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Wednesday, 15 June 2005
Page: 104


Senator HUMPHRIES (4:40 PM) —I am very pleased to rise to support the Aged Care Amendment (Extra Service) Bill 2005 today, because it clearly fulfils promises made by the Howard government both at the time of the last federal election and in the budget that was handed down last month. It is important to see these changes as fulfilling two particular objectives within the aged care sector that have been articulated very clearly.

One of those objectives is that the government wishes to continue to increase the quality of care available to older Australians in aged care facilities of a variety of descriptions. We believe that the need to increase care is a very real one. It is a need that was clearly not focused on by the former Labor government. We all know that quality of care was not present under the former government and of the serious consequences for older Australians as a result of that government’s failure to focus on the issue of quality. Since coming to office we have taken a number of steps to ensure that quality remains at the forefront of public policy with respect to aged care, and the results of that policy are evident.

The second objective—and this is perhaps a more recent area of focus for the government—has been to reduce the red tape that is faced by the aged care sector. The desire to see that complexity in the administration of aged accommodation in this country reduced is reflected in submissions made to the Senate Community Affairs References Committee inquiry into aged care. It is a signal that has been picked up not only by that inquiry but also very strongly by the government itself. I commend the Minister for Ageing, Julie Bishop, for taking the trouble to put those sorts of measures very clearly at the forefront of public debate about aged care policy in this country.

The government has a strong commitment to ensuring that there is a robust and viable aged care sector in this country. By the term ‘robust’ I mean that there should be competition. There should be a variety of options available to a provider and to a person who wishes to purchase services. There needs to be a strong and well-articulated element of choice in aged care services. No-one should be forced to take what is available locally because that is the only thing they can get. They should be in a position to shop around, to compare and to see what is available in the marketplace. That process should encourage greater quality among providers as they vie for custom. It is important as part of that process that government removes the red tape, which has been very much a part of the sector, because of that concern about quality.

It is important to note that a few years ago the government’s chief priority was to increase the quality of services. As a result, the aged care accreditation program was designed to ensure that people in the marketplace providing substandard services were driven out or made to lift their game. That was the chief area of concern of the government at the time it came to office nine years ago. That level of quality has certainly been addressed and there has certainly been an appreciable increase in the standards being offered in Australian nursing homes in that period of time. I grant that there are occasional exceptions, publicised in the media, of clearly substandard levels of service provided to some Australians—hopefully to an increasingly rare class of Australians.

There is evidence at the moment that the extent to which we have engineered higher standards in nursing homes and the mechanisms put in place to ensure that those higher standards are produced by providers may have resulted in a level of red tape and bureaucratic administration which is unnecessary to maintaining and indeed lifting those standards. There has certainly been ample evidence put before the Community Affairs References Committee. I am a little surprised to hear Senator McLucas suggest that perhaps we do not need to remove the requirements in this bill that are being removed, namely for regular renewal of the extra service status which an institution or an aged care facility might have to go through if they wish to retain that status. There are other mechanisms now in place in the sector to ensure that we monitor what goes on within a particular facility. I think it is fair to see that as the safety net which ensures that standards do not decline by virtue of, in this case, an aged care provider having the freedom to charge residents or perhaps some residents in that facility more to receive extra services.

If this were an unmonitored sector, if the sort of regime was in place that gave rise to the report in 1994 which so profoundly condemned much of the aged care sector in Australia, then we might have a different response to the amendment that is before the Senate today. But what is before us is a measure to reduce what is at this stage unnecessary red tape, and it should be proceeded with. Senator McLucas can keep her watching brief over that, and I suppose we all can, but the call for us to take unnecessary administrative burdens off the aged care sector is now a very strong call. It is coming from everywhere in Australia that people such as the members of the Senate committee—and, no doubt, members of the Department of Health and Ageing and others—go to, and it is important that we heed those calls.

It is also important to acknowledge that residents who cannot afford to pay for extra services in an aged care facility will still be able to access care because of the other safeguards which the government have put in place. We do not relax those in any way merely because a provider is able to charge more to some residents. Only homes which have that extra services status—and that will be a very distinct minority of aged care facilities in Australia—accorded to them by a government auspiced process can charge an extra service fee and might also in those circumstances charge a bond for high care.

The question here is: why should the government engineer a situation where there are different levels of service being offered perhaps in the one facility? Why should one person side-by-side with another, as it were, receive higher care because they can afford to? The answer is that we do not mandate a one size fits all approach to accommodation and housing in this country. We provide for a vast variety of accommodation styles and options to Australians. When Australians move into aged accommodation they should not have to expect that no choice is available to them except perhaps which particular facility they might go to. If they are receiving a taxpayer subsidy in a facility, as is their right, then it should be possible for them to say, ‘Thank you. I will receive that subsidy, but I also have the capacity—or perhaps my family has the capacity—to pay a little more to receive extra services, and I would like to do that.’ It comes back to the question of the element of choice within the sector. That choice is part of making sure that there is a capacity for people to understand what is available to them and to receive different levels of care depending on a variety of circumstances, as long as that base level of care is maintained. Nobody who is in a home, even one with extra care places in it, should receive less than the basic amount of care and service expected anywhere in the country. That is an important principle, and I think it is respected and reflected in this legislation.

Extra service status is only approved where the provider can demonstrate that the facility in question will offer hotel type services significantly above those of the average aged care home and where the provider has a very good record of compliance with the sorts of standards which are required by the aged care accreditation process. This is not for everybody. This is not for everybody to say, ‘Yes, I’d like to have some of those places, because I’ve got some clients in my facility who could afford to pay.’ That is not how it is going to work. It is about assessing those quality providers who are able to service the needs of their residents as required within the context of that particular facility and which will meet the other quite exacting standards which this legislation imposes.

As of December last year, only five per cent of the residential aged care places allocated nationally had extra service status—only five per cent. The target under this legislation is that only 15 per cent of all residential aged care places will have that extra service status—a maximum of 15 per cent. So this is obviously meant to facilitate choice for a number of people in a number of circumstances. It is not meant to undermine the basic principles and standards which are available across Australia in aged facilities generally.

I believe that we facilitate the right balance here in removing such things as the expiry date for extra service status. That is a five-year expiry date at the moment. Whether a provider is achieving their accreditation requirements comfortably or not is irrelevant; it is a question of whether they are able to demonstrate an ongoing commitment to the standards. Where they do, removing the expiry date is clearly a desirable goal. Removing provisions covering the renewal of extra service status is equally appropriate, particularly where a facility or home might be seeking to rebuild or refurbish part of its accommodation. I think that we can look with confidence to those provisions to ensure that the Australian community will not be any worse off as a result.

Senator McLucas made a number of comments about other areas of aged care, and I want to respond to those briefly. She said that the CAP payments are, in a sense, being promised as a solution to a variety of problems within the sector and that, in a sense, this money is being spent several times over. I think that is the expression that she used. I think the implication of her remarks is that the CAP payments, while welcome, are not enough to deal with the range of issues and problems within the sector. Perhaps she is right. Perhaps we would welcome seeing more money in the sector—even greater payments than the ones which the government has promised and delivered on in the last few years.

It is impossible to look at this situation without taking a step back and looking at the long-term picture of aged care funding in this country. Then you can appreciate that there has been a massive increase in resourcing of Australia’s aged in the last nine years which simply did not happen before. Yes, it would be nice to do more than we have done, which has been to double expenditure on provision for the aged in Australia in the last nine years. Although the proportion of the population which is over the age of 65 has increased, it has not anything like doubled in that time. It would be great to treble it or quadruple it, but the fact is that it has doubled because this government has managed the Australian economy and the public purse so well that it has been able to generate that kind of extra spending on Australia’s aged without running our budget into the red and without threatening other important priorities of public expenditure. That is the overwhelming reality which I think Senator McLucas would do well to go back and reflect upon. I think this government will deliver more for aged care in the future, but we cannot get away from the fact that it has already enormously increased the amount available to those in aged care in this country.

Senator McLucas also made the comment that out of facility care—home and community care type programs—is an area that is frequently overlooked in Australian public policy. That may be true in some areas of government in Australia—at the state and territory level, perhaps—and it may have been true before 1996; but it certainly has not been true of this government. Home and community care has been an area of enormous focus by this government and will continue to be as we ensure that we provide real choices to Australians as to whether they stay in their homes with support or they move into an aged care facility. Those choices simply were not there often enough in the past, because there were not the opportunities for people to realistically stay in their homes when the packages to support them were not there. Perhaps there are some Australians who still cannot access those packages readily enough and at the level that they need, but many fewer Australians are in that position today as a result of what this government has done with respect to home and community care funding and equivalent programs.

I think that the measures in the Aged Care Amendment (Extra Service) Bill 2005 should be seen in the context of delivering a stronger aged care sector in this country. What we have done is to provide for a reduction in the red tape that homes and facilities in this country face, without a loss of quality of services, and to drive the public policy necessary to lift those standards in the sector all the time. We have funded the sector better, assured that accreditation processes are robust and are reviewed, and engaged with the sector to have a dialogue about what needs to be done—a dialogue which I think has produced very handsome dividends in recent years. This bill continues that process and, as such, it is to be supported and built upon in the future.