues in the aged care industry. But the Orange district aged care assessment team, the Calare Nursing Home, the dementia counsellors, none of these had seen the draft bill and there are concerns about inclusions within that bill which they want to highlight. Such concerns relate to the accommodation bonds scheme. They wonder about clients who may have the financial resources to pay an entry contribution, but may decline placement now that the bond is a requirement for entry.

The aged care providers also want to know what assurances are contained in the draft bill if entry contributions will indeed be used by residential facilities for capital improvement, and they want to know whether consideration has been given to the provision of suitable residential care for people with disabilities who are not aged.

I have spoken in this place in support of the thrust of the accommodation bonds proposal, particularly as it may very well maintain the viability of nursing homes in smaller communities and to enable older people to contribute to infrastructure within their own community and so stay close to relatives. But I cannot support the consultation process because it has not occurred at a grass roots level. This legislation is due to be introduced later this month, I understand.

Some other concerns expressed to me about the aged care bill from my electorate are fears that a two-tier system will develop, despite the checks and balances and accreditation requirements built into the act. It is also vital that the monitoring of access is very tightly controlled, so that the high entry contributor with low care requirements is not favoured over the low, or no entry client with high dependency. This is particularly concerning in Alzheimer's or dementia care patients. The recommendation of the aged care assessment teams should be paramount, but these teams need the assistance too of the very dementia counsellors who will be taken away from the Central West under this mainstreaming, which I see as downgrading.

In closing, I want to refer to the comments of the member for Dobell (Mr Lee) earlier in this debate about Lithgow Medicare. I want to clarify a statement I made to the House last week on another health issue when I said I had received no assurance from the Minister for Health and Family Services (Dr Wooldridge) that the Lithgow Medicare office would not be closing. The member for Dobell said that I had publicly repeated an assurance to this effect. A check of my records does reveal that I told the Lithgow Mercury last May that an assurance had been made to this effect by a ministerial staff member, later supported by a letter from the then parliamentary secretary, Senator Dr Bob Woods.

I let the minister and the member for Dobell know about that late last week and I checked out the circumstances over the weekend. However, I accepted at the time that the assurance related to the pre-budget concerns in the community that a closure of that office was imminent. I accept the minister's assurance now that current pharmacy trials of Medicare will be restricted to non-Medicare agency towns and that any consideration of agency closures in larger centres will involve full and public consultation.

I remain opposed to any closure of the Lithgow Medicare office. I apologise to the member for Dobell or, indeed, the minister if I have, inadvertently, misrepresented their positions on this matter.