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Thursday, 21 June 2001
Page: 28345


Mrs BRONWYN BISHOP (Minister for Aged Care) (4:25 PM) —I would like to echo and follow on from the remarks made by the Prime Minister in this debate where he expressed his disappointment at the way in which frail older Australians are made political capital for the benefit of scoring political points. As I go around Australia to visit aged care homes, as I do an amazing lot, and I meet the people who are the providers and the staff, particularly when they get their accreditation certificate and they worked so hard for it, the first thing they say to me is: why do they keep downing us? Why do they keep spoiling the work that we have done? Why don't we get any recognition for the hard work that we have put in that enables good care to be given to frail older Australians?' They hear Riverside being talked about. Let me say that Riverside was the inevitable end of 13 years of neglect. It was a home that had a chronic history of bad performance, and of course it culminated in those baths which contained kerosene. It was a home that was closed—that is, funding was taken away, approved providers status was taken away and alternate accommodation was found for the residents who lived there. As a result of their move to St Vincent's hospital, their health improved. There was a need for that to be done.

When we come to the question of what had to be done in accreditation, first of all we needed to visit every home in Australia, which had never been done before. The whole story of the bad reputation means that if you mention the words `nursing home' you will see people cringe, because it has had such a bad name for so long. What we did with the system was to no longer have nursing homes and hostels but to unify the system and have a system of aged care homes— with the accent on `home'—where people can feel that they have some control over their lives, where they live in a home-like atmosphere and where the care that they receive is care that is kind and is efficient. After all, let us understand that people who work in aged care are people who are working in the homes of the residents and they have to build a relationship with those residents. It is not like acute care nursing, where the aim is to get the person out as quickly as possible, and they are referred to as a leg or a hip or a stomach or something. These are people with names who have made their home and they need that interaction with the people who are giving them their care, who deserve credit for it. I get so many letters from people who write to me and say, `I just want to say a good word for the home where my loved one is, where the care is good.' Those people are being vilified just as much as the people who are mentioned at the home at Yagoona that the Labor Party mentions again and again. They suffer the same vilification for a political end, and it is not right.

There needs to be an understanding that the old system itself was moribund and it meant that bad care was being given, and it had to stop. In order to do this, it was worked out that we would bring in a policy of accreditation where we would legislate standards, and those standards must be complied with in order that a home could continue to receive subsidy for residents. The subsidy is very substantial. The subsidy is 75 per cent of the cost of keeping an individual according to their needs. We introduced a resident classification scale, with eight scales on it. According to need, the money is paid at a certain rate. For instance, No. 1 is the greatest degree of dependency. The amount of money that comes from the 75 per cent subsidy, the contribution that the individual makes themselves and other supplements that are paid amount to about $66,000 a year.

If you are in low level care, there is a subsidy. Three-quarters of the total amount is around $12,000 to $13,000 a year and then a quarter on top of that from the contribution of the individual. The government has increased this amount of money. You heard the Prime Minister say that in the Labor Party's last budget, in 1995-96, the total amount that they spent on aged care was $2.5 billion. Under this government, after the budget that was brought down only a few weeks ago, the total expenditure on residential aged care residents will be $4.2 billion a year—every year.

We not only brought in a new system but we put the money in place in order to do it. Then we put in Professor Gray to make sure that he could oversight what was happening with the two-year review. He published a very substantial report, and he found that the reforms are working. We then also looked at the various checks and balances. We have put more money into doing spot checks, because consumers feel safer with them. That is their expressed view. They also like the fact that there are people who come on a regular basis to visit the home. ANHECA checks to ensure that the providers are in fact spending the money on the care that is in the care plan against which their subsidy is paid and that we have people who come in on support visits. They are visits that are put in place in a schedule but they can be varied. There are spot checks, which means instant access to premises, and there are the advocacy groups, which I fund. They are very important because people can feel intimidated. We fund one in every state. It is a body of people who come in and speak on behalf of residents who feel intimidated. They are very important.

Then we have the Community Visitors Scheme. Some people do not have anyone to visit them so we actually fund charities, basically, and churches to go and visit and form a relationship with a resident so that they too have quality of life. What this is about is quality of life. It is about having the best quality of life we can have for people who are in need of care in residential care. And that means people who have Alzheimer's and other forms of dementia, people who are incontinent, people who are unable to be mobile any more, and people whose skin has become very thin and who need special attention. It also includes people who need to go from their home to hospital from time to time. I think it was the member for Dickson who asked the most fatuous question of the day when she said: why did Mrs Thomas go to hospital? The answer is: she was sick. And when you are sick you are entitled to go to hospital and have care. The question I asked was: why, when Mrs Thomas went to hospital and was sick with a temperature, was she discharged from that hospital with no care given to her? There was no treatment for her pressure sore. She did not begin antibiotics until she was returned to the nursing home. So then she had to be readmitted to the hospital. That is a complaint I hear again and again. I hear so often that hospitals do not want to admit older people, particularly from aged care homes.

I have another example, which I am referring to a new body I have established—our working group of the Aged Care Forum, who are going to investigate the treatment that older Australians receive in hospitals. The problem is this: this is now winter, and you will hear many a cry from state health ministers saying, `There are not enough nursing home beds. We have got bed blockers.' They want to get the old people out. I will tell you why they have a shortage of beds. It is because they have been closing public hospital beds systematically for the last 10 years— from 1987 to 1997-98—right across Australia. They have closed by a staggering 21 per cent. Then we have winter. We have an ageing population—that is, more older people. They have pneumonia, they have respiratory disease and they have things occur to them that need hospital treatment. But there are not the beds because they have been shut, and the people need to be there more than the 3.5 days that the hospitals like them to be there before they shoot them out the door. They write on their reports: `acopia—can't cope at home'. It might be someone such as we heard of in this chamber recently who had cancer and needed morphine to deal with the pain. The morphine dosage had got out of kilter and it needed to be dealt with in a hospital. Again and again I am hearing this.

I have a case of somebody who came to see me recently whose uncle went from a nursing home in excellent condition—and she knows because she put the socks on her uncle's feet. He went to hospital for pneumonia. They fixed the pneumonia but, when he came out, there were huge ulcers on his heels and they were headed for gangrene. They were shown to the niece as he was leaving the hospital. She was told, `Do you realise what's happened in here?' It has got to stop. This bandying of older people and using them as a political football has also got to stop. They deserve respect. They deserve to be treated with kindness and with care and with respect for the knowledge that they have. That applies whether you are the most disabled person, whether you have got dementia or because you have suffered a stroke. You are still entitled to the respect of being a human being. That communication can still happen and there is still the capacity for joy.

We have heard the tale that is being told of this place. We have heard of the complaints and we have heard the opposition ask that a home be shut down because the hot water system did not work and because the continence pads were not available. Yet I look at the complaint that was made against the Victorian state home run by the Victorian state government. The agency believed the Victorian state government when they said they would remedy this. The report said that three incident forms reported that staff had found three residents covered in ants, one on 5 February 2001 and two on 15 February. In two cases the residents were in bed and the ants were in the beds and the bed linen. The other residents were found to have ants in their underwear, continence pads and over their body. No action was recommended for this home.

As was quite properly said, this world is not perfect. We are dealing with human beings who are dealing with very difficult circumstances. In Victoria the agency listened to the undertakings of the department of the minister concerned, Minister Pike. They listened to the undertakings that they would remedy this situation and they did not downgrade the accreditation. As I said, I do not think there was any political influence by Mr Bracks contributing to the Liberal Party or being a first best friend of mine. Indeed, Mr Bracks has shown a particular lack of understanding of the need to have compassion in the interface between hospitals and residential aged care.

I will deal very briefly with the question of the reforms I put in place last year dealing with the ability to appoint administrators and advisers. The power was always there, but it needed to go into legislation which I introduced into this place. There were amendments moved in the Senate to compile a list of people who should be kept, which I readily agreed to because that was the practice. The fact of the matter is that I have 11 homes under sanctions now, and in 10 of them there are either nurse advisers or administrators, and they are there for periods of up to six months. The department makes the decision about whether or not an approved provider, being the proprietor, will concur and agree to implementing the plan which the agency has formulated or whether they will not. We have improved aged care, and it was much needed. (Time expired)