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Thursday, 20 June 2002
Page: 4115


Mr ANDREN (9:58 AM) —I want to make some brief comments on this department's budget in Appropriation Bill (No. 1) 2002-03. My views on changes to the Pharmaceutical Benefits Scheme have been recorded in debate elsewhere. I am sorry the minister is not here but I intend to have a meeting with him on Monday to ask him a few of these questions. I want to concentrate mainly on aged care but endorse the comments that my colleague the member for New England made in his contribution here yesterday on allocated provider numbers and differential Medicare payments. Some initiatives in this budget, such as additional resources for carers of older Australians particularly in dementia care, greater commitment to cancer treatment and more money for palliative care, are worthy of very strong support.

In the area of aged care provision there are increases in money set aside for aged care nurses, which is welcome, residential aged care subsidies and community aged care packages. But there is a growing crisis in the provision of aged care generally within my area of the central west. We are told that the region is overserviced in respect of the existing ratio of 100 aged care places per 1,000 people over the age of 70. It has been suggested that aged care bonds may be a way of attracting investment into that sector. We have an ageing population in regional areas and—to put it crudely—we have a resource in our aged population. It is not going to disappear in any sort of a hurry and it strikes me that it could be a very attractive investment option if such bonds could be structured and government guaranteed as an investment vehicle for the very scarce resources available—or not available—for the aged care sector. We have heard of the phantom beds and the licences being granted to aged care providers right around Australia but many of them, particularly in places like Lithgow, are really struggling to raise the capital necessary for the bricks and mortar.

Aged care assessment teams tell me that there is a continuing overdemand for nursing home places—demand is in constant excess of the supply of such places, despite the fact that we are told that the central west is overserviced in terms of that 100 per 1,000 ratio. Exacerbating the problem is the continuing pressure on the state hospital system from aged patients who by any judgment should be in a nursing home. Last week the son of an 84-year-old woman who is in Orange Base Hospital and seriously ill—in the terminal stages of her life—was angered that she is to be shifted as a public hospital patient to Eugowra, 70-odd kilometres away, because there is no bed available in the Orange area. The bed in the hospital is obviously needed for more urgent medical patients.

This lady is in addition to the 30 people assessed as needing nursing home accommodation in Orange, yet the recent announcement of nursing home places for the central west put out by the minister in the last week or two has no provision for aged care providers to apply for any high or low care places. All that is on offer are home based care community care packages with a chance for people to apply for 40 unallocated low care nursing home places. I commend the minister for detailing these allocations before aged care providers go to the trouble of preparing detailed submissions in the vain hope of winning some licences, but it is no good funding home care packages without providing more medium and high care nursing home places, because inevitably home care aged will need intensive nursing care for the remainder of their lives unless they choose to die in their own home and their family can support that wish. We have a situation in country Australia where the population is ageing and the policy of ageing in place does not offer the family care option as much as it perhaps might in the city. The kids are not there; they have headed for greener pastures, sometimes overseas, to the cities or to the coast. I contend that there is a greater need for aged accommodation in major regional centres like Bathurst, Dubbo and Tamworth than there is in more populated areas on the coast.

I know that the statistics say that 90 per cent of older people choose to stay in their own homes as long as they can. (Extension of time granted) Perhaps there has been a disproportionate concentration on bricks and mortar aged care as opposed to home care because 90 per cent of people do choose to stay in their own home. The government must be applauded for extending the home and community care process but we must be careful that these packages are real care packages. We cannot afford to cut corners. I believe the care packages should include the bed and breakfast option—not in a food sense but the care should be provided at the beginning and the end of the day when the most need for that backup is required, and when the most comforting aspect of that service can be provided rather than a once-a-day visit. That is the lonely time and the period of the day when a person's wellbeing, comfort and loneliness in their own home is most obvious. I know that, having had my mother die in her own home, refusing to go anywhere else and causing great stress to the family, which was dispersed to all points of the compass, and feeling guilty that the pressure was on the neighbours to keep an eye on her. It was a very difficult situation.

I think the packages at this point are lacking in both their quantitative and qualitative component. The degree to which aged care providers take them up should not be the measure of their success. They are a much needed income stream for many nursing homes and some of them are converting—as is Wontama in Orange—some of their residential aged care beds into community care packages. They have good intent and they deliver a good service, as far as it goes, but I think that they need to be looked at in terms of greater quality of service delivery.

While there is a welcome allocation of an extra $211 million for subsidies for residential aged care, the figures I have detailed on the allocation of places in the central west highlight the fact that not enough licences are coming through to areas of real need—areas which the formula says are not in need. I know things have improved significantly over the past five years since the aged care reforms but I also know there is a tremendous administrative load on staff of aged care facilities with the new compliance regime. There are precious few resources to cope with this. The member for New England also mentioned this in his delivery yesterday.

The allocation of increased funding for aged care administration is targeted at compliance investigation, community care program management and assistance to Indigenous and rural aged care. That is very welcome but I suggest that more will be needed to take the administrative burden off nursing and management staff, who are struggling to meet their compliance requirements over and above their care duties to their clients.